Veterans care is one of those third rails no one in politics want to touch. Americans, and the politicians they elect, like to feel good on what’s available for veterans once they’re out of the military. It’s something pretty much every politician brings up in speeches, especially on the GOP side. The problem is no one seems to be willing to discuss actual solutions to solving the horror of the Veterans Administration scandal. It seems like every GOP presidential candidate, including the so-called “freedom and liberty” ones, want to keep the VA afloat even though there’s no reason to. It’s all platitudes and not wanting to be “that guy (or girl)” who calls for something to be shut down, especially when it’s supposed to help veterans. This ignores the facts of how poorly the VA system is run and throwing money at it isn’t going to work.

The other problem is how vague most GOP presidential candidates are in “fixing” the VA. Rand Paul’s website is pretty thorough on most of his policy positions, but doesn’t really describe what he’d do with the VA.

We owe it to the men and women who have served in combat to provide them with quality care for injuries sustained in defense of this nation.  We must provide our veterans the necessary support tools as they adjust back to civilian life.

We consider all veterans, service members and their families to be an important part of our local communities. As President, I will continue to support veterans and service members of this country. It is my strong belief that we must protect those who have made the ultimate sacrifice to protect our nation.

This is pretty disappointing, but something which plagues other candidates. Jeb Bush, Marco Rubio, and Ted Cruz have similar ideas on VA reform but don’t really explain how they’d be administered. Here’s Rubio’s:

Similarly, competition will push the VA to provide top quality care. If veterans don’t feel like the Veterans Health Administration suits their needs, Marco supports giving them the option to use the exact same funds to see an approved private sector provider of their choice.

Cruz used the same language when talking to Breitbart in August.

“There needs to be accountability for those responsible for the unjustifiable delays in life-saving treatment. We need to ensure we honor the commitment that was made to every one of our veterans… we need to reform the VA system so that every veteran can see the doctor of his or her choice. If you want to go to the VA, you should be able to do so, but if you want to go see a cardiologist at the hospital down the street, you should be able to do that as well. We need to give vets true choices.”

Here’s Bush’s idea.

“This is where I think empowering people with the equivalent of a voucher that gives you the same economic benefit of receiving care inside of a clinic or a hospital,. If you had a chance to go to another place where the money followed the patient, it would give the veterans — you wouldn’t have these kind of hostile reactions, my job is protected for life, don’t mess with it.”

These aren’t bad ideas, but if the VA system is that screwed up, why would anyone want to go to it? A friend of mind told me he went to a VA hospital after getting out of the Navy because he thought, “Hey free health care.” But he discovered long wait times, so he went to a private physician instead. It’s possible he had the wherewithal to do this (he is a graphic designer, writer, and opiner), but it’s also possible he just took the time the find other doctors and had health insurance to cover the visit. I’ve written before on how government involvement in health care started seeing insurance companies gain more power. The vets who don’t have health insurance are essentially forced to go to the VA because other docs might not take them. It’s just a cycle of dependence.

The only GOP candidate to roll out a more detailed plan on fixing the VA system is Donald Trump. He’s got some good ideas, but other ideas would cause a massive increase in the social safety net.

Under a Trump Administration, all veterans eligible for VA health care can bring their veteran’s ID card to any doctor or care facility that accepts Medicare to get the care they need immediately. Our veterans have earned the freedom to choose better or more convenient care from the doctor and facility of their choice. The power to choose will stop the wait time backlogs and force the VA to improve and compete if the department wants to keep receiving veterans’ healthcare dollars. The VA will become more responsive to veterans, develop more efficient systems, and improve the quality of care because it will have no other choice.

It’s great Trump wants to give vets choices, but he’s ignoring the issues with the Medicare physician payment system and the impact on the debt. The reason it could cost $6.4T to fund Medicare from 2010 to 2019 is because the government automatically enrolls people in Medicare, without giving them the choice of opting out or not. So if Trump wants to automatically enroll vets into Medicare it’s just going to push that $6.4T tab higher and higher. The Washington Post wrote last year how often Congress has had to pass “doc fix” bills to reimburse docs who accept Medicare.

In 1997, Congress created the Sustainable Growth Rate (SGR), a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, within a few years, health-care costs far outpaced economic growth — creating a multibillion-dollar shortfall in funding for Medicare payments.

How much more is this going to increase if vets get added into Medicare? “Doc fix” bills will have to passed over and over and over again to make sure payments to docs don’t go down. This isn’t the way to do things. Washington can’t just keep kicking the can and keep going “deadline to deadline” and crisis to crisis. This has to stop. The biggest problem with the VA system is that it’s always been based on the idea of “giving veterans the care they deserve.” Congress put together the old Veterans Bureau in 1921 because of public pressure. A write up from The Chicago Times shows how touchy of an issue it was.

The long fight for legislation to end the nation’s shameful neglect of its disabled veterans won a victory today when congress put the final stamp of its approval on the Sweet bill.

By a vote of 264 to 4 the house agreed to the conference report on the measure, following the example set by the senate yesterday. The bill will become a low just as soon as the President signs it…

There’s nothing wrong with wanting to make sure people get the best medical care available, but should it be paid for by the government? The best option to solving all the VA system problems is just to shut the thing down completely. This wouldn’t keep veterans from getting care. They can go to a private physician or a hospital to get help. There are also veterans groups out there who partner with corporations and others to help vets. They could keep doing what they’re doing to help vets. But fixing the VA system also means getting the government out of health care. This is going to take a while to do and those who want to see this happen will have to message correctly. That might be the hardest part of it all.