In the Bay Area, public meetings critical of conservatives are not hard to find. But when about 200 San Francisco military veterans jammed into an auditorium in their city’s Veterans War Memorial Building in mid-April, they added diversity to the local “resistance.” Those in attendance—representatives of veterans-service organizations, patients of the Veterans Health Administration, health-policy experts, and local Congresswoman Nancy Pelosi—were trying to educate veterans and the public about proposals that could destroy a single-payer plan for 9 million Americans whose past military service, in combat and noncombat jobs, makes them eligible for VHA coverage.
The threat—faced by VHA users and staff (one-third of whom are veterans themselves)—is privatization. The Trump administration has no trouble boosting an already swollen Pentagon budget. But it favors only a modest increase in VHA funding, most of which would be spent on steering veterans’ care toward non-VHA doctors and hospitals and to for-profit companies for services like audiology and optometry. As part of their ever-expanding outsourcing strategy, Trump’s Republican allies—and even some Democrats—have demonized VHA employees and attacked their workplace rights and union protections. Meanwhile, according to a number of VHA clinicians I have recently spoken with, VHA leadership is making it difficult for facilities to hire needed staff. An in-house electronic medical-records system that’s one of the best in the country is slated to be replaced by one produced by a private vendor. More importantly, Congress is considering legislation that could pave the way for agency dismantling.
Such steps will dramatically increase costs to the US taxpayer—and strike a collateral blow against efforts by labor and the left to defend federally funded medical coverage in any form, whether through the Affordable Care Act (ACA), Medicaid, or Medicare.
The current VHA privatization push first gained traction in 2014, when staff whistle-blowing drew public attention to appointment delays at some overwhelmed VHA facilities, like the Phoenix VA Health Care System. Serious problems existed at the Phoenix VA and other VHA medical centers, where administrators, since fired or disciplined, were caught gaming performance measures that mandated that veterans be seen within 14 days of requesting an appointment (a performance standard many criticize as unrealistic and unattainable). A subsequent inspector general’s report identified “patterns of obstacles to care” in the Phoenix VA Health Care System, including a faulty appointment-making system and limited access to psychotherapy and mental-health services. The inspector general’s report found that 40 VHA patients had died while on treatment wait lists—a number that was widely reported in the mainstream media—but the report went on to say that only six of those deceased patients had experienced “clinically significant delays,” and concluded that it could not “conclusively assert that the absence of timely quality care caused the deaths of these [six] veterans.”