Tapped: The Prospect Group Blog

Why Did Brookings Ignore Federal Pre-K's Positive Results?

In the five decades since its launch, more than 33 million low-income children have participated in Head Start, the federal government’s early-childhood education program designed to narrow the gaps between rich and poor students by providing disadvantaged children with comprehensive preschool. Nearly one million children were enrolled in 2015 alone, and research has shown that the program has had positive effects on children later in life and in their education.

But last month, the Brookings Institution, an influential, centrist think tank based in Washington, D.C., published a “consensus statement” on the “current state of scientific knowledge” as it pertains to pre-K research, and failed to include some of the most important research available on Head Start’s impact.

There’s been growing bipartisan interest in expanding pre-kindergarten systems, as legislators and policy experts increasingly view early-childhood learning as a smart investment for youth development and success later in life. The Brookings report, a collaboration among ten social scientists over the past year, was created to help inform policymakers and practitioners on how best to expand and improve pre-K systems based on the existing research evidence.

Yet the Brookings consensus statement, entitled “Puzzling It Out,” is puzzling. The authors write:

“Convincing evidence on the longer-term impacts of scaled pre-K programs on academic outcomes and school progress is sparse, precluding broad conclusions. The evidence that does exist often shows that pre-K induced improvements in learning are detectable during elementary school, but studies also reveal null or negative longer-term impacts for some programs.”

In fact, the most prominent “scaled pre-K program” is Head Start, but here’s what the Brookings consensus statement has to say about the program:

The challenges of scale-up are illustrated by the national Head Start program, for which consistently strong and enduring impacts have been elusive. … Studies examining adolescent and adult outcomes for graduates of Head Start programs during the 1970s and 1980s found positive impacts into early adulthood … but the results of a large-scale, randomized trial of Head Start launched in 2002 were much less encouraging. Despite a boost for children’s academic skills at the end of their Head Start year, the Head Start Impact Study (HSIS) found that these initial gains rapidly dissipated once children began formal schooling.

Curiously, “Puzzling It Out” fails to mention the recent work out of University of California, Berkeley, where social scientists have reanalyzed data used in the 2002 HSIS study, finding much more positive results than previously understood. In a policy brief synthesizing these newer studies, Claire Montialoux of Berkeley’s Institute for Research on Labor and Employment, writes that the original HSIS conclusions “are too pessimistic and substantially underestimate the benefits of Head Start.”

Brookings’s consensus report also ignores the work of two of its own research fellows, Lauren Bauer and Diane Whitmore Schanzenbach, who published a study last summer finding that Head Start participation increased the probability that students would graduate from high school, attend college, and obtain a post-secondary degree. The researchers also found that overall, and particularly among African Americans, Head Start led to social, emotional, and behavioral gains that were evident in adulthood.

 

Bauer told the Prospect that she disagrees with the new report’s conclusion that Head Start has largely failed to produce long-term gains. “I think we have fairly convincing evidence from the Perry preschool program, from the Abecedarian program, from the quasi-experimental long-term studies of Head Start, that all suggest that decades after the opportunity to get a high-quality preschool education, children’s’ lives become meaningfully better,” Bauer says. She was not involved in drafting the “Puzzling It Out” report, and says she could not speak to how the authors chose what to include or exclude.

When asked about the report’s omission of positive Head Start studies, Deborah Phillips, a psychology professor at Georgetown and the report’s lead author, first responded by saying that the report simply wasn’t focused on Head Start, and that her team of collaborators “did not delve into that evidence base [when] coming up with their consensus statement.”

Yet their report specifically discusses Head Start, and presents conclusions strongly suggesting that the research to date on the program is not notable. When pressed on this, Phillips said: “Again, we just did not look at that secondary data [from Berkeley]. I think in another year it will be a perfect time to draw conclusions, but for this effort—we were doing much of our work in the fall and early winter and we knew more work would be coming out—we just didn’t feel we could reframe it and include it. But all of us feel it is very important work.”

Important as the work may be, the coalition of scholars working on the new Brookings report apparently saw no reason to let it influence their “consensus” statement. Which, in turn, raises some questions about what, exactly, drives consensus in the first place. 

 

Extreme Gerrymandering Complicates 2018 Congressional Map for Democrats

It will take nothing short of an electoral wave for Democrats to retake the House in 2018, and that’s exactly the problem.

A new report from the Brennan Center at the New York University School of Law underscores the devastating effect of gerrymandering on recent House elections: The researchers found that over the past decade, not only have Republicans stepped up their gerrymandering efforts, they have become more aggressive in drawing maps to benefit GOP candidates.

Of the 26 states that account for 85 percent of congressional districts, only a handful are responsible for the largest imbalances—and Republicans had sole control of the redistricting process in those states.

“It’s easier than ever to create skewed maps. There’s much more robust data and sophisticated technology than there used to be,” says Michael Li, a redistricting expert and a coauthor of the new report. “Gerrymandering was once an art. Now, it’s a science.”

Republicans derived a net benefit of at least 16 congressional seats from gerrymandering in the 2016 election, according to the report. That’s eight less than the 24 currently needed by Democrats to take back the House.

The report found that Michigan, North Carolina, Pennsylvania, Florida, Ohio, Texas, and Virginia were all under single-party control when state lawmakers created new congressional districts in 2011. It’s no surprise that all of these states, with the exception of Texas, are tightly contested. The most gerrymandered states are usually battleground states, where the slightest advantage can make a difference.

Democratic and Republican state lawmakers have always tried to redraw districts to their own party’s advantage. But since the last census, Republicans have done it more often and more aggressively. Why? Because they can.

“One of the reasons Republicans are doing it more is because you need sole control of a state to aggressively gerrymander,” says Li. “Republicans have sole control over far more states than Democrats.”

California is a rare exception. Democrats control the Golden State legislature, yet the state has mostly avoided unfair maps thanks to an independent redistricting commission. The report found that maps drawn by independent or bipartisan commissions consistently exhibited far less partisan bias than those drawn solely by Republicans or Democrats. Maps drawn by the courts following a legislative deadlock were also markedly fairer than those drawn by a single party.

For voters in the dozens of states without redistricting commissions, taking unfair maps to court is often the only option. Lawsuits challenging those maps have been filed in 38 states since the 2010 census—and most have failed.

Without any standard for gauging when state lawmakers have gone too far in a partisan direction when they create new districts, judges have preferred to stay out of the political thicket unless absolutely necessary. The authors of the report aim to equip courts with better ways of assessing partisan manipulation. “Courts have had a hard time deciding where the line is drawn,” Li says. “But when three formulas point in the same direction, it gives [courts] comfort.”

Despite promising initiatives to redraw maps in Pennsylvania and Wisconsin, it’s unlikely that the electoral landscape will change much before the midterm elections.

Overcoming a 24-seat deficit isn’t impossible—Democrats took back control of the House after a 31-seat swing in 2006— but it won’t be easy. Despite President Trump’s low approval ratings and a radioactive Republican health care bill, Democrats face an uphill battle in 2018.

“If your only hope of winning a majority is through a huge, ‘500-year flood’ voting wave, that’s not exactly encouraging for your party,” says Li.

Despite Assurances, VA Secretary Pushes Toward Privatization

Secretary of the Department of Veterans’ Affairs, David Shulkin, has pledged not to privatize the Veterans Health Administration (VHA). He understands, he says, that the VHA’s ability to provide care that, as studies document, is superior to those in the private sector is because veterans are treated in an integrated system that meets all their health needs. In testimony to the House Committee on Appropriations Veterans Oversight Hearing on May 3, Shulkin argued that unlike the private sector, the VHA “defines health far more broadly as physical, psychological, social, and economic.” Such a “unique national resource … often cannot be found in the private sector.”

In spite of this some of Secretary Shulkin’s recent decisions are very troubling. In March, Shulkin announced that the VHA would begin providing emergency mental health services to veterans previously ineligible for them. While that coverage is long overdue, the VA’s budget will likely push some already enrolled patients out of the VHA system and onto private providers. At the same time, Shulkin has proposed outsourcing optometry and audiology care to the private sector. In both cases, the changes threaten to jeopardize the kind of integrated services the VHA provides.

For years, the VHA has not been able to provide care to an estimated 500,000 veterans who have what are known as “other than honorable” (OTH) discharges (as documented by the San Francisco-based veterans service organization Swords to Plowshares). This is because a veteran’s eligibility for VA benefits is determined by the kind of discharge they receive when they leave the military. Only those with honorable, general, or medical discharges qualify. Those with “other than honorable discharges” or “dirty or bad papers” are disqualified because they committed acts that, while not worthy of a court marshal, led to their discharge. In reality, many of these vets went AWOL, got into fights, abused drugs or alcohol, or had discipline problems because they had PTSD, suffered from military sexual trauma, or other conditions arising from their military service.

Shulkin has announced that he wants to provide these veterans with emergency mental health services if they are in crisis, but his position on funding the coverage is worrisome. During his Appropriations Committee appearance, Shulkin was asked how he would pay for caring for hundreds of thousands of veterans who may not have had health-care services for years, even decades. “Maybe this doesn’t fit into the budget,” he replied. “But frankly I don’t care … I don’t want more money for this. We’re going to figure out a way to help these people and then connect them to community resources and get them help because this is the right thing to do.”

Serving these veterans is definitely the right thing to do. But creating what could be an unfunded mandate may be the wrong way to do it.  As Shulkin admitted during his testimony, the VHA is already short 1,500 mental health professionals needed to serve its currently enrolled patients. It will need more staff, and more inpatient psychiatric beds, and outpatient services to care for hundreds of thousands more.

“By definition, the veterans with OTH discharges need intensive mental health treatment because they will enter our system only when they are in crisis,” one VHA psychologist, who asked to remain anonymous, told the Prospect. “Many will have to be admitted to inpatient units and not every facility has enough beds. They will also need intensive treatment. We want to help them. But we need the staff and funds to do it well.”

Veterans with OTH discharges are also, by definition, ineligible to be referred to Choice care in the private sector, the psychologist explained. If the VHA does not have sufficient mental health staff to care for them, currently eligible veterans with mental health problems will face longer wait times or be pushed into Choice. They will thus be referred to private sector providers, who as numerous studies document, may not be trained to treat their complex, military related conditions. 

More recently, Shulkin has proposed yet another way he may seek to privatize VHA services.  Shulkin has told VA health-care directors from around the country that he wants to stop providing audiology and optometry services. “There are LensCrafters on every corner,” the secretary reportedly commented. Not only would this impact the optometry and audiology training the VHA provides to future clinicians, it would curtail two of the most popular and cost effective services the VHA delivers.

Hearing problems from toxic noise exposure are, in fact, a primary reason veterans seek VHA care. VHA optometrists do more than prescribe eyeglasses. Among other things, they evaluate whether patients with impaired vision are eligible for the impressive services offered through the VHA’s national system of 13 Blind Rehabilitation Centers.

And like all VHA employees, VHA audiologists and optometrists are trained to recognize if patients are at high risk for suicide. Would a technician at LensCrafters recognize that a veteran is seriously depressed and contemplating suicide if the patient (now customer) makes a stray comment indicating that he may not be around to collect his glasses?

Outsourcing public sector services and starving a public institution of necessary funding is one of the facilitators of privatization. The challenge facing Shulkin is how to respond to real needs and problems without setting in motion what Garry Augustine, executive director of the Disabled American Veterans, has called the “withering on the vine” of the VHA.

Reminding the People of Their Power

On Monday, the working-class political organizing group People’s Action held its first annual convention, entitled Rise Up 2017, featuring Senator Bernie Sanders. At a time when record numbers of progressives seem to be running for office, scores of activists proclaimed their candidacies on stage.

Following a brassy opening—a marching band played “When the Saints Go Marching In”—a range of social justice activists, almost all of them children of immigrants, came forward to relate their personal narratives of struggle and, in many cases, to announce their candidacies for public office.

Martha Lugo, the daughter of a Mexican immigrant, told the group that she will be running for city council in Aurora, Colorado. While 60 percent of Aurora’s population are people of color, she said, 100 percent of the city council members are white. “I’m currently a PhD candidate,” she told the audience. “Imagine that, the janitor’s kid.”

After remarks from Lugo and other community leaders, the organization invited onto the stage all of the people in the room who will run for office. Seventy-two people, many of them children of immigrants, people of color, and women, flooded the stage.

Sanders then joined them. “We are not going to let Donald Trump or his friends divide us up by race, or gender, or sexual orientation,” he vowed. “When we stand together, there is nothing that we cannot accomplish.”

Sanders also announced that he will be introducing legislation in the coming weeks that would establish Medicare for all and raise the federal minimum wage to $15 an hour.

 

What States and Cities Can Do To Fight Climate Change

Today, the Prospect is posting Ben Adler’s long-form piece, which also appears in the spring issue of our print magazine, on how states and cities are moving ahead on policies that limit climate change, and what they’re doing to counter the Trump administration’s policies that will make climate change even more severe.

As Ben points out, the regulations and standards for utility companies are set by states and in some cases, by municipalities. In the coastal states with Democratic governments—extending from Massachusetts to Maryland in the east, and California to Washington (with Hawaii thrown in for good measure) in the west—governments have set Renewable Portfolio Standards for their utilities that mandate transitions away from the use of coal and conversion to entirely renewable forms of energy over the next couple of decades. California and Washington have required new buildings to meet energy efficiency standards, through the use, for instance, of rooftop solar panels.

For their part, cities with progressive governments (which far outnumber states with such governments) have in recent years appropriated funds for light rail lines, bike paths, and other forms of transportation that provide alternatives to autos. And following the pattern set by new EPA chief Scott Pruitt when he was the much-beloved-by-oil-companies attorney general of Oklahoma, such enviro-conscious state attorneys general as New York’s Eric Schneiderman have announced they’ll be suing the federal government when it moves to undo long established environmental protections and climate-change legislation.

You can read the article in full here.

DC Paid Leave Coming (Slowly)

Earlier this month Washington, D.C.’s new paid leave law, considered one of the most generous in the United States, went into effect. As The Washington Post reports:

The D.C. law provides for up to eight weeks of paid time off to new parents, six weeks to workers caring for ailing family members and two weeks of personal sick time.

Just four states have paid family leave programs—California, Rhode Island, New Jersey, and New York. They didn’t create these programs from scratch, however: All four had temporary disability programs already in place, which have been amended to include paid leave. (Only five states have temporary disability programs at all.) D.C.’s paid family leave program is unique because the city, which did not have a pre-existing temporary disability program, will have to build an entirely new policy infrastructure to administer the new entitlement. The district will pay for paid leave by levying a new payroll tax on employers.

According to Bloomberg BNA, D.C. lacks sufficient funds to get the program up and running any time soon, though the city has a few years to get its act together. Workers can start taking the paid leave benefit in 2020.

If D.C. leaders successfully build a new paid leave program from scratch, they will not just be helping residents in the nation’s capital, but will also be charting a progressive blueprint for other cities and states to follow.

 

 

 

A Close Look at Education Reform in Washington, D.C.

Today, The American Prospect published a feature story by Rachel Cohen on D.C. school reform. The District of Columbia has been cast as one of the nation’s most successful examples of education reform. Over the last decade, the city has significantly expanded charter schooling and implemented a new teacher evaluation system based in part on student test scores. The Obama administration repeatedly touted D.C.’s new school policies, and states across the country looked to the nation’s capital as a model to emulate.

Proponents of D.C.’s new school policies say there is clear evidence that the reforms are working, but critics say the success narratives have been blown way out of proportion. Here are other key takeaways from Cohen's story:

  • Racial achievement gaps have narrowed in D.C. since 2003, but they remain large, and socioeconomic achievement gaps have widened.
     
  • Researchers say that accessing data to study the effectiveness of D.C. school reform has been quite difficult. City leaders and DCPS officials have often been resistant to the idea of rigorous, independent evaluations, and the lack of transparency has created confusion over how effective or ineffective D.C.’s school reforms have actually been.
     
  • Some local researchers and education advocates want to see the government establish an agency—similar to the Congressional Budget Office—that could offer independent, objective analysis of D.C. education policy. But whether local politicians could be persuaded to fund a think tank that might possibly reveal less-than-flattering information about DCPS remains to be seen.

You can read the article in full here.

Why D.C.’s First Charter Union Election Was Called Off

In February, I reported on the first public union campaign at a charter school in Washington, D.C. Teachers at Paul Public Charter School wanted to form their own local—the District of Columbia Alliance of Charter Teachers and Staff (DC ACTS)—which would be affiliated with the American Federation of Teachers. Seventy-one percent of Paul’s staff signed a petition in support of joining DC ACTS, and asked their administrators on February 22 to voluntarily recognize their union.

When the administration refused to do so, Paul teachers filed for an NLRB election—scheduled for Thursday, March 30. (In a statement, the charter’s management said, “We do not believe that a union is necessary at Paul PCS.”) But the day before the scheduled vote, a surprising thing happened. The AFT, not the charter school teachers, called it off.

David Koenig, a government and history teacher at Paul told WAMU that their teacher organizing committee felt they had enough votes to win, and wanted to go ahead with their election, but “we did not have enough people who were willing to be public with their support to convince AFT that we were definitely going to win.”

While 58 of Paul’s 82 teachers, instructional aides, and counselors signed the initial union petition given to administrators in February, in the days leading up to the NLRB election just 33 people were willing to publicly commit to voting “yes” on March 30. Teachers on the organizing committee said that despite this, they were confident, based on private conversations with their colleagues, that they would still have a majority in support of the union when taken to a secret vote.

Experts who’ve studied NLRB elections have no such confidence, however. “If the teachers went forward, they would lose, absolutely,” says Kate Bronfenbrenner, the director of labor education research at Cornell University’s School of Industrial Labor Relations. “If workers will not publicly say that they will vote for the union, that means they are voting no. That has been proven a hundred times over.”

If the staff’s support for the union has dwindled, that looks to be chiefly the result of management’s opposition. Since the time teachers went public with their union campaign, Paul’s administration engaged in what some teachers described as an aggressive, scorched-earth effort to dissuade teachers from voting to unionize.

The charter school maintains that it never pressured staff on how to vote, and that it “support[s] the right of all employees to participate in such [union] activity.”

But on March 15, Emily Farley, the high school dean of academics; Danielle Singh, the middle school principal; and Rosemarie Ragin, the director of student services, sent Paul staff the following letter:

Make no mistake, this election will have a lasting impact on you, your job, and the entire Paul community.

We are deeply concerned about what this election means to Paul’s staff and our Scholars. We do not believe that this union would be good for you or for our school, and believe the entire community—including teachers and staff—will be better served by continuing a collaborative, cooperative dialogue and problem solving process that does not include a third-party union. One of the advantages that draws both teachers and students to Paul is our ability to work directly and efficiently with our staff on a range of things that matter to all of us. This allows us to meet the needs of our students and families while engaging directly with teachers and staff to create the work environment you need to be successful. We readily agree that this is not always been a perfect process and that it can always be improved, but by voting for AFT in the election, you may be voting away your legal rights to deal directly with Paul and your supervisors on issues that will determine your pay, benefits and working conditions.

We also believe that our future success and security hinges on our ability to provide a high quality education to our Paul Scholars. This is why their families entrusted them to us. We do not believe that the involvement of AFT will help any of us educate our students.

This issue is about our commitment to each other. You will be asked to decide whether you want to continue to have a cooperative working relationship with the Paul administration, or whether you want an outside third party, AFT, to speak for you. Remember, AFT can only promise to do things; we have proven that the Paul community can deliver when we work together. Our proud history demonstrates that we do not need outsiders trying to get us to work against each other.

Over the next few weeks, we will try to provide you with the facts about AFT and the potential impact of unionization at our school. We believe that once you get all the facts you will see that unionization is not right for Paul staff or students, and you will vote “NO.”

And in an email sent to staff on March 20, Paul administrators told staff to “PROTECT YOUR PAYCHECK. VOTE NO ON MARCH 30TH.”

Moreover, on March 27, three days before the vote, Tammy Wythe, the school’s director of talent, sent a letter to Paul staff saying the school would hold off on issuing employment contract information for the 2017–2018 school year until after the NLRB vote. The school had previously told staff that they would receive this information by the end of March—acknowledging that “this information allows all of us—teachers, staff, and school leaders to plan for the next year.” The AFT filed an Unfair Labor Practice (ULP) complaint in response, saying administrators crossed a line by withholding information about whether teachers would continue to have their jobs until after the vote. (Following the election’s cancellation, the union withdrew its ULP.)

Despite all of this, the teachers still wanted to move forward with their vote. An AFT spokesperson told POLITICO that Paul’s administrators “created a toxic environment so full of fear, harassment and intimidation that we felt a fair election would be impossible at this time.”

From the union’s perspective, the fact that more teachers no longer wanted to publicly declare that they would vote for a union meant that management’s aggressive tactics were working, and that they had lost a significant amount of support.

By cancelling the NLRB election, teachers are able to schedule a new one in six months. If they had held the election and lost, then staff would have to wait one year before filing again. More importantly, from the union’s perspective, if the teachers lose their union election, then management might take that as a mandate to do whatever they want over the next school year. But by canceling it, management will have to remember that a failure—union advocates would say, a continued failure—to satisfy teachers’ conditions could mean that the staff could file again quickly for a vote. In other words, the union says it can help keep the boss on their best behavior.

Bronfenbrenner says that based on her 25 years of labor research, the AFT was right to conclude that the vote would fail given the drop in public commitments to vote in favor. “The initial petition is not a measure of ‘yes’ votes—it’s a benchmark as to whether you should go forward to the next step,” she says. “And if you vote and lose, it’s much harder to win than if you withdraw and try again. If you vote and lose, then the employer can go after the pro-union teachers and reward the anti-union ones. If they withdraw, then the campaign can continue.”

Despite not getting to vote for a union, it appears the staff’s organizing effort already helped increase teacher voice somewhat within Paul Public Charter. Since the teachers went public with their campaign, Paul’s administration added teachers to both the charter’s CEO hiring committee and the high school’s principal hiring committee.

The optics of canceling a vote that teachers wanted to hold doesn’t look great for the AFT, given that union officials regularly make a point to say that workers should have the freedom to decide for themselves if they want to be represented by a union. Bronfenbrenner stresses, however, that a unionization campaign isn’t about voting, per se. “It’s about winning. And if they vote, they will lose—they will get slaughtered,” she says. “It’s not democracy to let them vote. What would be democratic is to let them build their union.”

One Paul teacher, who didn’t want to be specifically mentioned in this article, said the campaign’s stalwarts are likely to continue organizing with their colleagues, but that it’s unclear what shape those efforts will take, or if they’d consider working with the AFT in the future. 

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.

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