Pete Hegseth, President-elect Donald Trump‘s defense secretary nominee, and Doug Collins, his pick for veterans affairs secretary, have advocated greater privatization of veterans‘ healthcare, leading a former VA secretary to brand it “the worst-case scenario” for veteran healthcare.
The stance shared by Hegseth and Collins is rooted in giving veterans a choice on where they want to receive medical care. If veterans “want to go back to their own doctors, then so be it,” Collins told Fox News last month.
Dr. David Shulkin, a former VA secretary, wrote a memoir in 2019 in which he quoted Hegseth telling Trump in March 2018, “We want to have full choice where veterans can go wherever they want for care.”
Hegseth told the Shawn Ryan Show podcast that he wants “to effectively let the dollars follow” veterans to their preferred doctors, raising flags for critics who see that as the first step toward further privatizing healthcare and tearing down the VA system.
Shulkin said he warned Hegseth against giving veterans unrestricted healthcare choices. In his memoir, Shulkin recalled telling Hegseth, “Your version of choice would cost billions more per year, bankrupting the system. How can we responsibly pursue this? Unfortunately, he didn’t want to engage at the level of budget and other aspects of day-to-day reality.”
Shulkin told CNN on Wednesday that some access to private healthcare would be beneficial, such as when VA wait times for appointments are too long. However, he argued Hegseth has no experience in veterans affairs or healthcare and, therefore, does not understand the “complexities” of the delicate system.
Amy McGrath, a retired Marine fighter pilot who tried to flip Sen. Mitch McConnell’s (R-KY) seat blue in 2020, told the outlet that while the privatized healthcare debate has been “going on for years,” there has yet to be a “wide-spread outcry from veterans to privatize the VA.”
“I’m not saying the VA is perfect, it’s certainly not,” McGrath said. “But I don’t think there’s this huge outcry to privatize it.”
How the DOGE could harm the VA
The incoming Department of Government Efficiency, a commission led by Vivek Ramaswamy and Elon Musk, could also pose a threat to the VA, as the pair’s goal is to “cut wasteful expenditures and restructure Federal Agencies.” The two have proposed cutting down on federal spending no longer authorized by Congress, which could include money for veterans’ healthcare, NASA, and early education.
Just because a program might lack congressional authorization does not mean it does not still receive funding, though. The Veterans’ Health Care Eligibility Reform Act of 1996, which expired in 1998, helps provide funding for veterans’ medical care and still receives about $120 billion in funding.
However, McGrath is not sure that privatizing healthcare for veterans would cut costs for the VA.
“Healthcare is expensive, no matter how you go about it,” she said. “And I fear, and I think a lot of people fear, you will lose quality of care because now you’re switching over veteran care to the private sector, the private sector has an incentive to make money. … Health insurance makes money by denying care. Is that what we want?”
Privatization in reality
Small aspects of veterans’ healthcare could be privatized. Kate Kuzminski, the director of the military, veterans, and society program at the Center for a New American Security, said aspects not connected to military services, such as annual check-ups or regular vaccination shots, could be overseen by organizations outside the VA.
“There is a potential for individuals who need access to care, either being delayed in accessing that or not being able to access it at all … and we as a nation have philosophically said, ‘Yeah, that is our responsibility,'” Kuzminski said.
The shift toward privatized care has previously harmed service members more than benefited them. Members could not access doctors due to staffing shortages at military facilities. TriCare, a health program that allows members and their families to access private doctors and clinics, was not being accepted by multiple private providers, according to a DOD inspector general report from last year.
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“I can appreciate that it sounds good to advocate for people to have the most freedoms and abilities to choose,” Shulkin said. “There’s no question that that’s an important part of healthcare. But you have to have a system you can send them to that knows how to deal with toxic exposures and post-traumatic stress, and the injuries that were happening to our young men and women who were coming back after IED explosions and needed that type of complex prosthetic care.”
Max Rose, an Army Reserve officer and former Democratic congressman, said, “Being able to walk into an institution and speak to someone who understands not just the experience of combat, but the experience of just being in the military — a private health care facility couldn’t replace that.”