Trump’s plan to privatize the VA will hurt vets

In June, Congress passed the VA Accountability and Whistleblower Act, which makes it easier to dismiss any of the 300,000 employees of the Veterans Administration.

Republicans and Democrats who supported the legislation argued that VA care givers must be held accountable to the highest standards of  clinical excellence and ethical behavior.

At a subsequent bill signing, President Donald Trump pledged that managerial or staff misconduct — like the falsification of data about wait times for patient appointments at a few VA hospitals — will never occur again.

{mosads}In pursuit of this goal, the VA has launched an Office of Accountability and Whistleblower Protection. It is now posting a list of how many employees – and in what region or occupation and for what infraction — have been fired or disciplined.

At the same time, however, top leaders of the Veterans Health Administration (VHA) as well as a number of Congressional representatives are pressing ahead with plans to put more veterans’ healthcare in the hands of private sector healthcare providers as they try to replace the Veterans Choice Program.

Under the three-year-old Choice program, veterans who live too far away from the nearest VHA facility or need a quicker medical appointment have been able to use private doctors and hospitals, at VA expense.

Critics of a variety of proposals to replace the Choice program fear that outsourcing veteran care to the private sector will divert billions of dollars from needed funding of VHA services to medical providers with less specialized training, little experience caring for veterans, and insufficient supervision.

They also fear these providers will not be held accountable for the care they provide.

Given the testimony the VHA provided at a July 12th hearing at the Senate Committee on Veterans Affairs, it looks like these fears are well founded and that private sector providers will not be held to the same standards now being applied to all in-house VHA staff.

At that hearing,  Baligh Yehia, VHA deputy undersecretary for Health for Community Care, told senators that the CARE program his agency wants to create as a replacement of Choice will be based on “high-performing, integrated networks” in the private sector.

Sen. Joe Manchin (D-W.Va) asked Yehia whether the VA is “capable of overseeing and qualifying” such a vast private sector network — making sure providers have the “skill sets” needed to take care of patients with complex service- related conditions. Yehia assured Manchin that free continuing medical education (CME) credits will be offered to any approved providers not on the VHA staff.

Under tough questioning by the West Virginian, Yehia then admitted that such training will be voluntary, not mandatory, which clearly struck Manchin as problematic.

“Well, you have the checkbook,” the Senator pointed out.  “If you tell me I gotta do something in order to qualify, I’m going to do it.”

Yehia responded that such requirements would be feasible only in areas where doctors recruited, under a Choice replacement program, gained enough new patient volume to give the VA more “market power” over them.

In rural areas, he argued, “if you put a lot of burdens on the community providers and they’re seeing a handful of veterans, they won’t sign up.”

Yehia’s testimony was not reassuring. Studies document that VA patients get far better treatment from healthcare professionals who have veteran-centered expertise.

If our veterans are now dispersed throughout our fragmented, market-driven U.S. healthcare system, most outside providers participating in any Choice replacement program will add only a small number of veterans to their overall patient load.

Private sector providers — even in urban areas where primary care or mental health providers are in short supply — will have little incentive to devote the time and energy needed to become familiar with symptoms of Agent Orange or military burn-pit exposure or better recognize suicidal thoughts or tendencies among veterans adjusting poorly to civilian life.

Plus, if the proposed reimbursement rates under CARE or other privatization proposals fall short of private insurer payment levels, how many high quality providers will be accepting veterans at all, as new patients?

Instead of diverting former military personnel to outside healthcare networks already “rife with quality and access to care issues,” Amy Webb of AMVETS, the nation’s largest and oldest veterans service organizations, urged a different approach: “Why not invest in a system that has already been designed to meet the needs of veterans?” she asked at the hearing.

As she noted, “veterans want the VA to work for them”—not be destroyed through “a bleed-it-dry strategy” of outsourcing and underfunding. But that’s where the Trump Administration and Congressional conservatives may be headed unless veterans and their families, VHA caregivers and veterans’ organizations succeed in their fight for real accountability.

Suzanne Gordon is author of The Battle for Veterans’ Healthcare: Dispatches from the Frontlines of Policy-Making and Patient Care.

The views expressed by contributors are their own and are not the views of The Hill.