Veterans Day 2014 arrives with the Department of Veterans Affairs still wobbling from the scandal that will define the agency for the foreseeable future. Secretary Robert McDonald, who took over the VA in July after revelations of excessive wait times and secret wait lists at VA hospitals led to the resignation of Eric Shinseki, spent Monday looking forward, however, as he announced a major restructuring plan for the agency.

As McDonald pointed out, the VA faces a number of steep internal struggles to improving care and restoring public trust. At the same time, it also will face challenges from those who want to use the scandal to push for more privatization in the VA health care system.

Additional Images

Joslyn Shipman, an Army veteran with PTSD, reacts to having small acupuncture needles put in her ear at a Richmond, Va., VA hospital that is piloting alternative therapies. The VA health care system scandal was a product of understaffing and undertraining, not low quality of care. Timothy C. Wright/For The Washington Post

The best place for veterans to receive health care, however, is within the VA. The agency delivered that care well until the recent problems, brought on by a surge in veterans seeking care and a lack of leadership with the agency. And it can do it again – if McDonald is given the support and time he needs to reshape the agency.

BIRTH OF A SCANDAL

It’s an enormous task. The department has more than 330,000 employees, second only to the Department of Defense. The VA operates 150 medical centers and 819 outpatient clinics, caring for 9 million patients and rising, thanks to the wars in Iraq and Afghanistan and aging baby boomer veterans.

From 2002 to 2012, the VA handled a steady increase in outpatient visits, from 46.5 million annually to 83.6 million. The number of veterans receiving mental health treatment grew from less than 900,000 in 2006 to more than 1.2 million in 2012. The 1 million new disability claims filed in 2009 were an all-time high, until 2010 and 2011, when new records were set.

It was under that stress that the VA, chronically understaffed and undertrained, ultimately broke. The VA set goals for patient care – including a mandate to see new patients within 14 days – that were unattainable at hospitals with not enough staff.

It was that pressure, and a culture of silence and cover-up, that led to the scandal.

TURNING IT AROUND

McDonald’s plan targets the poor culture – by proposing to fire at least 1,000 employees who “violated our values,” the secretary said – as well as the employee shortage – by seeking to hire 28,000 doctors, nurses and medical professionals.

To the latter, McDonald is traveling the country to recruit young doctors. His pitch includes increased salaries and school debt forgiveness, as well as the opportunity to serve the country in a health care system that has a mission like no other.

Some have suggested that veterans would be better served by a voucher system that would allow them to use private doctors. That’s fine for patients who live far from a VA center, as with the pilot program being developed in Caribou.

However, there is a shortage of primary care physicians generally, not just at the VA, and veterans are likely to face many of the same barriers to care outside the system.

And it should not be forgotten that VA hospitals, which are uniquely qualified to address the specific health care needs of veterans, delivered high-quality, patient-driven care under solid administration for years, until the system was overwhelmed.

In the past few years, even as the wait lists grew, the patients who did receive care gave the VA high marks.

That’s a call to get more veterans the care they need at the VA, under an agency with proper funding and renewed accountability, not to send them elsewhere.

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