Editor’s Note: For an alternative viewpoint, please see: Point: True VA Privatization Would Save Veterans
The public reasons given for firing Dr. David Shulkin as head of the Department of Veterans Affairs and the withdrawal of Rear Adm. Ronny Jackson’s nomination to replace him were misleading. Shulkin was not forced to resign because he took one unauthorized trip (compared to EPA Administrator Scott Pruitt, he was a paragon of virtue). Nor was Jackson forced to withdraw because of his lack of management experience (three former VA chiefs endorsed him, and this criteria did not keep Trump from selecting many others for Cabinet positions).
Shulkin and Jackson were pushed aside because neither believed that completely privatizing veterans’ health care was a good idea for veterans or the country.
Advocates of privatizing the veterans’ health care system, like the Koch brothers-funded Concerned Veterans for America, claim that the VA, like any other government entity, is simply not up to the task of providing efficient and effective health care in a timely manner for America’s 20 million veterans. Therefore, they argue that veterans would be better served by doing away with the entire system and giving veterans a voucher and let them go to a doctor of their own choice — something that Nancy Schlichting, the former head of the Henry Ford Medical System, called not only frightening but morally reprehensible.
The Koch brothers’ real agenda — and of those pushing for privatization — is to get the government out of the health care business completely in order to prevent the United States from ever moving from Obamacare to a single-payer system.
The VA, which is currently the second largest federal government agency, runs the largest health care system in the United States. It provides for the health care needs of 9 million veterans. Its annual budget is $200 billion, $72 billion of which is spent on medical care at its more than 1,200 medical facilities. And it employs 370,000 people. In addition to providing health care, it oversees education funding for veterans using the GI Bill, handles disability compensation benefits for wounded veterans and manages the nation’s military cemeteries.
There is no doubt that the VA, like any government bureaucracy, has some problems, but every independent assessment of the VA by such private firms as Grant Thornton and McKenzie, along with research organizations like Rand and Mitre, has found that compared to the private sector, VA care in nearly every case is better and more effective. Because they are not subject to scrutiny from two congressional committees, a well-organized press, an inspector general, or veterans’ service organizations, one does not hear as much about the private sector’s problems.
Moreover, four of the VA’s problems are not of its own making. First, the VA has seen too much turmoil at the top. Shulkin’s replacement, whoever she or he may be, will be the fourth person to head the VA in six years. Second, the VA has 33,000 vacancies, including several senior staff positions, and continues to lose many people because of Trump’s war on government bureaucrats, which includes a pay freeze. Third, the VA has an aging infrastructure that needs to be replenished and have the guidelines benefit eligibility — which Congress often changes — stabilized. Finally, it needs to modernize its health records system and make it comparable with that of the Department of Defense so that individuals can move seamlessly from the Pentagon to the VA, and that the VA can better serve its current clients. But this process that has been delayed because of technical problems caused by a contractor, which is supported by Jared Kushner.
The VA should also continue to allow some veterans to access health care from the private sector under certain circumstances. The VA already has a long history of partnering with major academic health care systems and purchasing care in the community. Moreover, particularly in several areas where it lacks the facilities and personnel, it should and does join with private providers. Last year, of the 60 million medical appointments the VA coordinated, one-third of those had doctors and offices outside the VA because the department did not offer the right services or felt veterans would be better cared through outside options.
But, funding for these outside operations has not and should not come at the expense of reducing funding for in-house VA projects — like replacing its facilities or training its own doctors or hiring sufficient medical personnel — or that the authority to make the decisions should be taken out of the hands of the VA: a policy supported by every national veterans’ service organization.
