Common Sense Over Privatization

BY PETE PETERSON, CHAIR, AND GOVERNMENT AFFAIRS STAFF

Congress passed the Veterans Access, Choice, and Accountability Act in 2014. It was a woefully belated piece of legislation. Congress all of a sudden was in a hurry to do something to rectify a situation that had existed for upwards of two decades—a situation of delaying medical appointments at VAMCs—that had been ignored by at least three administrations.

One of the provisions in the so-called Choice Act established the Commission on Care, which was charged with examining how the VA health care system functioned then and what might be changed so that in twenty years it would be better equipped and oriented to deal with significantly changing demographics.

There were those in Congress who thought that the commission would be appalled by the fragilities of the VA system and, in the wake of the access scandal, see the light: the wisdom of privatizing most of the VHA’s health care role by granting eligible veterans the right to go to whatever health care providers they wanted, with the VA picking up the tab.

But twelve of the fifteen commissioners came to realize that the VA provided, for the most part, good-to-excellent health care, and had special expertise in treating veterans with some unique wounds of war. The only real issue, they agreed, was one of access.

They also acknowledged that the underlying problem was the lack of enough clinicians to deal with the increasing demand for VA health care. Demand was fueled by two factors:  troops returning from deployments to Afghanistan and Iraq; and the Great Recession, which drove thousands of Vietnam War veterans to the VA.

However, they decided, it would be folly to in essence tear apart the VA. Because gaining access to care could be even worse—and far more costly—if eligible veterans were given the wherewithal to go to whomever for the care they needed. The commissioners shot down the fond dreams of some who preached the need for smaller government, who would turn the VA health care system for the most part into a cash cow, yet who didn’t comprehend the ramifications of what they were advocating.

Chief among these free-market stars were the Brothers Koch, Charles and David. The two multimillionaires set up and funded a number of front organizations to preach their mantra. Among them is something called Concerned Veterans for America (CVA). It is not a veterans service organization. The role of its spokesmen is simply to lobby for the privatization of the VA.

Because CVA has millions of Koch cash, some in Congress take them seriously. One of their main mouthpieces has been called on to testify before the House Veterans’ Affairs Committee. Today, he is ensconced in the White House, where he has entree to top policy-makers to whom he can preach his tired philosophy: What’s good for veterans is good for business. Or is it the other way around?

Meanwhile, the gifted Secretary of Veterans Affairs, David Shulkin, an M.D. with extensive experience in hospital management, has been attempting to integrate care from community providers in an expansive vision of how to obtain the best possible health care for the more than six million veterans who use the VA for most, if not all, of their health care needs.

What Secy. Shulkin is attempting to accomplish is a sensible solution to a vexing problem: the lack of enough medical professionals to fully staff VA medical centers and CBOCs, its 800-plus community-based outpatient clinics. What the Koch Brothers would like the VA to become is a bankrupt vision, one that will in all likelihood bankrupt the entire VA health care system should it ever come to pass.

This nobody needs, not the government, and certainly not the veterans the VA serves. But will those on the side of privatization ever give up? No. Which means the rest of us—which is most of us—have to be vigilant, and go to war if necessary with those who would destroy what so many of us have worked so hard to build up.

Do you feel you have been wronged by the character of your discharge?  Now there is some hope—maybe.

In the wake of our war, the federal government funded what were called Discharge Upgrade Centers. A lot of veterans served honorably, but once they were back in The World, their lives started to fall apart. Those who remained on active duty got into trouble before they got out; those who had been discharged immediately after returning home found themselves enveloped day and night by half-buried demons from what they had experienced. 

Many exited military service with bad paper, up to and including a dishonorable discharge, thus depriving them of an array of benefits they would have earned by virtue of their service in a combat zone.

If a veteran’s bad paper was a result of an administrative action, the veteran stood a chance, however small, of getting an upgrade. After several years, though, these centers faded away due to lack of funding.

Today, the VA wants to help veterans who left the military with other-than-honorable discharges and who may be eligible for discharge upgrades due to mental health issues that either had not been diagnosed or were ignored. So the VA launched new online tools after having fielded more than 5,000 calls concerning upgrade procedures, which most found either incomprehensible or too cumbersome.The goal of this effort is to help vets navigate the “complex requirements for upgrade petitions.”

VA and DoD officials hope their new tools will be helpful for many of the estimated 300,000 veterans whose characters were besmirched because of the nature of their discharges.

Veterans seeking an upgrade of their discharge can find additional resources at https://law.yale.edu/studying-law-yale/clinical-and-experiential-learning/our-clinics/veterans-legal-services-clinic/forms-resources-veterans-seeking-discharge-upgrade

Because discharge upgrades, historically, are difficult to achieve, “Congress and the administration need to make fixing bad-paper a top priority, and take more proactive measures to help the most vulnerable segment of our population of veterans,” VVA’s Kris Goldsmith maintains.

First came the realization that dioxin, the key ingredient in Agent Orange, is responsible for more than a dozen health conditions plaguing veterans—and, for many, their offspring—who saw service in Southeast Asia and elsewhere. Now, a recent report by the Associated Press highlighted yet another silent killer. 

“VA Study Shows Parasite from Vietnam May Be Killing Vets” reads the headline in one West Virginia newspaper. The article is about a parasite ingested from consuming liver flukes in raw or undercooked fish; a parasite that lurks in the body, often for decades; a parasite that manifests with intense pain; a parasite responsible for cholangiocarcinoma, or bile duct cancer (See “Liver Fluke: Update on a Cancer-Causing Parasite,” January/February 2017, and “Toxic Hitchhikers: Parasites from the War Zones,” March/April 2014).

Granted, the VA study was small, but its results were unnerving. For years, VVA has maintained that we would not, if ever, know the extent of parasitic illnesses that originated in our time in country, some of which might manifest as heart or liver problems.

Perhaps it’s time for the VA to send out notices to all patients who served in Vietnam about parasitic infections and their symptoms. This may save some lives. The VA should start measuring the worth of prospective research projects against the potential effect toward the treatment of the wounds, maladies, injuries, and adverse medical conditions and possible derivative conditions due to military service.