“Content-Free Carping”: From VA To Obamacare To Medicare
At the moment most Republicans are looking at the VA scandal that broke out in Phoenix as a sheer political bonanza without any long-term significance: a federal agency responsible for an especially valued constituency (veterans) has screwed up fatally on Barack Obama’s “watch.” That’s enough to powerfully reinforce a number of important conservative memes about Obama (and indirectly, Democrats): he and his people are incompetent, they don’t have the normal patriotic impulse to take care of veterans, and when held accountable they stonewall and lie.
But a few voices are beginning to figure out how to link the VA mess not only to the overriding issues of Obamacare, but to the “socialized medicine” treatment of Obamacare that would be applied to Medicare, too, if the political climate was right.
Here’s the Cleveland Plan Dealer‘s Kevin O’Brien spelling it all out:
Putting a government bureaucracy in charge of one’s health is a gamble likely to end badly.
And yet, if Obamacare stands, that is precisely the gamble each and every American eventually will take.
There is no better predictor of the course of a single-payer medical system in the United States than the VA system, because it is a single-payer system….
Americans who watch this story play out and fail to make the clear and obvious connection to Obamacare will be guilty of willful ignorance. The systemic flaw is identical. It’s just magnified on a massive scale. Rather than making a false promise to treat all of the ills of a relatively few sick and injured military veterans, Obamacare has put the federal government on the path to taking responsibility for the medical needs — and the attendant costs — of the entire U.S. population.
Like most conservative attacks on “bureaucracy,” O’Brien’s ignores the powerful bureaucracies that operate in the private sector with even less accountability. As TNR’s Jonathan Cohn puts it:
It’s worth remembering that some of the problems veterans are having right now have very little to do with the VA and a whole lot to do with American health care. As Phil Longman, author of Best Care Anywhere, noted in his own congressional testimony last week, long waits for services are actually pretty common in the U.S.—even for people with serious medical conditions—because the demand for services exceeds the supply of physicians. (“It took me two-and-a-half years to find a primary care physician in Northwest Washington who was still taking patients,” he noted.) The difference is that the VA actually set guidelines for waiting times and monitors compliance, however poorly. That doesn’t happen in the private sector. The victims of those waits suffer, too. They just don’t get the same attention.
But nonetheless, the longer the VA scandal stays in the public eye, the more we will hear arguments the VA should be broken up and its services privatized with federal regulations and subsidies replacing federal bureaucracies–creating a system much like the one contemplated by Obamacare, as it happens. But at the same time, we’ll be told Obamacare itself is a failure because it involves the government in guarteeing heath care. And where conservatives speak to each other quietly, it will be understood that Medicare is subject to the same complaints and deserves the same fate.
No wonder most GOP pols confine themselves to content-free carping about Obama being responsible for the VA scandal.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal. May 22, 2014
“Vets To Burr–You Clearly Represent The Worst Of Politics”: Quite Frankly Senator, You Should Be Ashamed
For Republicans, the politics of the VA scandal were pretty straightforward. All GOP officials had to do was express outrage – an emotion that spanned the partisan and ideological spectrum – and demand that the White House improve the system through which veterans receive care.
But Sen. Richard Burr (R-N.C.), the ranking Republican on the Senate Veterans Affairs Committee, apparently couldn’t leave well enough alone.
The conservative Republican, who never served a day in the military, decided it’d be a good idea to start condemning veterans’ groups that had not yet called for VA Secretary Eric Shinseki to resign. In an “open letter,” Burr argued that leading veterans’ organizations are less interested in helping those who served and “more interested in defending the status quo within V.A., protecting their relationships within the agency, and securing their access to the secretary and his inner circle.”
It’s hard to know what Burr was thinking. Perhaps the senator assumed he could pressure the veterans’ groups, bullying them into calling for Gen. Shinseki’s ouster. But if that was the Republican’s strategy, it became clear over the weekend that Burr’s gambit did not go according to plan.
The Veterans of Foreign Wars, the Disabled American Veterans and the Paralyzed Veterans of America hit back hard. […]
The responses were unusually personal. Bill Lawson, the national president of the paralyzed veterans group, and Homer S. Townsend Jr., the executive director, criticized Mr. Burr for supporting the filibuster of the veterans bill in February, and said, “You clearly represent the worst of politics in this country.”
William A. Thien, the commander in chief of the V.F.W., and John E. Hamilton, the adjutant general, pointed to a staff with more than 47 combat deployments in Vietnam, Somalia, Iraq and Afghanistan and four Purple Hearts, 16 Air Medals, Bronze Stars and other honors.
Responding to Burr’s attacks on its motives, the VFW added, “Senator, this is clearly one of the most dishonorable and grossly inappropriate acts that we’ve witnessed in more than forty years of involvement with the veteran community and breaches the standards of the United States Senate. Your allegations are ugly and mean-spirited in every sense of the words and are profoundly wrong, both logically and morally. Quite frankly Senator, you should be ashamed.”
One of the more striking aspects of Burr’s offensive is that it was entirely unprovoked. The Veterans of Foreign Wars, the Disabled American Veterans, and the Paralyzed Veterans of America have expressed ample criticism of the VA scandal, but because they hadn’t called for the resignation from Shinseki – himself a retired four-star general – the North Carolina Republican decided he was justified in publicly questioning their commitment to veterans’ issues.
And Burr did this, for reasons that make sense only to him, on Memorial Day weekend.
Look, I don’t imagine Republican senators are looking for my guidance, but here’s a tip: if you never served a day in the military and you recently filibustered a bill to expand VA health care access, tuition assistance, and job training, maybe you shouldn’t question the motivations of those who’ve devoted their careers to looking out of veterans.
Just throwing that out there.
As for Burr, instead of walking back his shots at the veterans’ groups and recognizing the fact that he went too far, the senator told the New York Times yesterday, “Clearly I hit a nerve. I think they’ve shown more outrage toward my open letter than outrage toward the current crisis at the V.A.”
In other words, the North Carolina Republican has decided he was right all along. We’ll see what happens, but I have a hunch he’s picking a fight against some men and women who don’t back down easily.
By:Steve Benen, The Maddow Blog, May 27, 2014
“If It’s Too Expensive, Don’t Send Them Off To War”: Instead Of Austerity And Slogans, VA Needs Full Funding And Accountability
The troubles at the Veterans Administration are not just a serious issue for veterans. They are a serious issue for every American who believes the federal government can and must meet the basic commitments necessary to maintain a civil society.
Unfortunately, that seriousness is not reflected in the frenzy of fingerpointing that has developed as a response to “the public’s outrage over excessive wait times and rigged recordkeeping at Veterans Affairs hospitals” — an outrage that the president of the American Federation of Government Employees (AFGE), the union that represents caregivers for vets refers to as “more than justified.”
There is no question that the VA has a problem that must be addressed.
The question is whether the politicians in Washington are ready to address it.
The most predictable of the political careerists, Republicans and Democrats, seem to think that firing VA Secretary Eric Shinseki will somehow “fix” things, or that the removal of a few failed managers will suddenly create a functional VA. But that is an absurdly insufficient response.
Depending on what reports regarding the agency reveal, there may well be a place for new leadership and a management shakeup. And those changes might briefly produce a fantasy of action and improvement. But that is all it could be: a fantasy. And a cruel fantasy at that.
Neither the immediate crisis, nor serious issues relating to the long-term future of the VA, will be settled with a mere reorganization of upper management. The real issues are closer to the ground. The VA needs to have enough doctors, nurses and aides to provide the care that is needed – and the doctors, nurses and aides who are now on duty must have the resources and the flexibility to assure that this care is delivered in a timely and responsible manner.
That is not now the case.
“When we look deeper into this issue of extended wait times for veterans to receive an appointment, we have to recognize that understaffing is a major culprit,” explains AFGE president J. David Cox Sr. “All around the country, medical facilities are understaffed, with numerous frontline care positions going unfilled. How can the VA expect to keep up with the growing needs of our nation’s heroes if it doesn’t properly staff its facilities?”
AFGE notes that, “According to the Independent Budget for the Department of Veterans Affairs, developed each year by leading veterans groups, funding levels will remain an estimated $2 billion short in FY 2015 and approximately $500 million short for FY 2016.”
Members of Congress – at least those who pay minimal attention to veterans issues – have for some time been aware of the funding shortfall. Yet, too many of them have resisted calls for action.
The reason is that the current Congress is packed with partisans who are more concerned with maintaining an austerity agenda than with caring for Americans who are in need.
Too many members of Congress continue to prattle on about how government is the problem, about how spending must be cut to meet their imagined bottom lines, about how the resources are not there to keep promises to vulnerable Americans – even if the resources are always there for wars of whim and a military-industrial complex that provides daily evidence of the extremes to which waste, fraud and abuse can be taken.
The current Congress includes a striking number of members who express open antipathy to meeting the guarantees that have been made to all Americans, including veterans. These members of Congress are so unthinking in their approach, so cruel in their budgetary calculus, that they casually, in some cases gleefully, presided over a government shutdown last fall.
Republicans get blamed for advancing the austerity agenda, but it is important to remember that more than a few Democrats have compromised with it. And the difference between those who promote austerity and those who make the compromises that allow for austerity means very little to Americans who are stuck on the waiting lists that are created by budgeting that owes more to Ayn Rand tomes than accounting textbooks.
The VA crisis is a wake-up call.
It is time to get serious. It is time to abandon austerity, and to recognize that core commitments cannot be compromised in order to maintain ideological fantasies.
Senate Veteran Affairs Committee chairman Bernie Sanders, I-Vermont, tried to get ahead of a host of issues concerning veterans in February, when he proposed comprehensive legislation to improve VA health care, education and job-training. Though it was strongly backed by the American Legion, Veterans of Foreign Wars, Disabled American Veterans, Iraq and Afghanistan Veterans of America and other organizations representing vets, the measure was blocked when most Senate Republicans opposed it. To Republicans who suggested the measure was too expensive, Sanders said, “”If you think it’s too expensive (to fund veterans programs), then don’t send them off to war.”
Last week, Sanders announced that he would reintroduce his plan to allocate $21 billion more for veterans initiatives over the coming decade. He is, as well, proposing a new VA accountability measure. The latter legislation removes bureaucratic barriers and makes it easier for the Secretary of Veterans Affairs to make management changes that are necessary to protect those who have served in the military.
The Sanders approach recognizes the need to move beyond the failed responses of America’s austerity-minded politicians while at the same time increasing accountability. It’s a smart long-term fix that eschews the easy sloganeering and empty promises of those who would politicize the VA crisis.
Conscious of the urgency of that crisis, the senator plans to move quickly to get both measures to the Senate floor. “In recent years, as a result of the wars in Iraq and Afghanistan, 1.5 million more veterans have entered the VA health care system,” says Sanders. “Congress must do everything possible to make certain that the VA has the financial resources and administrative accountability to provide the high-quality health care and timely access to care that our veterans earned and deserve.”
By: John Nichols, The Nation, May 25, 2014
“Let’s Not Be Misled”: In VA Scandal, Let’s Have Accountability For All — Including Congress
While Congress eagerly prepares its latest political stunt – a resolution to oust Gen. Eric Shinseki as Veterans Affairs Secretary – members might want to consider their own responsibility for the scandalous inadequacy of veterans’ health care. Unlike most of them, especially on the Republican side, Shinseki opposed the incompetent war plans of the Bush administration that left so many American service men and women grievously wounded. And unlike most of them, especially on the Republican side, Shinseki has done much to reduce the backlog of veterans seeking care, despite the congressional failure to provide sufficient funding.
Anyone paying attention knows by now that those secret waiting lists at VA facilities – which may have led to the premature deaths of scores of injured veterans – are a direct consequence of policy decisions made in the White House years before Barack Obama got there. The misguided invasion of Iraq, carried out with insufficient numbers of troops shielded by insufficient armor, led directly to thousands of new cases of traumatic brain injury, post-traumatic stress disorder (PTSD), and other physical and mental illnesses requiring speedy treatment.
A substantial portion of the estimated three-trillion-dollar price of that war is represented by the cost of decent care for veterans. But even as that war raged on, the Bush administration and Republicans in Congress repeatedly refused to appropriate sufficient funding for VA health care. This financial stinginess toward vets was consistent with Bush’s refusal to take any steps to pay for his expensive war (and to protect his skewed tax cuts instead). As Alec McGillis explained in The New Republic, legislators who voted for war while opposing expansion of the VA are hypocrites, particularly when they claim to care about veterans. So are the Republican governors who claim to care about vets but refuse to expand Medicaid, which would provide coverage for more than 250,000 impoverished veterans.
Breaking down the voting record, year after year, the pattern along party lines is clear: Republicans regularly seek cuts in VA funding and oppose Democratic efforts to increase that funding – a pattern that extends back to the first years of the Iraq and Afghan conflicts and continues to this day. As recently as last February, Senate Republicans filibustered a Democratic bill that would have added $20 billion in VA funding over the next decade, which would have built at least 26 new VA health care facilities. The Republicans killed that bill because Democratic leaders refused to add an amendment on Iran sanctions – designed to scuttle the ongoing nuclear negotiations – and because they just don’t want to spend more money on vets. Senator Bernie Sanders, the Vermont independent who chairs the Veterans Affairs Committee, said the costs of the expansion bill would be covered by savings from the end of troop deployments in Iraq and Afghanistan. But with cruel irony, according to The Washington Post, “Republicans indicated that they prefer to dedicate the savings toward deficit reduction” rather than improved services.
What those who have served should get is the kind of care that has made the VA among the most successful health systems in the world (for those who can access its services). Instead they will get political swaggering, as members of Congress seek to score points against President Obama by attacking Shinseki, and dogmatic opportunism, as right-wing ideologues insist the VA is just another big government program to cut or even abolish. The Republicans who are susceptible to such proposals should be very careful, lest they arouse the anger of the normally conservative American Legion and Veterans of Foreign Wars, whose leaders react with anger and outrage to the idea of privatization. As American Legion commander Dan Dellinger said in congressional testimony last week, his organization overwhelmingly “finds that veterans are extremely satisfied with their health care team and medical providers.”
So let’s not be misled about the VA by Washington’s loudmouths and poseurs – the warmongers who never face up to the price of their enthusiasm in lives and treasure. When politicians demand accountability from their betters, including a war hero like Eric Shinseki, let’s remember that they should be held accountable, too.
By: Joe Conason, Editor in Chief, NationalMemo.com; Featured Post, The National Memo, May 23, 2014
“What The VA Scandal Is Not About”: Conservative’s Desire To Privatize All Health Care
While the media furor over revelations of potentially death-dealing delays in eligibility determinations and care scheduling at the Veterans Administration is leading to all sorts of promiscuous talk by conservatives about the inherent incompetence of government and/or the need to privatize all government health-related services (presumably including the provision of insurance by Medicare), let’s be clear what the scandal is not about, as noted by CBS’ Rebecca Kaplan:
There…doesn’t appear to be a major quality problem among the agency’s doctors and nurses either, even though it appears that not enough veterans can get through the door to see them. Veterans’ advocates who appeared before Congress last week agreed that once veterans get access to care within the VA system, it is high-quality care. The problem is getting access to that care in the first place.
The American Customer Satisfaction Index (ACSI), the nation’s only cross-industry measure of customer satisfaction, ranks VA customer satisfaction among the best in the nation — equal to or better than ratings for private sector hospitals. When asked if they would use a VA medical center the next time they need inpatient or outpatient care, veterans in the 2013 ACSI survey overwhelmingly indicated that they would (96 and 95 percent, respectively).
Backlogs in eligibility determinations would exist whether veterans were being sent to VA hospitals for care, or to private hospitals with a voucher in their hands. And physician shortages and scheduling backlogs are hardly an unfamiliar phenomenon at private health care facilities.
Of course conservatives will try to use the issues at VA to undermine any and all public involvement in health care. But the only way to make absolutely sure veterans aren’t placed at risk by inefficient eligibility or scheduling systems is to deny them care altogether. Replacing public health care bureaucracies with private health care bureaucracies won’t fix the problems, and could make the care itself a lot worse and a lot more expensive.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 23, 2014
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