Tuesday, March 20, 2018By Michael Corcoran, Truthout | Report
The Veterans Health
Administration (VHA) has long been the subject of aggressive privatization efforts. However, veteran
organizers say the fate of the program, drowning in fresh scandals under embattled Veteran
Affairs (VA) Secretary David Shulkin, has never been in more danger than it is
now.
The efforts to outsource
veterans care are waged by the Koch brothers and their front group Concerned Veterans for America (CVA), among
other advocates of privatization. The group held a press conference to discuss its privatization efforts
-- which they like to call "choice" -- on Friday in DC. Should they succeed in
their goals, it will have consequences not only for veterans, but also for the
broader movement for a public system like
Medicare for All. The VHA is the only truly public, fully
integrated health system in the US. The attacks against it aim to undermine
public support for government-run care.
In recent weeks, two critical
VA Inspector General (IG) reports were released: one about Shulkin's excess
spending during travel, the other about bad
conditions in a VHA hospital in DC. Reports say the scandals could cost him his job. A Washington Post investigation described Shulkin's
efforts to save his job "amid a mutiny," and relayed a surreal
anecdote about the secretary working with an armed guard outside his door. His own aide
was trying to push him out, according to several media reports.
This chaos and negativity
around the VA is in line with the sorts of circumstances that the Kochs have thrived on in the past, notably when
they "exploited the Veterans Affairs crisis," as a 2014 Nation article observed, to further attack the
"the idea of government-provided healthcare." Many veterans and
organizers say Shulkin's troubles have little to do with traveling expenses and
are more about an effort to push a militant ideologue in power to privatize
the VHA.
"Veterans groups are
worried that privatization advocates are using the [Inspector General reports]
to get their way," according to James Clark at Task and Purpose, a news outlet devoted to veterans
issues.
This sentiment was evident
from public statements from veterans’ service organizations (VSOs) about the possibility
of Shulkin being replaced.
"Their goal is to have
somebody in place who, a couple days after they are confirmed, will go about
bulldozing VA facilities," said
Will Fischer, the director of government relations at VoteVets, a
progressive veterans organization.
Trump's Ominous Phone Call to
Koch Associate
Rumors of threats to Shulkin's
job security come amid a flurry of changes in major positions in the Trump
White House, including at the head of the State Department and the CIA. While initially Trump supported his VA chief enthusiastically, he recently
scolded Shulkin at a meeting, Axios reported on March 11.
During the meeting he took the
unusual step of calling former Koch associate Peter Hegseth (now a Fox News pundit) to discuss how best to privatize the
agency. Hegseth, former CEO of CVA, was strongly considered for the post during the transition
-- an ominous sign for Shulkin, who is seen as too moderate by many
conservatives in the White House.
"If Trump picks Hegseth,
it's going to be war," Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of
America (IAVA), told The New York Times during the Trump transition.
These ideological factors, and
not merely the ethical issues raised in the IG report, help explain why right-wing commentators are so loudly calling for
Shulkin's ouster, while VSOs, which largely oppose privatization, are still mostly supportive of Shulkin, despite his political
liabilities.
"We don't want to see
someone come in and start over. I think we will see the VSOs remain supportive
of Shulkin," said William Attig, executive director of the Union Veterans
Council, AFL-CIO, in an interview with Truthout. "There is a lot of
money for some to make by farming out services to the private sector, but what
the VHA needs is to be fully funded, not privatized."
Even if Shulkin manages to
keep his job -- he is not likely to go down without a fight -- he will be in a weakened
state at an agency where Trump's conservative "staffers are advancing
health policy at odds with his own," according to a ProPublica/Politico report from February, which said war
was "raging between the White House and veterans' groups, with Shulkin
caught in the middle."
It's possible that Shulkin
could accelerate privatization efforts to appease Trump or deflect the news
away from his personal scandals. Meanwhile, whatever becomes of Shulkin, the
Koch war on the VHA is clearly reaching a boiling point.
A Mixed Record on
Privatization
Shulkin is not a progressive
icon by any means. His appointment, however, did bring about relief for many
veterans and Democrats. He was appointed by President Obama to be the VA's
undersecretary of health, and wrote a book praising the VHA. During his confirmation
hearings for his position under Trump, where he was unanimously supported, he said the privatization of the VA
"will not happen on my watch." He won the support of key VSOs who "had fended off far worse candidates."
This is not to say everyone is
pleased with his performance. Some argue he has not followed through on this promise and has been
complicit in Trump's ongoing efforts to privatize the system. "He is an
unreliable advocate for the VA health system," said Suzanne Gordon,
author of The Battle for Veterans Healthcare, in an interview with
Truthout. "He sometimes doesn't call it privatization, but that is what he
is doing. He has also been using the same conservative rhetoric about the VA
being broken."
Six months into the Trump
administration, Shulkin wrote a USA Today op-ed that insisted, once again, that he
would not privatize the VHA, saying "nothing could be further from the
truth." But in the same article he added that veterans should get the best
care possible, "whether it comes from the VA or the private sector."
Shulkin put forth these contradictory arguments while lobbying for $2 billion to extend the controversial VA Choice program for
another six months through a variety of cuts and fees that were opposed by VSOs. Shulkin also suggested farming out the VHA's optometry services because "there is a
LensCrafters in every corner."
None of this has stopped VSOs
from standing with Shulkin, if only to avoid his replacement. As Clark wrote
(emphasis in original): "the rallying cry for Shulkin amounts to: Better
the VA chief we know."
Now there is a struggle between the VSOs and conservative power brokers within
the Trump administration. Although the attempted VA
"coup" on Shulkin, to use The Washington Post's phrase, is "popular in the White
House, the effort is viewed skeptically by the American Legion and other
veterans groups that fear it will lead to VA's downsizing."
Louis Celli, national director
for veterans affairs for the American Legion -- the largest VSO in the country
-- called the attack on Shulkin a "salacious
conspiracy," and "treason." VoteVets filed a Freedom of
Information (FOIA) request for documents about replacing Shulkin.
Meanwhile conservative lawmakers and media called for Shulkin's ouster. "His main
agenda is to block any real reforms for veterans, which includes expanding
their ability to obtain care from private doctors and hospitals," said
syndicated columnist Michelle Malkin. "He needs to hear those famous
words from [Trump]: 'You're fired.'"
On February 15, a day after
the first IG report was released, The New York Times reported that critics within the
Trump administration wanted to "knock Shulkin down a peg or two"
for "not pushing harder for privatization." Some
conservative/Koch-funded attacks on Shulkin predate not only the IG report, but
the Trump presidency. In 2016, when Shulkin was under secretary for health at
the VA during the Obama presidency, Concerned Vets for America criticized
Shulkin for embarrassing
the VA. "The American people were treated to a show of
incompetence and shifting of responsibility by Dr. David
Shulkin," a story
on their website said of a congressional hearing.
The Veterans' Health
Administration: Myth vs. Reality
Negative press on the Veterans
Health Administration is not new. In many ways it mirrors the US media's
treatment of foreign health systems, such as Canada, which get similar treatment in the national
debate. (This is improving since awareness of single-payer has grown, due in part to the
Bernie Sanders campaign in 2016.)
The popular narrative of the
VA as a frightening case study in the horrors of "socialized
medicine" is largely the result of an effective Koch-fueled messaging
campaign. The Kochs make it easy to attack the VHA, amplifying any bad news
they can find from around the country on their front group's website and
on social media using the hashtag #VAFail:
Often they use this hashtag to
push legislation such as the Veterans Empowerment Act promoted by Rep. Doug Lamborn (R-Colorado), which would privatize the VHA in major
ways.
Rarely, however, do the
pundits who mock the VHA compare it to private insurance using metrics like
cost, quality and patient satisfaction. The VHA, studies show, is superior to
private health options, is more cost efficient and has happier patients. The
VHA has, according to numerous reports, been found to "compare favorably" to our private system: Better
surgical conditions, higher vaccination rates, better outcomes with stroke
treatment and controlling blood pressure are just a few of the areas where VHA
care was superior. This helps us understand why the VHA scores high on satisfaction surveys among its
patients. One Gallup poll from 2015 showed veterans as the most
satisfied group of patients in the country, followed by Medicaid and Medicare
recipients, with private care being last.
In the New England Journal of Medicine, Shulkin himself
boasted that the VA outperforms private industry in "lower risk-adjusted
mortality rates, better patient-safety statistics, and better performance on a
number of other accepted process measures."
It also ranks especially well
in mental health services. As a 2016 report from Psychiatric Services, a
peer-reviewed journal of the American Psychiatric Association, concluded:
"We found that the quality of care provided by the VA to veterans with
mental and substance use disorders consistently exceeded the quality of care
provided by the private sector for the performance indicators examined,
sometimes by large margins."
The VHA was recently praised
for having a good record with transgender patients, compared with private
insurers. "This is an optimistic and promising finding for VA and
perhaps reflects the recent advances in transgender health in VA,"
concluded the Journal for Medical Care in September 2017.
The VHA, of course, has major
flaws. While the Kochs often amplify bad stories, the VA has made their job too
easy with public scandals. There were serious problems in the aforementioned
2014 incident involving falsified reports to hide long wait times, which still hamper the agency today. This was
only six years after another high-ranking VA official, according to Veterans
for Common Sense, "cooked the books" on suicide data, to make the crisis
seem less severe.
The VHA compares favorably to
private care, but it is still lacking in many ways. Many veterans with PTSD receive subpar care, in part due to a lack of mental
health staff. The VA estimates that about 20 veterans a day commit suicide.
Underfunding is a major problem. "Congress left the VA woefully
unprepared for all the problems that took place in two wars in Afghanistan and
Iraq," Attig said. "My feeling is if you can afford to send people to
war, waged for some questionable reasons, you should be able to afford to take
care of them when they come back."
Private insurance providers,
however, have major problems too, including wait times that are worse than the
VHA, according to a September 2017 study commissioned from the
American Legion. "Does anyone doubt that many Americans have died
while waiting for approval from private insurers?" asked Paul Krugman
of The New York Times in 2014.
Indeed, every health system
has flaws. If the VHA were sufficiently funded, and there were more public
investment in it, it could improve its care dramatically. Conservatives,
however, have been effective at telling Americans that the problems are caused
by government. The story of the VHA is one largely being told by its harshest
critics.
Socialized Medicine Saves
Lives
But there is another story to
tell: about the VHA that saves lives. Samuel Jay Keyser, 82,
is a
professor emeritus of linguistics and philosophy at MIT. At 78, he
went paralyzed from the chest down and was told by doctors he would never walk
again. After spending months in the Intensive Care Unit, rehab and various
other hospital beds, he was told he would no longer be able to have his
treatment covered.
A nurse heard he served in the
Air Force in the 1960s and suggested calling the VHA, he told Truthout.
"This was my introduction to 'socialized medicine,' and the difference was
palpable. I had been through virtually every part of the US health system, and
the VHA was the only place where money didn't seem like a major priority,"
he said.
Now Keyser spends time
talking about his story, and how the VHA was the only place that
didn't give up on him until he was healthy enough to go home. "Everyone
should be able to experience care like that," he said.
Save the VHA: An Election
Issue?
The effort to stop the
Koch/Trump attack on the VHA is a subject on which VSOs, progressive groups and
single-payer advocates can find common cause. While single-payer advocates
routinely defend systems in Canada, the United Kingdom or Taiwan, the VHA is far less frequently noted, though it is
the only socialized health care system in the United States. It could be held
as a model for the benefits of public health care.
VSOs have also taken similar
positions as progressives on several contemporary health care issues.
VoteVets has opposed Trump's latest attack on Medicaid via work
requirements, saying Trump "has now officially declared war on
veterans in need." For similar reasons, they were among the many veterans groups that opposed the Medicaid cuts in Trumpcare bills from 2017.
More than 30 percent of
veterans make less than $30,000 annually, Attig maintains, and depend on these
social programs. The VHA covers about 9 million veterans and has strict
eligibility requirements that leave many former service members unable to use
the service. "Cuts to Medicaid, Medicare, unemployment -- they are all
cuts to veterans as well," he said.
If the Democrats chose to put
a lot of political capital into protecting the VHA, they could rightly hit
Republicans for cutting support for the troops. This priority could also appeal
to single-payer advocates and the 80 percent of Democratic voters who support a public
health system.
"I would like to see
candidates put this issue at the center of their campaigns," Attig said.
So far, however, VSOs have
mostly had to fend for themselves, with the media and the Democrats focused so
strongly on other issues. If Democrats aren't interested in making the
preservation of the VHA a priority, advocates say, organizers and veterans
groups will have to continue to pressure them.
"Privatization is a very
real issue right now," Verna Jones, executive director for the American
Legion, recently told reporters at the National Press Club. "This
isn't something we can sit idly by and hope that it doesn't happen."
