Unhealthy Skepticism

Source: Suzanne Gordon and Jasper Craven, Washington Monthly, July/August 2018

The Department of Veterans Affairs was back in the news this spring—and, as usual, the news wasn’t good. … But here’s a different story about the VA, from the exact same time period, that major media outlets didn’t bother to report: In March, researchers at the nonprofit research organization RAND published a study revealing the gross inadequacies of New York State’s health care system to effectively treat veteran patients. A month later, RAND found that the quality of VA care was generally better than private health care. These were just the latest of scores of studies that have come to the same conclusion for nearly two decades now. … As the U.S. continues to debate what to do about its unsustainable health care system—and as conservatives continue to push for “free market” solutions, including privatizing the VA itself—the fact that a government-owned and -operated system is outperforming the private sector should be a major story. If VA care is as good or better than the alternative, how would pushing vets into private-sector care make them better off? But that question rarely gets asked, because too many people are unaware that the premise guiding these policies—that the private sector inevitably outperforms government—is false.

… The point is not that the VA has no problems; it does. The point is that by failing to compare it to other health care systems, journalists can present a distorted impression that plays into ongoing efforts to privatize an agency that outperforms the rest of the U.S. health care system on most metrics. … Most recently, with bipartisan support, Congress passed the VA Mission Act, a “reform” package that could massively divert more veterans’ care from the VA to private-sector providers—which, in turn, would likely force the closing of many VA hospitals. Meanwhile, the Trump administration would clearly like nothing better than to be able to outsource lucrative contracts for VA care to its friends in the private sector. If the press doesn’t get this story right soon, America’s biggest and most successful example of government-provided health care will soon pass into history.


For the first time, a senator is opposing the VA secretary nominee
Leo Shane III, Military Times, July 11, 2018

Senate Veterans’ Affairs Committee members on Tuesday voted to advance the nomination of Robert Wilkie to be the next secretary of Veterans Affairs, but the move came with a symbolic and historic opposition vote against the move. The panel by voice vote sent Wilkie’s nomination to the Senate floor, but with Sen. Bernie Sanders, I-Vt., opposing the move. … Sanders, the former chairman of the committee, said he also intends to vote against Wilkie when his nomination comes to the full Senate for a vote. … “This has less to do with Mr. Wilkie than President Trump,” Sanders said following the vote. “Trump has been very clear about his desire to move to the privatization of the VA, and I suspect any of his appointees will try and move the agency in that direction.”

VA nominee pledges to oppose privatization
Source: Nahaniel Weixel, The Hill, June 27, 2018

President Trump’s nominee to lead the Department of Veterans Affairs on Wednesday said he doesn’t believe in privatizing the agency and pledged to oppose privatization efforts. “My commitment to you is I will oppose efforts to privatize,” even if it runs counter to the White House agenda, Robert Wilkie told a Senate panel. Under questioning from Sen. Bernie Sanders (I-Vt.), Wilkie said he would keep the VA “central” to the care of veterans, but indicated there can be a balance. Democrats and some veterans service organizations believe the White House is being influenced by Charles and David Koch, conservative billionaires who back the group Concerned Veterans for America (CVA), which is pushing to loosen current restrictions on veterans receiving private-sector care. …

Trump Signs Bill to Expand Private Care at Troubled VA
Source: Hope Yen, Associated Press, June 6, 2018

President Donald Trump signed a bill into law Wednesday that will give veterans more freedom to see doctors outside the troubled Veterans Affairs system, a major shift aimed at reducing wait times and improving care by steering more patients to the private sector. … The sweeping $51 billion plan, which would also expand a VA caregivers program to cover families of veterans of all eras, cleared the Senate on a 92-5 vote last month. The House approved it on a 347-70 vote. The legislation will give veterans access to private care when they have endured lengthy wait times or the treatment was not what they had expected. But it could escalate costs, and some lawmakers warn this could put the VA at risk of budget shortfalls next year. …

Congress OKs Trump bid to widen private care at besieged VA
Source: Hope Yen, Associated Press, May 23, 2018
Congress delivered a victory to President Donald Trump by expanding private care for veterans as an alternative to the troubled Veterans Affairs health system. The Senate cleared the bill on a 92-5 vote Wednesday, also averting a disastrous shutdown of its Choice private-sector program. The program is slated to run out of money as early as next week, causing disruptions in care. The sweeping measure would allow veterans to see private doctors when they do not receive the treatment they expected, with the approval of a Department of Veterans Affairs health provider. Veterans could access private care when they have endured lengthy wait times or VA medical centers do not offer the services they need. …

House Passes Sweeping Bill to Overhaul VA-Funded Private Care, Shutter Facilities
Source: Eric Katz, Government Executive, May 16, 2018
The House on Wednesday passed 347-70 a major overhaul to veterans health care, voting to expand their access to private sector care on the government’s dime and to bring the Veterans Affairs Department through a process that would close some of its federally run facilities. The Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act won widespread support in the lower chamber and will now head to the Senate, where it already has bipartisan backing.

Ronny Jackson Withdraws As VA Nominee
Source: Jessica Taylor, NPR 26, 2018

Rear Adm. Ronny Jackson, President Trump’s embattled nominee to lead the Department of Veterans Affairs, has withdrawn from consideration for the post amid allegations he had fostered a hostile work environment and behaved improperly while serving as the top doctor leading the White House medical unit. …

After Trump Hints V.A. Nominee Might Drop Out, an Aggressive Show of Support
Source: Nicholas Fandos and Michael D. Shear, New York Times, April 24, 2018

President Trump acknowledged Tuesday that Dr. Ronny L. Jackson, his nominee to lead the Veterans Affairs Department, is in serious trouble amid accusations that as the White House doctor he oversaw a hostile work environment, improperly dispensed prescription drugs and possibly drank on the job. … The turmoil around his nomination all but ensures that the Department of Veterans Affairs, the federal government’s second largest, will remain without a permanent leader for at least several weeks at a moment when it was supposed to be adopting systematic changes to its electronic health records system and to programs that allow veterans to seek care from private doctors at government expense. … Lawmakers were already preparing to press Dr. Jackson on his views on the role of private medical care for veterans, instead of the department’s government-run health care system. …

Democrats see red line for Veterans Affairs nominee on privatization
Source: Juana Summers, CNN, April 19, 2018

Democratic senators who have met with White House physician Ronny Jackson, the President’s pick to lead the Department of Veterans Affairs, have made clear that privatization of veterans’ medical care is a red line for them. If Jackson, a rear admiral in the Navy, supports privatization, they won’t back his nomination. So far, they say, Jackson has signaled emphatically that he doesn’t support it. …

Is This Hedge-Fund Titan Greasing the Levers for Privatizing the Veterans Health Administration?
Source: Jasper Craven and Suzanne Gordon, The Nation, April 11, 2018

On March 28, via Twitter, President Donald Trump publicly dismissed David Shulkin, the embattled veterans-affairs secretary. Almost immediately, Shulkin fired back with an op-ed in The New York Times, charging that conservatives had pushed him out because of his resistance to outsourcing health care at the Department of Veterans Affairs. “They saw me as an obstacle to privatization who had to be removed,” Shulkin wrote. … Though Shulkin did not mention specific names, the group of privatization advocates he alluded to includes hospital CEOs, business leaders, and the Koch brothers. Among the most significant of these players is a hedge-fund titan named Steven A. Cohen. Cohen rose to prominence as the founder of SAC Capital Advisors, amassing a personal fortune estimated at roughly $14 billion. But from 2013 to 2016, eight of SAC’s leaders pleaded guilty or were convicted of organizing what was the largest insider-trading scheme in US history, and the firm received a $1.8 billion fine.

… Among the most significant of these players is a hedge-fund titan named Steven A. Cohen. Cohen rose to prominence as the founder of SAC Capital Advisors, amassing a personal fortune estimated at roughly $14 billion. But from 2013 to 2016, eight of SAC’s leaders pleaded guilty or were convicted of organizing what was the largest insider-trading scheme in US history, and the firm received a $1.8 billion fine. … That same year, with an initial investment of $275 million, Cohen founded the Cohen Veterans Network, a private nonprofit mental-health-care network. … While the venture sounds altruistic, some lawmakers and veterans advocates worry that Cohen’s long-term goal is to replace much of the Veterans Health Administration’s exceptional mental-health-care services with what could be a more expensive, untested, and less accountable treatment network. ….

Opinion: David J. Shulkin: Privatizing the V.A. Will Hurt Veterans
Source: David J. Shulkin, March 28, 2018

… It seems that these successes within the department have intensified the ambitions of people who want to put V.A. health care in the hands of the private sector. I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans. …

The VA Is the Closest Thing We Have to Single Payer. Now Trump Wants to Privatize It.
Source: Bryce Covert, In These Times, March 15, 2018
Aaron Hughes, who was deployed to Kuwait and Iraq in 2003 and 2004, now has a serious, very rare lung condition. But he told In These Times he gets “really outstanding care” at the nearby Jesse Brown VA Medical Center. “The doctors are at the top of their class,” he said. Because his condition is so rare, Hughes has been sent to a hospital outside of the Department of Veterans Affairs (VA) for specific tests. And his taste of the private healthcare system has been sour. “As soon as I went there, all hell broke loose,” he said said, explaining there were problems with sharing records between the two institutions. … Hughes thinks these problems could get worse if efforts to fully privatize the VA are successful. President Donald Trump has supported privatizing the system, and has called to make permanent the Veterans Choice Program, an experiment Congress launched in 2014 that gives vouchers to veterans to see private doctors, while cutting other parts of the agency. These developments have provoked concerns that Trump will usher in a full private sector takeover. …

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.