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June 20th, 2018

Insight

The concocted uproar over 'privatizing' the VA

Jeff Jacoby

By Jeff Jacoby

Published April 9,2018

The concocted uproar over 'privatizing' the VA

President Trump's TWEET terminating David Shulkin as Secretary of Veterans Affairs hadn't even had a chance to cool before the deposed Cabinet member was hurling some heat of his own.

Within hours of his removal, Shulkin had taken to The New York Times with a column portraying himself as a martyr crucified in "a brutal power struggle." He had been driven from his post, he claimed, by malicious schemers bent on "privatizing V.A. health services" for the purpose of "rewarding select people and companies with profits." These conspirators, whom Shulkin didn't identify, "saw me as an obstacle to privatization who had to be removed," he wrote, and they cut him down because he chose to resist. He concluded mournfully: "It should not be this hard to serve your country."

In reality, Shulkin lost his job because of scandal and mismanagement. His days at Veterans Affairs had pretty clearly been numbered since February. That was when the department's inspector general reported that he had altered documents and used taxpayer funds to pay for his wife to travel with him to Europe, he had improperly accepted a gift of tickets to Wimbledon, and he had spent most of what was supposed to be a working trip sightseeing and shopping.

Meanwhile, internal department documents leaked to USA Today showed that more than three years after a national scandal erupted over revelations that veterans were dying while waiting for nonexistent medical appointments at VA hospitals, dozens of facilities continue to perform abysmally. On a scale of one to five, with one being the worst, the agency still classified multiple medical centers, including those in Phoenix, Memphis, Los Angeles, Dallas, and Detroit, as rating no better than a one in 2016

Shulkin mentioned none of this. He declared instead that he had "accomplished a tremendous amount," and cast himself as a victim of nefarious privatizers. It was a canny tactic. A slew of anti-Trump voices in the media and in Congress immediately echoed Shulkin's charge. Democrats on the Senate Veterans Affairs Committee, including Vermont's Bernie Sanders and Richard Blumenthal of Connecticut, announced that they would oppose any nominee for VA secretary who fails to denounce privatization.

There's only thing wrong with this defiance to privatizing the VA. Nobody has called for privatizing the VA.

There is no plot to deny veterans access to government-funded health care as part of a grateful nation's compensation for their service. There has been no recommendation that VA hospitals be auctioned off to for-profit medical conglomerates. There is no push to transfer the functions of the Veterans Health Administration — the government agency that operates veterans hospitals and outpatient clinics — to the private sector.

What there have been are various proposals to give veterans more choices. A bill introduced in the House last fall, for example, would allow veterans to decide for themselves whether to be seen by a private doctor or to use VA facilities, without having to first get the VA's permission. It would liberalize a measure signed into law by President Obama (and later extended by Trump), under which veterans who have been waiting more than 30 days for appointments or who live more than 40 miles from a VA facility can turn to a private provider at public expense.

It should go without saying that giving veterans the option of seeking private-sector care isn't "privatizing" the VA — just as giving them the option of using their educational benefits at a private university isn't "privatizing" the GI Bill.

If the latter isn't controversial, the former shouldn't be either. Twice the Washington Post has debunked what it called "the stale Democratic talking point" that expanding veterans' health-care options in the private market could lead to dismantling the VA. Both times it gave the claim three Pinocchios — the Post's term for assertions that are largely false or highly misleading.

Given the VA's long history of dysfunction and bureaucratic inefficiency, Republicans and Democrats alike ought to be able to agree that more private-sector services could be a boon for the VA. A March 2016 essay in the New England Journal of Medicine made just such an argument. In somewhat dry and formal language, it urged the VA to adopt a "new model of care" that would emphasize "working with the private sector to address critical access issues" for veterans' health. The VA's own network, the writer proposed, should be expanded to include private-sector providers — not as the first step of a sneaky strategy to undermine the VA, but as a way of getting veterans the care too many of them were being denied.

"In the nearly two years since unacceptable VA waiting times came to light," the author wrote, "it's become apparent that the VA alone cannot meet all the health care needs of US veterans."

The writer of those words was David Shulkin. At the time his focus was on achieving better results for the 9 million veterans who rely on the VA for medical care. He had no trouble acknowledging then that the private sector had to be part of any solution. Odds are he would have no trouble acknowledging it now, if only his top priority were still veterans' health and not his own reputation.


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