By Lambert Strether of Corrente.
With the release of new proposed eligibility rules under the VA Mission Act, we see that privatization at the Veterans Administration (VA) continues to unfold, as outlined in the neoliberal playbook, to which we have alluded before:
The stories intertwine because they look like they’re part of the neoliberal privatization playbook, here described in a post about America’s universities:
It’s almost like there’s a neo-liberal playbook, isn’t there? No underpants gnomes, they! (1) Defund or sabotage, (2) Claim crisis, (3) Call for privatization… (4) Profit! [ka-ching]. Congress underfunds the VA, then overloads it with Section 8 patients, a crisis occurs, and Obama’s first response is send patients to the private system. Congress imposes huge unheard-of, pension requirements on the Post Office, such that it operates at a loss, and it’s gradually cannibalized by private entities, whether for services or property. And charters are justified by a similar process.
(I’ve helpfully numbered the steps, and added ‘sabotage’ alongside defunding, although defunding is neoliberalism’s main play, based on the ideology of austerity.) We can see this process play out not only in public universities, public schools, the Post Office, and the TSA, but in Britain’s NHS, a national treasure that the Tories are systematically and brutally dismantling.)
The political class has been trying to privatize the VA across several administrations — “Veterans groups are angry after President Obama told them Monday that he is still considering a proposal to have treatment for service-connected injuries charged to veterans’ private insurance plan” — although it is true that the Trump administration has brought its own special brand of crassness to the project, as we shall see. As we might expect, the project has nothing to do with the wishes of veterans:
Nearly two-thirds of veterans oppose “privatizing VA hospitals and services,” according to a poll released Tuesday by the Vet Voice Foundation. And some 80 percent of the veterans surveyed believe veterans “deserve their health care to be fully paid for, not vouchers which may not cover all the costs.”
A plurality of veterans, or 42 percent of those surveyed, agreed with the statement that the VA “needs more doctors,” according to the poll, indicating they believe the VA’s problems are at least partly due to a personnel shortage [Step (1)].
Although Vet Voice is a progressive organization, the poll of 800 veterans was jointly conducted by a Democratic polling firm and a Republican one.
And the Veterans are right, because VA hospitals provide better care. Besides many anecdotes, we have this in Stars and Stripes, “Dartmouth study finds VA hospitals outperform others in same regions“:
A new study by Dartmouth College that compares Department of Veterans Affairs hospitals with other hospitals in the same regions found VA facilities often outperform others when it comes to mortality rates and patient safety.
Researchers compared performance data at VA hospitals against non-VA facilities in 121 regions. In 14 out of 15 measures, the VA performed “significantly better” than other hospitals, according to results from the study.
“We found a surprisingly high, to me, number of cases where the VA was the best hospital in the region,” said Dr. William Weeks, who led the study. “Pretty rarely was it the worst hospital.” “One has to wonder whether outsourcing care is the right choice if we care about veterans’ outcomes,” Weeks said. “The VA is, for the most part, doing at least as well as the private sector in a local setting, and pretty often are the best performers in that setting.”
“One has to wonder” indeed! Be that it may, the new VA eligibility rules accelerate privatization. USA Today:
Nearly four times as many veterans could be eligible for private health care paid for by the Department of Veterans Affairs under sweeping rules the agency proposed Wednesday.
VA officials estimated the plan could increase the number of veterans eligible for private care to as many as 2.1 million – up from roughly 560,000.
And here are the rules (apparently modeled after TriCare Prime, the military’s insurance plan):
- For primary and mental health care, veterans who had to wait more than 20 days or drive more than 30 minutes for a VA appointment could choose to go to private doctors instead.
- For specialty care, veterans who had to wait longer than 28 days or drive more than 60 minutes to be seen at VA could go private “with certain exceptions.”
- For urgent needs, veterans could select a private clinic approved by VA and walk in when they needed to, but they might be responsible for a co-payment.
- VA said it encourages public comments on the proposed regulations. “We look forward to receiving this feedback,” the agency said.
Assuming that wait time is a function of resources, you can easily see how the playbook would work: (1) Reduce resources, (2) whinge about wait time, and (3) drain patients from the VA system, for profit! (Note that while Democrats are ostensibly jumping on board the #MedicareForAll train, they are, in the main, silent — Warren and Sanders being the only notable exceptions — about the destruction of an existing, and highly functional, single payer system. So how do we get to this point? A previous iteration of the neoliberal playbook, of course!
Our story begins with the “hastily enacted” Veterans Choice Program of 2014:
The program, which began in 2014, was supposed to give veterans a way around long waits in the VA. But veterans using the Choice Program still had to wait longer than allowed by law. And according to ProPublica and PolitiFact’s analysis of VA data, the two companies hired to run the program [TriWest and Health Net] took almost $2 billion in fees, or about 24 percent of the companies’ total program expenses.
More on those fees from Pacific Standard:
According to the agency’s inspector general, the VA was paying the contractors at least $295 every time it authorized private care for a veteran. The fee was so high because the VA hurriedly launched the Choice Program as a short-term response to a crisis. Four years later, the fee never subsided—it went up to as much as $318 per referral….. In many cases, the contractors’ $295-plus processing fee for every referral was bigger than the doctor’s bill for services rendered, the analysis of agency data showed.
Ka-ching! So, step (3) — profit! — worked out very well for TriWest and Health Net, piling up $2 billion in loot. (Step (2) was a scandal of “35 veterans who had died while waiting for care in the Phoenix VHA system,” step (1) being the usual denial of resources/sabotage). The VA Mission Act was the legislative response to Veterans Choice debacle. Naturally, it moved the privatization ball down the field. The American Prospect:
Only two of the 42 members on the House and Senate Veterans Affairs Committee opposed Mission last year, when it came up for a vote.
In other words, privatizing the Veterans Administration has strong bipartisan support. But:
One of those lawmakers, Bernie Sanders, the Vermont Democrat, reiterated his opposition to Mission in December.
“This is nothing short of a steady march toward the privatization[1] of the VA,” Sanders said. “It’s going to happen piece by piece by piece until over a period of time there’s not much in the VA to provide the quality care that our veterans deserve.”
Now, just because privatizing the Veterans Administration is a project of the political class as a whole doesn’t mean that the Trump Administration hasn’t brought its own special mix of corruption and buffoonery to the table. Indeed it has! Who, we might ask, were the actual factions in the Republican administration pushing for VA Mission? Three of Trump’s squillionaire golfing buddies at Mar-a-Lago[2], as it all-too-believably turns out. From Pro Publica, “The Shadow Rulers of the VA“:
[Bruce Moskowitz, is a Palm Beach doctor who helps wealthy people obtain high-service “concierge” medical care] is one-third of an informal council that is exerting sweeping influence on the VA from Mar-a-Lago, President Donald Trump’s private club in Palm Beach, Florida. The troika is led by Ike Perlmutter, the reclusive chairman of Marvel Entertainment, who is a longtime acquaintance of President Trump’s. The third member is a lawyer named Marc Sherman. None of them has ever served in the U.S. military or government….
The arrangement is without parallel in modern presidential history.
Everything is like CalPERS.
The Federal Advisory Committee Act of 1972 provides a mechanism for agencies to consult panels of outside advisers, but such committees are subject to cost controls, public disclosure and government oversight. Other presidents have relied on unofficial “kitchen cabinets,” but never before have outside advisers been so specifically assigned to one agency. During the transition, Trump handed out advisory roles to several rich associates, but they’ve all since faded away. The Mar-a-Lago Crowd, however, has deepened its involvement in the VA.
In September 2017, the Mar-a-Lago Crowd weighed in on the side of expanding the use of the private sector. “We think that some of the VA hospitals are delivering some specialty healthcare when they shouldn’t and when referrals to private facilities or other VA centers would be a better option,” Perlmutter wrote in an email to Shulkin and other officials. “Our solution is to make use of academic medical centers and medical trade groups, both of whom have offered to send review teams to the VA hospitals to help this effort.”
In other words, they proposed inviting private health care executives to tell the VA which services they should outsource to private providers like themselves. It was precisely the kind of fox-in-the-henhouse scenario that the VA’s defenders had warned against for years.
While it is true that the ideological ground for privatization was laid by the Koch Brothers, among others, the actual vector of tranmission, as it were, seems to have been the Mar-a-Lago crowd. There has been pushback against them, in the form of a Congressional request for a GAO investigation, and a lawsuit by veterans, but as we have seen, the neoliberal play continues to run.
The wretched excess of Trump’s policy-by-golfing buddies aside, I don’t see why privatiizing the Veterans Administration shouldn’t become a major campaign issue, especially given Sanders’ presence on the relevant committee. We send our children off to die in wars for regime change where the only winners are military contractors. Then, when our children come home, we’re going to send them into a health care system that’s been as crapified as everybody else’s (and that’s before we get to PTSD, homelessness, and suicide). Surely a pitch along those lines would play in the heartland? If Sanders doesn’t pick up the ball and run with it, Gabbard should.
NOTES
[1] More from Sanders. Common Dreams:
[SANDERS:] No one disagrees that veterans should be able to seek private care in cases where the VA cannot provide the specialized care they require, or when wait times for appointments are too long or when veterans might have to travel long distances for that care. The way to reduce wait times is to make sure that the VA is able to fill the more than 30,000 vacancies it currently has. This bill provides $5 billion for the Choice program. It provides nothing to fill the vacancies at the VA. That is wrong. My fear is that this bill will open the door to the draining, year after year, of much needed resources from the VA.
In other words, the way to solve the problem is not to take Step 1: Give the VA the resources that it needs.
[2] I continue to believe that golf play, or knowledge of golf play, should be a disqualification for high office.
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I am in favor of maintaining government control of the VA and the Post Office etc. The stealth moves to overburden them financially then call for privatization is criminal. Three generations of my family have worked in the mails and I have some experience in going to the VA with my father and previously my grandfather over the years so I have seen both organizations from the inside. They are not without severe challenges today and are no where near the quality they attained 40 years ago. But it is possible to bring them back with high standards and a lot of work. Privatizing them is not the answer.
The grifters will grift until they can’t.
(Hidden) Questions about VA personnel, also applicable to any other government employee at any level:
1. What is your political party?
2. For whom did you vote in the last elections?
3. Are you now, or have you ever been, a member of a union?
For inclusion or exclusion?
Neoliberals exclude.
Many D include.
Most R exclude
Based on my experience with both personal finance investment and the Canadian and US healthcare systems, I think it is pretty clear that finance and healthcare are similar in that simple low-cost efficiency generally produces better results simply because it concentrates its attention on fundamentals instead of profit-seeking.
In the case of healthcare, single-payer government run healthcare produces comparable performance to the complex US private-public mess with about half to two-thirds of the funding. The remaining money in the US appears to be siphoned off into unnecessary administration, unnecessary redundant facilities, and excess corporate profits without providing any patient benefit.
In many cases, complaints about publicly funded healthcare quality can be traced to simply too little funding at less than one-half the US funding level (some countries are about 1/3). So it appears the sweet spot for maximizing cost-effectiveness is about one-half to two-thirds of the US per capita health care cost.
I view much of the US healthcare system as equivalent to where the American auto companies were in the 1970s. Bloated, inefficient, and low-quality about to go over a major restructuring over the ensuing 30 years.
As a veteran with significant damage (Vietnam) I can state unequivocally that VA healthcare is state of the art. The TriCare interface is a bureaucratic obstacle course.
Vietnam era vet (not in country) here. 30 years navigating VA and recently (after moving to semi rural area) the “private” options for service connected disability.
VA superb. Private options nowhere close. Signs of Resource and staff shortages appearing everywhere in VA hospitals.
The GAO has already identified the VA as “high risk”. From 2017,
Managing Risks and Improving VA Health Care
Oversight, what a concept. Why would anyone be surprised when the golf buddies show up at the door ready to “fix things”?
Speaking of Moguls. Such as Koch’s influence and VA funding: Senator Pat Roberts – from Kansas – attempted to write into the Tax Reform Bill (2017) legislation that would cause tax credit funded affordable housing to be used only for veterans. Retro-actively. Sound compassionate? – Service the Vets!
I live in a tax credit housing complex in California, so I was concerned – not being a veteran – how would this affect myself and the 300 people living here. We have many artists here – only a few veterans? I called Washington, D.C. during the Tax Reform debate – and spoke to a Sen. Roberts aid who told me there is not enough money for both artists and veterans: a choice had to be made. Sorry.
However, This legislation addendum, was ultimately removed from the Tax Reform Bill. Nice for us! But why?
What happened to remove Sen. Roberts addendum?
My guess, is that since the banks were already funding tax credit properties of all kinds, they stood to lose much of their tax credit breaks. This bill then was pitting the rich (Koch Brothers, etc) versus the rich (the banks) – it was not just the poor (non veterans) in their tax credit properties that were going to be screwed.
(Lesson: Don’t F&*k with bankers.)
The last thing I want to see is vets vs non-vets being pitted against each other for resources. We all know the real problem is funding.
However, one thing I can tell you is the reason this was probably being promoted for vets: The high rate of veteran homelessness.
The late Senate Paul Wellstone did a survey of the homeless in the metropolitan Mpls-St. Paul area long before Iraq 1 and 2 and the multitude of subsequent wars. Yup, vets all over the place homeless.
A few years ago when I was still living in CA, I learned that the VA there was providing overnight housing for homeless vets AT THE HOSPITAL. My husband had an overnight sleep study scheduled and we were surrounded by homeless waiting to be checked in on the same floor. We had to step through special security to the room he was to use.
When a bed was not available for my husband to be transferred to the VA hospital after he was taken to a local hospital by paramedics, I started screaming bloody murder to the advocates and even the hospital director. I was angry that my husband, a 100% service connected disabled veteran and other service connected veterans, were being denied service because the hospital was being used as a homeless shelter. This happened multiple times.
We loved the VA. The docs, especially the specialty clinics, were the best. Inpatient care was the best. My comparison was my own private medical care. I had a concierge doctor, one of the best in the area, and yet I always told people that the only reason I regretted not joining the service was not being eligible for VA care. BTW, I paid extra for the concierge doc because otherwise every doc I saw had 10 minute appointments!
To make a long story short, our wonderful, compassionate government is trying to hide the fact that they are sending home from their wars broken individuals who may never be whole again. Can you imagine hiding them by use of an expensive hospital area for a shelter? What a misuse of resources. Guess they were desperate!! So now they are going after your housing probably because they ran out of hospital space.
.
The veterans should be housed and cared for. Yes. a priority.
But – Ooh boy. California! – Meanwhile, a homeless encampment popped up – spontaneously – a couple months ago – just about 150 yards or so from our building. There are 100-200 people crammed into a makeshift tent city on the levee…The city brought in 7 porta-potties. This is Santa Cruz. I don’t know what is going to happen with it. People living nearby are feeling afraid – due to the drug traffic/violence/theft – not to mention the squalid conditions for all those people living in that camp.
A mixture of… all kinds of destitute people. Including vets I presume.
I am extremely fortunate to be housed here in a facility I can afford. I feel the USA can afford to do better for the homeless – meaning we not only can afford to do this – and it does not make sense not to!
I look at it like the Medicare (Medicaid) For All. It just make sense – morally/ economically.
I lived in Oceanside in a subdivision right next to Camp Pendleton Marine Base and had base rights. I would look at all those young faces at the base and feel like I was looking at cannon fodder. Not a good feeling.
I sold my house at the right time since I learned a few months ago that the homeless living in the river banks below my subdivision are now starting to camp out in my old neighborhood.
I can’t blame them. It is safe there.
In some ways tents cities can be useful if we want to change things. The problem is visible.
By hiding homeless vets, the politicians were attempting to hide the problem with a horrible misuse of the VA hospital resource. In the meantime, the VA medical system struggles on with all these unfunded mandates just like our public schools.
By the way, I don’t think the public was supposed to know about the hospital being used as a shelter. Just a feeling I got in talking to personnel.
Veteran’s benefits are the little black dress, good for any occasion, that the Dems cart out when they need to restore their cred after taking heinous votes on other issues. John Tester is a master of the strategy. It’s really barbaric in a Roman kind of way. Parade the litigants before Caesar for a patriotic litmus test – pass and off to get the health care you need, fail and it’s to the lions with you. It’s part of the design.
Maintaining the status quo where health care is somehow sacred for some and not others seems to be a recipe for electoral success.
You lived a mere 450 miles South of Santa Cruz. California is so huge. Big problems. Tent cities up and down the coast it seems. This latest tent city here is really obvious for anyone driving past: it’s right alongside Highway 1. I figure the city is not happy about that kind of visibility.
The thing that really galls me, is the fact that All members of BOTH houses of Congress, the depts. they oversee, AND the top military brass, recieve what I would assume is quite generous “differential”medical care, compared to the lowly mopes and grunts …. and on the taxpayer’s dime to boot ! But hey folks, top of the crop must-get-theirs .. be it those nice-n-shiny F-35 reach-around$ .. or to be wisked away via a helicopter or otherexpensive conveyance .. ALSO paid for, by .. you guessed it .. while the increasing homeless, the lessor ‘bourgeoisie, and vets get bootstrapped.
I think you could quite reasonably use sabotage as the playbook play, with the note that defunding is the primary mechanism for sabotage. Sabotage is more general and accurate.
Yes, maybe I need to issue an updated version! I came at this from the funding angle orginally, since that’s were the fight was taking place.
Any workers at Mar a Lago need to start recording these conversations like that other grifter and the 47%
The person who recorded Romney’s 47% remark was, IIRC, one of catering staff for a fundraiser. By contrast, my picture (see “Trump confidant Chris Ruddy on the president’s ‘inner Democrat’” for a “Lunch with the FT”) is that the staff at Mar-a-Lago tend to have been there for quite some time. So I don’t think that’s a bad idea at all, but I also think it’s unlikely. (Think of having a loyal staff at Mar-a-Lago in the same category as a Third World dictator being very, very careful that his aircraft mechanics were well taken care of).
Adding, the concerned citizens here at NC would be very happy to recieve such a tape!
VA is not single payer. It is single owner. Much different. Medicare-for-All would be single payer.
I always chime in whenever Lambert discusses the VA health care system (thanks for being so diligent about the health care issue Lambert). I have been treated by the VA for the last 15 years and have received nothing but excellent care most of the time. The exception was when I needed a test that the VA could not provide (did not have the equipment) so it was outsourced to a local hospital through the Veterans Choice program. It was a disaster. Not only did I find the staff at the private hospital to be almost completely inept at their jobs, they displayed a considerable lack of courtesy in dealing with their patients. And to top it off, it took Veterans Choice over 2 years to pay that hospital! They started hounding me with letters and calls. I finally had to get my Congressman (2x) and Senator involved, and when that failed, I finally got a lawyer friend to send them (the hospital) a letter. As a Vet, you cannot contact the Veterans Choice billing dept directly. The phone is never, ever answered, and the address of their facility (at least here in SC) is classified. I guess they finally got paid because they stopped contacting me after the lawyer’s letter. On a final note, the studies that were mentioned about the quality of VA care are really nothing new. The VA for a long time has outperformed the private health care industry for years. I believe the reason for that is that the medical VA staff’s job is to treat patients, not waste a lot of time on billing or coding. My docs do make computer entries (EHR), but these records are just treatment notes. Nothing to do with billing.
+1
As a Vietnam-era veteran, I get my health care from the VA, and my experience has been very good. It’s true that my VA hospital is 90 minutes away, but I choose to live in a remote area.
Furthermore, a story: When my son was a teenager, he was diagnosed with leukemia, and was treated at the Clinical Center of the National Institutes of Health (NIH), in Bethesda, Maryland for five years. The doctors and nurses, among the best in the world, were all officers of the Public Health Service (PHS), paid on a government pay scale comparable to the military pay scale. During those five years of excellent intensive care, I never received a single bill. It was easy to imagine a future of health care where all doctors and nurses were members of the PHS and all medicine was research linked to the scientific advancement of medical care.
Fast forward 26 years, now my son is an MD/PhD doing medical research in cancer genetics in Lund, Sweden. In addition to teaching at the medical school there, he also founded a company to commercialize his inventions in cancer diagnostics, Saga Diagnostics. It has been interesting to see the differences in getting venture capital in Europe versus the United States, where the short-term prospects of profit rule so mightily.
Single payer solves so many probems
1.It solves the VA manpower. Fund the VA to pursue PTSD , Physical Rehab Medicine and Prosthetics. Areas where they are now World Class.
2. Ends the albatros of forward healthcare funding on USPS. Making USPS solvent
3. It solves the 50-65 y/o uninsured dilemma.
Let there be a Co-pay in the Single Payer and allow Veterans first dollar coverage.