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The GOP's Veterans Health Care Trap

How politicking the VA scandal without a plan to improve care could backfire

Brendan Smialowski / Getty Images

John Boehner's reluctance to call for Eric Shinseki's head was shrewd before Shinseki resigned and pays dividends now that Shinseki is gone and Boehner can keep beating the scandal drum without appearing opportunistic.

But the political fight over VA care is closely linked to the question of if and how Congress will act to reduce wait times at VA hospitals, and on that terrain, Republicans don't win by virtue of the fact that the VA's current woes were exposed during a Democratic presidency. To the contrary, the Republicans' position on veterans' health care is deeply unpopular, particularly with actual veterans groups. And the risk to them is that their incessant politicking of the VA scandal will increase the public's expectation of Congressional action, at which point Republicans will have to kill vet-backed Democratic legislation without offering an alternative, or propose a privatization plan that will backfire politically. Or else they'll have to cave.

This isn't a familiar Congressional impasse where Democrats want to spend a certain amount of money on something while Republicans want to spend less money. Those sorts of fights are destructive, too. In a way they've defined the Obama presidency. But they're also resolvable. Veterans health care is different—the story here is 100 percent ideological, and zero percent fiscal.

It's not that big government foes are after spending less money on the VA, per se, or want to isolate efficiencies within its existing structure and ply the savings into building out capacity within the department. They instead want to spend more money on veterans by transitioning them into an entirely different, private-sector oriented system of care. This includes House Speaker John Boehner.

Costing out the idea of paying for veterans' health care outside the VA system is a thorny business, both because the GOP doesn't really have a score-able plan, and because of the methodological problems you encounter when you try to compare VA and non-VA costs per patient or unit of care.

But you can come pretty close. Phil Longman tackled the problem in the third edition of his book Best Care Anywhere.1 He cites a study published in 2004, undertaken before the wars in Iraq and Afghanistan, which asked the question ”What would it cost to provide the same healthcare benefits as the VA using Medicare as the surrogate payor?"

According to Longman, "[t]he answer that came back was that Medicare would cost 21 percent more." 

(Another alternative would be to provide vets with fully subsidized, ACA-compliant insurance, but somehow I can't imagine Republicans arguing that we should replace the tyranny of the VHA with the liberty-restoring ambrosia of Obamacare.)

The point is, Republicans won't easily be able to disguise a "smaller-government" plan to voucherize veterans health care in the language of fiscal prudence. They'll either have to propose spending as much or more money than Democrats propose on an unpopular plan, or appear to be completely unresponsive to the problems they're claiming to be so incensed about.

And if the legislative response we've seen thus far is indicative of how the issue will ultimately play out, then Republicans will choose the latter. Their initial answer to the scandal wasn't to propose financing private-sector care for vets, but to pass a House bill providing the VA secretary more authority to fire people. Democrats in the Senate are poised to counter with legislation that would also authorize the creation of 27 new medical facilities—something Republicans filibustered just three months ago.

“To restore veterans’ trust in the reliability of VA health care, we must take action to address the root causes of these problems," Harry Reid said Thursday. "Millions of American service members are coming home from Iraq and Afghanistan and entering the VA system, and that system needs more resources to provide them the best care."

Two months ago, the VA wasn't a huge deal in American politics. It is today in part because Republicans decided to cast a complex, still developing story about VA management and personnel as a simple tale of the perils of government control. Their reward for that decision will be to answer Democrats' request to spend more money on veterans' health care under significantly more scrutiny than they had to deal with back in February. Maybe they'll cave this time around. But if they don't, and if they mask their opposition with non-specific opposition to government spending… 

…keep in mind that spending isn't really the motivating factor here. At all.

  1. As a researcher at the New America Foundation in 2006, I helped Longman research an unrelated chapter of the first edition of Best Care Anywhere.