Beware of the MISSION

BY PETE PETERSON, CHAIR,
AND GOVERNMENT AFFAIRS STAFF

The press release heralding the much-anticipated new access standards for veterans’ health care announced by VA Secretary Robert Wilkie painted a positive picture. An article in The New York Times, however, hinted at the real story behind the gauzy press release announcing the VA’s implementation of the MISSION Act.

With Congress and the president enamored of Choice, more and more health care likely will be farmed out to private clinicians. Some veterans will be pleased—without understanding the cost of community care or its implications. We have little doubt about two things: that confusion will reign among veterans who are unclear about what health care services they may avail themselves of, particularly considering they can choose a primary care physician not in the VA, and that the cost to provide health care in the community is sure to burgeon and become fiscally unsustainable—and politically indefensible.

The NYT reported that the percentage of veterans eligible “for what VA officials refer to as ‘community care’ currently—roughly 8 percent of the 7 million treated annually—would rise to between 20 and 30 percent,” according to VA officials.

Of course, the VA Secretary was upbeat. “Most Americans can already choose the healthcare providers that they trust,” Wilkie said. “With VA’s new access standards, the future of the VA healthcare system will lie in the hands of veterans—exactly where it should be.”

“This is the most transformative piece of legislation since the G.I. Bill,” Wilkie told the Times. “It gets us on the road to becoming a 21st century healthcare institution.”

Yet it plays into the hands of those who have long championed private-sector care for veterans—at government expense—and who would, it seems, cheerfully applaud the demise of the VA as a provider of quality health care.

This push for privatization continues, despite the significant advances the VA has made in reducing wait times for most specialty care as well as primary care. And despite a recent report in the Journal of the American Medical Association, which concluded that VA wait times for new appointments are equal to or better than those in the private sector. And despite the ability of the VA to hold medical inflation in the low single digits, something unique and too often ignored by Congress and the White House; and despite the role the VA plays in educating hundreds of thousands of residents, interns, and other medical students every year.

The push for privatization continues despite surveys concluding that health care at VA medical facilities is often superior to the care provided by private-sector hospitals and clinicians, and despite a recent Dartmouth College study comparing performance between VA medical centers and private hospitals in 121 regions across the country which found that in 14 out of 15 measures government care fared “significantly better” than care in private hospitals.

You read it here first, in the column by Tom Hall, chair of VVA’s PTSD & Substance Abuse Committee, in the January/ February issue: The VA, in a top-down decision, is replacing open-ended, long-term PTSD therapy with twelve-week talk therapy.

This is, in effect, a betrayal of the veteran-centric modalities the VA claims it provides. Make no mistake: This is a step in the wrong direction. One size doesn’t fit all.

Part of the reason for this seashift is the critical need for more mental health workers imbued with an understanding of military culture and the impact of war on the psyches of those sent off to fight. The effect of this policy change is to cast adrift thousands of veterans who have come to depend on the weekly or biweekly gatherings of vets in the group sessions. These veterans are not going to find salvation from community care practitioners.

Just when the Department of Defense has received the largest multibillion dollar budget allocation ever, plans are afoot to eliminate more than 17,000 uniformed medical positions—doctors, nurses, dentists, technicians, medics, and support personnel. This amounts to a cut of some 13 percent of DoD’s medical staff. Thousands of U.S. Public Health officers are also on the cutting block.

Top brass justifies this move citing a variety of reasons: Congress made us do it; surgeons need to keep up their skills by doing more rather than fewer surgeries, which will strengthen their wartime medical skills; with the winding down of the fighting in Southwest Asia, we just don’t need the same numbers of medical personnel.

Until the next big conflict, that is.

What is relegated to a footnote is the very real possibility of converting military medical positions to civilian positions, if deemed necessary to meet operational readiness needs, columnist Tom Philpott  has written.

“If the goal is to tear down the military health system, this would be a reasonable way to do it,” one service health official told Philpott. It would likely be military families who will suffer the most.

There is a silver lining, however, for the VA: Perhaps the VA can arrange to be the first to reach out to those medical professionals who find themselves booted from the military.

Since 2008, hundreds of veterans have filed lawsuits claiming they’d been sickened by the fumes they ingested from burn pits, the noxious mix of toxic agents in the wars in Afghanistan and Iraq.

Last year, the Fourth U.S. Circuit Court of Appeals sided with DoD and defense contractor KBR. The court found that KBR was acting under the orders of the U.S. military. Now, the U.S. Supreme Court has refused to hear the case, leaving the plaintiffs without any further recourse.

There is hope, however. Rep. Tulsi Gabbard (D-Hawaii), joined by fellow representative and Iraq war veteran Brian Mast (R-Fla.) and Senators Amy Klobuchar (D-Minn.) and veteran Dan Sullivan (R-Ark.), introduced bipartisan legislation to evaluate the exposure of U.S. service members to open burn pits and toxic airborne chemicals.