For those who follow veterans’ policy, there are generally two types of conventional wisdom with regard to how to improve the Department of Veterans Affairs (VA).
The first is to provide the VA with additional resources such as increasing its budget and number of employees, and the second is to outsource some of VA’s noncore functions to contractors and the private sector.
For example, with regard to the former type of conventional wisdom, earlier this month, Senate Minority Leader Charles Schumer (D-N.Y.) called for an additional $750 million in funding for the VA to hire more employees and secure more in-house medical services.
And, with regard to the latter type of conventional wisdom, although he has pledged that he will not privatize the VA, Secretary Robert Wilkie has stated that he will continue to implement the Mission Act, which increases options for veterans to seek care in the private sector pursuant to President Trump’s campaign promise.
However, as noted by economist Steven D. Levitt in the bestselling book “Freakonomics,” “the conventional wisdom is often wrong.”
Indeed, contrary to conventional wisdom, the best way to improve the VA is to empower veterans through access to meaningful employment opportunities. Unfortunately, as many lawmakers continue to clash over the future of VA versus non-VA care, this is an issue that does not receive adequate legislative attention.
Employment is a key social determinant of health — i.e., a nonmedical factor that influences health outcomes and costs. People, including veterans, who are unemployed tend to have worse physical and mental health than those who are gainfully employed. And, other social determinants that impact a sizable number of veterans — poverty and lack of housing, for example — are not only often tied to unemployment, they also contribute to poor health outcomes that in turn can overburden the VA health-care system.
In addition to access to health care, obtaining meaningful employment is often a challenge for those transitioning from active service to veteran status. Veterans often struggle with matching their skills and certifications from the military with the needs of civilian employers, as well as with switching gears from the collaborative environment in the military to the competitive environment found in many civilian workplaces.
According to Matthew Hudson, a program manager for Google Cloud who served as a civil engineer in the Air Force, “as a result, 1 in 3 veterans — of the roughly 250,000 servicemembers who transition out of the military each year — end up taking jobs well below their skill level.” And underemployment can result in mental health issues for veterans, just as unemployment can.
Thankfully, with help from the private sector, the ability to match military skillsets with civilian jobs is improving, due to a new job search feature by Google that allows veterans to enter their military occupational specialty code and see results that match their skillset with similar civilian jobs.
In addition, the VA is also working to address this issue by hiring more counselors to strengthen its vocational rehabilitation program. Congress has also been examining ways to strengthen the military’s mandatory Transition Assistance Program to aid service members with the shift from active duty to civilian life.
In addition to the obvious benefits of helping veterans find employment that allows them to use their skills to support themselves and their families, focusing on veterans’ employment matters also helps alleviate the current burdens on the VA health-care system.
First, as noted above, veterans who are gainfully employed tend to be healthier, thus requiring less emergency, mental health and specialty health-care services. And, second, veterans who are gainfully employed tend to seek health-care coverage from their employer rather than government programs, such as the VA.
In what might be a surprise to some, the VA is not the primary source of health care for working age veterans. The most common health insurance coverage for working age veterans is actually employer-sponsored health-care coverage. According to the U.S. Census Bureau, as of 2016, nearly 60 percent of working age veterans used employer-sponsored health coverage, whereas only 30 percent used VA health care. (The remaining working age veterans were primarily covered by other government programs such as TRICARE, Medicaid or Medicare.)
Thus, as the VA continues to struggle with how to ensure timely access to care for those who choose to rely on the VA for their health care, they can improve outcomes by ensuring that those who would prefer to rely on employer-sponsored health-care coverage have the opportunity to do so. And the first step to ensuring access to employer-sponsored health-care coverage is access to employment itself.
In analyzing a problem, the solution often lies several steps either in front of or behind the issue at hand. To this end, ensuring optimal health outcomes for veterans involves a focus on social determinants such as employment — not just whether health services, when required, are provided by the VA or the private sector.
I therefore encourage lawmakers to start devoting as much attention to the importance of social determinants of veterans’ health, such as employment, as they do to both sides of the VA health-care privatization wars. I guarantee that, if they do, they will find that issues of timely access to VA care become obsolete.
