The VA should provide healthcare to its employees as an employee benefit as a substitute for the commercial health insurance provided as an employee benefit.
The VA aspires to be the provider of the highest quality healthcare available, yet most of the 250,000 employees of the VA must seek their healthcare elsewhere. The costs of providing healthcare at the VA is lower than providing care elsewhere, but the VA pays commercial rates for private health insurance as an employee benefit. Aviation systems are often cited as examples of systems designed for safety that should be emulated in healthcare. In aviation the pilot has a great incentive to ensure airplane safety because the pilot is also a passenger (as noted in our Picker Training). The VA administrators and providers of healthcare set priorities and make decisions that often have no impact on them personally. Caring for themselves would save money and provide a great incentive for seeking quality.
The VA serves more than 5.5 million Veterans with 250,000 employees; this proposal would increase enrollment by about 4.5% (more if families were also enrolled). It would be self funding by internalizing the current insurance premiums. The VA would need to begin providing services not currently available, including acute trauma care, obstetrical care, pediatric care, and care for patients with congenital medical conditions, etc.