Casualties of Care
Another issue of concern to veterans' advocates: over the past several years, government reports reveal a pattern of mismanagement in procurement and oversight of private-sector contracts through Veterans Affairs. "Their effectiveness is questionable," Jon Wooditch, a deputy inspector general for the VA, told a House veterans' affairs subcommittee on oversight and investigations in February 2008. There are numerous examples of contracts gone wrong, including a $248 million contract for Dell computers that was "not necessary or in the best interest of the V.A.," according to a June 2008 report. An April 2006 report shows that a company based in Mundelein, Illinois, sold faulty sterilizing devices to VA hospitals. These devices, which had not been approved by the FDA, may have led to "catastrophic eye injuries" in eighteen patients.
Despite some disastrous results, VA officials have largely set aside concerns about the flaws within the contracting system and have forged ahead with the program's expansion. Poteet, the 59-year-old chief executive officer of Humana Veterans, has long been out of the Army, but he still carries himself like a gunship pilot (he served in Vietnam in 1970 and 1972). "Vets' organizations may believe it's a slippery slope of doing away with the VA," he says of Project HERO. But, he assures, putting his hand on his heart, "this is not about taking over the VA healthcare facility."
One thing is certain, though: the program is big. Thirty percent of all veterans enrolled with the VA are now covered by Project HERO, national program manager Greg Eslinger told WCCO-TV, a Minneapolis station, in February. "There was a good representation of both dense and rural populations, and that was a matter of intent," explains Baker. "Clearly, it's a demonstration project, and if it turned out to be successful, the VA would evaluate that and decide whether to expand it."
Most everybody thinks the Obama administration is on the right track when it comes to veterans' issues. Obama has proposed an 11 percent increase in the agency's budget, raising it to $56 billion, an increase that would allow VA officials to hire 17,000 new employees. Nevertheless, a penchant for privatization could continue to affect the VA in the coming months and years.
On April 1 Hawaii Democrat Daniel Akaka, chair of the Senate Veterans' Affairs Committee, raised his concerns about outsourcing veterans' care during a nomination hearing for two VA secretaries. Akaka said that VA officials had apparently been using a lengthy and time-consuming process to evaluate candidates for the new staff positions "with the focus of potentially contracting these positions out."
Obama, too, seems willing to consider outsourcing veterans' care as a way to save money. He recently floated a plan, apparently recommended by the White House Office of Management and Budget, to bill private health insurers for the care of soldiers and marines who are injured in battle. In a rare display of solidarity, the major veterans' service organizations--ranging from traditional groups like the Veterans of Foreign Wars to new organizations like Iraq and Afghanistan Veterans of America--banded together to push back. In a meeting with Obama in the White House Roosevelt Room shortly after the program was announced, the BVA's Zampieri and others pointed out the various flaws in the program (many insurance companies do not cover airline crashes, for example). "He didn't want to hear if there were moral objections to this," said Zampieri. "He wanted to know how and why it wouldn't work."
Obama quickly abandoned the plan. But the possibility remains that he will heed the advice of budget-conscious advisers who may lose sight of the philosophical reasons the government has promised to care for the people it sends to the front lines--as well as the practical aspects of providing care for veterans.
Zampieri says that downsizing the VA would be a mistake. "If someone comes back and they've lost both legs and an arm, you don't say, 'Here's a Blue Cross and Blue Shield card,'" he tells me. "If they're broke when they come home, you own them for the next eighty years. Maybe it will make people realize there is a cost to war that goes beyond what the Pentagon spends on bullets and bombs."