This afternoon the Senate passed and sent to the White House the VA Mission Act of 2018. This is what it does:

Access to non-VA health care:

It requires veterans to become eligible for private-sector care options if VA does not provide adequate medical options for patients, including long travel times, long wait times or poor service ratings. It revises payment rates for community care to Medicare rates, to ease concerns about reimbursement for those visits.

And it would also authorize two walk-in visits at local private-sector offices for any veterans who have used department health care services in the last two years. Those appointments may require a co-pay.

Caregiver stipend

Under current law, only caregivers of veterans from the post-9/11 era are eligible for monthly stipends through the department. The new proposal would expand that to veterans of all eras, first starting with pre-1975 veterans and later phasing in the remaining group.

I think this is huge as it allows a stipend for family members to care for a veteran and keep them out of a nursing home.

This is the equivalent of a base realignment and closure commission for VA facilities

An review of VA facilities — similar to the military’s base closing commissions, although supporters bristle at the comparison — is the third major initiative in the VA Mission Act but won’t have any real impact for another four years.

That’s because under the measure, the first report to Congress on possible VA facility closings or expansions won’t come until sometime in 2022, after years of study and deliberation.

The legislation calls for the president to establish a nine-member Asset and Infrastructure Review Commission, with representatives from veterans service organizations, the health care industry and federal facility management.

The panel would meet in coming years to set parameters for their work, with an eye towards “the modernization or realignment of Veterans Health Administration facilities.” That could include closing, reducing or expanding a host of VA health facilities across the country.

VA facilities were built based on veterans densities in the 50s and 60s. So you have a lot in the northeast and upper midwest that are underutilized and a lot in the Sunbelt that are overcrowded. This will be unpopular, just like BRAC was, but it is vital.

The VA is an effervescing puddle of #FAIL that burns through billions of dollars a year and does a damned poor job in most instances. Incompetent administrators, callous staff, and general welfare state mentality abound and union rules make it difficult to discipline, much less fire, anyone. The long-term solution, I think, is for the VA to concentrate on a handful of areas peculiar or common to the veterans: rehab for multiple amputees; research and treatment of traumatic brain injuries; management of PTSD; severe burns; etc. For run of the mill medical care, veterans need access to civilian medical facilities at no charge. Veterans and the nation will be better off.