WASHINGTON -- With calls rising for the resignation of Eric Shinseki, secretary of the Department of Veterans Affairs, the House and Senate are confronting the broadening health scandal at the department in ways that will challenge both parties to rethink the future of the medical system for veterans.
House legislation would nudge the department toward privatization by allowing any veteran who had to wait 30 days for care to seek it through private medical providers at the department's expense. The Senate is preparing legislation to fund as many as 27 new health care facilities within the VA system to address the backlog of care at a cost of billions of dollars.
With shockingly long wait times at some facilities eliciting bipartisan condemnation, the next steps from Congress will hold significant ramifications for veterans' health care -- and government-run health care broadly.
"Certainly we ought to address the issue of personnel who made mistakes and falsified records, but that's not going to solve the problems of veterans who've had to wait for so long," Sen. Charles E. Schumer, D-N.Y., said. "We have to look at the underlying problems."
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The scandal was amplified Wednesday with the release of a report by the department's inspector general that found wide-ranging and "systemic" abuses of its waiting lists to mask the problems of long wait times for care. The investigation's preliminary report found 1,700 veterans at the agency's medical facility in Phoenix were left off the official waiting list and wait times were systematically understated.
Six Democratic senators, all campaigning for election this year, have called for Shinseki's resignation: Mark Udall of Colorado, Kay Hagan of North Carolina, John Walsh of Montana, Jeanne Shaheen of New Hampshire, Al Franken of Minnesota and Mark Warner of Virginia.
Sen. John McCain, R-Ariz., added his voice to the growing chorus. He and Walsh are the Senate's only combat veterans.
"The systemic problems at the U.S. Department of Veterans Affairs are so entrenched that they require new leadership to be fixed," Udall said. "Secretary Shinseki must step down."
The House Veterans Affairs subcommittee on disability assistance held a hearing Thursday on the agency's performance transitioning service members to civilian life, a usually dry affair likely to be consumed with attention over the issue of wait times at veterans health care centers.
In the House, Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, and Rep. Howard "Buck" McKeon, R-Calif., chairman of the House Armed Services Committee, also said Shinseki should step down. For weeks, Miller had said a change at the top would only shift attention from the changes needed to address the underlying problems.
The "report makes it painfully clear that the VA does not always have our veterans' backs," said Paul Rieckhoff, chief executive and founder of the Iraq and Afghanistan Veterans of America.
How to fix the problem, however, is a broader political issue. House Speaker John Boehner of Ohio made that point Thursday morning when he again declined to call for Shinseki's resignation.
"The question I ask myself is, 'Is him resigning going to get us to the bottom of the problem? Is it going to help us find out what's really going on?' And the answer I keep getting is no," Boehner said. "This is more than just about phony waiting lists. This is also about the quality of care we provide for our veterans."
That leaves both parties with a fundamental question: Does Congress expand a government health program to deal with a net increase 1.5 million new veterans, their ranks swollen by the wars in Iraq and Afghanistan, or does it move toward a privatized health system?
"Veterans are caught in a philosophical argument between people who want to get rid of the VA entirely and people who think the VA is wonderful," Rieckhoff said. "Maybe there will be some newfound urgency for compromise around a clear strategic, military and real priority. Maybe we can unite this country around one big thing: caring for our veterans."
Rep. Nancy Pelosi of California, the House minority leader, said she had no problem with the call by House Republicans to channel more veterans into private care to lessen the backlog. But, she said, "We have to think in a bigger way."
That might mean new incentives to train primary care physicians, student debt forgiveness for primary care doctors who choose to work at the VA, and more extensive use of federally accredited community health centers.
Most veterans organizations are leery of more vouchers for private care, maintaining the Department of Veterans Affairs has expertise unmatched outside the system in areas such as traumatic brain injury, post-traumatic stress disorder, amputee care and other combat-related ailments.
Sen. Bernard Sanders, I-Vt., chairman of the Senate Veterans Affairs Committee, said veterans returning from Iraq and Afghanistan are overwhelming facilities in the Southwest and South. And, he noted, the nation's entire health care system is facing acute shortages of primary care physicians, so vouchers may not relieve the backlog.
Senate legislation written by Democrats in February that would have expanded the department's health system with 27 new facilities fell to a filibuster over its cost. But Democrats are betting that Republicans who have focused on the wait times as a scandal will not be able to vote similar legislation down again. Sanders plans to have a new bill ready by the hearings Thursday on the crisis.
Miller, his House counterpart, will introduce wait-time legislation this week with the backing of Boehner. Michael Steel, a Boehner spokesman, said vouchers to help veterans seek help from private caregivers would be the fastest remedy for thousands of veterans unable to get their initial appointments with department physicians.
"Building new facilities is not a lickety-split affair," he said. "The issue will be whether Senate Democrats can stand in the way of the immediate relief that the House is offering."
Sanders and Sen. Richard M. Burr of North Carolina, the ranking Republican on the Senate Veterans Affairs Committee, said there could be compromise. New department facilities could be located inside community hospitals or federally licensed community care centers. In Alaska, veterans have access to federal Indian Health Centers.
"It's time to look at the existing model and ask ourselves, 'Is this the right model for the 21st century?'??" Burr said.