Speaking to nurses, veterans, and other constituents inside the auditorium of Public School 83 in the Bronx on Wednesday, Representative Alexandria Ocasio-Cortez (D-NY) recalled an adage that she said applied to the Department of Veterans Affairs: “If it ain’t broke, don’t fix it.”
Since the spring of 2014, after administrators at a Phoenix veterans’ hospital were found to have been tampering with wait-time data, conservative lawmakers and Koch-backed forces have argued that the agency needed “fixing.” They portrayed the VA as consumed by corruption, unable to deliver adequate care, and nearly broken beyond repair.
The Phoenix scandal did reveal serious capacity issues and administrative wrongdoing, but it was not indicative of endemic issues. Numerous nonpartisan studies have ranked VA health care as generally superior to the private sector’s, and the vast majority of veterans trust the VA to treat their ailments. In January, the Journal of the American Medical Association found that VA patients generally face shorter wait times for care than civilians in the private sector.
Unfortunately, few on the left have crafted a coherent argument in defense of the agency, thereby allowing and, in some cases, abetting a slew of privatizing measures. In response to Phoenix, a bipartisan crew in Congress passed a hastily drafted law called the Choice Act, which outsourced millions of veterans appointments to the private sector and, ironically, resulted in longer wait times for veterans.
Despite the high cost and myriad problems with Choice, the law’s privatizing principles were made permanent two weeks before Ocasio-Cortez won her upset primary victory. On June 6, 2018, President Donald Trump signed the VA Mission Act, a law that could outsource millions more appointments to private-sector providers. Mission was supported by virtually every Democrat in Congress. Just two Democratic senators, Oregon’s Jeff Merkley and Hawaii’s Brian Schatz, joined Senator Bernie Sanders (I-VT) in voting no.
On Wednesday, Ocasio-Cortez broke from party orthodoxy. She offered a full-throated defense of the agency and made clear whom lawmakers are really serving with the new legislation: “They are trying to fix the VA for pharmaceutical companies, they are trying to fix the VA for insurance corporations and, ultimately, they are trying to fix the VA for a for-profit health-care industry that does not put people or veterans first.”
“If we really want to fix the VA so badly, let’s start hiring, and fill up some of those 49,000 [staff] vacancies,” Ocasio-Cortez continued, as nurses in scarlet scrubs and veterans roared back in agreement.
Ocasio-Cortez highlighted much of the good done by the VA, from the agency’s comprehensive screening process for war-related maladies to its holistic and coordinated approach to treatment. She protested an agency policy that severely restricts access to care for veterans with other than honorable discharges, noting that these military expulsions are often related to “a mental-health issue you generated on the job.”
She said that should Medicare for All be passed, the VA would most likely remain unchanged. While many champions of universal health-care coverage are fighting to essentially abolish private health insurance while retaining the private-hospital system, AOC said in an ideal world, the civilian health system would mirror what’s currently offered to veterans. “If you ask me, I would like VA for all,” she said to cheers.
Ocasio-Cortez’s district, NY-14, is home to one of the largest concentration of veterans in New York City. Also in her district is the Bronx VA hospital, a highly regarded institution that has been home to a number of innovative medical minds over the years, including Rosalyn Sussman Yalow, a pioneering diabetes researcher who, in 1977, became the first American-born woman to receive a Nobel Prize in medicine.
“The VA helps more than veterans, it helps all of us through research, it’s the biggest research army in the country,” said Suzanne Gordon, a longtime health-care journalist and patient advocate, in remarks at PS 83. “It teaches 70 percent of our doctors, 40 percent of our nurses and other health-care professionals. The health-care system in this country would be devastated if we didn’t have the VA.”
Before the town-hall event began, Ocasio-Cortez met with members of National Nurses United, which represents 11,000 nurses at 23 VA hospitals across the country. Veterans advocates from a number of organizations—the American Legion, Vietnam Veterans of America, Veterans for Peace—were also in attendance. While most of the major veterans’ service organizations reluctantly supported the Mission Act, in large part because of the expansion of caregiver benefits it offered, some are now building opposition to its planned implementation date of June 6, which, coincidentally, is the 75th anniversary of D-Day and the Battle of Normandy.
In a recent congressional hearing, veterans’ advocates expressed concern that the private sector would deliver subpar care and alarm over signs that the agency’s IT systems for coordinating outside care won’t be set up by the due date. In the hearing, Adrian Atizado, a staffer for Disabled American Veterans, said the VA “seems unlikely to meet the June 6 deadline set by law without sacrificing quality and endangering veterans’ health outcomes.”
Separately, the nursing union is planning agitation in front of VA hospitals across the country, and legislative staffers are working to build support in Congress for legislation to defang the Mission Act. There’s also chatter from inside veterans’ groups and the nursing union of a potential lawsuit to block or delay the law’s implementation.
Josue Feliciano, a registered nurse who attended Wednesday’s event, said he works each day to deliver a quality of health care unimaginable to the civilian population. He noted that every veteran patient is assigned a Patient-Aligned Care Team, or PACT, consisting of a primary-care provider, a care manager, a registered nurse, a social worker, a pharmacist, and a nutritionist.
“You don’t see that outside the VA,” he said. “My patients love it. They know they have a team who will help them.” Under Choice outsourcing, Feliciano has already seen the problems with ensuring this continuity of care for veterans who take appointments in the private sector.
“When the patient goes outside the VA, the biggest problem is fragmentation of care and a potential pitfall is safety,” he said. “And if there’s a failure in care outside the VA, we are going to get blamed. It’s going to fall on us.”