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“The Larger Answers Must Come From Within”: The VA Reform Legislation Is A “Trojan Horse” For Privatization

In the aftermath of the Veterans Affairs scandal, Democrats and Republicans are moving swiftly to pass legislation to fix the problems at the department. In their haste, though, policymakers have crafted a bill that would do more harm than goodand it comes with a hefty price tag.

On Tuesday and Wednesday respectively, the House and Senate each passed a bill to reform the VA. The bills, would both create a two-year pilot program to allow veterans who do not live within 40 miles of a VA facility, or face a long wait time, to seek care at a non-VA facility. The Senate bill also includes funding for the VA to lease 26 new facilities and hire more medical staff. Now, the two houses will head to conference over the bills to try to agree on a final version.

The bills have not received much attention this week, but that could change: the Congressional Budget Office reported that allowing certain veterans to seek care at non-VA facilities would cost $35 billion over the two-year program, as The New Republic’s Brian Beutler predicted. If made permanent, CBO estimates it could cost $50 billion a year. For comparison, the VA currently spends $44 billion a year on its health care system. CBO notes that its estimate is preliminary, but it still is much higher than the expected cost. And this is only for the partial privatization part of the bill.

While the potential for a new $50 billion a year program is worrisome, the bill would not even address the underlying problems at the VA.

The fundamental problem with the VA scandal is not about long wait times or a shortage of physicians. Those problems exist in the private sector as well. Often, they are even worse there. It’s also not about quality of care either. Veterans routinely rate their VA experience above average. That advantage may have diminished in recent years, but it still exists. At its heart, the scandal revolves around poor financial incentives and fraudulent behavior by VA employees. These problems are systemic and reforms are needed. But many of the problems veterans face are not isolated to VA hospitals. They are larger problems of the American health care system.

The reason that clinics and hospitalsat both VA and non-VA facilitieshave such long wait-times is a shortage of primary care doctors. This shortage has happened for a number of reasons: Medical students face financial incentives to choose a specialty field instead of becoming a primary care doctor. State occupational licensing laws prevent nurse practitioners from performing many straightforward medical tasks. Medical schools receive billions in federal funding with little oversight for how may primary care doctors they produce. The bills’ partial privatization scheme does nothing to ease these problems.

It’s a common misconception that the VA does not contract with private sector providers. As recently as 2012 the VA was fending off attacks that they outsourced care too much. And veterans who have been waiting for a long time for care, or those who are dealing with life-threatening situations, certainly deserve the ability to seek care at non-VA facilities. In fact, President Barack Obama has already ordered the VA to do so.

Republicans have long wanted to privatize the VA, but have never had the political power to do so, owing to veterans groups’ opposition. This recent scandal, though, has changed that: Veterans groups support the bills. While the partial privatization is only a two-year pilot program, Republicans will likely push to make it permanent in 2016, potentially undermining the entire VA health care system and leading to the total privatization that Republicans covet.

“You’re already in the situation where we’re having to close really excellent VA hospitals for a lack of patients,” Phillip Longman, a senior editor at the Washington Monthly and author of a book on the VA, said. “And now you’re going to say, ‘OK, anybody who lives 40 miles from a hospital can get free health care wherever they want.’ Now, you’re going to take revenue out of those hospitals and patients out of those hospitals. If they can’t maintain a certain volume, they can’t be safe. You wouldn’t want to be treated by a heart surgeon who only performs three operations a year.

“[The partial privatization plan] really is a Trojan horse,” Longman added. “It’s a really dangerous provision.”

Even if the legislation doesn’t cause VA hospitals to close, it could undermine the quality of care the VA provides. The VA is specifically designed to treat veterans and has vast experience doing so. Since most of its medical visits and procedures happen at its own hospitals and clinics, it coordinates care better than private sector providers do.

“The VA can treat the whole patient as opposed to one body part at a time,” Longman writes at the Washington Monthly. “And due to its near lifelong relationship with its patients, which often extends to long-term nursing home care at the end of life, the VA also has incentives for investing in prevention and patient wellness that are largely absent elsewhere in U.S. medicine.”

Beyond that, the legislation includes very little to address the management issues within the VA. That’s not Congress’s fault, per se, because those fixes must come from within the department. But government officials have the chance to use this renewed focus on the VA to improve the care it provides. By passing a bill that does not address the underlying problems, Congress might waste this opportunity.

“The access issue, which is where everyone has focused, is one important, but ultimately narrow slice of the bigger problem,” Ashish K. Jha, a professor of public health at the Harvard School of Public Health and practicing internist at the VA, said. “What I worry about is because it has gotten all the attention, if we work on fixing this we’re not going to use this opportunity to have the broader conversation is that veterans don’t just want access to care, they want access to good care.”

In an article for the New England Journal of Medicine, Jha writes with Dr. Kenneth W. Kizer, the undersecretary for health during the Clinton administration, that the VA must change its performance management, reassess the VA’s use of technology to provide even better caregiver-patient connectivity, and increase its transparency so the public can evaluate its performance. The VA has already eliminated the 14-day average-wait rule that led to the rampant fraud, acknowledging that the incentive backfired, but much work remains.

What happened at VA facilities across the country was a tragedy. Former VA Secretary Eric Shinseki deserved to be fired. So do other senior VA officials. Policymakers naturally want to pass a big piece of legislation in response to the scandal. But like the American health care system, the VA system has no simple solutions. Congress can help on the margins, but the larger answers must come from within.


By: By: Dany Vinik, The New Republic, June 13, 2014

June 15, 2014 Posted by | Veterans, Veterans Administration | , , , , , , , | Leave a comment

“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


May 26, 2014 Posted by | Veterans, Veterans Administration | , , , , , , , | Leave a comment


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