Project 2025's VA Health-Care Plan: Audit, Efficiency, and the Steady Pull Toward Privatization
Project 2025 proposes an independent VA audit, public quality reporting, expanded CBOCs, and a 19-patient-per-day provider load. While some elements echo existing authority, the cumulative effect is to starve VA direct care of funding and personnel, accelerating a privatization that costs more, delivers worse specialty care, and weakens the public-health safety net for veterans.
The central tension in Project 2025's VA proposals is between the stated goal of 'efficiency' and the proven reality that privatized community care is both more expensive and less comprehensive than direct VA care. The call for an independent audit similar to the 2018 DOD audit is instructive: that audit received a disclaimer of opinion because DOD could not fully verify its assets, and the process consumed enormous resources without yielding actionable financial reform. Replicating this for the VA would likely produce a similar black eye while diverting attention from the fundamental problem — chronic underfunding of the direct-care system that forces veterans into costlier, fragmented community networks.
The push to increase daily patient loads to 19 per provider, matching DOD benchmarks, ignores RAND research showing that VA providers see patients with higher complexity and longer appointment times. Applying a private-sector productivity metric to a public system that treats a sicker, older, and more disabled population is a recipe for burnout, rushed care, and medical error. Likewise, expanding Community Based Outpatient Clinics while de-emphasizing full-service hospitals may save infrastructure dollars in the short term, but it reduces access to integrated specialty care for conditions like spinal cord injury, PTSD with complex comorbidities, and polytrauma. The VA's own 'Red Team' of health-care leaders sounded the alarm that community care spending is spiraling out of control without corresponding improvements in outcomes.
The EHR modernization debacle — safety glitches, incomplete data migration, repeated delays — is a genuine crisis that deserves high-priority assessment, as the proposal recommends. But the cure cannot be more privatization. The real path forward is fully funding the VA's direct-care workforce, modernizing the EHR with clinician input and patient safety as the North Star, and using the community care program as a supplement for services the VA cannot itself provide, not as a replacement for a system that, when adequately resourced, outperforms the private sector in quality and patient satisfaction.
Original source — excerpted
project2025 Project 2025 ch. 21: Department of Commerce (pp 679-681)"— 646 — Mandate for Leadership: The Conservative Promise 3. Section 121 (developing and administering an education program that teaches veterans about their health care options available from the Department of Veterans Affairs). 4. Section 152 (returning the Office for Innovation of Care and Payment to the Office of Enterprise Integration with a joint governance process set up with the VHA). 5. Section 161 (overhauling Family Caregiver Program expansion, which has gone poorly, so that it focuses on consistency of eligibility and awareness that the most severely wounded or injured may require the program indefinitely). l Require the VHA to report publicly on all aspects of its operation, including quality, safety, patient experience, timeliness, and cost-effectiveness, using standards similar to those in the Medicare Accountable Care Organization program so that the government may monitor and achieve continuous improvement in the VA system more effectively. l Encourage VA Medical Centers to seek out relevant academic and private- sector input in their communities to improve the overall patient experience. Budget l Conduct an independent audit of the VA similar to the…"