Veterans’ health care in crosshairs of privatization forces

CHICAGO — “Let the veterans have a say-so in anything that’s going to happen to these hospitals,” said Larry Blake, a Vietnam War veteran outside Chicago’s Jesse Brown VA medical center. Blake, 64, is one of a group of friends who often see each other at the facility. They expressed anger at a privatization proposal that is likely to come before Congress this month. If accepted and implemented, it could drastically change the services on which the vets rely at this medical center.

James Roberts, a U.S. Navy vet, said he sees the proposal as a way to “put money in someone else’s pocket.” He said he wasn’t ashamed to say that he comes to the facility almost daily to participate in groups that help with PTSD and drug addiction issues related to his service. “A lot of people who work here are vets themselves,” said Roberts, adding that privatizing the VA would change that.

Privatizing the Veterans Administration’s massive healthcare system might seem to some to be unthinkable, but a recommendation to start down that path will be presented to Congress this week by a blue ribbon “Commission on Care” dominated by private health care industry executives.

The Commission’s draft report, issued June 8, calls for a process that could lead to gradually shutting down the Veteran’s Administration’s 150 hospitals and 1,400 outpatient facilities, funneling the money now allocated to veterans’ care through private health care companies.

The Commission on Care was formed in 2014 when Congress passed the Veterans Access, Choice and Accountability Act. That year, medical clerks, emergency room doctors and other VA employees in Phoenix brought problem spots in the system to light – long waiting lists and cases of substandard care.

Privatized care “isn’t working”

The revelations opened the door to Congressional action. Congress set up the Commission on Care to recommend ways to improve how the VA provides veteran care. It appropriated $5 billion additional funding to VA that allowed it to improve its response time. Congress also appropriated $10 billion to a three-year “community care” (privatization) experiment called Veterans Choice which was supposed to reduce the waiting list by allowing vets to essentially use vouchers for their care. Two for-profit contractors, Tri West and HealthNet, were hired to administer the program.

“This experiment isn’t working,” said Marilyn Park, legislative representative for the American Federation of Government Employees. “There have been enormous problems for people trying to navigate these new bureaucracies, getting medical records, getting diagnoses — and a lot of people falling through the cracks.” Park reported that for the first time veterans were experiencing the same problems as other Americans dealing with private health care insurers, even being hounded by bill collectors because the providers they used had not been paid by the insurers.

Nevertheless, the Commission is now recommending that the privatization program be expanded. Health care columnist Suzanne Gordon warned in her blog at the American Prospect, “As funding for costly private sector care eats up more of the VHA’s annual budget, there will be hospital and clinic closings, along with VHA staff layoffs.”

“Community-based” — code for privatization

In its 228 pages, the report refrains from using the words “private ” or “privatization.” Instead it repeatedly invokes the terms “community-based delivery models” and “choice.”

The terms “community service provider” and “community choice” may sound welcoming, but according to Dr. Peter Orris, professor at the University of Illinois School of Public Health, the terms are often “a cover for private for-profit health care companies to take over services from public sector institutions, in other words, privatization.”

Conflict of interest

“It’s clear that there was a group in the Commission dead set on privatization,” Sherman Gillums, Jr., executive director of the Paralyzed Veterans of America told Peoples World in a phone interview. Gillums pointed out that the Commission’s charge from Congress was to make recommendations to improve veterans’ care within VA, not move it to the private sector.

“If you shut down the [VA’s]  spinal cord injury center in Cleveland, a center that, by the way, does very well by its patients, where would those veterans have to go? ” Gillums asks. “To the [private] Cleveland Clinic, of course! It screams conflict of interest.”

The central recommendation of the Commission’s draft report is to move veterans away from the current model of comprehensive care which is now delivered at the VA’s hospitals and clinics. This care comes without the involvement of insurance companies. The proposed new model — complex networks of private providers — would actually undermine the current high level of integrated care now offered to veterans, according to Gillums, and would increase costs.

American Legion National Commander Dale Barnett has charged that several Commission members are medical industry executives who stand to gain financially if a privatization proposal goes forward. In fact, the chair and vice chair of the group of 15 Commissioners are, respectively, Nancy Schlichting, CEO of the Henry Ford Health System; and Delos M. (Toby) Cosgrove, M.D., the CEO of Cleveland Clinic. Other commissioners include: a member of the board of trustees of Sunrise, a Nevada for-profit hospital, and a retired officer of Kaiser Permanente health system.

Veterans’ voices ignored

Veterans groups are outraged that while health industry CEOs are represented , veterans themselves have no voice on the commission. Indeed, not even one of the nation’s veterans’ service organizations is represented. “To deny veterans a voice…is an invitation…for continued mistrust between those who served in uniform and the government they swore with their live to defend, ” Barnett said in a press statement on March 24.

Veterans’ groups brought the issue to the attention of their members and the public in a joint statement  April 1, warning of  “decrease(d) access to high quality, comprehensive and truly veteran-centric care for millions of veterans, particularly those who were injured or made ill through their service.”

The signers, who include the executive directors of eight veterans’ service organizations such as the American Legion, VFW and Vietnam Veterans of America vowed to denounce any proposal to privatize the VA health care system, citing “the utter lack of consideration that veterans would want to improve and expand the VA health care system” rather than shut it down.

Real causes of waiting lines — “a scandal of underfunding”

After years of inadequate funding and staffing, the shortcomings at the VA came to light as millions of young veterans were returning home from overseas, explained J. David Cox, national president of the American Federation of Government Employees which represents 113,000 VA workers.

“The lawmakers who sent them there had failed to adequately plan for their return and complex needs,” Cox wrote in the Huffington Post April 28. In 2009 alone, 1.4 million new patients entered the system.

Adding to VA’s responsibilities, in 2010, the VA recognized that for Vietnam war veterans, Parkinson’s disease and some kinds of heart disease and leukemia could be linked to their exposure to Agent Orange. Almost immediately, a wave of Vietnam vets whose previous claims had been denied flooded the VA system. At the same time, thousands of new vets were coming home from Iraq and Afghanistan, joining Gulf war vets with horrific injuries, toxin exposure, and PTSD cases.

It was this tidal wave of strain on the VA resources alongside refusal of Congress to provide adequate funding, that underlay the long waiting lines for appointments that was portrayed in the media as a scandal of poor administration. It was really a scandal of underfunding, according to Cox. “The waitlist and understaffing issues are one and the same. Until Congress gives the VA the resources to hire enough frontline clinicians to meet demand, our veterans will continue to face long waits, ” he wrote in 2014. Congress ultimately granted $5 billion in additional funding, allowing for 43,000 new staff positions and 4 million square feet of additional clinic space.

By 2015, 97 percent of veteran’s appointments were fulfilled within 30 days according to a report from U.S. Secretary of Veterans Affairs Robert McDonald.

Veterans interviewed at Chicago’s Brown clinic had noticed the improvement. Keith Maltz, 63, who served in the Navy in the 70s, acknowledged that there had been problems a few years ago. “They’re fixing it up well,” said Maltz, seated on a bench in front of the giant medical complex with his daughter Michelle Faulkner. “It’s so much better.” Faulkner, 40 who was accompanying her dad to his appointment added, “Privatizing might just make the problems again.”

Koch Brothers lobby group calls itself a voice for veterans

A People’s World reporter combing the halls and entryways of the Brown Center in Chicago was unable to find even one vet who supported privatization. However, privatization is the only agenda for Concerned Veterans, a nonprofit organization that is represented on the Commission. Paralyzed Veterans of America, in an unusually strong statement, labels CV4A as a “lobby group masquerading as a voice for veterans.”

“Concerned Veterans” cannot call itself a “veterans service organization” like VFW or American Legion. It does not offer actual services to veterans, according to Ryan who answered the phone at the group’s inside-the-Beltway office in Arlington, Va. Ryan declined to give his last name. “What we do is advocate for better veteran policy on the Hill,” he explained.

According to its mission statement, Concerned Veterans “advocates for policies that will preserve the freedom and prosperity that we and our families so proudly fought and sacrificed to defend.”  However, the legislative goals promoted on Concerned Veterans’ website call for privatizing and dismantling VA health care, not freedom and prosperity. In the name of decreasing the budget deficit, Concerned Veterans also lobbies for tightening restrictions on veteran access to VA benefits and other “cost-cutting” measures. “They have these people out there saying, ‘We’re giving VA too much.’  … their whole purpose is to give support to anyone who wants to cut government, particularly for veterans,” Joseph Violante, national legislative director for Disabled American Veterans told Stars and Stripes columnist Tom Philpott.

The principal officer of Concerned Veterans is listed on its tax filings as Wayne Gable, who is also managing director of Federal Affairs at Koch Industries according to The commissioner representing Concerned Veterans, Darin Selnick, was appointed to the Commission on Care by former Republican Speaker of the House John Boehner.

More code: “Dollars follow patients”

This spring, a minority faction of the Commission on Care met in secret and unilaterally expanded the Commission’s mandate, preparing a 20-year comprehensive plan to dismantle the VA.  The faction proposed a process whereby more and more patients are moved into private care networks. The faction envisioned VA becoming primarily a “payor” of “community service providers” and no longer providing any veteran healthcare.

“I don’t understand how commissioners paid by the federal government are able to …create an unapproved report, advance self-serving agendas while operating as congressional appointees,” said American Legion Commander Barnett in a March 24 press statement.

The faction was led by David Blom, CEO of Ohio HealthCare and also included Selnick, the Concerned Veterans lobbyist. The faction’s report was built around a concept they termed “the dollars follow the patients,” which Gillum said is just a euphemism for vouchers. “We’re looking at people who are going to divert resources from construction of new hospitals and expanding long term care and use them to go to private insurance companies,” said Gillum.

“If it ain’t broke, don’t fix it”

The veterans’ groups March statement opposing privatization cited an independent assessment that concluded that “VA performed significantly better on almost all 16 outpatient measures when compared with commercial, Medicare and Medicaid HMO’s.” Veterans consistently rate VA health care higher than private-sector health care.

In a poll last year conducted for Vet Voice Foundation, a non-partisan group focused on increasing veteran civic participation, strong majorities of veterans from every age group, branch of service and both Republican and Democrat approved of the services VA hospitals were providing for them and strongly opposed privatizing the VA hospitals. Eighty percent did not want private vouchers to replace fully-covered health care.  “What is most unsettling … is the utter lack of consideration that veterans would want to improve and expand the VA health care system,” said the veteran service organizations’ letter.

VA treats veterans holistically, mind and body, says AFGE’s Pres. Cox, who himself served for years as a nurse at VA. He cited volumes of evidence that VA provides better service than private care. For example, he pointed out, from 2000 to 2010, rates of veteran suicide increased by 40 percent in those who did not use the VA, while suicide rates decreased by 20 percent over the same period in VA patients. VHA primary care providers, who are salaried, spend at least 30 minutes with their patients per visit compared to the ten or 15 minutes allotted to patients in the private sector.

“If it ain’t broke don’t fix it,” said veteran Roberts, “We’ve come a long way.”

Besides the Veterans who are treated at VA the privatization proposal could also have a devastating impact on the 113,000 veterans who work in the VA, who make up one third of its workforce. The VA’s work force is made up of 59 percent women and 40 percent minorities, according to Cheston McGuire, a spokesperson for AFGE.

Asked for his opinion on whether to go forward with vouchers for private care, Maltz was blunt: “I can tell they’re trying to address their problems at the VA. Leave them alone. I don’t think they need a corporate boss here.”

Photo: Navy veteran James Roberts.  |  video snapshot


Roberta Wood
Roberta Wood

Roberta Wood is a retired member of the International Brotherhood of Electrical Workers and the Coalition of Labor Union Women. Wood was a steelworker in South Chicago, an officer of Steelworkers Local 65, and founding co-chair of the USWA District 31 Women's Caucus. She was previously Secretary-Treasurer of the Communist Party. Currently, she serves as a Senior Editor of People's World.