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| Pressure Builds to Oust Veterans Affairs Chief and Make Changes | Pressure Builds to Oust Veterans Affairs Chief and Make Changes |
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| WASHINGTON — With calls rising for the resignation of the secretary of the Department of Veterans Affairs, Eric Shinseki, the House and Senate are confronting the broadening health scandal at the department in ways that will challenge both parties to rethink the future of the medical system for veterans. | WASHINGTON — With calls rising for the resignation of the secretary of the Department of Veterans Affairs, Eric Shinseki, the House and Senate are confronting the broadening health scandal at the department in ways that will challenge both parties to rethink the future of the medical system for veterans. |
| House legislation would nudge the department toward privatization by allowing any veteran who has had to wait for care for 30 days to seek it through private medical providers, at the department’s expense. The Senate is preparing legislation that would fund as many as 27 new health care facilities within the Department of Veterans Affairs system to address the backlog of care at a cost of billions of dollars. | House legislation would nudge the department toward privatization by allowing any veteran who has had to wait for care for 30 days to seek it through private medical providers, at the department’s expense. The Senate is preparing legislation that would fund as many as 27 new health care facilities within the Department of Veterans Affairs system to address the backlog of care at a cost of billions of dollars. |
| With shockingly long wait times at some facilities eliciting bipartisan condemnation, the next steps from Congress will hold significant ramifications for veterans’ health care — and government-run health care broadly. | With shockingly long wait times at some facilities eliciting bipartisan condemnation, the next steps from Congress will hold significant ramifications for veterans’ health care — and government-run health care broadly. |
| “Certainly we ought to address the issue of personnel who made mistakes and falsified records, but that’s not going to solve the problems of veterans who’ve had to wait for so long,” Senator Charles E. Schumer, Democrat of New York, said. “We have to look at the underlying problems.” | “Certainly we ought to address the issue of personnel who made mistakes and falsified records, but that’s not going to solve the problems of veterans who’ve had to wait for so long,” Senator Charles E. Schumer, Democrat of New York, said. “We have to look at the underlying problems.” |
| The scandal was amplified Wednesday with the release of a report by the department’s inspector general that found wide-ranging and “systemic” abuses of its waiting lists to mask the problems of long wait times for care. The investigation’s preliminary report found that 1,700 veterans at the agency’s medical facility in Phoenix were left off the official waiting list and that wait times were systematically understated. | The scandal was amplified Wednesday with the release of a report by the department’s inspector general that found wide-ranging and “systemic” abuses of its waiting lists to mask the problems of long wait times for care. The investigation’s preliminary report found that 1,700 veterans at the agency’s medical facility in Phoenix were left off the official waiting list and that wait times were systematically understated. |
| Six Democratic senators, all campaigning for election this year, have called for Mr. Shinseki’s resignation: Mark Udall of Colorado, Kay Hagan of North Carolina, John Walsh of Montana, Jeanne Shaheen of New Hampshire, Al Franken of Minnesota and Mark Warner of Virginia. Senator John McCain, Republican of Arizona, added his voice to the growing chorus. He and Mr. Walsh are the Senate’s only combat veterans. | |
| “The systemic problems at the U.S. Department of Veterans Affairs are so entrenched that they require new leadership to be fixed,” Mr. Udall said. “Secretary Shinseki must step down.” | “The systemic problems at the U.S. Department of Veterans Affairs are so entrenched that they require new leadership to be fixed,” Mr. Udall said. “Secretary Shinseki must step down.” |
| On Thursday afternoon, the House Veterans Affairs subcommittee on disability assistance will hold a hearing on the agency’s performance transitioning service members to civilian life, a usually dry affair likely to be consumed with attention over the issue of wait times at veterans health care centers. | On Thursday afternoon, the House Veterans Affairs subcommittee on disability assistance will hold a hearing on the agency’s performance transitioning service members to civilian life, a usually dry affair likely to be consumed with attention over the issue of wait times at veterans health care centers. |
| In the House, Representative Jeff Miller of Florida, a Republican and chairman of the House Veterans Affairs Committee, and Representative Howard (Buck) McKeon of California, a Republican and chairman of the House Armed Services Committee, also said Mr. Shinseki should step down. For weeks, Mr. Miller had said a change at the top would only shift attention from the changes needed to address the underlying problems. | In the House, Representative Jeff Miller of Florida, a Republican and chairman of the House Veterans Affairs Committee, and Representative Howard (Buck) McKeon of California, a Republican and chairman of the House Armed Services Committee, also said Mr. Shinseki should step down. For weeks, Mr. Miller had said a change at the top would only shift attention from the changes needed to address the underlying problems. |
| The “report makes it painfully clear that the V.A. does not always have our veterans’ backs,” said Paul Rieckhoff, chief executive and founder of the Iraq and Afghanistan Veterans of America. | The “report makes it painfully clear that the V.A. does not always have our veterans’ backs,” said Paul Rieckhoff, chief executive and founder of the Iraq and Afghanistan Veterans of America. |
| How to fix the problem, however, is a broader political issue. | How to fix the problem, however, is a broader political issue. |
| Speaker John A. Boehner of Ohio made that point Thursday morning when he again declined to call for Mr. Shinseki’s resignation. “The question I ask myself is, ‘Is him resigning going to get us to the bottom of the problem? Is it going to help us find out what’s really going on?’ And the answer I keep getting is no,” Mr. Boehner said. “This is more than just about phony waiting lists. This is also about the quality of care we provide for our veterans.” | Speaker John A. Boehner of Ohio made that point Thursday morning when he again declined to call for Mr. Shinseki’s resignation. “The question I ask myself is, ‘Is him resigning going to get us to the bottom of the problem? Is it going to help us find out what’s really going on?’ And the answer I keep getting is no,” Mr. Boehner said. “This is more than just about phony waiting lists. This is also about the quality of care we provide for our veterans.” |
| That leaves both parties with a fundamental question: Does Congress expand a government health program to deal with a net increase of a million and a half new veterans, their ranks swollen by the wars in Iraq and Afghanistan, or does it move toward a privatized health system? | That leaves both parties with a fundamental question: Does Congress expand a government health program to deal with a net increase of a million and a half new veterans, their ranks swollen by the wars in Iraq and Afghanistan, or does it move toward a privatized health system? |
| “Veterans are caught in a philosophical argument between people who want to get rid of the V.A. entirely and people who think the V.A. is wonderful,” Mr. Rieckhoff said. “Maybe there will be some newfound urgency for compromise around a clear strategic, military and real priority. Maybe we can unite this country around one big thing: caring for our veterans.” | “Veterans are caught in a philosophical argument between people who want to get rid of the V.A. entirely and people who think the V.A. is wonderful,” Mr. Rieckhoff said. “Maybe there will be some newfound urgency for compromise around a clear strategic, military and real priority. Maybe we can unite this country around one big thing: caring for our veterans.” |
| Representative Nancy Pelosi of California, the House minority leader, said she had no problem with the call by House Republicans to channel more veterans into private care to lessen the backlog. But, she said, “We have to think in a bigger way.” | Representative Nancy Pelosi of California, the House minority leader, said she had no problem with the call by House Republicans to channel more veterans into private care to lessen the backlog. But, she said, “We have to think in a bigger way.” |
| That might mean new incentives to train primary care physicians, student debt forgiveness for primary care doctors who choose to work at the V.A., and more extensive use of federally accredited community health centers. | That might mean new incentives to train primary care physicians, student debt forgiveness for primary care doctors who choose to work at the V.A., and more extensive use of federally accredited community health centers. |
| Most veterans organizations are leery of more vouchers for private care, maintaining that the Department of Veterans Affairs has expertise unmatched outside the system in areas such as traumatic brain injury, post-traumatic stress disorder, amputee care and other combat-related ailments. Senator Bernard Sanders, independent of Vermont and chairman of the Senate Veterans Affairs Committee, said veterans returning from Iraq and Afghanistan are overwhelming facilities in the Southwest and South. And, he noted, the nation’s entire health care system is facing acute shortages of primary care physicians, so vouchers may not relieve the backlog. | Most veterans organizations are leery of more vouchers for private care, maintaining that the Department of Veterans Affairs has expertise unmatched outside the system in areas such as traumatic brain injury, post-traumatic stress disorder, amputee care and other combat-related ailments. Senator Bernard Sanders, independent of Vermont and chairman of the Senate Veterans Affairs Committee, said veterans returning from Iraq and Afghanistan are overwhelming facilities in the Southwest and South. And, he noted, the nation’s entire health care system is facing acute shortages of primary care physicians, so vouchers may not relieve the backlog. |
| Merritt Hawkins, a health care consulting firm, found this year that the average wait time to see a family physician in 15 markets studied was 19.5 days, longer than Mr. Shinseki’s goal of 14 days to access care at the department. | Merritt Hawkins, a health care consulting firm, found this year that the average wait time to see a family physician in 15 markets studied was 19.5 days, longer than Mr. Shinseki’s goal of 14 days to access care at the department. |
| “Do we have the staffing to achieve that goal?” Mr. Sanders asked. “In some parts of the country, clearly we do not.” | “Do we have the staffing to achieve that goal?” Mr. Sanders asked. “In some parts of the country, clearly we do not.” |
| Senate legislation written by Democrats in February that would have expanded the department’s health system with 27 new facilities fell to a filibuster over its cost. But Democrats are betting that Republicans who have focused on the wait times as a scandal will not be able to vote similar legislation down again. Mr. Sanders plans to have a new bill ready by the June 5 hearings on the crisis. | Senate legislation written by Democrats in February that would have expanded the department’s health system with 27 new facilities fell to a filibuster over its cost. But Democrats are betting that Republicans who have focused on the wait times as a scandal will not be able to vote similar legislation down again. Mr. Sanders plans to have a new bill ready by the June 5 hearings on the crisis. |
| Mr. Miller, his House counterpart, will introduce wait-time legislation this week with the backing of Speaker John A. Boehner, Republican of Ohio. Michael Steel, a Boehner spokesman, said vouchers to help veterans seek help from private caregivers would be the fastest remedy for thousands of veterans unable to get their initial appointments with department physicians. | Mr. Miller, his House counterpart, will introduce wait-time legislation this week with the backing of Speaker John A. Boehner, Republican of Ohio. Michael Steel, a Boehner spokesman, said vouchers to help veterans seek help from private caregivers would be the fastest remedy for thousands of veterans unable to get their initial appointments with department physicians. |
| “Building new facilities is not a lickety-split affair,” he said. “The issue will be whether Senate Democrats can stand in the way of the immediate relief that the House is offering.” | “Building new facilities is not a lickety-split affair,” he said. “The issue will be whether Senate Democrats can stand in the way of the immediate relief that the House is offering.” |
| Mr. Sanders and Senator Richard M. Burr of North Carolina, the ranking Republican on the Senate Veterans Affairs Committee, said there could be compromise. New department facilities could be located inside community hospitals or federally licensed community care centers. In Alaska, veterans already have access to federal Indian Health Centers. | Mr. Sanders and Senator Richard M. Burr of North Carolina, the ranking Republican on the Senate Veterans Affairs Committee, said there could be compromise. New department facilities could be located inside community hospitals or federally licensed community care centers. In Alaska, veterans already have access to federal Indian Health Centers. |
| “It’s time to look at the existing model and ask ourselves, ‘Is this the right model for the 21st century?' ” Mr. Burr said. | “It’s time to look at the existing model and ask ourselves, ‘Is this the right model for the 21st century?' ” Mr. Burr said. |