Tapped: The Prospect Group Blog

Congress Determined To Keep Private Sector In Vets’ Heath Care

Lawmakers on Capitol Hill mulling legislation to extend a program that lets veterans seek health care in the private sector have revived their longstanding complaints about long wait times for care at the Veterans Health Administration facilities. Veterans Affairs Secretary David Shulkin and Dr. Baligh Yehia, the agency’s assistant under secretary, appeared before the House Committee on Veterans Affairs to testify on HR  369, a bill that would allow the Veterans Access, Choice, and Accountability Act to continue past its sunset date of August 2017. 

In 2014, after revelations of wait-time problems at some Veterans Health Administration (VHA) facilities, Congress created the three-year Choice program allowing eligible veterans to seek care in the private sector if they live 40 miles from a VHA facility or have to wait for more than 30 days for an appointment. The bill would let the VHA spend what remains of the initial $10 billion (about $1 billion) allocated to Choice on care in the private sector. 

At the hearing earlier this month, House Committee on Veterans Affairs Chairman David “Phil” Roe, a Republican from Tennessee, complained of VHA wait times as long as 81 days. His comments and those made by other committee members suggest that congressional Republicans are determined to ignore any evidence that outsourcing care to private sector providers won’t do much to improve access to or coordination of care for veterans. They seemed unaware, for example, that wait times for private-sector health care are also a significant problem.

A 2014 study of wait times in American hospitals by health-care consulting firm Merritt Hawkins found long wait times and large disparities depending on location. In their just released 2017 study of wait times, the firm found that wait times in 15 metropolitan areas had increased by 30 percent since 2014. The average wait time for a new physician appointment was 24 days. In Boston, the average wait time to see a family physician was 109 days while in Albany patients had to wait 122 days. Some practices were entirely closed to new patients. In Boston patients who had to wait to see a cardiologist for 133 days in 2014 were now waiting as much as 365. In Houston the longest wait for a heart doctor jumped from 26 to 43 days. In Denver the longest wait to see a dermatologist went from 180 to 365 days while the shortest delays increased from one to seven.

A 2013 Commonwealth Fund report found that, of those adults surveyed, 26 percent reported six or more days for a primary care appointment when they were actually “sick or needing care.” As the report stated “Among the 11 nations studied in this report; Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in 2010, 2007, 2006, and 2004.”

The American Prospect recently reported on an independent assessment of VHA performance and access which concluded that, “Enrollees living more than 40 miles from VA facilities are much less likely to have geographic access to specialized services in non-VA hospitals … they are much less likely to have access to academic and teaching hospitals, the sites in which more complex care is offered.”

VHA wait times mirror those in the private sector for the same reason, a nationwide shortage of primary care providers and mental health professionals. Another contributing factor is that a government agency like the VHA is unable to offer market-rate salaries to healthcare professionals. In high-cost urban areas, health care professionals who want to work at the VHA are being offered thousands,  sometimes tens of thousands, more in the private sector. Not surprisingly, they follow the money. During the committee’s three-hour hearing, the issue of how low pay affected the quality of care never came up.

Committee members also considered another Choice Program problem, the coordination of care between VHA and private sector providers. Committee members offered a number of short-sighted observations, including defining care coordination exclusively in terms of giving private sector providers access to the VHA’s electronic medical records. 

Coordinating care for VHA patients who are, on average, sicker, older, poorer, and have more chronic mental health conditions than their counterparts in the private sector, requires far more than access to data. The VHA has pioneered a model of care coordination: Clinicians who work in the VHA system and often in the same work on multidisciplinary teams that have been trained to engage in face-to-face communication (sometimes via Telehealth) about the complex needs of their patients. 

As many studies have consistently documented, this is one of the main reasons that the VHA often delivers care that is superior to that treatment delivered by private sector providers. It is also why, as Dr. Shulkin testified, of the 1.2 million veterans who have had appointments through the Choice program in the private sector, only  5,000 of them chose to receive care only from private sector providers. 

Shulkin has  promised to unveil a new version of the program, what he likes to call Choice 2.0, sometime this fall. The future of the VHA will depend on how this program is configured  and if members of Congress are willing to consider whether private sector providers can actually deliver high quality care. The Choice program has not worked well because it was designed hastily and implemented far too rapidly. If the recent House hearing is any indication, Congress may be poised to repeat history with Choice 2.0.

This story has been updated to include newly released data on wait times.

Wisconsin Progressive Giant Ed Garvey’s Vital Message

When Wisconsin progressive Ed Garvey succumbed to a long illness February 22 at age 76, Senator Bernie Sanders hailed him as “one of the smartest, funniest, and most decent people I have ever known.”

It was a fitting tribute to the humanity of Garvey, whose passion for economic democracy and social justice had made him deeply beloved in his home state.

That Sanders delivered it was also fitting. In both electoral and issue campaigns, Garvey had pioneered a sharp-edged message about mounting inequality and shrinking democratic space that had cultivated the ground for Sanders’s Wisconsin primary win. Garvey spoke directly to Wisconsin’s unusually harsh inequities, and job losses caused by globalization. Sanders sounded similar populist themes in his  57–43 percent primary victory over Hillary Clinton, in which he carried 71 of 72 counties. Clinton went on to lose the state on Election Day, by just 23,000 votes.

Garvey blended generosity of spirit with a remarkable strategic audacity and fearlessness, overcoming seemingly insuperable odds in countless battles. Above all, Garvey was a masterful communicator—an old-fashioned, spellbinding orator and a sophisticated modern-media strategist who saw the importance of teaching working people how to speak about their pain and aspirations to the broadest possible audiences.  

Having worked alongside Garvey for more than three decades, I regard the annual “Fighting Bob” festival as the capstone of Garvey’s lifelong efforts to build working people’s capacity to develop and deliver a powerful diagnosis of society’s ills, and to offer a compelling alternative vision. The festival, which originated in 2001 with Garvey a central founder, is named after the firebrand progressive Robert La Follette Sr., Wisconsin’s governor a century ago. “Fighting Bob” became a central point of mobilization, where Garvey spread his communications philosophy to thousands of grassroots activists drawn from across the Badger State. Over the years, the festival has attracted many of the nation’s most thoughtful progressives, including Sanders, Jim Hightower, Jesse Jackson, Wisconsin Democratic Senator Tammy Baldwin, among numerous others.

Many “Fighting Bob” attendees became active because of Garvey, who indefatigably crisscrossed the state to share his energy, strategic acumen, and legal skills with workers battling against plant closings and wage cuts, and with environmentalists resisting “factory farms” and other threats to clean water.  

Garvey’s signature method first found full expression back in 1982, when he directed the NFL players union’s campaign for a fixed share of the football league’s massive, fast-growing revenues. Under Garvey, the union developed and drove home a compelling message that motivated the players and resonated with fans. As Garvey would later recall, “We built support among the public by emphasizing, ‘We are the game’—emphasizing that while the owners were dispensable, the players are not.”

The message kept the players consistently fired up. “Once the players really understood that they truly are the game, they were well on the way to victory,” Garvey explained at the time. This consistent message enabled the NFL stars to quickly out-maneuver the league and its hardliner anti-union majority. By the strike’s end, not a single player had crossed the picket lines, the public solidly supported the union, and the owners were forced to agree to provide the players with 55 percent of revenues.

Not that Garvey’s strategy was always appreciated within the ranks of labor or by Democrats. Garvey once recounted how then–AFL-CIO President Lane Kirkland, a dour and cautious figure, told him “to avoid too much publicity. He demanded, ‘What if you lose?’”

Garvey retorted, “Well, what if we win?” With the NFL players’ strike, as with numerous local fights involving unions and environmentalists, the Garvey method paid off by combining a powerful message with grassroots activism and public outreach.

Some Wisconsin Democrats never got comfortable with Garvey. To them, openly proclaiming a progressive, anti-corporate message risked alienating the Democrats’ donor class, and galvanizing and intensifying right-wing opposition to frightening levels. In his 1986 race for the U.S. Senate seat held by arch-conservative Robert Kasten, Garvey’s surging poll numbers alarmed Kasten consigliere Roger Ailes (later of Fox News infamy) into devising a major TV ad buy that falsely accused Garvey of stealing $750,000 from the NFL union he had represented. After his narrow re-election, Kasten was shamefacedly forced to admit that there had been no basis for the charge, but the outcome was of course unchanged.

Garvey’s fierce allegiance to rank-and-file union members also caused some rifts with labor leaders across the state.

But today, under Republican Governor Scott Walker and President Trump, Wisconsin Democrats face unprecedented existential threats to labor rights, the public commons, the environment, and civil liberties. They need Ed Garvey’s full-throated progressive message of economic inequality, and his genius for communication, more than ever. This may be Garvey’s most important legacy—and what makes his loss untimely in more sense than one.

Supreme Court: Defendant’s Race Cannot Inform Sentencing

In October, we covered Buck v. Davis, a death penalty case that was being argued before the U.S. Supreme Court. On Wednesday, February 22, the Court ruled in favor of convicted murderer and condemned prisoner Duane Buck and sent his case back to the appeals court. Procedurally, the case was a complicated mess, but it was ultimately about keeping racial bias from contributing to a man’s execution. As we noted at the time:

In the broadest sense, the moral and societal question facing the Court is whether in America a man may be sentenced to death based on evidence that is unconstitutionally tainted by racial stereotyping. But the actual technical and legal question before the Supreme Court is whether the Fifth Circuit erred in upholding a lower court’s refusal to grant Duane Buck the right to appeal a district court’s finding that his case is not sufficiently “extraordinary” for a federal court to intervene.

A 6-2 majority of the Court ruled that the Fifth Circuit was wrong to deny Buck the certificate required to make this appeal. The majority opinion by Chief Justice John Roberts ruled that Buck’s counsel was ineffective, noting that that the jury in his sentencing phase had been told by the expert called by Buck’s own lawyer that “that the color of Buck’s skin made him more deserving of execution.”

Buck’s attorneys praised the ruling. “Today, the Supreme Court made clear that there is no place for racial bias in the American criminal justice system,” said Christina Swarns, litigation director of the NAACP Legal Defense and Educational Fund. “By acknowledging that Mr. Buck’s trial counsel’s injection of racially biased evidence into the capital sentencing proceedings was unconstitutional, the Court has reaffirmed the longstanding principle that criminal punishments—particularly the death penalty—cannot be based on immutable characteristics such as race.”

Justice Clarence Thomas dissented, joined by Justice Samuel Alito. Thomas wrote that the majority opinion “bulldozes procedural obstacles and misapplies settled law” to achieve a desired outcome. Thomas argued that the testimony presented in Buck’s sentencing that being black made him more violence prone was not prejudicial. 

GOP Pushes to Repeal Regulations on Prepaid-Card Companies

Republican legislators have moved to repeal a rule constraining prepaid–debit card companies before the rule can take effect, marking the latest effort in their recent campaign of widespread deregulation.

Seven GOP senators—led by David Perdue of Georgia—and four representatives—led by Tom Graves, also of Georgia—filed identical resolutions in the Senate and House of Representatives last week, invoking an obscure law called the Congressional Review Act to smother a proposed Consumer Financial Protection Bureau (CFPB) rule before it can be enacted.

The CFPB rule, scheduled to take effect in October, would provide safeguards for those who use prepaid cards, which are similar to debit cards but are preloaded with a designated amount of money by the cardholder. The rule would require providers to disclose hidden fees and protect against loss, theft, and unauthorized charges. The rule would also force prepaid-card companies to limit overdraft fees.

NetSpend, a division of the Georgia-based Total System Services (TSYS), is the only major provider of prepaid cards that has overdraft fees and, as such, is the biggest apparent beneficiary of the GOP move. The prepaid-card provider, which has lambasted the rule as “onerous,” announced in an October earnings call that it expected to lose $80 million to $85 million each year in overdraft fees, comprising 10 percent to 12 percent of its current revenue, as a result of the CFPB rule.

“It is outrageous that Congress may block basic fraud protections on prepaid cards so that NetSpend can keep gouging struggling families with overdraft fees that have no place on prepaid cards,” Lauren Saunders, associate director of the National Consumer Law Center (NCLC), said in a statement.

In 2016, parent company TSYS donated thousands of dollars to the Senate and House campaigns of the Georgia Republicans and also contributed to the campaign of Senator Ron Johnson of Wisconsin, another co-sponsor of the repeal resolution.

The resolution would give NetSpend a reprieve from federal scrutiny of its business practices. The company is currently in the middle of a legal battle with the Federal Trade Commission over deceptive marketing allegations.

Under the Congressional Review Act, which allows federal lawmakers to eliminate recently finalized rules with a simple majority vote in both chambers, the resolution would still require presidential approval. President Trump, who promised to “do a number” on Dodd-Frank, the Wall Street reform law, has shown a penchant for deregulation and would seem a safe bet to sign off on such a resolution.

The Republican push to gut the CFPB rule comes as more and more Americans are giving up on traditional banks and relying more on alternative payment methods like prepaid cards. In 2015, 7 percent of U.S. households, or about 15.6 million adults and 7.6 million children, didn’t have a bank account at all, according to the Federal Deposit Insurance Corporation. Prepaid cards are most popular among low-income people who can’t qualify for a credit card. Even consumers with good credit histories sometimes turn to prepaid cards to avoid high overdraft fees, thereby sacrificing the legal safeguards that come with conventional banking. If the GOP repeal plan is successful, they’ll get the worst of both worlds. 

A Price Confirmation Would Continue Obstruction of Gun Violence Research

The prospects for reinvigorating gun violence research could become even more remote. Federal funding for studies into gun violence and gun-related deaths has effectively been frozen for the last two decades, a worrying trend that looks to continue under a Trump administration and a Republican-controlled Congress, especially if the Senate confirms Representative Tom Price, President Trump’s nominee to head the U.S. Department of Health and Human Services.

Critics have taken on Price, an outspoken gun-rights advocate and conservative spending hawk, on a wide array of issues throughout his confirmation hearings, but his ardent support of gun rights has flown under the radar.

“Guns are used more often to protect lives, not take lives,” the Georgia Republican told Georgia’s Marietta Daily Journal last year. “Steps to remove firearms from the hands of law-abiding citizens endanger those very citizens.”

The 1996 Dickey Amendment blocked Centers for Disease Control and Prevention (CDC) funds from being “used to advocate or promote gun control.” Since Congress passed the Consolidated Appropriations Act of 2012, a similar rule has also applied to the National Institutes of Health (NIH). Price, who received an “A” rating from the NRA’s Political Victory Fund and a 90 percent approval rating from Gun Owners of America, has previously pushed to cut funding from both the CDC and NIH.

Jay Corzine, a University of Central Florida sociology professor who studies violent crime, insists that gun violence research is essential to mitigating gun-related deaths and that federal gun policies should be based on the best research available, not party politics. “It’s a mistake for lawmakers to restrict other federal agencies’ abilities to invest money in types of research that they see as meeting a national need,” says Corzine.

As head of the HHS, Price could shift how the agencies spend funds and curtail research or steer studies in other directions. That doesn’t augur well for new inquiries in this cash-strapped field. 

A recent Journal of the American Medical Association study found that gun violence research funding lagged behind investigations into other causes of death by billions of dollars.

(Source: Journal of the American Medical Association)
 

David Stark, a co-author of the study, aimed to find out how congressional restrictions affected research into gun-related deaths. Stark noted that had federal research funding been linked to the actual gun violence death toll, gun researchers would have received about $1.4 billion between 2004 and 2014, but they only received $22.1 million. Gun violence killed nearly ten times more people than fires, but research efforts received nearly $1 billion less in funding.

“No one would say that the intent of traffic safety research was to eliminate automobiles from the road,” Stark told The Trace. “No one is necessarily saying that the intent of gun violence research is to eliminate guns.”

Following the 2012 Sandy Hook Elementary School shooting, President Barack Obama issued an executive order to end the freeze on gun violence research. However, with Congress continuing to block dedicated funding, the executive order has largely failed in resuscitating any new research. The congressional funding restrictions have also spilled over into academia. “Graduates gravitate to a field where there’s funding,” says Corzine. “If there is less funding, [they] will go elsewhere.”

Having secured the backing of the NRA early on in the presidential campaign season, Trump is unlikely to request funding for new research. Despite calls from Democrats, academics, doctors, the American Medical Association, and even former congressman Jay Dickey of Arkansas (the Dickey Amendment’s author) to eliminate these restrictions, Corzine does not hold out hope that the situation will change anytime soon.

“There might be movement to loosen up [gun] control [restrictions],” Corzine says. “But in terms of movement towards research, I just don’t see that happening.” 

An Alternative to Puzder

Fast-food CEO Andy Puzder, Donald Trump’s pick for labor secretary, is a big fan of robots—and not so much of humans. In an interview with Business Insider last March, Puzder had this to say about our robotic little friends: “They’re always polite, they always upsell, they never take a vacation, they never show up late, there’s never a slip-and-fall, or an age, sex, or race discrimination case.”

Correspondingly, Puzder’s record makes clear that the wants and needs of human workers repel and disgust him. He’s opposed increases to the minimum wage, and the extension of overtime eligibility to workers making more than $23,000 a year. His fast-food outlets have been penalized for violating minimum-wage laws. And as his Business Insider disquisition makes clear, things like employee vacations and slipping on the job—things that come out of Puzer’s profits, that is—drive him batty.

When the Senate convenes in January to consider Trump’s cabinet nominations, it might be prudent for the solons to apply Puzder’s tests for human frailty to the nominees—at minimum, to Puzder himself. Is he always polite? Has he been known to take vacations? Or slip? Or fall? If so, wouldn’t a robot do a better job? Any robot programmed to become labor secretary, after all, would likely understand better than Puzder that its mission is to advance rather than retard the interests of American workers.

The senators should heed Puzder’s advice: Reject his nomination and petition Trump to send them a robot, which, by any criterion, including that of human empathy, would be more qualified than the current nominee. 

VHA Support for Nurse Practitioners Draws Fire from Medical Leaders

The Veterans Health Administration has weighed in on a controversy that has embroiled medicine and nursing for the last 50 years: whether advanced practice registered nurses (APRNs) can operate without direct physician supervision. On December 14, the VHA amended its medical regulations to “permit full practice authority” to many of the system’s nurse practitioners, a move that immediately drew the ire of the medical community.

Since APRNs appeared on the health-care stage in 1965 with the enactment of Medicare and Medicaid, physicians have responded with deep ambivalence. Some have embraced them as full members of the health-care team, while others—particularly leaders of organizations like the American Medical Association—have argued that nurses should not function on their own and should always—no matter how much experience they have—work under the direction of doctors. APRNs have consistently argued that they should be allowed to make diagnoses and prescribe treatments without physician supervision.

The Institute of Medicine has recommended APRNs be granted what is known as “full practice authority,” and countless studies have documented that APRNs provide safe and effective care at lower costs than physicians. The fight has been waged in various states, 22 of which have granted full scope of practice to APRNs. But as a federal employer, the VHA’s own internal regulations can supersede state law on nursing practice when there is conflict between state law and federal law. The VHA’s new ruling, which will establish additional “professional qualifications an individual must possess to be appointed as an APRN within the VA,” might actually lead to requirements stricter than those of some states.

This is by no means an arcane, internecine fight. Advanced-practice nursing appeared in the 1960s because of the need to expand health-care access in a country that did not, and still does not, produce enough generalist physicians but overproduces medical specialists. Over the years, nurse practitioners and other APRNs have become increasingly critical in both pediatric and adult primary care, as well as in specialist clinics and acute-care settings where they work on medical teams.

Of the 93,500 registered nurses, licensed practical nurses, and nursing assistants employed by the VHA, more than 5,700 are advanced practical nurses (APRNs), hired to work on primary-care teams or in settings with provider shortages. In its deliberations on the future of the VHA, for example, the VA Commission on Care recommended that APRNs be allowed to practice to the full extent of their education, training, and certification, which means without direct physician supervision.

When the VHA’s regulation came out, medical leaders expressed their usual reservations about APRN practice. During the 60-day comment period for the proposed ruling, just the hint of liberating APRN practice unleashed an unprecedented torrent of comments from the American public (including many veterans and their families) and professional organizations. AMA President Andrew Gurman immediately denounced it, saying, “We are disappointed by the VA’s decision today to allow most advanced practice nurses within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law.”

Medical leaders must stop defending an outdated model in which physicians, some of whom may have no training in either leadership or teamwork, dominate the health-care team. It is time to follow the lead of the VHA and establish a model of care that helps not just veterans, but all Americans.

Trickle Upper: Portland Cracks Down on Excessive CEO Pay

In 2017, Portland, Oregon, will become the first city to impose a surtax on companies with CEOs who make more than 100 times their workers’ median pay—an idea that was floated by Prospect executive editor Harold Meyerson two years ago.

“If congressional liberals want to diminish economic inequality, they should also promote legislation that would link corporate tax rates to the ratio between CEO pay and the firm’s median pay,” Meyerson wrote in 2014. “They [CEOs and their boards] would … have a self-interest in raising their workers’ wages.”

The Portland rule, which Councilmember and City Commissioner Steve Novick told Meyerson was inspired by Meyerson’s writing, requires companies to pay an additional 10 percent in taxes if their CEO pay is 100 times their median worker’s pay, and an additional 25 percent if the ratio is more than 250 to 1. Novick told Meyerson that there were 540 such corporations doing business in Portland—five of which are based there.

A similar bill was proposed in California in 2014, but died on the state Senate floor. The 2010 Dodd-Frank financial-reform law required the Securities and Exchange Commission to publish U.S. corporations’ CEO-to-worker pay ratios.

“When I first read about the idea of applying a higher tax rate to companies with extreme ratios of CEO pay to typical worker pay, I thought it was a fascinating idea,” Novick told The New York Times after the measure passed on December 7. In The Guardian, economist Branko Milanovic was also quoted praising the idea, saying “it seems [to be] the first tax that targets inequality as such. … It treats inequality as having a negative externality like taxing carbon emissions.” 

Democrats Misunderstood Racial and Class Divisions but Cannot Reject Inclusiveness Now

As we wrestle with the consequences of a Trump presidency, Democrats, especially progressives, risk whitewashing the American electorate. In a blind rush to appeal to the voters the Democrats lost, we risk not comprehending and embracing the experiences of the millions of people we won. It was not Hillary Clinton’s message of inclusiveness that cost us the White House, but a major miscalculation of the depth of America’s racial and class divide.

This white identity crisis, tied to a newly ascendant white supremacy, is a psychic struggle that is as old as this country. Our insistence on downplaying this struggle fuels our misunderstanding of the politics of race and racism. For the past 240 years, we have assumed that white men are at the center of the American experience—and as a result, we treat everyone else as a deviation from this “norm.”

Yet ignoring our differences won’t grow the Democratic Party contrary to what Columbia University political scientist Mark Lilla suggested in his recent New York Times piece, “The End of Identity Liberalism.” Instead it is imperative that we, as Democrats, examine whites’ fears of no longer being the default “majority” and their assumptions of what it means to be a minority.

Does minority status for whites mean their voices no longer matter? My nine-year-old daughter has never been asked to reflect on her identity as a white person, nor on her identity as a girl in our society—as Lilla claims is common even among preschoolers. Yet, many people of color, LGBTQ people, and people with disabilities live their lives as “the other” and get treated poorly at times as a result. The reverse won’t necessarily be true when we become a “majority-minority” country, but based on the current treatment of Americans who are not straight white males, that is the fear.

Seizing the mantle of white male identity politics, Trump won by stoking those fears and by blaming immigrants, Muslims, African Americans, and women for the struggles and alienation of white men. Given this message, it is not surprising that Hillary Clinton was the one whose rallies resembled America today, attracting men and women of different races and ethnicities, people who indeed believe their commonalities are more important than their differences.

Republicans, not Democrats, have convinced white Americans that they are now a disadvantaged group. Since the passage of the Civil Rights Act, Republican Party leaders have been on a mission to convince white people that the government overwhelmingly benefits people of color. They have relied on subtle feints, and then, more overt appeals to racism to unravel the New Deal coalition and its programs—even though most of the beneficiaries are white.

As my Demos colleagues, President Heather McGhee and Senior Fellow Ian Haney Lopez, pointed out in "How Populists Like Bernie Sanders Should Talk About Racism":

Conservatives have been working hard to convince white people for decades that addressing racism is itself anti-white discrimination. For 50 years, conservatives have hammered the message that liberalism is excessively sympathetic to people of color, claiming that major institutions—from the Democratic Party to the federal government, from universities to unions—care more about people of color than about white people. In this context, when [Senator Bernie] Sanders repeats the refrain that Black Lives Matter, many white people hear him as kowtowing to a powerful special interest, or even engaging in a form of racial betrayal.

We cannot fully understand the progress that still needs to be made without fully appreciating how deeply embedded racism, sexism, and homophobia is in our country’s political systems. To pivot to a conversation about our nation’s economy—which both Democratic and Republican leaders aim to do—we must recognize that our identities are often the very reason why class divisions grow by the day.

In these volatile times, we should not try to sell the idea that whiteness is equal to or the same as being an American—and Democrats cannot afford to buy that vision as they find a new path forward. 

Fact-Checking Fact-Checkers on Privatizing Vets’ Health Care

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. According to Lee, the CVA’s position does not constitute privatization because, the “CVA has not proposed a wholesale transfer of VHA’s services over to the private sector—which is what ‘privatization’ usually describes.”   

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.

Ironically, as Starr and other critics point out, the privatization movement decreases accountability and oversight of services currently delivered by the private sector by directing attention to poor government performance while deflecting attention from similar flaws in the private sector.

Privatization can erode public support for the belief that government plays a positive role in handling social needs. So CVA officials are keen to promote a counter-narrative: The VHA is broken. The group relies on stories from veterans who have had negative experiences at the VHA to support its claims. (One female veteran recently told me she’d sent in a story about her positive VHA experiences and never received any acknowledgment.) CVA allies like Florida’s Republican Representative Jeff Miller, the House Veterans Affairs Committee chairman and one of President-elect Donald Trump’s candidates for Veteran Affairs secretary, have also attacked agency employees and targeted the unions that represent them.  

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.

CVA officials continue to claim that these moves do not constitute privatization. Some staff members like Darin Selnick, who was a member of the VA Commission on Care (and is now a member of Trump’s VA transition team), have supported eliminating the VHA as a care provider. Selnick was a coauthor of the Strawman Document that outlined a vision of a privatized VHA. In his dissent from the Commission’s final report, Selnick also proposed emulating military insurance programs like TRICARE, which would ultimately turn the VHA into just another insurer. So who really deserves the Pinocchios: two Democratic members of Congress, the CVA, or The Washington Post?

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