In his new book, former Veterans Affairs secretary Dr. David Shulkin details the Trump administration’s sustained attacks on the Department of Veterans Affair, many of which were led by what he dubs “subversive staff” and calculating outside allies, including the “Mar-a-Lago crowd” and the Koch-backed advocacy group Concerned Veterans for America.
Shulkin also recalls an unlikely actor who seemed to borrow right-wing talking points to criticize the department: Elizabeth Warren. A veteran died quietly in the wee hours of the morning in hospice care at the Bedford VA hospital. The patient’s family had declined further treatment at a non-VA hospital, but a VA nurse had missed an hourly check-in with him. The press went wild.
In response, Warren visited the facility, escorted by Shulkin, who recalled that veterans and their families “uniformly raved about the quality of care” at the hospital. Shukin writes that Warren was “calm and understanding and seemed generally impressed by the quality of care she witnessed.”
“As soon as she got in front of the cameras, though, she went on the attack, saying how badly we need to fix the VA,” he added. In a statement on the matter, Warren said she was “sick and tired of seeing horrifying reports about the mistreatment of veterans and employee misconduct at a VA facility in Massachusetts.”
The VA does have problems due to underfunding and understaffing, which have been dramatically exploited by right-wing forces like Concerned Veterans for America. But voluminous research rates VA care as equal to and, on many metrics, better than care in the private sector. Warren, like many Democrats, seemed to fall prey to the narrative and rhetoric largely promulgated on the right that maintains the VA is failing and that its employees are corrupt, callous, and uncaring.
All other contenders for the Democratic presidential nomination have shared problematic views on the VA at one point or another, save one—Bernie Sanders, who, in 2016, was also the most popular candidate among active-duty troops.
Although some Democrats finally seem to be waking up to how significantly the right wing has chipped away at VA services, they are still, by and large, pursuing this constituency in terms defined by the right.
The Republican’s VA agenda has always been clear: Tarnish the reputation of the department, use that reputation to gut the budget, and then argue that the only way to fix the system they’ve so depleted of resources is to privatize it. Pointing to the VA as a poster child for the failure of government and the virtues of the free market, ideological and corporate health care interests have recently begun rallying veterans to fight Medicare for All.
These same interests have also helped shape laws further undermining the department, including the VA Accountability and Whistleblower Protection Act, which gutted due process and other union rights for employees, and the VA MISSION Act, which sets the stage for the total privatization of the department.
With the exception of Sanders, all of the lawmakers now running for president voted for these policies. (Representative Tulsi Gabbard voted in favor of the Accountability Act, but was absent for the MISSION vote.)
More than this, Democrats have failed to staunchly defend the VA or help veterans and the broader public understand why it’s a model for providing integrated, high-quality, and cost-effective health care. Such arguments could help assuage broader concerns over socialized medicine and shore up support for the department for decades.
Warren is hardly an isolated example of this in the Democratic Party. At a California Democratic Party event earlier this year, Gabbard told a veterans caucus that the VA is “a bureaucracy that still serves the bureaucracy rather than putting veterans first.”
In 2014, Senator Cory Booker contributed language to the 2014 Veterans Access, Choice, and Accountability Act, which allowed veterans to seek government funding for private health care.
Although he’s no longer in the race, Massachusetts Representative and Marine Corps veteran Seth Moulton has contended that he’s seen the “good, bad, and the ugly of the VA.” He cites a time when a VA pharmacist gave him a less powerful painkiller than the one prescribed. Moulton also voted for the VA Accountability Act and the VA MISSION Act and worked with a Republican representative on a bill, later withdrawn from consideration, that would have privatized VA mental health care.
On Veterans Day, the top contenders for the Democratic presidential nomination, including Joe Biden, Warren, Sanders, and Pete Buttigieg, dropped detailed veteran policy plans. Many include laudable goals but parrot right-wing rhetoric. Biden, for instance, slams the department’s “poor organizational performance,” while Buttigieg calls for “blending the best of private-sector innovation with the unique assets of the VA’s broad reach and resources.”
What these proclamations leave out is the broad failures of private-sector health care. They also ignore the data showing that private-sector hospitals and doctors fail miserably to coordinate with their non-VA counterparts and evince scant knowledge or interest in veteran-specific health care problems. These pronouncements also ignore the fact that the quality of VA care is actually improving.
Warren and Sanders have the two most progressive policy prescriptions, yet they diverge on the key issue of VA outsourcing.
Warren’s plan aims to help service members, military families, and veterans by addressing veteran suicide and homelessness and extending benefits to those with less-than-honorable discharges, and she opposes efforts “to privatize large chunks of VA service.” She calls for “reining in our bloated defense budget and reducing the influence of defense contractors at the Pentagon.” But the Massachusetts senator also voted for the VA MISSION Act, which is set to funnel billions into the pockets of contractors and private-sector health care industry profiteers. (Biden and Buttigieg have also expressed support of MISSION.)
Among the contractors who began administering VA privatization measures in 2014, which included organizing health appointments for veterans seeking care in the private sector, were TriWest Healthcare Alliance, Health Net, and Optum. In their previous VA work, TriWest and Health Net demonstrated gross incompetence and, in the case of TriWest, potential criminality. Yet TriWest and Optum are third-party administrators of the VA MISSION Act’s private-sector care program, which went live in June 2019.
Warren, Biden, and Buttigieg are also silent on perhaps the most pernicious section of the law, which establishes an Asset and Infrastructure Review Commission, a task force that could—with little or no congressional input—force the closure of VA facilities around the country. Even West Virginia’s conservative Democratic Senator Joe Manchin, another early MISSION supporter, now believes this section of the MISSION Act “threatens the longevity of rural VA hospitals across the country.” Manchin has introduced much-needed bipartisan legislation to repeal that section of the act. This bizarrely puts Warren to the right of Manchin on the VA.
Warren is now a cosponsor of the Improve Well-Being for Veterans Act, which, under the guise of reducing the veteran suicide rate, will further accelerate VA privatization and channel millions to private programs that provide care of dubious value. She is the only member of Congress currently running for president who cosponsored the bill. Because of this threat, the Democratic chairman of the House VA Committee, Mark Takano, has proposed alternative legislation that would not outsource veteran mental health care to the private sector. Takano’s bill was recently passed by the House Veterans Affairs Committee.
Buttigieg, who is a veteran, has also taken on the issue of veteran health care and suicide in his plan for veterans and active-duty service members. But his plan is centered around the assumption that the VA is not “keeping a promise” to veterans. While the Republican Congress has indeed failed to do just that, while blaming the VA for the inevitable results, much of what Buttigieg proposes—improve telehealth services and mental health outreach, creation of better services for women veterans—is already being undertaken by the VA.
Supporting flawed Trump policies and repeating right-wing talking points as many Democrats do is not the way to win the veteran vote, nor the way to provide care for veterans. Pushing for increased funding and fighting privatization measures, including the MISSION Act, as Sanders has done throughout his career and when he served as chairman of the Senate Veterans Affairs Committee, is the way to strengthen the VA.
On Veterans Day, the Vermont senator released his own comprehensive slate of proposals, which stands in stark contrast to the rest of the Democratic field.
While acknowledging its problems, Sanders demands an end to the “attacks on the good people who go to work every day to serve our veterans,” accurately stating that a majority of veterans “want more care through the VA, not less.”
Sanders pledges to offer more comprehensive services and invest $62 billion in modernizing the department’s infrastructure; he vows to expand home health care options for veterans, end student veteran debt, and make medical marijuana available at VA hospitals; and he adds hearing loss and musculoskeletal injuries to the VA’s list of service-connected disabilities. He goes further than Warren in caring for veterans unfairly discharged from the military, pledging to support presidential pardons for veterans with “bad paper” discharges.
If the Democratic presidential candidates don’t directly counter the right-wing narrative that the VA is fundamentally broken and then mobilize veterans to speak out to increase funding and support the model for what has been our most successful example of government health care, Democrats run the risk of losing this crucial constituency in 2020. They also risk losing battles for broader health care reform. And, of course, failures to address creeping privatization will lead to lower-quality care to veterans, more veteran suicides, and, if costs for private-sector care escalate dramatically, facility closures that threaten access to care, particularly in rural areas.