In most cases, the Department of Veterans Affairs gets things right. Across the entire Veterans Health Administration, 66.7%, exactly two-thirds, of patients would recommend their medical center to someone else. The VA does some things—like prosthetics and care for PTSD and traumatic brain injury—better than anyone else. But when it fails, it fails spectacularly. That is unacceptable.
The gap between great and unacceptable care was back in the news this week.
Where I come from, AOC stands for Army Operations Center. But say that acronym to the wider public, and you’re talking about Alexandria Ocasio-Cortez, the firebrand Democratic Socialist congresswoman from New York City.
AOC and her Democratic Socialist comrades know how to get the media’s attention, to the point that House Majority Leader Steny Hoyer reminded the audience at the American Israel Public Affairs Committee convention that there are 62 Democratic freshmen representatives, “not three.”
Her latest media attention grabber has been to be the VA’s champion. In her quest to trade free enterprise for government programs, AOC has decided that the VA provides “first-class” care. She told her constituents, “If it ain’t broke, don’t fix it.”
I managed to control my laughter long enough to write this column.
Who are they trying to fix it for?
Speaking at a recent event in her district, the congresswoman took aim at the VA MISSION Act, passed last year. The law establishes a permanent community care program for veterans who lack easy access to a VA medical center, or who cannot get the care they need at their local VA medical center. It ensures that veterans can get convenient care for their service-connected health issues, when they need it, regardless of who provides it.
That’s not “privatization,” it’s giving veterans the flexibility to get care that’s convenient for them, not for the government. It’s such a popular idea that it enjoyed rare, overwhelming bipartisan support. It passed the Senate 92-5, and the House by 347-70.
But to AOC, any care not provided by the government is somehow a handout to the healthcare industry. In her remarks, she said, mockingly, “it is radical to believe that caring for our veterans should not be for sale in America.” I don’t want to be accused of taking her words out of context, so here is an extended quote from a video you can see here.
That is the opening and the approach that we’ve seen when it comes to privatization, is the idea that this thing that isn’t broken, this thing that provides the highest quality care for our veterans somehow needs to be fixed, optimized, tinkered with, until you can’t even recognize it.
And here’s the thing: they are trying to fix it. But “who are they trying to fix it for?” is the question we gotta ask. This is who they’re trying to fix the VA for: they’re trying to fix the VA for pharmaceutical companies; they’re trying to fix the VA for insurance corporations; they’re trying to fix the VA for a for-profit healthcare industry that does not put people or veterans first. And so we have a responsibility to protect it. Because if it is any community that deserves Cadillac, first-class healthcare in the United States, it is our military service members and veterans. Period.
As the veteran of a long military career, a VA customer, and the friend of countless other veterans, While many don’t have a major complaint, I can honestly say that I do not know one person who thinks the care they receive from the VA is “Cadillac.”
the one thing we can agree on
Americans agree with me. In early 2017, the Pew Research Center surveyed Americans on their attitude towards government agencies. Of the ten agencies mentioned, the one with the highest “unfavorable” rating, at 34%, was the Department of Veterans Affairs. Even the IRS had a better reputation. The 2017 number was only a five-point improvement from Pew’s 2015 survey, when 39% had an unfavorable view of the department.
The department has earned that negativity. Despite a Fiscal Year 2019 budget of more than $201 billion and having more than 342,500 employees, the VA has failed to deliver the quality healthcare that veterans deserve. One telling statistic: despite that nationwide 66.7% recommendation rate, the VA’s Office of the Inspector General found that less than half—49.5%, to be precise—of patients would recommend the Washington, D.C. VA Medical Center, the supposed jewel in the crown of the entire system, to others.
The truth is that the nation has never done a particularly good job at caring for those who bear the scars of battle. In its infancy, the U.S. very nearly fell prey to a military coup when the Continental Congress could not pay its soldiers. Only George Washington’s personal charisma saved the day. In 1932, amidst the Great Depression, a so-called “Bonus Army” of World War I veterans marched on Washington to demand their promised bonuses early. The treatment of Vietnam veterans is well documented; the nation’s collective guilt over that episode largely drives the current “thank you for your service” attitude.
A lousy deal for the healthcare industry
Wanting to give veterans the best healthcare possible is now almost universal. It’s practically the only thing we can all agree on. But the hard reality is that the Federal government is not good at most things, and running a hospital system is at the top of the list. When a country has the best healthcare providers in the world working at civilian hospitals and clinics everywhere, why would anyone want to insist on the government providing the care?
Especially given the fact that the government’s reimbursement rate is lousy. If the VA is paying local caregivers like other Federal programs do, there is no incentive, other than propriety, for the private sector to help. Medicare, and the military’s health insurance TRICARE, reimburse providers at the same rate. That rate is not particularly attractive to providers. Specifically, a 2018 report from the Congressional Budget Office found that Medicare pays doctors less than Medicare across the board, by as much as 50 percent for some services. My own civilian doctor stopped accepting TRICARE years ago, and many doctors across the country will not accept new Medicare or Medicaid patients, because they simply can’t afford to do so.
That isn’t exactly fixing a system for the benefit of a for-profit healthcare industry. Rather than take a knee-jerk reaction to the problems the VA faces, I’d invite AOC to come with me to the Washington VAMC, where she can see the dysfunction for herself. It’s simple things that contribute to failure. Things like a backlog of paper records dating back to 2014 measuring 1,550 inches—more than 129 feet—that had not yet been scanned into electronic records, making them unavailable to doctors.
We all agree that veterans with illness and disability resulting from their service deserve the best care. We need to agree that means getting it where they can, not where they must.