April 25, 2016
Truthout, April 25, 2016
There are few areas where there is more bipartisan support than the need to provide adequate health care for the country’s veterans. While many of us opposed the war in Iraq and other recent military adventures, we still recognize the need to provide medical services for the people who put their lives at risk.
This is why it is especially annoying to see right-wing groups invent scandals around the Veteran Administration’s (VA) hospitals in order to advance an agenda of privatizing the system. If there was a real reason to believe that the current system is badly hurting our veterans, and that they would be better cared for under a privatized system, then it would be reasonable to support the transition.
But this is the opposite of the reality. All the evidence suggests that a privatized system would make worse any problems veterans now face in getting care — and it is likely to cost more money.
To back up a step, we actually have a great deal of evidence on the quality of care provided by the VA system. In an outstanding book, The Best Care Anywhere, Washington Monthly editor Phillip Longman documents how the VA’s system of integrative care outperforms the models used by private insurers. The key point was that the VA system effectively tracks patients through their various contacts with doctors and other health care professionals.
This reduces the likelihood that they will get unneeded treatment, but more importantly, ensures that the patient’s doctors are aware of the other treatments their patient is receiving. A major problem for patients seeing multiple doctors is that none of them may have full knowledge of the set of conditions afflicting the patient or the drugs they might be taking. By keeping a central system and having a general practitioner assigned to oversee the patient’s care, the VA system minimizes this source of mistakes. In fact, this model is so successful that most providers have tried to move in the same direction in recent years.
Longman was writing about the VA system of the 1990s, which had undergone a remarkable turnaround under the leadership of Kenneth Kizer who President Clinton had appointed to head up the health care system as under secretary of veterans affairs. The quality of care established by Kizer deteriorated somewhat under President Bush. This was partly a result of the large inflow of new veterans associated with the administration’s wars. It was also partly due to the fact that Bush’s political appointees showed the same sort of commitment to veterans’ health as his appointees to the Federal Emergency Management Agency did to preparing for disasters like Hurricane Katrina.
Nonetheless, as Alicia Mundy points out in a recent Washington Monthly piece, the VA system still did quite well by most measures. An analysis done for the VA in 2010 found that nearly all the studies comparing the quality of VA care with its counterparts in the private and public sector found that the VA provided care that was as good or better than what was available in its competitors.
Given this reality, the proponents of privatization had to invent a scandal to push their case, and they got one. They found evidence of substantial waiting lists at the VA hospital in Phoenix. According to accounts promoted in the media, 40 patients died while they were waiting to see a doctor. This of course sounds horrible.
In reality, a report by the VA’s Inspector General found that six, not 40 patients had died while waiting for appointments. And it wasn’t clear that in any of these cases the death was related to lack of treatment. But the reality didn’t matter, the right had their story and they were determined to push it everywhere they could.
The Koch brothers funded a new veterans organization, Concerned Veterans of America, which made attacking the VA health care system the major goal of its work. While full-fledged privatization is clearly a step too far at this point (most veterans really value the health care they get through the VA system), their goal is to piecemeal privatization through a process of gradually outsourcing more and more services.
As this process gains momentum, full-scale privatization may look like less of a lift. The outsourcing is likely to undermine the quality of care, most importantly by making the VA system’s practice of integrative care more difficult. It is also likely to increase costs, since the privatized services will almost invariably cost more than the services provided through the VA.
In short, the practice of outsourcing more services from the VA and eventually privatizing it is likely to be a really bad deal from the standpoint of the country’s veterans. It is also likely to be a bad deal from the standpoint of taxpayers, who will be getting a larger bill for lower quality care. But, it is likely to be a very good deal for the contractors making profits on VA business, and for that reason privatization of the VA is a very real threat.