By Suzanne Gordon
The American Prospect, Tapped Blog, Dec. 12, 2016
In the debate over the future of the Veterans Health Administration (VHA), no concept has attracted more controversy than “privatization.” Since wholesale privatization of the VHA is deeply unpopular among veterans and their advocacy organizations, groups like the Koch brothers-funded Concerned Veterans for America (CVA) argue that they do not support “privatization” of the VHA. As the CVA’s “Fixing Veterans Health Care” report, published earlier this year explains, the group just wants to give veterans “the same degree of choice that is available to other Americans,” with the federal government paying the tab.
Last week, The Washington Post entered the fray. Writing for the paper’s “Fact Checker” column, reporter Michelle Ye Hee Lee gave Senator Jon Tester of Montana and Representative Mark Takano of California, both Democrats, three out of a possible four Pinocchios (signifying “significant factual error and/or obvious contradictions”) for suggesting that the CVA and Trump transition team members support VHA privatization. According to Lee, the CVA’s position does not constitute privatization because, the “CVA has not proposed a wholesale transfer of VHA’s services over to the private sector—which is what ‘privatization’ usually describes.”
Lee’s interpretation flies in the face of volumes of academic and policy research on the privatization movement that went mainstream in the 1980s, notably in the United States and Britain. As the Prospect’s Paul Starr wrote in a 1988 essay, privatization is “any shift of activities or functions from the state to the private sector; any shift of production of goods and services from public to private; including the wholesale of transfer of services from the public to the private sector or what Starr calls “privatization by attrition,” as furnishing costlier private-sector services lead to an underfunding of public ones.
Ironically, as Starr and other critics point out, the privatization movement decreases accountability and oversight of services currently delivered by the private sector by directing attention to poor government performance while deflecting attention from similar flaws in the private sector.
Privatization can erode public support for the belief that government plays a positive role in handling social needs. So CVA officials are keen to promote a counter-narrative: The VHA is broken. The group relies on stories from veterans who have had negative experiences at the VHA to support its claims. (One female veteran recently told me she’d sent in a story about her positive VHA experiences and never received any acknowledgment.) CVA allies like Florida’s Republican Representative Jeff Miller, the House Veterans Affairs Committee chairman and one of President-elect Donald Trump’s candidates for Veteran Affairs secretary, have also attacked agency employees and targeted the unions that represent them.
The CVA claims it wants to preserve the VHA, but its proposal would shift government funds to private-sector providers, depriving VHA doctors and other staff of the ability to maintain a high level of clinical and research expertise by treating the specific service-related problems of a large numbers of patients. Such a move would also drain resources for supporting current workers and recruiting new ones.
Moreover, the CVA promotes private-sector care even though such care would be more expensive. Like many proponents of privatization, the group supports shifting costs to veterans through out-of-pocket payments and mechanisms like interest-bearing health savings accounts. The CVA proposal would also limit eligibility for care in the private sector or in what remains of the VHA, to veterans with service-related conditions—a change that would hit low-income and indigent veterans the hardest.
CVA officials continue to claim that these moves do not constitute privatization. Some staff members like Darin Selnick, who was a member of the VA Commission on Care (and is now a member of Trump’s VA transition team), have supported eliminating the VHA as a care provider. Selnick was a coauthor of the Strawman Document that outlined a vision of a privatized VHA. In his dissent from the Commission’s final report, Selnick also proposed emulating military insurance programs like TRICARE, which would ultimately turn the VHA into just another insurer. So who really deserves the Pinocchios: two Democratic members of Congress, the CVA, or The Washington Post?
Suzanne Gordon is a journalist and co-editor of a Cornell University Press series on health-care work and policy issues. One of her latest books is “Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety.” Her website is www.suzannegordon.com.