Concerned Veterans for America Aims to Be Part of the Solution
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A Letter From The Co-Chairs Dear Reader, Few of us are unaware that there are imperfections in the way we provide health care DEAR READER to our nation’s veterans. After the headlines of 2014, Americans of all stripes—veterans and civilians, Democrats and Republicans—know we can do better. Concerned Veterans for America aims to be part of the solution. Last fall, CVA convened a Taskforce that we called “Fixing Veterans Health Care.” The mission of the Taskforce was straightforward: to propose concrete reforms, that could be turned into legislation that would dramatically improve the delivery of health care to veterans. We are veterans and health care experts with a shared charge: to do the right thing to meet the needs of veterans. In order to advance this mission, our Taskforce took an honest, inquisitive, and nonpartisan look at the veterans’ health care delivery system. Today’s system for veterans health care exists for a reason. But few policymakers, afforded a clean slate, would recreate it in its current form. Modern veterans health care delivery is ripe for a full-scale reassessment, and this report aims to deliver one. Our due diligence process was veteran-centered, expert-driven, and open-minded, with a focus on systemic reforms to the Department of Veterans Affairs-the Veterans Health Administration (VHA) specifically. The timeliness and quality of care for veterans varies throughout the country, driven by a myriad of known and unknown variables. We asked questions about eligibility, access, choice, and accountability in the VHA. The majority of employees at VHA are dedicated and competent professionals. Standing in their way are bureaucratic constraints that make it hard to innovate and leave little incentive for excellence. Furthermore, there are storm clouds on the demographic horizon that will place additional pressure on veterans health care facilities. In order to avoid ineffective and reactionary policies in the future, our goal was to proactively ensure that eligible veterans of today and tomorrow receive timely and quality care. In working to develop the best policies for fixing veterans’ health care, we sought perspectives from health care scholars, experienced policymakers, veterans service organizations and—most importantly—veterans all across the country. You cannot comeDEAR up with READER veteran-centered reforms without understanding what veterans need and want. Our questions to each participant in our process were always the same: What’s working? What isn’t? What must be reformed? What must be protected? How do we put the veteran at the center of veterans’ health care? Fundamental change to any system threatens the status quo, often provoking attacks on both the messenger and message. We anticipate this may happen to us and to our proposal. But because of our thorough process, we rest assured that veterans across America will eagerly welcome our proposal. We are committed to these recommendations, and to the follow-through required to advance them: continuing our commitment to Lincoln’s promise “to care for him who shall have borne the battle.” We would like to thank CVA’s CEO Pete Hegseth, our Taskforce Executive Director Darin Selnick, and the entire policy team at CVA for their indispensible support in this endeavor. We look forward to sharing our findings. Thank you for your interest in joining us to serve America’s veterans. Sincerely, Dr. William Frist (R-TN) Cong. Jim Marshall (D-GA) Taskforce Co-Chair Taskforce Co-Chair Dr. Michael Kussman Avik Roy Taskforce Co-Chair Taskforce Co-Chair 2 Taskforce Biographies Dr. William H. Frist, M.D. Congressman Jim Marshall Dr. Michael Kussman (R., Tenn., 1995-2007) (D., Ga., 2003-2011) Taskforce Co-Chair Taskforce Co-Chair Taskforce Co-Chair Dr. First is a nationally acclaimed heart Congressman Marshall is a former Mayor Dr. Kussman was Under Secretary for and lung transplant surgeon and former of Macon, Georgia and a member of the Health for the Department of Veterans U. S. Senate Majority Leader. Dr. Frist 2014 National Defense Panel. During Affairs from 2007 to 2009, capping a served the Tennessee Valley VA as a staff his four terms in Congress, Jim earned distinguished 37 years of government service. Cardiac Surgeon staff for nine years before a reputation for being a principled and As Under Secretary for Health, Dr. going on to represent Tennessee in the U.S. bipartisan legislator. During his first Kussman directed a health care system Senate for 12 years (1995-2007). In the term, he received recognition from many with an annual budget of approximately Senate he served on both the Committee veterans organizations for devising $40.2 billion, overseeing the delivery of for Health, Education, Labor and Pensions and successfully leading a campaign to care to more than 5.6 million veterans. (HELP) and the finance committee, and eliminate the Disabled Veterans Tax (aka Before joining the VA in 2000, Dr. Kussman as Senate Majority Leader from 2003 until the prohibition on concurrent receipt), retired from the United States Army as a 2007. His leadership was instrumental to the freeing tens of billions of dollars wrongfully Brigadier General. He is a graduate of the passage of the 2003 Medicare Prescription denied to disabled military retirees. Jim Army War College and an honor graduate Drug, Improvement and Modernization is a graduate of Princeton University, where of the Command and General Staff College. Act and PEPFAR, the unprecedented he was a University Scholar, and Boston Dr. Kussman earned his undergraduate and national commitment to fight HIV/ University School of Law, where he medical degrees from Boston University, AIDS globally. He is currently Adjunct graduated magna cum laude. He is a receiving his medical degree in 1968. Professor of Cardiac Surgery at Vanderbilt business and finance lawyer and a law In 1994, he earned a master’s degree in University and Clinical Professor of Surgery professor who has taught at Princeton management from Salve Regina University at Meharry Medical College. He is also University and served as the President in Newport Rhode Island. Co-Chair of the Health Project at the and CEO of the United States Institute Bipartisan Policy Center. His board service of Peace. Jim is also an infantry combat includes the Robert Wood Johnson Foundation veteran of Vietnam where he served as a the Kaiser Family Foundation, and the reconnaissance platoon sergeant. He has Center for Strategic and International received numerous military awards and Studies (CSIS). recognitions, including the Purple Heart and membership in the United States Army Ranger Hall of Fame. 3 Mr. Avik Roy Mr. Darin Selnick Mr. Pete Hegseth Taskforce Co-Chair Taskforce Executive Director CEO, CVA Mr. Roy is a Senior Fellow at the Manhattan Mr. Selnick is the Fixing Veterans Health Mr. Hegseth is the Chief Executive Officer Institute’s Center for Medical Progress. He Care Taskforce Executive Director and for Concerned Veterans for America. He is also the Opinion Editor at Forbes, and the Senior Veterans Affairs Advisor for also volunteers his time as an adviser to the a former health care policy adviser to Mitt Concerned Veterans for America. An Air Eagle’s Healing Nest, a Minnesota-based Romney’s presidential campaign. He edits Force veteran, he also volunteers his time organization committed to meeting the The Apothecary, a widely read Forbes blog as Chairman of the West Los Angeles needs of our veterans, service members and on health care and entitlement reform. Veterans Home Support Foundation. their families who suffer from the invisible Recently, Mr. Roy authored a widely- From 2001-2009, Mr. Selnick was an wounds of war. Prior to joining CVA, acclaimed health care reform proposal, appointee at the Department of Veterans Pete was Executive Director for Vets for Transcending Obamacare: A Patient Affairs, serving as a special assistant Freedom, an Iraq and Afghanistan veterans Centered Plan for Near-Universa Coverage to three VA secretaries. His positions advocacy organization. An Army infantry and Permanent Fiscal Solvency. Mr. Roy included the Director of the Center for veteran, he served tours in Afghanistan, was educated at the Massachusetts Institute Faith-Based and Community Initiatives Iraq and Guantanamo Bay, Cuba. Pete of Technology, where he studied molecular and Special Assistant to the Secretary and earned two Bronze Stars and a Combat biology, and the Yale University School Associate Dean, VA Learning University. Infantryman’s Badge for his time in Iraq of Medicine. In this role he was responsible for provid- and Afghanistan. He graduated from ing program and operational oversight of Princeton University in 2003 and earned a VA Learning University. Prior to joining master’s degree in Public Policy at Harvard the VA, Mr. Selnick spent eight years in University’s John F. Kennedy School of private sector health care as a senior manager. Government in 2013. 4 Table of Contents Chapter 1: Executive Summary 7 Chapter 2: Introduction 17 Background 18 Scope of the Taskforce 19 Procedures and Methodologies 20 Chapter 3: The Mission of Veterans Health Care: An Evolution 22 Chapter 4: Challenges and Opportunities in Veterans Health Care 30 The Challenge of Veterans Health Care 31 The emographicD Unsustainability of Today’s VHA 37 The mpedimentsI to Veterans’ Health Care Reform 37 Veterans’ Opinions on VA Reform 39 Chapter 5: Ten Principles for Veterans Health Care Reform 42 Chapter 6: The Veterans Independence Act: Transforming Veterans Health Care for the Twenty-First Century 45 New Role for the Veterans Health Administration 46 Veterans-Centered Health Care 52 Additional Policy Considerations 58 Chapter 7: Fiscal Considerations 62 Chapter 8: Conclusion 67 Chapter 9: Annexes 69 Taskforce Meetings and Participants 70 Submission Portal 71 National Veterans Survey 73 Veterans Service Organization Roundtable 74 Fiscal Impact Analysis 75 Endnotes 95 The digital version of this book is availble at taskforce.cv4a.org 1.