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Donald Trump Adviser Signals Plan to Change Veterans’ Health Care<http://www.wsj.com/articles/donald-trump-adviser-signals-plan-to-change-veterans-health-care-1463064129> Wall Street Journal – Ben Kesling Donald Trump says the Department of Veterans Affairs’ health-care system is badly broken, and this week his campaign released some guidelines that would steer changes he would implement if he wins the presidency. While short on details, the presumptive GOP presidential nominee would likely push VA health care toward privatization and might move for it to become more of an insurance provider like Medicare rather than an integrated hospital system, said Sam Clovis, Mr. Trump’s chief policy adviser, in an interview. “We want quality care top to bottom,” Mr. Clovis said in an interview. “If that means we have some form of privatization or some form of Medicare, we don’t see anything wrong with that.” Mr. Clovis, who is also Mr. Trump’s national campaign co-chair, said the candidate’s priority would be to give veterans timely health care close to home. That could mean restructuring the system in a way to more resemble an insurance provider along the lines of the popular Tricare system used by 9.6 million members of the Department of Defense, where civilian facilities routinely augment department-run hospitals. “We’ll certainly look at that model, we want to make it as comprehensive as possible,” said Mr. Clovis when asked about Tricare. “The VA’s a broken system now. We can’t continue down that road.” Mr. Clovis cautioned that Mr. Trump won’t try to fix what is working. “There are a lot of VA facilities that are being run very well,” Mr. Clovis said, adding that Mr. Trump doesn’t “want to take away the veterans hospitals and the things that are working well.” VA officials declined to comment on Mr. Trump’s plans. The campaign’s proposal to move toward privatization isn’t necessarily new, Mr. Trump’s website has long said the businessman wants to “ensure our veterans get the care they need wherever and whenever they need it,” but he has yet to provide specifics about how he would do that. Currently, 9 million of the nation’s 22 million veterans are enrolled in the VA’s health-care system, and 6 million use those benefits regularly. ENLARGE Currently, 9 million of the nation’s 22 million veterans are enrolled in the VA’s health-care system, and 6 million use those benefits regularly. PHOTO: ALEX WONG/GETTY IMAGES As with many of Mr. Trump’s policy positions, some of which he has seemed to reverse, the campaign has been reluctant to provide details. Mr. Clovis declined to lay out specifics, saying, “every time we put a detailed plan out we just get eviscerated in the media.” He added that the campaign is using broad guidelines on the matter and likely will hold back on releasing a comprehensive plan until Mr. Trump’s first 100 days in office. He also said that Mr. Trump will crack down on fraud, waste and abuse in the system to keep the VA budget essentially flat or even bring costs down. The Democratic front-runner, Hillary Clinton, has said multiple times in campaign appearances that while she wants to restructure the VA she opposes privatization, referring to it on her website as a “misguided ideological crusade.” Jon Murray, veterans outreach director for Mrs. Clinton’s campaign said in a statement that the Democrat would “make much-needed reforms to the VA without forcing veterans into a private health-insurance market ill-suited to handle their specialized needs.” Though Mr. Trump says such plans can work while keeping costs flat, the Congressional Budget Office, which does nonpartisan analysis, said in a 2014 report, the most recent available, that moving the VA toward privatization could increase costs dramatically. Currently, 9 million of the nation’s 22 million veterans are enrolled in the VA’s health-care system, and 6 million use those benefits regularly. The CBO report noted that of those veterans who use the benefits, 70% receive most of their care outside the VA, often using coverage like private insurance or Medicare. The CBO also estimated that services provided by the VA would cost about 20% more if obtained in the private sector and prescription drugs would likely cost about 70% more under Medicare and Medicaid. Expanded privatization could also flood the system with veterans who don’t use the program now, the report said. The VA’s health-care system, though it has been under fire since revelations in 2014 that employees had been falsifying wait-time records, consistently rates highly with those using the system. “On really almost every measure, VA health care is as good and in many measures is even better than the private sector,” said Carrie Farmer, a senior policy researcher focusing on veterans’ issues at Rand Corp., a nonpartisan think tank. “Relatedly, the VA is providing, not all the time, but probably better than in the private sector, military cultural competent care.” In other words, the VA’s doctors are trained to deal with the veteran community and the unique issues they face from post-traumatic stress disorder to traumatic brain injury, hallmarks of the most recent wars. And older veterans are more likely to be sicker and have more total illnesses and injuries than a civilian patient, which can be related to military-specific injuries such as exposure to Agent Orange, a powerful chemical mixture used to defoliate forest cover during the Vietnam War. VA officials tout that it is the largest integrated health-care network in the U.S., where centralized systems ensure veterans’ health records can be seen by any doctor and veterans are treated holistically rather than each injury or illness in isolation. “Cost is really only the tip of the iceberg here when you’re talking about the potential effects,” Ms. Farmer said, noting that by her estimates only about 20% of civilian doctors are properly trained and equipped to deal with veterans’ issues. Many veterans’ organizations, including the Disabled American Veterans, have steadfastly maintained opposition to privatization of the VA, warning that as services slowly get outsourced to civilian doctors, veterans will start to lose the comprehensive care they get at the VA. Other organizations, such as the Iraq and Afghanistan Veterans of America, agree. “We are not for full choice,” said Elizabeth Welke, a political associate at the organization, adding that the Iraq-Afghanistan group wants the VA to remain the provider and coordinator of veterans care. “There are specific programs that VA offers that aren’t in the private sector: poly-trauma and spinal cord injuries,” said Ms. Welke. And “when you go to the VA everyone is a vet. Doctors who are out in the community don’t necessarily understand that.”