By Lambert Strether of Corrente.
With the release of new proposed eligibility rules under the VA Mission Act, we see that privatization at the Veterans Administration (VA) continues to unfold, as outlined in the neoliberal playbook, to which we have alluded before:
The stories intertwine because they look like they’re part of the neoliberal privatization playbook, here described in a post about America’s universities:
It’s almost like there’s a neo-liberal playbook, isn’t there? No underpants gnomes, they! (1) Defund or sabotage, (2) Claim crisis, (3) Call for privatization… (4) Profit! [ka-ching]. Congress underfunds the VA, then overloads it with Section 8 patients, a crisis occurs, and Obama’s first response is send patients to the private system. Congress imposes huge unheard-of, pension requirements on the Post Office, such that it operates at a loss, and it’s gradually cannibalized by private entities, whether for services or property. And charters are justified by a similar process.
(I’ve helpfully numbered the steps, and added ‘sabotage’ alongside defunding, although defunding is neoliberalism’s main play, based on the ideology of austerity.) We can see this process play out not only in public universities, public schools, the Post Office, and the TSA, but in Britain’s NHS, a national treasure that the Tories are systematically and brutally dismantling.)
The political class has been trying to privatize the VA across several administrations — “Veterans groups are angry after President Obama told them Monday that he is still considering a proposal to have treatment for service-connected injuries charged to veterans’ private insurance plan” — although it is true that the Trump administration has brought its own special brand of crassness to the project, as we shall see. As we might expect, the project has nothing to do with the wishes of veterans:
Nearly two-thirds of veterans oppose “privatizing VA hospitals and services,” according to a poll released Tuesday by the Vet Voice Foundation. And some 80 percent of the veterans surveyed believe veterans “deserve their health care to be fully paid for, not vouchers which may not cover all the costs.”
A plurality of veterans, or 42 percent of those surveyed, agreed with the statement that the VA “needs more doctors,” according to the poll, indicating they believe the VA’s problems are at least partly due to a personnel shortage [Step (1)].
Although Vet Voice is a progressive organization, the poll of 800 veterans was jointly conducted by a Democratic polling firm and a Republican one.
And the Veterans are right, because VA hospitals provide better care. Besides many anecdotes, we have this in Stars and Stripes, “Dartmouth study finds VA hospitals outperform others in same regions“:
A new study by Dartmouth College that compares Department of Veterans Affairs hospitals with other hospitals in the same regions found VA facilities often outperform others when it comes to mortality rates and patient safety.
Researchers compared performance data at VA hospitals against non-VA facilities in 121 regions. In 14 out of 15 measures, the VA performed “significantly better” than other hospitals, according to results from the study.
“We found a surprisingly high, to me, number of cases where the VA was the best hospital in the region,” said Dr. William Weeks, who led the study. “Pretty rarely was it the worst hospital.” “One has to wonder whether outsourcing care is the right choice if we care about veterans’ outcomes,” Weeks said. “The VA is, for the most part, doing at least as well as the private sector in a local setting, and pretty often are the best performers in that setting.”
“One has to wonder” indeed! Be that it may, the new VA eligibility rules accelerate privatization. USA Today:
Nearly four times as many veterans could be eligible for private health care paid for by the Department of Veterans Affairs under sweeping rules the agency proposed Wednesday.
VA officials estimated .
And here are the rules (apparently modeled after TriCare Prime, the military’s insurance plan):
- For primary and mental health care, veterans who had to wait more than 20 days or drive more than 30 minutes for a VA appointment could choose to go to private doctors instead.
- For specialty care, veterans who had to wait longer than 28 days or drive more than 60 minutes to be seen at VA could go private “with certain exceptions.”
- For urgent needs, veterans could select a private clinic approved by VA and walk in when they needed to, but they might be responsible for a co-payment.
- VA said it encourages public comments on the proposed regulations. “We look forward to receiving this feedback,” the agency said.
Assuming that wait time is a function of resources, you can easily see how the playbook would work: (1) Reduce resources, (2) whinge about wait time, and (3) drain patients from the VA system, for profit! (Note that while Democrats are ostensibly jumping on board the #MedicareForAll train, they are, in the main, silent — Warren and Sanders being the only notable exceptions — about the destruction of an existing, and highly functional, single payer system. So how do we get to this point? A previous iteration of the neoliberal playbook, of course!
The program, which began in 2014, was supposed to give veterans a way around long waits in the VA. But veterans using the Choice Program still had to wait longer than allowed by law. And according to ProPublica and PolitiFact’s analysis of VA data, the two companies hired to run the program [TriWest and Health Net] took almost .
More on those fees from Pacific Standard:
According to the agency’s inspector general, the VA was paying the contractors at least $295 every time it authorized private care for a veteran. The fee was so high because the VA hurriedly launched the Choice Program as a short-term response to a crisis. Four years later, the fee never subsided—it went up to as much as $318 per referral….. In many cases, the contractors’ $295-plus processing fee for every referral was bigger than the doctor’s bill for services rendered, the analysis of agency data showed.
Ka-ching! So, step (3) — profit! — worked out very well for TriWest and Health Net, piling up $2 billion in loot. (Step (2) was a scandal of “35 veterans who had died while waiting for care in the Phoenix VHA system,” step (1) being the usual denial of resources/sabotage). The VA Mission Act was the legislative response to Veterans Choice debacle. Naturally, it moved the privatization ball down the field. The American Prospect:
, when it came up for a vote.
In other words, privatizing the Veterans Administration has strong bipartisan support. But:
One of those lawmakers, Bernie Sanders, the Vermont Democrat, reiterated his opposition to Mission in December.
“This is nothing short of  of the VA,” Sanders said. “It’s going to happen piece by piece by piece until over a period of time there’s not much in the VA to provide the quality care that our veterans deserve.”
Now, just because privatizing the Veterans Administration is a project of the political class as a whole doesn’t mean that the Trump Administration hasn’t brought its own special mix of corruption and buffoonery to the table. Indeed it has! Who, we might ask, were the actual factions in the Republican administration pushing for VA Mission? Three of Trump’s squillionaire golfing buddies at Mar-a-Lago, as it all-too-believably turns out. From Pro Publica, “The Shadow Rulers of the VA“:
[Bruce Moskowitz, is a Palm Beach doctor who helps wealthy people obtain high-service “concierge” medical care] is one-third of an informal council that is exerting sweeping influence on the VA from Mar-a-Lago, President Donald Trump’s private club in Palm Beach, Florida. The troika is led by Ike Perlmutter, the reclusive chairman of Marvel Entertainment, who is a longtime acquaintance of President Trump’s. The third member is a lawyer named Marc Sherman. None of them has ever served in the U.S. military or government….
The arrangement is without parallel in modern presidential history.
Everything is like CalPERS.
The Federal Advisory Committee Act of 1972 provides a mechanism for agencies to consult panels of outside advisers, but such committees are subject to cost controls, public disclosure and government oversight. Other presidents have relied on unofficial “kitchen cabinets,” but never before have outside advisers been so specifically assigned to one agency. During the transition, Trump handed out advisory roles to several rich associates, but they’ve all since faded away. The Mar-a-Lago Crowd, however, has deepened its involvement in the VA.
In September 2017, the Mar-a-Lago Crowd weighed in on the side of expanding the use of the private sector. “We think that some of the VA hospitals are delivering some specialty healthcare when they shouldn’t and when referrals to private facilities or other VA centers would be a better option,” Perlmutter wrote in an email to Shulkin and other officials. “Our solution is to make use of academic medical centers and medical trade groups, both of whom have offered to send review teams to the VA hospitals to help this effort.”
In other words, they proposed inviting private health care executives to tell the VA which services they should outsource to private providers like themselves. It was precisely the kind of fox-in-the-henhouse scenario that the VA’s defenders had warned against for years.
While it is true that the ideological ground for privatization was laid by the Koch Brothers, among others, the actual vector of tranmission, as it were, seems to have been the Mar-a-Lago crowd. There has been pushback against them, in the form of a Congressional request for a GAO investigation, and a lawsuit by veterans, but as we have seen, the neoliberal play continues to run.
The wretched excess of Trump’s policy-by-golfing buddies aside, I don’t see why privatiizing the Veterans Administration shouldn’t become a major campaign issue, especially given Sanders’ presence on the relevant committee. We send our children off to die in wars for regime change where the only winners are military contractors. Then, when our children come home, we’re going to send them into a health care system that’s been as crapified as everybody else’s (and that’s before we get to PTSD, homelessness, and suicide). Surely a pitch along those lines would play in the heartland? If Sanders doesn’t pick up the ball and run with it, Gabbard should.
 More from Sanders. Common Dreams:
[SANDERS:] No one disagrees that veterans should be able to seek private care in cases where the VA cannot provide the specialized care they require, or when wait times for appointments are too long or when veterans might have to travel long distances for that care. . My fear is that this bill will open the door to the draining, year after year, of much needed resources from the VA.
In other words, the way to solve the problem is not to take Step 1: Give the VA the resources that it needs.
 I continue to believe that golf play, or knowledge of golf play, should be a disqualification for high office.