By Michael Blecker
San Francisco Chronicle, July 15, 2016
Now that we are in the final stretches of the presidential campaign, it is important to examine both Donald Trump’s and Hillary Clinton’s views on the Veterans Health Administration — particularly the hot-button issue of “expanding choice” — that is, privatizing veterans’ health care.
I served as one of 15 commissioners on the congressional Commission on Care, which last month adopted the dangerous idea of moving toward privatization. That will degrade the Veterans Health Administration’s veteran-centered health care system. I made it clear when I joined the commission that if I thought the results of our work would hurt veterans, then I would not sign the final report.
I didn’t sign.
The commission was appointed by the president and Congress to improve the veterans health care system, not dismantle it. I was one of the very few commissioners who represented veterans who use and depend on the health administration.
The commission’s final report includes 18 recommendations aimed at strengthening the administration, and 17 of them outline solid and bold plans for improvement. The most significant recommendation, however, redesigns the care-delivery system to include private health care providers.
The commission’s recommendation for “choice” was not based on data that show cost savings, improved quality of care, shorter wait times or a belief that veterans’ health care and access will be improved. In fact, independent assessments found that VA care is comparable or even better in clinical quality than private health care. Seventy-five recent studies confirmed this, and yet the commission report does not explain why expanding reliance on lower-quality private health care options will improve veteran care. Ultimately, the decision came down to the fact that the majority of the commissioners were determined to establish a path to privatization.
Increase costs, because VA doctors are salaried, not incentivized.
Reduce access, because resources will be diverted.
Not improve the quality of care, because it does not ensure that health care providers are well equipped to address veterans’ specific health and cultural needs. For example, fewer than 50 percent of private health care providers regularly screen for PTSD, and fewer than 20 percent are trained to document a veteran’s military history, which can be critical in identifying service-connected health issues.
Not shorten wait times to see a doctor. No data found that wait times in the private sector are any shorter than at the VA. Unlike the VA, the private sector isn’t required to measure wait times.
Dismantle the Veterans Health Care system because, unlike the VHA, the private health care sector has considerable funds dedicated to marketing its services. Economists estimate that “choice” could reduce the patient base by as much as 40 percent. The Veterans Health Administration would have to pay private health care providers to care for veterans, but would not be able to control how providers deliver that care.
When it comes to providing choice to veterans who live more than 40 miles from a VA facility, the VA has been more than willing to enable veterans to use private health care in their communities. Expanding choice in areas like San Francisco, where veterans have access to excellent care at the Fort Miley and Palo Alto veterans hospitals, is not necessary.
Clinton and Trump disagree on private health care options for vets.
Trump said he wants to ensure that “every veteran has the choice to seek care at VA or private care, paid for by our government.” In his 10-point plan for fixing the VA, he states, “The power to choose will stop the wait-time backlogs and force the VA to improve and compete if the department wants to keep receiving veterans’ health care dollars.”
Clinton has said that she wants to restructure the VA but opposes privatization. In her VA platform plan, she states, “From the top leadership to mid-level managers to entry-level employees, everyone at the VA must embody the highest workplace standards. Supervisors must be empowered to suspend or remove underperforming employees in accordance with due process not only for the good of the organization, but in service of our nation’s veterans.”
When I enlisted, I was promised that the nation would take responsibility for the medical and health consequences of military service. We must design our veterans’ health care system for those who need it most, not for those who want it least.
True, operations failures have overshadowed successes in recent years, yet the system is worth saving. The commission’s recommendations related to improving clinical operations, facility and capital assets, governance, health care equity, information technology, supply chain, and workforce management should be implemented promptly. If we adopt the “choice” model, however, we will eviscerate any chance of improving the systems that provide care for more than 9 million veterans.
As a commissioner, a veteran and a lifelong advocate for community-based veteran support services, I have seen the VHA transform into the comprehensive, integrated, wraparound provider of veteran-centered health care that it is now. I do not want to see us move backward.
Michael Blecker is the executive director of Swords to Plowshares, a community-based nonprofit that provides services to 3,000 veterans in the San Francisco Bay Area. To comment, submit your letter to the editor at http://bit.ly/SFChronicleletters.
Tell your congressional representative know that we cannot degrade our nation’s health care system for our veterans.
Tell your political party leaders it is important to improve the operations, not dismantle, the Veterans Health Administration.