Suzanne Gordon is the Senior Policy Fellow at the Veterans' Health Care Policy Institute, as well as a journalist and co-editor of a Cornell University Press series on health-care work and policy issues. Her latest book is The Battle for Veterans' Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care. She has won a Special Recognition Award from Disabled American Veterans for her writing on veterans' health issues, much of which has appeared in The American Prospect. Her website is www.suzannegordon.com.
By Suzanne Gordon | Mar 22, 2016
The VA Commission on Care, the 15-member bipartisan body created by Congress to make recommendations about the future of the Veterans Health Administration (VHA), has been meeting for months and plans to publish its findings in June. Until this week, Congress had not interfered with the commission’s supposedly independent deliberations.
That all changed on March 14 when Republican Congressman Jeff Miller, the House Veterans’ Affairs Committee chairman and a staunch advocate of privatizing the Veterans Health Administration, wrote an angry letter to the commission chairwoman Nancy Schlichting. In this unprecedented missive, Miller personally attacked Phillip Longman, a commission member who has advocated not only preserving but strengthening the veterans’ health-care agency in part by eliminating its cumbersome eligibility requirements, and expanding health-care services to veterans’ families.
Miller accused Longman, a Washington Monthly senior editor and author of a sympathetic appraisal of the VHA, Best Care Anywhere: Why VA Health Care is Better than Yours, of personally editing a recent article by former Wall Street Journal reporter Alicia Mundy. Mundy criticized Miller for his singular focus on VHA wait times and his insistence that 40 veterans had died because they were waiting for care. She also detailed the role that Miller and other congressional conservatives have played in the Koch brothers’ campaign to privatize veterans’ health care. Mundy warned that private hospital systems, which have representatives on the commission, are “circling like vultures over the idea of dividing up the VA’s multibillion-dollar budget.”
Miller said Longman helped spread “blatantly false propaganda in an attempt to minimize the wait-times scandal at the Department of Veterans Affairs” through the Mundy magazine article. Longman “either believes the article’s false claims or he—as an editor of the piece—signed off on them knowing they were untrue,” Miller wrote. He warned the commissioners “to take anything Longman says with an extremely large grain of salt.”
A subsequent Washington Monthly blog post by Paul Glastris, who actually edited Mundy’s article, rebutted Miller’s claims about patient deaths and other issues. Longman, who is a part-time staff member at the magazine, also reviewed Mundy’s piece but did not edit it. (However, members on the commission, which includes health-care industry executives, veterans’ advocates, and a representative of the Koch brothers-backed Concerned Veterans for America, can continue to perform their professional duties as long as they do not claim to be acting on behalf of or speaking for the commission.)
Veterans advocates say that Miller’s tirade was the first time any of them could remember a congressman attacking a commission member.
Retired Army captain Steve Robertson, a former Senate Veterans’ Affairs Committee staff director, told The American Prospect that, in his 30 years working on veterans issues, he couldn’t “recall a member of Congress ever instructing members of a commission or advisory group to ignore one of their members.” Robertson said, “Miller is way out of line.” Another representative of a major veterans service organization who did not wish to be identified, called Miller’s letter an attempt to “intimidate an independent commission and politicize their recommendations”
One week later, Miller appeared before the commission and continued his critique of the agency. In his hour-long comments, Miller had nothing good to say about the VHA. He ignored the findings of an independent assessment commissioned by Congress that found that the VHA delivers care that is often superior to the private sector. When commission member Michael Blecker of San Francisco-based Swords to Plowshares tried to defend the VHA’s model of integrated care and worried that many veterans would fall through the cracks of a private health-care system, Miller barely let Blecker finish his comments. The congressman argued that the VHA is “holding veterans inside” the system and must allow them to move into private sector care. Miller concluded by encouraging the commission to offer “bold ideas” on overhauling the system in their upcoming report.
The congressman may want to “empower veterans,” as he terms it. But moving them into a private health-care sector that has primary care physician shortages, coordination of care difficulties, serious wait-time challenges, and hundreds of thousands of deaths due to preventable medical errors poses risks that the commission can ill-afford to ignore.
By Suzanne Gordon | Feb 09, 2016
The Commission on Care—a congressionally mandated federal body tasked with evaluating alleged shortcomings at the Veterans Health Administration (VHA)—is deliberating largely behind closed doors and, according to sources close to the deliberations, may have a heavy bias towards privatization. This is ironic because one of the critiques against the VHA has been its purported lack of transparency. The commission's pro-privatization tilt also worries veterans health advocates who point to research documenting that private health-care providers are not performing as well as the VHA on many measures critical to veterans.
Although some portions of the Commission’s meetings are open to the public, most of its internal deliberations are closed. The commission holds all of its meetings in Washington, D.C., making it impossible for veterans who don’t have the money to fly to the capital to be heard and to observe. Of course, veterans may send in comments to the Commission, but it’s impossible to know how much influence those will have. This in spite of the fact that the VHA is the largest health-care system in the United States, serving eight million veterans—intensifying public interest in the commission’s deliberations.
The commission did release an interim report, as required by the 2014 law that mandated its creation. The Veterans Access, Choice and Accountability Act, passed in the wake of public concern over alleged treatment delays at VA hospitals around the country, charged the commission with examining how the VA should best locate, organize, and deliver its veterans health-care services.
Yet that report identified certain practices that are built in to any government program, such as the federal personnel system, as detrimental to the VA. Among other findings, the Interim Report concluded that one of the primary challenges facing the VHA is meeting the “standards governing health care in the private sector,” a critique with a distinctly conservative ring.
The commission’s explicit charge is “to examine strategically how best to organize the Veterans Health Administration (VHA), locate health resources, and deliver health care to veterans during the next 20 years.” Some veterans’ health-care advocates who have attended the commission’s open sessions say they see signs that influential commission members are pushing for privatization of at least some VHA services. “There seems to a consensus among most of the commission members that some privatization should occur with some members recommending total privatization. It’s clear that a number of the members of the commission—particularly those who come from private sector health-care institutions—have little experience with or knowledge of the unique problems of veterans,” commented one veterans’ health advocate who has attended most of the open sessions and has talked with commission members and staff.
“The mind set seems to be that the Commission should ‘split the difference’ between those who are determined to hand over services to private sector providers and those who believe veterans are best served if the VA is strengthened and continues to deliver comprehensive services,” said another veterans’ advocate who also asked not to be identified. “Splitting the difference would compromise a high-quality integrated health-care model without saving any money.”
The subtext of the commission’s interim report and of its open meetings appears to be that the VHA is fundamentally broken, and that private sector health-care is both superior to VHA care and can handle an influx of veterans with complex medical and psychological problems. Yet a 2014 Rand study of veterans’ mental health care explicitly tackled the question of whether the private sector healthcare system was “ready to serve” the needs of veterans. The answer was no.
The commission’s final recommendations are not due until later this year. The big question now is whether the commission will base its recommendations on empirical research, such as the findings of the Rand study, or on the talking points of the VA’s conservative critics on Capitol Hill.
And check out Suzanne Gordon's in-depth take on the Veterans Health Administration's strong performance in the face of right-wing attacks from our Fall 2015 issue.
By Suzanne Gordon | Feb 08, 2016
On Sunday, The New York Times published a wildly misleading front-page story titled, “Faith in Agency Clouded Bernie Sanders’ V.A. Response.”
The gist of the piece was that Sanders, blinded by his friendliness to government agencies, did not acknowledge the VA scandal of long wait times for services until very late in the game. But read far enough into the detail of the story and the headline is not documented at all—quite the opposite is true.
As the Times admits much later in the piece, Sanders, as chairman of the Veterans Affairs Committee, realized that Republicans were seriously underfunding the VA, and fought hard for adequate financing. It was the underfunding, not the deeply flawed agency of the Times’s imagination, that led to the long wait times.
The Times got the story wrong in its earlier reporting of this trumped up scandal, and its attack on Sanders relies on its earlier mistakes. For nearly two years, its reporters have been shaping and amplifying a deeply flawed and factually challenged mainstream media narrative that dovetails neatly with the privatizing agenda of right-wing Republicans in Washington.
As I reported for the Prospect, the VHA is far more cost effective and compassionate than other counterparts in the health-care system treating comparable patients. The right’s agenda, a threat that Sanders appreciated early on, is to privatize much of the VHA. The Times relies heavily on latter day “Veterans Services Organizations” for its sources.
Wade Miller, a Heritage Foundation-funded critic of the VHA, expresses the GOP bias well when he argues that, “the best way we can help veterans is by reducing their need to use the VA.” According to Miller, the “biggest hurdle” to meeting that increased demand is the very fact that veterans’ health care is provided by “a government program.”
In the front-page Monday story by Steve Eder and Dave Philipps, the Times revisited congressional debates about VHA funding and service delivery in 2014 that were much influenced by this perspective. However, the GOP’s ideological fixation with shrinking government is cited only in passing, via a single reference to the views of “some Republican Presidential candidates and a veterans’ organization backed by the billionaires Charles G. and David H. Koch.”
Instead, Eder and Phillips focus their criticism on Sanders. When Republican opposition to measures like SB 1982, a $21 billion funding package that Sanders introduced in early 2014, helped aggravate the longer wait times that became a Times-reported “scandal” later that same year, Sanders faced “a moment of crisis,” according to Eder and Phillips. “His deep seated faith in the fundamental goodness of government blinded him, at least at first, to a dangerous breakdown in the one corner of it he was supposed to police.”
What was slowing Sanders down and revealing supposed leadership shortcomings, then and now? In part, the Times contends, it was because he “initially saw a conservative plot” to discredit and undermine the VHA so more veterans would support dismantling of the VHA and its replacement with private sector health-care coverage instead. Was this threat a mere figment of the senator’s imagination? Apparently not, according to his rival for the Democratic presidential nomination. Just three days before the Times piece debunking Sanders’s defense of the VHA appeared, Hillary Clinton told MSNBC debate viewers the push for VHA privatization is “another part of the Koch brothers’ agenda. They’ve actually formed an organization to try to being to convince Americans we should no longer have guaranteed health care, specialized health care for our veterans.” Like Sanders—and under pressure from him on this issue—Clinton said she would work with other “veterans’ service organizations, the veterans of America” to “fix the V.A.” but would “never let it be privatized.”
The group Clinton was referring to is called Concerned Veterans for America, which has few actual members, and unlike real Veterans Service Organizations—like the Disabled Veterans of America (DAV), Veterans of Foreign Wars (VFW) and Paralyzed Veterans of America and Amvets—it provides no veterans services. Until only six months ago, these four traditional VSOs worked in an alliance called the Independent Budget. In the past, this coalition provided Congress and the White House with its own assessment of the VA’s funding needs. Sanders consulted all of those groups when crafting S.B. 1982 and they supported it.
The other veterans’ group the Times reporters quote heavily is Iraq and Afghanistan Veterans of America (IAVA). According to a monograph, by Stephen Trynosky, on the political environment that now influences the fate of the VHA, the IAVA is a new kind of VSO—one that has “assiduously embraced a fundraising and revenue model focused heavily on corporate underwriting. … The group’s 2012 annual report lists a constellation of corporate donors and wealthy patrons, some of whom appear to have an interest in the increased privatization of VHA services.”
The Times presents the $21 billion price tag for SB 1982 as excessive, when $21 billion spent over ten years is just a sliver of the VA’s total annual budget of about $160 billion, and miniscule compared to the more than a trillion of direct spending on the Iraq and Afghanistan wars that have created so much demand for VHA services. As the Times belatedly acknowledges late in the piece, Sanders did work effectively with his Republican counterparts to enact a $16 billion bill—less than was needed but enough to finance improvements. So apparently, the $21 billion that Sanders originally called for wasn’t so crazy.
In short, Sanders saw the privatization threat and the consequences of underfunding well in advance. He did his best to deal with both threats but was blocked by Republicans. As the Times admits very late in the piece, Sanders’s original funding bill with a price-tag of $21 billion actually got 56 votes in the Senate—not a fringe measure at all—but was blocked by a filibuster. In fact, Republican opponents of the bill weren’t “puzzled” by it as the Times reports—they were adamant that more money should not be spent on veterans’ health care—unless that money is channeled, through the Choice Act and other Republican-sponsored legislative proposals, to private sector providers. Judging by the facts of the case, a better headline and storyline of the piece could have been, “Sanders Resisted GOP Assault on Veterans Benefits.”
The Times needs to move its singular fixation on wait times—real or exaggerated—and also inform its readers about the things the VA does well. A recent study, for example, compared the outcomes for 700,000 California cancer patients who were treated at the VHA with patients covered by private insurance, or Medicare and Medicaid. Particularly relevant to the current wait time debate, it documents the fact that although veterans had to wait longer for access to care than those covered by the other insurance programs, they received more appropriate treatment and had better outcomes. As one of its authors Kenneth W. Kizer MD, MPH (and former Under Secretary for Health at the VA) explains, short delays in care, while unacceptable, may not be as important a variable as getting the right kind of care. Which is why, according to Garry Augustine, executive director of the Disabled Veterans of America, most of DAV’s 1.3 million members want delays in care to be fixed and the system to be well-funded because they “prefer to be treated at the VHA where they receive holistic services in one place instead of the kind of disjointed care they get in the private sector.”
And check out Suzanne Gordon's in-depth take on the Veterans Health Administration's strong performance in the face of right-wing attacks from our Fall 2015 issue.
Correction: An earlier version of this story stated that Sanders was a ranking Democrat on the Veterans Affairs Affairs Committee. In fact, he was a ranking independent member who caucused with Democrats.
Despite ideological attacks and under-funding, the Veterans Health Administration is a model public system.Suzanne GordonNovember 2, 2015