More funding, accountability for VA Choice program proposed, now what?

Source: Steff Thomas, Federal News Radio, August 7, 2017

Veterans Affairs Secretary David Shulkin received his wish last week as the House passed a bill that will add an additional $2.1 billion for the Veterans Choice Program. The bill, also known as the Choice Act, was introduced just weeks before the current Choice program funding was set to expire, and passed as a last-minute decision before Congress left for the August recess. One question that still lingers is, if passed into law, how will that money be spent? In an interview on the Federal Drive with Tom Temin, Shulkin outlined in detail some of the ways the Veteran Affairs Department would use the extra funds in a system of modernization projects, construction of new facilities and comprehensive public-private sector partnerships.

… These private-public partnerships would allow veterans to get best-in-class care at VA facilities and, when they needed to, take advantage of the services from community providers. It would alleviate some waiting times and give veterans more options for health care. Shulkin strongly urged that this idea was not an attempt to privatize VA operations, but to create a stronger and more modern system. He said even President Donald Trump’s budget proposal was supportive of improving more services within the VA, and not at all representative of someone supporting privatization. …


How VA Reform Turned Into a Fight Over Privatization
Source: Russell Berman, The Atlantic, July 17, 2017

In 2014, the Department of Veterans Affairs was mired in a scandal. An inspector general’s report had found “systemic” manipulation by government officials to hide lengthy and growing wait times at its medical centers. … Spurred to action, Congress created a program aimed at temporarily alleviating the strain on the VA: Veterans who lived more than 40 miles from a health-care facility or who had to wait more than 30 days for an appointment could take their benefits outside the system and seek treatment from private doctors. …The Choice Program, as it was called, would allow veterans to get the care they needed while giving policy-makers time to make broader fixes at the Department of Veterans Affairs, which suffered from mismanagement and insufficient resources. Three years later, attempts by Republicans in Congress and the Trump administration to extend and significantly expand the Choice Program have given these groups and leading Democrats a new worry: a creeping privatization of the VA. …

Senate Easily Confirms Trump Pick of Shulkin as VA Secretary
Source: Hope Yen, Associated Press, February 13, 2017

The Senate on Monday easily confirmed physician David Shulkin to be secretary of Veterans Affairs, charged with delivering on President Donald Trump’s campaign promises to fix long-standing problems at the department.  Senators voted 100-0 to approve the former Obama administration official, who was the VA’s top health official since 2015, in a rare show of bipartisanship amid partisan rancor over Trump’s other nominees. Shulkin secured the backing of Senate Democrats after pledging at his confirmation hearing to always protect veterans’ interests, even if it meant disagreeing at times with Trump. … The 57-year old physician has ruled out fully privatizing the agency and says wide-scale firings of VA employees are unnecessary, describing the VA workforce as “the best in health care.” … The immediate challenge includes revamping scheduling and access for VA medical appointments following a 2014 wait-time scandal. Shulkin is urging a more integrated VA network where veterans could seek outside private care only in coordination with the VA. He has not sketched out full details. “We’ve yet to hear from him how he’ll pursue President Trump’s vision for a public-private partnership at the VA,” said Dan Caldwell, policy director for the conservative group Concerned Veterans for America. …

Veterans Affairs Nominee Vows Not to Privatize Health Care
Source: Dave Philipps, New York Times, February 1, 2017

President Trump’s pick to lead the Department of Veterans Affairs, David J. Shulkin, vowed at his Senate confirmation hearing Wednesday to reform — but not privatize — veterans’ health care, potentially putting him at odds with Mr. Trump’s campaign promise to allow all veterans to choose private health care.  “V.A. is a unique national resource that is worth saving,” Dr. Shulkin told the Senate Veterans Affairs Committee. He added, “The Department of Veterans Affairs will not be privatized under my watch.” …

Privatizing Veterans’ Health Care Isn’t The Cure
Source: Coleman Nee, Cognoscenti, January 24, 2017

President Donald Trump is considering privatizing the health care services of the U.S. Department of Veterans Affairs. During the campaign he promised that veterans should be able to access care from any provider they choose, including for-profit private-sector health networks. It is an idea that has been long championed by the conservative Koch-brothers-funded group, Concerned Veterans of America, and its former leader Pete Hegseth, who was an adviser to the Trump campaign on veterans issues. Yet, the president’s recent selection of David Shulkin to serve as the new VA secretary seems to conflict with Trump’s campaign rhetoric. As VA undersecretary for health in the Obama administration, Shulkin testified that privatizing the VA would be “a terrible mistake.” … While privatization of the VA may sound like a panacea, it’s actually closer to Pandora’s box. … A better way forward is to examine, refine and promote models of public-private partnerships that protect our commitment to those who have served. … What too often gets forgotten in this debate is that the VA has a successful history of providing quality continuum-of-care services through its integrated networks and electronic medical record system. Destroying the integrity of this system could, at best, lead to care delivered by people unfamiliar with health issues specific to veterans and isolated from treatments and medicine at other institutions. At worst, it could create the potential for systematic fraud that moves billions of government dollars into corporate bottom lines, until that care becomes prohibitively expensive and veterans are denied treatment or the taxpayers are on the hook again. Many of us hope that Shulkin can bring a fresh perspective to this debate within the Trump administration. …

Why privatizing the VA won’t do much to help veterans
Source: David Dayen, Business Insider, January 3, 2017

He promised to overhaul the Veterans Administration (VA) health care system and “take care” of the vets. Everyone has interpreted this as code for privatizing the VA, a long-awaited conservative goal. But last week at Mar-a-Lago, after a meeting with health care executives about his VA plans, Trump told reporters this: “We think we have to have kind of a public-private option, because some vets love the VA. Definitely an option on the table to have a system where potentially vets can choose either/or or all private.” … It’s clear that conservatives expect the private market to deliver better service than any public agency. The VA, they expect, would obviously wither on the vine if challenged by the free market. These true believers have perhaps never had to navigate the private health care system and its even longer wait times; comparatively the VA looks like a dream. Republicans tried to lay the groundwork for back-door privatization. The 2014 VA reform legislation mandated a report from a bipartisan Commisson on Care on how to best redesign the VA. This was a stacked deck, widely expected to give Republicans a blue-ribbon pro-privatization report to “prove” their case. Three of the 15 commissioners were CEOs of health care companies that would financially benefit from breaking up VA hospitals; two others had ties to the Koch Brothers, who have bankrolled the privatization front group Concerned Veterans for America for years. But a funny thing happened. The final report of the Commission on Care did not endorse privatization. It recommended enlisting credentialed community provider networks to increase capacity for veterans care, integrated with the VA’s electronic medical records system. The 18 recommendations largely tracked with what VA Secretary Robert McDonald has already been implementing. …

Fact-Checking Fact-Checkers on Privatizing Vets’ Health Care
Source: Suzanne Gordon, American Prospect, December 12, 2016

In the debate over the future of the Veterans Health Administration (VHA), no concept has attracted more controversy than “privatization.” Since wholesale privatization of the VHA is deeply unpopular among veterans and their advocacy organizations, groups like the Koch brothers-funded Concerned Veterans for America (CVA) argue that they do not support “privatization” of the VHA. As the CVA’s “Fixing Veterans Health Care” report, published earlier this year explains, the group just wants to give veterans “the same degree of choice that is available to other Americans,” with the federal government paying the tab. Last week, The Washington Post entered the fray. Writing for the paper’s “Fact Checker” column, reporter Michelle Ye Hee Lee gave Senator Jon Tester of Montana and Representative Mark Takano of California, both Democrats, three out of a possible four Pinocchios (signifying “significant factual error and/or obvious contradictions”) for suggesting that the CVA and Trump transition team members support VHA privatization. … Lee’s interpretation flies in the face of volumes of academic and policy research on the privatization movement that went mainstream in the 1980s, notably in the United States and Britain. As the Prospect’s Paul Starr wrote in a 1988 essay, privatization is “any shift of activities or functions from the state to the private sector; any shift of production of goods and services from public to private; including the wholesale of transfer of services from the public to the private sector or what Starr calls “privatization by attrition,” as furnishing costlier private-sector services lead to an underfunding of public ones. … The CVA claims it wants to preserve the VHA, but its proposal would shift government funds to private-sector providers, depriving VHA doctors and other staff of the ability to maintain a high level of clinical and research expertise by treating the specific service-related problems of a large numbers of patients. Such a move would also drain resources for supporting current workers and recruiting new ones. Moreover, the CVA promotes private-sector care even though such care would be more expensive. Like many proponents of privatization, the group supports shifting costs to veterans through out-of-pocket payments and mechanisms like interest-bearing health savings accounts. The CVA proposal would also limit eligibility for care in the private sector or in what remains of the VHA, to veterans with service-related conditions—a change that would hit low-income and indigent veterans the hardest. …

Democrats’ misleading claim that Concerned Veterans for America wants to ‘privatize’ VA
Source: Michelle Ye Hee Lee, Washington Post, December 7, 2016

The two Democrats, who serve on the Senate and House committees on veterans affairs, are resurrecting the stale Democratic talking point that Concerned Veterans for America wants to “privatize” the Department of Veterans Affairs. Concerned Veterans for America, or CVA, is a veterans advocacy group in the Koch brothers’ political network and has been one of the most vocal critics of VA since the 2014 wait-time scandal. The CVA is poised to become more influential under the new administration, as President-elect Donald Trump has tapped the group to help overhaul the veterans health-care system. The most controversial proposal by the group is an expansion of veterans’ health-care options in the private marketplace — which critics, including traditional veterans advocacy groups and Democratic lawmakers, say could lead to the dismantling of the current VA. But CVA has not proposed a wholesale transfer of VA’s services over to the private sector — which is what “privatization” usually describes. We took a deeper look at the group’s proposal. … Under the CVA’s proposal, it is the veteran’s choice whether to get medical care from VA or a private doctor. There’s no mandate for a certain percentage of VA’s services to be provided in the private market or for certain medical facilities to be shut down. We award Three Pinocchios to this misleading rhetoric. …

Conservative veterans group proposes privatized health care
Source: Heath Druzin, Stars and Stripes, February 26, 2015

A conservative veterans group is testing its clout with a radical plan unveiled Thursday to largely privatize VA health care. Concerned Veterans for America is calling for the Veterans Health Administration — the wing of the VA that oversees health care — to be turned into an “independent, government-chartered nonprofit corporation.” After decrying “inefficiency, bureaucracy and deadly wait lists” at the VA, Concerned Veterans for America CEO Pete Hegseth acknowledged the uphill battle he has faced in getting support for the plan, which has no congressional sponsors.