Privatizing Veterans’ Health Care Will Be a Disaster

Long before becoming secretary of the Department of Veterans Affairs (VA), Doug Collins’s intention to steer veterans and their health care dollars away from VA medical facilities and into private hands was well established. During his tenure in the U.S. House of Representatives, Collins was a staunch ally of the Koch-backed Concerned Veterans for America (CVA), a group whose ideological North Star is privatizing VA services. He embraced three key bills the organization championed that laid the groundwork for outsourcing care for large numbers of VA patients and weakening protections for VA employees.

During his January confirmation hearing, Collins tried his best to shroud his objectives, lulling skeptical committee members with reassuring-sounding platitudes, such as “there’ll always be a VA for the veteran.” He has continued to spread these unconvincing assertions as VA secretary in interviews, press releases, Twitter videos, and congressional hearings, while, at the same time, swiftly advancing proposals to deeply cut VA resources and personnel and redirect the so-called “savings” toward expanded outsourcing to private-sector care.

His approach has become more combative, marked by disparaging comments directed at reporters, VA employees, and officials responsible for overseeing his agenda. During one recent exchange with Sen. Patty Murray (D-WA), Collins lashed out, “You’re not being truthful. I’m not going to let you get away with that.” Yet Collins’s stance calls to mind Shakespeare’s famous observation in Hamlet that “The lady doth protest too much.” It is often the case, after all, that those who most vehemently attack others’ credibility are themselves concealing the truth.

Collins’s privatization campaign rests on four misleading narratives.

First is his pledge that “we’re not cutting VA health care providers.” Collins has repeatedly assured stakeholders that, despite his plan to eliminate between 30,000 and 80,000 department positions this year, the number of providers furnishing direct health care won’t decline one bit.

Second, Collins wrongly portrays private health care as on par with what the VA provides. He has repeatedly asserted that “community care is VA care,” and “we’re going to hold community care to the same high standards as VA.”

Relatedly, Collins often states that “the vast majority of our health care can be done just as effectively outside the VA system.” This contention implies that VCCP care quality is comparable to the VA. However, decades of research has established that the VA produces health care outcomes equal or superior to the private sector across virtually every medical condition. A comprehensive summary of peer-reviewed studies published last month reinforces this conclusion. Moreover, a recent survey by Iraq and Afghanistan Veterans of America found that only 31 percent of IAVA members with VCCP experience felt their community providers understand their medical needs.

Finally, Collins claims that “the VA under the Biden administration stifled veterans getting care in the community.” While congressional hearings often spotlight anecdotal cases of veterans struggling to access private-sector care, it’s just not true that Biden’s VA cut off community care. During the first three years of his administration, half a million additional veterans gained access to the VCCP.

These misrepresentations carry serious consequences. Community care unquestionably serves as a vital safety net for rural veterans and those facing extended VA wait times. However, last year’s “Red Team” assessment by independent experts issued a dire warning: The swelling volume of private-sector referrals has created an “existential crisis” for VA health care. Excessive utilization of private providers threatens to close VA units and facilities nationwide, destabilizing the direct care system and undermining its long-term sustainability.

Secretary Collins has not been forthright about the adverse consequences of further expanding private-sector care. Taking concrete steps to counter this trend would ensure that the VA’s integrated system remains fully funded and staffed to meet all the desired health care needs of America’s current and future veterans.