Responding to pressure from Congress, veterans groups and at least one popular late night TV host, the Department of Veterans Affairs is changing the way it calculates qualifying distances for obtaining private health care at the government’s expense.
In the wake of last year’s scandals over long delays for patients in Veterans Administration health facilities, Congress passed the Veterans Access, Choice and Accountability Act of 2014 (VACAA). The law allows veterans who live more than 40 miles from a VA clinic or who have had to wait more than 30 days for an appointment to seek treatment from a private medical facility. The government would then reimburse vets for the private fees.
The 40 miles, however, was calculated as the crow flies — a point-to-point straight line, regardless of the actual distance of the surface commute.
This seemingly arbitrary decision proved the cause of much confusion, consternation, and in the case of Jon Stewart, host of “The Daily Show,” comedy, as well.
There are several documented instances of vets who have to drive (or, as with one case, have to take ferries) for 50 or 60 miles to get to a VA facility, but don’t qualify for reimbursement of private-caregiver fees because they live within 40 miles as the crow flies.
As Stewart explained to his Monday audience, as-the-crow-flies is “the least meaningful way to calculate how long it takes to get somewhere for non-crows.” But, it turns out it is a meaningful way to calculate qualifications if the goal is lower costs instead of more help.
If the choice program didn’t include a distance exclusion, it would reportedly cost upwards of $50 billion. But Congress only allocated $10 billion for VACAA, so VA rule makers had to put in limits to get the Congressional Budget Office (CBO) score down.
“They got a program that would cost $50 billion to really help people, and got it down to $10 billion,” Stewart said, “by just taking out the people it could help.”
“Dicking over veterans isn’t a bug of the program,” joked Stewart, “it’s a feature of the program.”
Veterans groups have been complaining since soon after VACAA took effect that the requirements were causing uncertainty and hardship. Sen. John McCain, R-Ariz., sent a letter last week, signed by 40 of his Senate colleagues from both sides of the aisle, to VA Secretary Robert McDonald asking for immediate modification of the rule. And Sen. Johnny Isakson, R-Ga., promised to broach the topic at a Tuesday hearing of the Veterans Affairs Committee, which he chairs.
“This straight-line application is crazy,” said Isakson in March. “It needs to be the time [or mileage] from leaving the garage of the veteran to pulling into the parking lot of the Veterans Administration."
Rep. Jeff Miller, R-Fla., was also said to support changing the 40-mile rule, but Miller, who chairs the House Committee on Veteran’s Affairs, insists it can be done without allocating any more funds.
Which is just the kind of seemingly principled but imminently insurmountable roadblock that would keep a debate like this simmering ineffectually on a government back burner for weeks, months, or even years.
But not even half a day after “The Daily Show” — following up on individual veterans’ stories broadcast by CNN and Seattle radio station KUOW — aired its segment on the Choice program, McDonald announced that trips would now be measured by driving miles, not straight-flying birds.
“We appreciate the constructive feedback shared by veterans and our partners to help us improve service to veterans,” McDonald said at the Senate hearing.
Or, as Stewart explained, “Sorry, crows. It looks like you’re going to have to drive to the doctor just like everyone else.”
The new definition could now double the number of veterans who qualify for the program, but McDonald didn’t thank “The Daily Show” for its help in bringing the matter to the public’s attention — and a celebratory host seemed to notice.
“Some naysayers out there,” Stewart observed Tuesday night, “will say, ‘But the VA made that decision before “The Daily Show” wrote, taped and aired that piece, and “The Daily Show” just didn’t know about that because that information hadn’t been made public yet.’”
“Fuck that,” Stewart added sarcastically. “I say credit where credit is due.”
Which is a statement that cuts many ways in this debate. Beyond the congressional grandstanding on the VACAA strictures when it was Congress that underfunded the program, there is the problem that provoked this awkward policy patch in the first place.
The federal government has chronically authorized wars without wanting to pay for the people who have to fight them. The Veterans Administration medical system — once considered one of the best health programs in the United States, and still highly rated by many who actually get the care — has been overwhelmed by the numbers and condition of military personnel fed into it by the dozen-plus years of war in Iraq and Afghanistan. The scandals last year that forced the resignation of then–VA chief Eric Shinseki and eventually led to the passage of VACAA were born of the dramatic underfunding of the VA. With too few facilities and too few doctors working longer hours for less pay than their civilian counterparts, it could be argued that a collapse of the system was also more intended feature than bug.
Congress, of course, has repeatedly rejected bigger VA budgets, and, even as the backlog scandal was hitting the papers last May, a bill to increase the number of clinics and medical personnel failed a procedural vote in the Senate. Instead of directly spending more on veterans through the comparatively efficient government system, Congress eventually passed the Veterans Choice Band-Aid, which funnels federal cash to private-sector providers (a move very much in ideological lockstep with the goals of those who advocate privatization of programs like Social Security and Medicaid, and even in line with the heavy reliance on private insurance in the Affordable Care Act).
And it is these kinds of complicated shell-game programs that lead to complicated, bottom-line maximizing accounting tricks like the 40-mile rule.
It’s almost as if the outrage feels more satisfying than the solution — as if indignation has many parents, but follow-through is an orphan.
“It turns out when it comes to veterans,” said Stewart Monday, extending the metaphor in a way best explained by him in the video above, “Congress are just deadbeat dads.”