Triaging the VA

Not so very long ago, in 2018, the Department of Veterans Affairs was celebrating a record-high financial bonanza of $230 billion in federal funding. Today, even as the population of veterans is diminishing, VA budgetary resources have increased by $100 billion, to more than $338 billion. In the intervening years, the VA, which continues to cope with severe staff shortages, hasn’t reformed its perpetually backlogged benefits-claim process, hasn’t solved or even noticeably diminished the veteran-suicide crisis, hasn’t solved the problem of veteran homelessness, hasn’t managed successfully to field its new and exorbitantly expensive electronic-health-records system, and hasn’t helped many veterans to land new jobs— but it has punished veterans for the VA’s own accounting errors. Every year, we’re spending ever more billions on fewer and fewer military veterans, without even knowing what that money is accomplishing.

Fiscally, this trend is unsustainable. Socially, we can hardly call this “taking care” of veterans. Morally, it’s a dismissal of veterans, not a form of thanking them for their service. But above all, it’s political posturing — and completely on par for the historical course of veterans’ policy.

In 2021, the left-leaning Center for American Progress noted that one of the VA’s most crucial issues was the need to harness its galloping budget. Even before American Rescue Plan allocations, the 2021 VA budget stood at a “whopping $243 billion,” which represented a 500 percent increase since 9/11, “an increase higher than that of any other federal agency” and greater than “the combined budgets of the Department of State, the US Agency for International Development, the Department of Justice, and the entire intelligence community.” Meanwhile, according to Jonathan Vespa of the U.S. Census Bureau, the veteran population declined by a third between 2000 and 2018, from 26.4 million to 18 million; according to VA statistics, the average decrease at the state level from 2000 to 2020 was 25 percent. And while today’s population of U.S. veterans totals around 17 million, not all those who served in the U.S. armed forces qualify for VA health care or the suite of disability, education, training, and home- and other loan programs. Yet the VA
budget is hardly the only public money spent on veterans: The Institute for Veterans and Military Families (IVMF) at Syracuse University has calculated that the 50 states collectively spend more than $3.3 billion on veterans. Other federal agencies also fund veterans’ programs from their individual budgets.

Most people assume that the entire point of the VA is to provide health care to those who served, but by law and by statute, this is not the case. Of the 17 million former active-duty members of the armed forces (to say nothing of those who served exclusively in the Reserves or National Guard), about 9 million are “enrolled” in the VA’s health-care system, which spans 1,255 health-care facilities (most of which are east of the Mississippi River, reflecting 20th-century population patterns rather than those of 21st-century veterans). But according to the VA’s own documentation, in fiscal year 2020, the most recent year for which data are available, only around 6.4 million veterans were treated by the VA (in 2000, the number was half that).

In truth, the costs of providing health care to an aging veteran population that is on average older and sicker than the civilian population are undeniably large, and they are increasing along with health-care costs in general. The expanding number of veterans using community care paid for by the VA thanks to the Mission Act (which took effect in 2019) has also required increased budget lines for the VA. And the VA has had additional financial burdens placed on it thanks to the Forever GI Bill (2017), the Blue Water Navy Act (2019), and court cases related to them, with yet more costs to come from the massively expensive PACT Act, which addresses the needs of veterans exposed to toxic substances while serving (2022). But veterans’ advocates and VA cheerleaders also need to be honest in their portrayal of and rhetoric about the numbers of veterans that the VA can and does serve — whether in its health system or otherwise — as a proportion of the entire veteran population. Not only do best accounting practices require such honesty, but it is a moral necessity stitched into
the fabric of democratic trust between citizens and the government.

Read the rest at National Review.

Rebecca Burgess is a Senior Fellow at Yorktown Institute.

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