A Koch-Supported Coup at the VA? The Veterans Health Administration Risks
Being Dismantled
Tuesday, March 20, 2018
By Michael Corcoran, Truthout | Report
Veterans Affairs Secretary David Shulkin testifies before the House
Veterans' Affairs Committee on Capitol Hill on February 15, 2018, in
Washington, DC. Many veterans and organizers suggest that Shulkin is being
pushed out in favor of putting an ideologue in charge willing to privatize
veterans' health care. (Photo: Aaron P. Bernstein/ Getty Images)
The Veterans Health Administration (VHA) has long been the subject of
aggressive privatization efforts. However, veteran organizers say the fate
of the program, drowning in fresh scandals under embattled Veteran Affairs
(VA) Secretary David Shulkin, has never been in more danger than it is now.
The efforts to outsource veterans care are waged by the Koch brothers and
their front group Concerned Veterans for America (CVA), among other
advocates of privatization. The group held a press conference to discuss its
privatization efforts -- which they like to call "choice" -- on Friday in
DC. Should they succeed in their goals, it will have consequences not only
for veterans, but also for the broader movement for a public system like
Medicare for All. The VHA is the only truly public, fully integrated health
system in the US. The attacks against it aim to undermine public support for
government-run care.
In recent weeks, two critical VA Inspector General (IG) reports were
released: one about Shulkin's excess spending during travel, the other about
bad conditions in a VHA hospital in DC. Reports say the scandals could cost
him his job. A Washington Post investigation described Shulkin's efforts to
save his job "amid a mutiny," and relayed a surreal anecdote about the
secretary working with an armed guard outside his door. His own aide was
trying to push him out, according to several media reports.
The VHA is the only truly public, fully integrated health system in the US.
The attacks against it aim to undermine public support for government-run
care.
This chaos and negativity around the VA is in line with the sorts of
circumstances that the Kochs have thrived on in the past, notably when they
"exploited the Veterans Affairs crisis," as a 2014 Nation article observed,
to further attack the "the idea of government-provided healthcare." Many
veterans and organizers say Shulkin's troubles have little to do with
traveling expenses and are more about an effort to push a militant ideologue
in power to privatize the VHA.
"Veterans groups are worried that privatization advocates are using the
[Inspector General reports] to get their way," according to James Clark at
Task and Purpose, a news outlet devoted to veterans issues.
This sentiment was evident from public statements from veterans service
organizations (VSOs) about the possibility of Shulkin being replaced.
"Their goal is to have somebody in place who, a couple days after they are
confirmed, will go about bulldozing VA facilities," said Will Fischer, the
director of government relations at VoteVets, a progressive veterans
organization.
Trump's Ominous Phone Call to Koch Associate
Rumors of threats to Shulkin's job security come amid a flurry of changes in
major positions in the Trump White House, including at the head of the State
Department and the CIA. While initially Trump supported his VA chief
enthusiastically, he recently scolded Shulkin at a meeting, Axios reported
on March 11.
During the meeting he took the unusual step of calling former Koch associate
Peter Hegseth (now a Fox News pundit) to discuss how best to privatize the
agency. Hegseth, former CEO of CVA, was strongly considered for the post
during the transition -- an ominous sign for Shulkin, who is seen as too
moderate by many conservatives in the White House.
"If Trump picks Hegseth, it's going to be war," Paul Rieckhoff, executive
director of Iraq and Afghanistan Veterans of America (IAVA), told The New
York Times during the Trump transition.
These ideological factors, and not merely the ethical issues raised in the
IG report, help explain why right-wing commentators are so loudly calling
for Shulkin's ouster, while VSOs, which largely oppose privatization, are
still mostly supportive of Shulkin, despite his political liabilities.
"We don't want to see someone come in and start over. I think we will see
the VSOs remain supportive of Shulkin," said William Attig, executive
director of the Union Veterans Council, AFL-CIO, in an interview with
Truthout. "There is a lot of money for some to make by farming out services
to the private sector, but what the VHA needs is to be fully funded, not
privatized."
Even if Shulkin manages to keep his job -- he is not likely to go down
without a fight -- he will be in a weakened state at an agency where Trump's
conservative "staffers are advancing health policy at odds with his own,"
according to a ProPublica/Politico report from February, which said war was
"raging between the White House and veterans' groups, with Shulkin caught in
the middle."
It's possible that Shulkin could accelerate privatization efforts to appease
Trump or deflect the news away from his personal scandals. Meanwhile,
whatever becomes of Shulkin, the Koch war on the VHA is clearly reaching a
boiling point.
A Mixed Record on Privatization
Shulkin is not a progressive icon by any means. His appointment, however,
did bring about relief for many veterans and Democrats. He was appointed by
President Obama to be the VA's undersecretary of health, and wrote a book
praising the VHA. During his confirmation hearings for his position under
Trump, where he was unanimously supported, he said the privatization of the
VA "will not happen on my watch." He won the support of key VSOs who "had
fended off far worse candidates."
This is not to say everyone is pleased with his performance. Some argue he
has not followed through on this promise and has been complicit in Trump's
ongoing efforts to privatize the system. "He is an unreliable advocate for
the VA health system," said Suzanne Gordon, author of The Battle for
Veterans Healthcare, in an interview with Truthout. "He sometimes doesn't
call it privatization, but that is what he is doing. He has also been using
the same conservative rhetoric about the VA being broken."
Six months into the Trump administration, Shulkin wrote a USA Today op-ed
that insisted, once again, that he would not privatize the VHA, saying
"nothing could be further from the truth." But in the same article he added
that veterans should get the best care possible, "whether it comes from the
VA or the private sector." Shulkin put forth these contradictory arguments
while lobbying for $2 billion to extend the controversial VA Choice program
for another six months through a variety of cuts and fees that were opposed
by VSOs. Shulkin also suggested farming out the VHA's optometry services
because "there is a LensCrafters in every corner."
None of this has stopped VSOs from standing with Shulkin, if only to avoid
his replacement. As Clark wrote (emphasis in original): "the rallying cry
for Shulkin amounts to: Better the VA chief we know."
Now there is a struggle between the VSOs and conservative power brokers
within the Trump administration. Although the attempted VA "coup" on
Shulkin, to use The Washington Post's phrase, is "popular in the White
House, the effort is viewed skeptically by the American Legion and other
veterans groups that fear it will lead to VA's downsizing."
Louis Celli, national director for veterans affairs for the American Legion
-- the largest VSO in the country -- called the attack on Shulkin a
"salacious conspiracy," and "treason." VoteVets filed a Freedom of
Information (FOIA) request for documents about replacing Shulkin.
Meanwhile conservative lawmakers and media called for Shulkin's ouster. "His
main agenda is to block any real reforms for veterans, which includes
expanding their ability to obtain care from private doctors and hospitals,"
said syndicated columnist Michelle Malkin. "He needs to hear those famous
words from [Trump]: 'You're fired.'"
On February 15, a day after the first IG report was released, The New York
Times reported that critics within the Trump administration wanted to "knock
Shulkin down a peg or two" for "not pushing harder for privatization." Some
conservative/Koch-funded attacks on Shulkin predate not only the IG report,
but the Trump presidency. In 2016, when Shulkin was under secretary for
health at the VA during the Obama presidency, Concerned Vets for America
criticized Shulkin for embarrassing the VA. "The American people were
treated to a show of incompetence and shifting of responsibility by Dr.
David Shulkin," a story on their website said of a congressional hearing.
The Veterans' Health Administration: Myth vs. Reality
Negative press on the Veterans Health Administration is not new. In many
ways it mirrors the US media's treatment of foreign health systems, such as
Canada, which get similar treatment in the national debate. (This is
improving since awareness of single-payer has grown, due in part to the
Bernie Sanders campaign in 2016.)
The popular narrative of the VA as a frightening case study in the horrors
of "socialized medicine" is largely the result of an effective Koch-fueled
messaging campaign. The Kochs make it easy to attack the VHA, amplifying any
bad news they can find from around the country on their front group's
website and on social media using the hashtag #VAFail:
2018 0320mc 2
Often they use this hashtag to push legislation such as the Veterans
Empowerment Act promoted by Rep. Doug Lamborn (R-Colorado), which would
privatize the VHA in major ways.
Rarely, however, do the pundits who mock the VHA compare it to private
insurance using metrics like cost, quality and patient satisfaction. The
VHA, studies show, is superior to private health options, is more cost
efficient and has happier patients. The VHA has, according to numerous
reports, been found to "compare favorably" to our private system: Better
surgical conditions, higher vaccination rates, better outcomes with stroke
treatment and controlling blood pressure are just a few of the areas where
VHA care was superior. This helps us understand why the VHA scores high on
satisfaction surveys among its patients. One Gallup poll from 2015 showed
veterans as the most satisfied group of patients in the country, followed by
Medicaid and Medicare recipients, with private care being last.
In the New England Journal of Medicine, Shulkin himself boasted that the VA
outperforms private industry in "lower risk-adjusted mortality rates, better
patient-safety statistics, and better performance on a number of other
accepted process measures."
It also ranks especially well in mental health services. As a 2016 report
from Psychiatric Services, a peer-reviewed journal of the American
Psychiatric Association, concluded: "We found that the quality of care
provided by the VA to veterans with mental and substance use disorders
consistently exceeded the quality of care provided by the private sector for
the performance indicators examined, sometimes by large margins."
The VHA was recently praised for having a good record with transgender
patients, compared with private insurers. "This is an optimistic and
promising finding for VA and perhaps reflects the recent advances in
transgender health in VA," concluded the Journal for Medical Care in
September 2017.
The VHA, of course, has major flaws. While the Kochs often amplify bad
stories, the VA has made their job too easy with public scandals. There were
serious problems in the aforementioned 2014 incident involving falsified
reports to hide long wait times, which still hamper the agency today. This
was only six years after another high-ranking VA official, according to
Veterans for Common Sense, "cooked the books" on suicide data, to make the
crisis seem less severe.
The VHA compares favorably to private care, but it is still lacking in many
ways. Many veterans with PTSD receive subpar care, in part due to a lack of
mental health staff. The VA estimates that about 20 veterans a day commit
suicide.
Underfunding is a major problem. "Congress left the VA woefully unprepared
for all the problems that took place in two wars in Afghanistan and Iraq,"
Attig said. "My feeling is if you can afford to send people to war, waged
for some questionable reasons, you should be able to afford to take care of
them when they come back."
Private insurance providers, however, have major problems too, including
wait times that are worse than the VHA, according to a September 2017 study
commissioned from the American Legion. "Does anyone doubt that many
Americans have died while waiting for approval from private insurers?" asked
Paul Krugman of The New York Times in 2014.
Indeed, every health system has flaws. If the VHA were sufficiently funded,
and there were more public investment in it, it could improve its care
dramatically. Conservatives, however, have been effective at telling
Americans that the problems are caused by government. The story of the VHA
is one largely being told by its harshest critics.
Socialized Medicine Saves Lives
But there is another story to tell: about the VHA that saves lives. Samuel
Jay Keyser, 82, is a professor emeritus of linguistics and philosophy at
MIT. At 78, he went paralyzed from the chest down and was told by doctors he
would never walk again. After spending months in the Intensive Care Unit,
rehab and various other hospital beds, he was told he would no longer be
able to have his treatment covered.
A nurse heard he served in the Air Force in the 1960s and suggested calling
the VHA, he told Truthout. "This was my introduction to 'socialized
medicine,' and the difference was palpable. I had been through virtually
every part of the US health system, and the VHA was the only place where
money didn't seem like a major priority," he said.
Now Keyser spends time talking about his story, and how the VHA was the only
place that didn't give up on him until he was healthy enough to go home.
"Everyone should be able to experience care like that," he said.
Save the VHA: An Election Issue?
The effort to stop the Koch/Trump attack on the VHA is a subject on which
VSOs, progressive groups and single-payer advocates can find common cause.
While single-payer advocates routinely defend systems in Canada, the United
Kingdom or Taiwan, the VHA is far less frequently noted, though it is the
only socialized health care system in the United States. It could be held as
a model for the benefits of public health care.
VSOs have also taken similar positions as progressives on several
contemporary health care issues. VoteVets has opposed Trump's latest attack
on Medicaid via work requirements, saying Trump "has now officially declared
war on veterans in need." For similar reasons, they were among the many
veterans groups that opposed the Medicaid cuts in Trumpcare bills from 2017.
More than 30 percent of veterans make less than $30,000 annually, Attig
maintains, and depend on these social programs. The VHA covers about 9
million veterans and has strict eligibility requirements that leave many
former service members unable to use the service. "Cuts to Medicaid,
Medicare, unemployment -- they are all cuts to veterans as well," he said.
If the Democrats chose to put a lot of political capital into protecting the
VHA, they could rightly hit Republicans for cutting support for the troops.
This priority could also appeal to single-payer advocates and the 80 percent
of Democratic voters who support a public health system.
"I would like to see candidates put this issue at the center of their
campaigns," Attig said.
So far, however, VSOs have mostly had to fend for themselves, with the media
and the Democrats focused so strongly on other issues. If Democrats aren't
interested in making the preservation of the VHA a priority, advocates say,
organizers and veterans groups will have to continue to pressure them.
"Privatization is a very real issue right now," Verna Jones, executive
director for the American Legion, recently told reporters at the National
Press Club. "This isn't something we can sit idly by and hope that it
doesn't happen."
Copyright, Truthout. May not be reprinted without permission.
Michael Corcoran
Michael Corcoran is a journalist based in Boston. He has written for The
Boston Globe, The Nation, The Christian Science Monitor, Extra!, NACLA
Report on the Americas and other publications. Follow him on Twitter:
@mcorcoran3.
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