Fixing the VA: The Positions of Trump, Clinton, & VVA
Both major party candidates vying for the presidency have outlined their goals, and the actions they say they will take, to reform the Department of Veterans Affairs and improve health care and other services and benefits for veterans. Their positions that follow are taken from their respective websites, www.donaldjtrump.com and www.hillaryclinton.com , and are excerpted here for space considerations. Please note, however, that the excessive verbiage in Secretary Clinton’s program had to be extensively reworked and reordered to line up, where feasible, with Mr. Trump’s plan. In the third column is VVA’s position on the issues they raise.
Donald Trump’s Plan
“The current state of the Department of Veterans Affairs (VA) is absolutely unacceptable. Over 300,000 veterans died waiting for care. Corruption and incompetence were excused. Politicians in Washington have done too little too slowly to fix it . . . The guiding principle of the Trump plan is ensuring veterans have convenient access to the best quality care. To further this principle, the Trump plan will decrease wait times, improve healthcare outcomes, and facilitate a seamless transition from service into civilian life.” (From https://www.donaldjtrump.com/positions/veterans-administration-reforms . Also, see his July 11th press release heralding his ten-point plan at https://www.donaldjtrump.com/press-releases/icymi-trumps-ten-point-plan-to-reform-the-va .)
Hillary Clinton’s Plan
“Hillary Clinton believes that supporting our veterans is a sacred responsibility . . . Yet too often, we as a nation failed to uphold our end of the bargain . . . The systemic failures of the VA to uphold its core mission underscore the need for fundamental reforms and focused leadership. Secretary Clinton will pursue a veteran-centric reform agenda that . . . creates a culture of accountability . . . ensures veterans receive the timely health care they deserve. She will oppose the privatization of the VA system, which would undermine veterans’ ability to get the unique care that only the VA can provide while leaving them vulnerable to a health care market poorly suited to their needs . . .” (From https://www.hillaryclinton.com/issues/veterans/ . Then see “Read the Fact Sheet” at https://www.hillaryclinton.com/briefing/factsheets/2015/11/11/supporting-our-veterans-troops-and-their-families/ .)
Position of VVA on the Issues
Everyone agrees that, by virtue of their service in uniform, veterans are deserving of timely and “convenient access to the best quality care.” VVA and the other veterans service organizations have long understood that “systemic failures of the VA to uphold its core mission underscore the need for fundamental reforms.” All of us believe in the inherent integrity of the VA healthcare system despite its past failures -- of leadership, of planning, of permitting issues like the backlog in claims (and now appeals) to fester and implode. But none of us buy the argument that the delivery and quality of health care will be improved by privatization. (And we have to wonder where Mr. Trump’s people got the notion that “300,000 veterans died waiting for care.” (We would very much like to see documentation of this claim, and where, so we can work with Mr. Trump to help secure accountability for those managers directly responsible!)
1. Ensure veterans get the care they need wherever and whenever they need it. No more long drives. No more waiting for backlogs. No more excessive red tape. All veterans eligible for VA health care can bring their veteran’s ID card to any doctor or care facility that accepts Medicare to get the care they need immediately . . . The power to choose will . . . force the VA to improve and compete if the department wants to keep receiving veterans’ healthcare dollars.
1. Fundamentally reform veterans’ health care to ensure veterans’ access to timely and high-quality care and block efforts to privatize the VHA, which . . . must maintain the ultimate responsibility of coordinating and ensuring comprehensive and quality health care for every veteran and the specialized services that they deserve – critical functions that would disappear if the VA were privatized. The VHA must refocus as a veteran-centric provider of service-connected care; and strategically purchase private-sector care when it makes sense to do so, such as for some specialty inpatient or surgical procedures, expanded access to mental health and substance abuse treatment, or when the VA cannot provide timely access to necessary care . . . Convene the Secretaries of Veterans Affairs and Defense regularly in the Oval Office and direct them to develop, execute, and report on an effort that integrates their health care operations to create a more efficient and a sustainable system.
1. Try and get an appointment with a specialist and see how often you can get that appointment “immediately.” But 96 percent of appointments with specialists and primary care clinicians at most VA facilities are now accomplished within 30 days. Even the raw numbers fail to tell the right story: if your VA cardiologist says he wants to see you in four months, you can make that appointment then and there -- but what will a statistical autopsy say about having to wait 120 days? Most often, you can see your primary care clinician and specialists under the same roof; you don’t have to shop around and travel from one to the other. You can get your prescriptions filled right there. And when the VA can’t provide proper care for your specific need, because they don’t have the right clinician on staff or because of the distance between your home and the VA facility, the VA will “strategically purchase private-sector care when it makes sense to do so.” In fact, some 10 percent of VA healthcare dollars are expended outside of the VA system.
2. Support the whole veteran, not just their physical health care, but also by addressing their invisible wounds . . . Increase funding for post-traumatic stress disorder (PTSD), traumatic brain injury and suicide prevention services to address our veterans’ invisible wounds . . . More funding will also support research on best practices and state of the art treatments to keep our veterans alive, healthy and whole.
2. End the veteran suicide epidemic and ensure that every veteran has access to world-class medical and counseling services whenever and wherever they are needed [by] increasing funding for mental health providers and training to ensure timely and ongoing identification and triage of mental health issues, and ongoing access to quality mental health care and substance abuse treatment, particularly for alcohol and opiate abuse, including private-sector care when necessary . . . Dedicate research funding and provide mechanisms for collaborative efforts to facilitate the development and expansion of evidence-based diagnostic tools and treatments for veteran-centric conditions.
2. The VA recognizes that the mental health of patients who have been through war is as important as physical health. VVA has agitated for more mental health professionals on staff -- clinicians who have the expertise to understand the needs of their veteran patients. More staff requires more resources. And the VA must fund additional research into the “invisible wounds” of war; provisions in the Toxic Exposure Research Act, which VVA initiated and has promoted, would help fund this needed, peer-reviewed research.
3. Fire the corrupt and incompetent VA executives that let our veterans down, by modernizing the VA, and by empowering the doctors and nurses to ensure our veterans receive the best care available in a timely manner . . . There will be no job security for VA executives that enabled or overlooked corruption and incompetence . . . Exposing and addressing the VA’s inefficiencies and shortcomings will be rewarded, not punished.
3. Create a culture of accountability, service, and excellence at the VA . . . [by] holding every employee accountable for their performance and conduct . . . Supervisors must be empowered to suspend or remove underperforming employees in accordance with due process . . . The performance evaluation system must be revamped to recognize and advance high-performing employees . . . Whistleblower protections must be bolstered.
3. The assumption that there are lots of “corrupt and incompetent VA executives” is both mean-spirited and wrong. It’s worth remembering that the VA is the nation’s largest employer of veterans. Draconian answers are no answer at all; after all, who will want to come to work for a Big-Brother-Is-Watching-You organization? The VA Inspector General needs to be more proactive on investigating employees who do wrong, but those who do should be suspended or dismissed “in accordance with due process.” Whistleblowers must of course be protected. And the system of rewarding “high-performing employees” also must be revamped.
4. Increase funding for job training and placement services (including incentives for companies hiring veterans), educational support, and business loans . . . Strengthen existing programs or replace them with more effective ones to get our veterans working.
4. Empower veterans and strengthen the economy and communities by connecting their unique skills to the jobs of the future. Make the Post-9/11 G.I. Bill a lasting part of the social contract, expand tax credits for veterans’ employment, improve certification and credentialing programs, strengthen veteran entrepreneurship programs, and create pathways for service members to enter growing career fields.
4. In reality, except for 18- to 24-year old members of the National Guard, the unemployment rate for veterans is significantly lower than it is for other workers. “The fact that the veteran unemployment rate of 4.7% is lower than the national unemployment rate of 4.9% is great news for the veteran community. And again demonstrates that veterans are in high demand in the civilian work place. The July 4.7% veteran unemployment rate while having risen again confirms that veterans are obtaining employment at a better rate than nonveterans.” VVA supported enactment of legislation for training veterans in jobs that will provide them a decent standard of living. And VVA has long championed leveling the playing field for veteran-owned small businesses as well as entrepreneurship initiatives for veterans.
5. Better support our women veterans . . . Every VA hospital in the country will be fully equipped with OBGYN and other women’s health services. In addition, women veterans can always choose a different OBGYN in their community using their veteran’s ID card.
5. Improve health care for women at the VHA. Provide new funding to go beyond modifying facilities and increasing the number of OBGYNs employed by the VHA, to include expanding provider training, ensuring culturally competent staff and policies . . . requiring the provision of reproductive services to ensure women have access to the full spectrum of medical services they need . . . broadening initiatives to provide childcare at VA medical facilities . . . ensuring that Military Sexual Trauma (MST) is acknowledged as a valid form of PTS, setting a burden of proof for MST that is no higher than for any form of trauma.
5. Inasmuch as women now comprise some 14 percent of our Armed Forces and 8 percent of the VHA caseload, it is important that the VA take whatever proactive measures it needs to ramp up staff and create a free-standing physical environment in which women veterans can be treated conveniently and confidentially. This goes far beyond equipping every VA medical center with an “OBGYN.” It requires adequate funding to provide the various other services Secretary Clinton enumerates.
6. End waste, fraud and abuse at the VA . . . Ensure the VA is spending its dollars wisely to provide the greatest impact for veterans and hold administrators accountable for irresponsible spending and abuse . . . so the current VA budget provides more and better care than it does now.
6. Establish a VHA Strategic Oversight and Governance Board of health care and management leaders . . . [that] would include strong veteran representation [and would] be empowered to provide oversight of VHA management processes, monitor accountability, promulgate best practices, and ensure the VHA remains true to its mission . . . Create a standing President’s Council on Veterans . . . to synchronize and integrate the patchwork of veterans programs and benefits . . . Convene a White House Summit on Veterans to address progress on veterans’ issues . . . meet early and regularly with a cross-section of veterans to understand their needs and ensure we meets our promises.
6. Just as police commanders must take responsibility for the performance of their officers, so should VA administrators be held accountable “for irresponsible spending and abuse.” Secretary Clinton’s ideas -- to set up “a VHA Strategic Oversight and Governance Board” and establish “a standing President’s Council on Veterans” -- make sense, if they are not created for show, and if the president and his or her advisors actually listen to these entities.
7. Modernize the VA . . . by accelerating and expanding investments in state of the art technology to deliver best-in-class care quickly and effectively. All veterans should be able to conveniently schedule appointments, communicate with their doctors, and view accurate wait times with the push of a button.
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7. The VHA, under the leadership of Under Secretary for Health Dr. David Shulkin and VA Secretary Bob McDonald, have been making great strides to “modernize the VA . . . to deliver best-in-class care quickly and effectively.” Technology is in place -- My HealtheVet; myVA; VA Telehealth Services -- to achieve much of what Mr. Trump, and VVA, believe needs to be done. My HealtheVet allows veterans to interact with their primary care teams, refill prescriptions online, and request specialty appointments. The “myVA Integrated Plan” outlines major milestones and deadlines for VA technological and customer-service reform. VVA will hold the VA accountable to meeting those deadlines.
8. Empower the caregivers to ensure our veterans receive quality care quickly. Caregivers should be able to easily streamline treatment plans across departments and utilize telehealth tools to better serve their patients . . . Abandoning the wasteful and archaic mindset of the public sector will give way to tremendously effective veteran healthcare.
8. Synchronize procurement to find cost savings by negotiating a single formulary of pharmaceuticals along with medical and office supplies and information systems to ensure compatibility and eliminate waste and redundancy; [and] streamline VA and DoD IT, ending the years of delay in developing an electronic health record (EHR) system that is fully interoperable . . . [which] must also link to private sector providers to enable full information sharing, care coordination, and integrated billing and payments.
8. The assumption that private-sector care is better than “the wasteful and archaic mindset of the public-sector” is just plain wrong. The Commission on Care has acknowledged that VA health care is in most respects as good as or superior to private health care. The VA is a leader in telehealth medicine, a boon to remote and rural veterans as well as to vets who are bedridden. VVA has been a proponent of what is in essence a single pharmaceutical formulary between VA and DoD, particularly for meds prescribed for active duty troops that are not on the VA’s drug formulary. VVA also has fought for years for adding the question “Have you ever served in the Armed Forces of the United States?” and relevant follow-up questions into an interoperable electronic health record.
9. Hire more veterans to care for veterans. The more veterans we have working at the VA, the better the VA will be . . . To increase the number of veterans hired by the VA, add an additional 5 points to the qualifying scores of veterans applying for VA jobs.
9. [[Nothing matches up]]
9. While we agree with Mr. Trump that the VA should hire more veterans, it is not so simple a proposition that this will make VA health care “better.” The VA needs to do a far better job in recruiting medics, corpsmen, and allied military healthcare personnel. To achieve this, Congress ought to consider enacting legislation to “add an additional five points to the qualifying scores of veterans applying for VA jobs” as well as embracing some of the proposals in the Commission on Care final report vis a vis recruiting and retaining top-flight medical professionals. Congress might also consider extending the Post-9/11 G.I. Bill to train veterans to fill healthcare positions on a prid pro quo basis, e.g., send a qualified veteran to medical or nursing school in exchange for a fixed number of years s/he must work at a VA healthcare facility.
10. Embed satellite VA clinics within hospitals and other care facilities in rural and other underserved areas . . . This will ensure veterans have easy access to care and local hospitals and care facilities can handle the influx of patients without backlogs while tapping the specialized knowledge of VA health specialists.
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10. Inasmuch as finding qualified clinicians to staff VA healthcare facilities in rural or inner city America is difficult enough, we’re not sure that embedding “satellite VA clinics within hospitals and other care facilities in rural and other underserved areas” is a viable proposition. On the other hand, advances in telehealth technology can achieve much of what Mr. Trump would have embedded satellite clinics accomplish.
Because the proposals in Secretary Clinton’s veterans fact sheet are far more extensive than Mr. Trump’s heralded 10-point plan, we are addressing half a dozen additional proposals we believe are worth considering.
11. End the disability benefits and appeals backlog [by] streamlining and simplifying the claims process by integrating DoD and VA medical evaluations, using “fully developed claims” from private providers, allowing rules-based automatic adjudication for the simplest of applications, and by ensuring veterans have an effective appeals process to make sure the VA gets it right.
11. The VBA, the Veterans Benefits Administration, has made significant progress in reducing the claims backlog. Yet at the same time, it has seen a corresponding increase in adjudicating appeals, of which there are some 440,000 awaiting adjucation. Certainly, instituting “rules-based automatic adjudication for the simplest of applications” makes sense -- and it’s a VVA priority. The VA is now authorized to coordinate with DoD and provide “Integrated Disability Evaluation System (IDES) Examinations” prior to discharge so that they can begin claims as they prepare to separate from the service.
12. Provide legal assistance to review and upgrade other-than-honorable discharge categorizations for service members who were improperly separated due to service-connected mental health and cognitive issues.
12. Perhaps the most radical, and certainly the most intriguing, recommendations of the Commission on Care’s Final Report is the suggestion that veterans who have rendered honorable service for much of their time in the military, yet who have been given an other than honorable (OTH) discharge, should be eligible for VA health care on a case-by-case basis. And certainly troops who were “improperly separated due to service-connected mental health and cognitive issues” must be given the resources to upgrade their OTH. The reality is that tens of thousands of veterans who have left military service since 9/11 with an OTH -- one estimate is that they number some 300,000 of the 2,500,000 who have served during the Global War on Terror -- are deserving of VA health care and other benefits.
13. Protect veterans from discrimination and predatory companies that unfairly target veterans and their families [by] fighting back against schools that prey on veterans through legislation that closes the 90-10 loophole exploited by for-profit schools, and by banning schools from receiving federal student aid if they are found guilty of fraudulently recruiting students . . . Enforce zero tolerance for firms that overcharge service members and veterans by banning bill collectors and loan servicers from contracts to service federal loans, and help defrauded students discharge debt from fraudulent schools.
13. Since the Post-9/11 G.I. Bill was legislated into existence, institutions of higher learning, many of them for-profit colleges, have reaped windfall profits. Many of these predatory institutions have left their veteran students destitute, with well-nigh worthless diplomas and crippling unforeseen debt. We certainly agree with Secretary Clinton that the 90-10 loophole must be closed, that schools that fraudulently recruit students must be discovered, denounced, and make reparations to the students they’ve defrauded, that a mechanism must be put in place so that the debt incurred by these students can be forgiven, and the eligibility for the time lost reinstated.
14. Move to end veteran homelessness by building on successful initiatives and expanding programs that help ensure long-term success . . . Increase funding for reducing homelessness while expanding public-private partnerships . . . Leverage federal resources to support community-based organizations, including reallocating excess and unused federal property for use by veteran-focused non-profit organizations . . . Expand outreach, especially in locations involving high densities of homeless veterans, and programs that prepare veterans for independent living to prevent recidivism . . . Address the needs of homeless women veterans and homeless veteran families.
14. The VA has made significant strides in reducing veteran homelessness, mostly via the HUD-VASH program. Still, thousands of veterans live on the streets, have demoralizing addictions to alcohol and drugs, have no home to call their own. We agree with Mrs. Clinton’s stated initiatives, particularly in expanding outreach “in locations involving high densities of homeless veterans.” While we doubt that it is possible to completely eliminate homelessness among veterans, proper leadership and appropriate funding can go a long way towards finding a home for any and all veterans who want one.
15. Continue efforts to identify and treat invisible, latent, and toxic wounds of war that continue to affect veterans, family members, and caregivers long after their service.
15. VVA initiated and has promoted enactment of the Toxic Exposure Research Act, the focus of which is research to identify health conditions that afflict the progeny of veterans exposed to toxic chemical and biological substances while in military service. The benefits of this legislation, if enacted, should have applications for the offspring of other citizens exposed to these toxic substances as well.
16. Support Veterans Treatment Courts, which provide an alternative to the traditional criminal justice system for veterans with minor offenses aggravated by mental health or substance abuse issues, using block grants while also directing the VA to expand pilot programs for “medical legal partnerships.”
16. VVA members have been in the forefront of the effort to establish veterans’ treatment courts in jurisdictions throughout the United States. These diversionary courts -- there are more than 300 of them now in operation, with scores more in various stages of planning and implementation -- are saving lives, reuniting families, strengthening communities, and ultimately saving taxpayers the costs of incarcerating these veterans. Earlier this year, the National Institute of Corrections issued a detailed overview of this initiative in coordination with VVA and the Veterans Health Council. That Secretary Clinton is a supporter of this alternative justice is more than gratifying.