VHA ’emoji’: Poop or ice cream?

Long overdue reforms, or destruction and backdoor privatization of the Veterans Health Administration? People are looking at the recommendations of the Commission on Care and seeing two sides of the moon.

It reminds me of an argument I had when I first saw the popular emoji depicting what I thought was soft-serve chocolate ice cream. Wrong. Never mind that the same set of pixels in white are in fact used atop the ice cream cone emoji.

Congress convened the commission back in 2014 to look comprehensively at the Veterans Benefits Administration and come up with ideas for overhauling it or modernizing it. Its final report contains a long list of recommendations. Topping the list: folding non-VA facilities into the care system so veterans have a wider choice of places to go. These “community-based” providers are already available to vets, reinforced by the Choice Act, which also established the commission.

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Commissioners recommend going further by creating what sound almost like mini Medicare systems, with the Veterans Health Administration as the payer.

To hear commission chair Nancy Schlichting describe it, nothing could be more reasonable. A seasoned health care executive, she readily acknowledges that in many medical areas — especially those particular to veterans — the VA itself is hard to beat.

Then the press release came from the American Federation of Government Employees, whose president, J. David Cox, is a former VA medical employee. He sees neither vanilla nor chocolate ice cream in the commission’s recommendations. He calls the whole thing horrendous and anti-veteran. In our interview, Cox argues against what he sees as the disintegration of VA. He notes, coupled with the community network proposal, the commission recommends streamlining the VA’s physical hospital network and updating its capital procedures. Cox is suspicious that means a BRAC-like process for shedding old buildings — along with the services the offer and the staffs they house.


Schlichting says too many VA buildings are 50 years old or older, and even rehabbed ones now need re-rehabbing. At some point, she says, hospitals get so old they can’t be brought up to current standards.

The report in fact has recommendations AFGE, the Commissioners and most everyone else for whom VA issues matter, can agree on. These include bringing IT systems up to date; improve supply chain management; develop a better appeals process for vets for denied coverage.

These obvious moves won’t bridge the gap between AFGE and several veterans groups against the VHA recommendations, and those that support them. The current VA debate started when the long appointment wait times came to light. Much of the 308-page commission report addresses that problem, so it’ll at least push the debate out of stasis.

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