The way John McCain tells it, the injuries he suffered at the hands of his captors in Vietnam would have ended his career as a Navy pilot were it not for the help of physical therapist Diane Rauch. And that's basically true: after months of painful treatment, he was well enough to pass his medical screening. But that leaves out an interesting part of the story. In his biography of McCain, Robert Timberg details the treatment McCain received at two naval hospitals. Navy doctors in Maryland were, in fact, McCain's first physical therapists, but they offered a bleak prognosis. Fortunately for McCain, the story of his imprisonment and torture was so widely known that strangers from across the country offered assistance. One of those strangers was Rauch, who provided her services at no charge.
As a vignette, it's charming--a POW, just released from a long and brutal stretch in captivity, finally stumbling upon some good fortune. But it's hardly a working model for veterans' health services. Most vets, after all, need government-provided treatment for the rest of their lives--first, like McCain, at military hospitals and then, unlike McCain, at VA facilities.
Thirty-five years after McCain's return to the United States, the Veterans Health Administration has undergone a sea change. Once a national embarrassment, it is now among the highest-functioning public bureaucracies. In fact, it's the best health system, public or private, in the country. (Military hospitals are a different story altogether, managed not by the Veterans Administration but by the armed services. To many, the words "military hospital" evoke images of the Soviet-style decay uncovered by journalists at Walter Reed Army Medical Center.)
Times have changed since McCain needed veterans services so urgently. And for many of those thirty-five years, McCain, the presumptive GOP presidential nominee, the candidate who talks the best talk on veterans issues, has demonstrated a tendency to work against veterans' interests, voting time after time against funding and in favor of privatizing services--in other words, of rolling back the VA's improvements by supporting some of the same policies that wrecked Walter Reed.
During a March 2005 Senate budget debate, McCain voted to kill an amendment that would have "increase[d] veterans medical care by $2.8 billion in 2006." That amendment lacked an assured funding stream, but lest one mistake this incident for a maverick's stance against budget-busting, there's more. Just a year later McCain voted against an amendment that would have "increase[d] Veterans medical services funding by $1.5 billion in FY 2007 to be paid for by closing corporate tax loopholes." Two days after it failed, he voted to kill "an assured stream of funding for veterans' health care that [would] take into account the annual changes in the veterans' population and inflation to be paid for by restoring the pre-2001 top rate for income over $1 million, closing corporate tax loopholes and delaying tax cuts for the wealthy." That amendment died quietly, forty-six to fifty-four.
In September 2006 McCain voted to table an amendment to a Defense appropriations bill that would have prevented the department from contracting out support services at Walter Reed. The amendment was indeed tabled--by a vote of fifty to forty-eight, the sort of margin a true veterans' senator might have been able to flip if he really cared about veterans' healthcare.
"John McCain voted against veterans in 2004, '05, '06 and '07," says Jeffrey David Cox, who spent twenty-two years as a VA nurse before moving to the American Federation of Government Employees, where he serves as secretary-treasurer (AFGE represents employees of several federal agencies, including the VA). Cox is right. Under Bush, McCain has voted for measures that target so-called Priority-7 and Priority-8 veterans (those whose injuries are not service-related and whose incomes are above a low minimum threshold) for annual fees, higher co-pays and even suspended enrollment. Priority-7 veterans without dependents earn more than $24,644 annually. Priority-8 veterans without dependents earn an annual minimum of $27,790.
Cox and AFGE are also concerned about McCain's pet plan to issue all veterans a "plastic card," which they could take "to the doctor or the provider of their choice and...get the treatment they need."
"We should give them freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location," McCain has said. AFGE sees it as a backdoor attempt to undermine, or even destroy, the VA. According to Phillip Longman, a senior fellow at the New America Foundation and an expert on the VA, such ideas aren't always inappropriate (disclosure: in 2006 I worked at NAF, where I provided research assistance to Longman and others). Private services, he says, can in some cases be essential to veterans in underserved communities. "But his idea shows just how uninformed [McCain] is about veterans and the VA. Veterans who are already in the system don't want to get out," Longman says. "Every veteran who moves from the VA system into the private system will find it more dangerous and more costly." And there are additional concerns. AFGE points to incidents like the ones in Hayward and Rice Lake, Wisconsin. Last summer veterans facilities in those cities outsourced the operation of their clinics to a private firm, Corporate Health & Wellness. Within a few months the company, citing major financial losses, jumped ship, leaving veterans in search of care locked out for weeks.
Cox adds that the privatization of other, nontreatment services--laundry and janitorial, for instance--aren't without costs of their own. Approximately 80 percent of VA jobs--and therefore an enormous percentage of the jobs that are outsourced to private firms--are (or were) held by veterans themselves.
These are the natural consequences of policies McCain and the Republican Party have supported. Despite the recent onslaught from the right, though, and despite the many incidents in which GOP cronyism has resulted in veterans' suffering, the VA is still providing the best care in the country. "It's endured seven years of hostile treatment from the Bush Administration, and it's still standing...it's still a bright star," says Longman. "I think the VA could probably withstand a McCain administration." But could it? If recent trends continue--outsourcing in particular--they could eventually erode the elements most crucial to the VA's success, and at the deadly expense of its quality of care. In November the Department of Veterans Affairs announced it would begin using the Cerner Corporation's proprietary laboratory information system "in more than 150 hospitals and 800 clinics in the Veterans Health Administration system" for the next nine years, ousting an open-source information system that was developed by VA programmers years ago. That system, VistA, has outperformed every comparable privately developed system on the market. It helped transform the VA from the country's most scandal-ridden health provider into its finest, and has become the envy of treatment facilities around the world.
In other words, VistA is critical to the VA's ability to provide quality care. In bringing an outsourcing culture into the VA, Longman says, Bush appointees are "destroying the open-source culture that turned the VA into what it is." Based on McCain's record, there's little reason to believe that as President he would stanch that bleeding. And that could portend a disaster for veterans--one that makes the problems McCain and the GOP have already created pale in comparison.