Sanders-McCain deal, done right, could be VA’s best chance

There are two theories on what the Department of Veterans Affairs needs to fix its sprawling health-care system: Better management or more money. The beauty of the deal struck by Sens. Bernie Sanders of Vermont and John McCain of Arizona is that it tries both strategies at once.

The proposed legislation, announced last week and now getting hashed out in committee, starts with the department’s immediate need to provide more care. It calls for the VA to lease 26 additional major medical facilities around the country, and it would enable the department to hire doctors and nurses more quickly, with existing unobligated funds.

The plan would also expand veterans’ choices beyond the VA system; those who face long wait times or live more than 40 miles from a VA facility could go to outside providers, including Department of Defense clinics and hospitals and doctors who participate in Medicare.

To fortify the system for the longer term, the Sanders-McCain plan would create two independent commissions, one focused on capital planning and the other on patient care and scheduling. Survivors of sexual assault would have easier access to treatment. And the VA would have an easier time firing poorly performing staff.

That’s an excellent starting point; the plan’s success, as usual, will depend on the details we don’t yet know. These are the essential open questions:

How much new funding will there be? The department’s health division had about $550 million at the end of the last fiscal year in unobligated funds, but it’s not clear how much of that money can be diverted toward new hiring. ...

Exactly how long will vets have to wait for the VA before opting for outside care? The proposal calls for adopting the agency’s existing two-week target, but that might not be good enough for primary care and it might be too ambitious for specialty care. ...

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