Veterans have long been breaking new ground for American social programs. A pension program for Civil War vets was the first national-level welfare program of any kind. Today the Department of Veterans Affairs runs the most socialized part of the U.S. health care system — like Britain's NHS, the Veterans Health Administration is both single-payer and single-provider, where the government owns and operates the hospitals.
The VA has always had a somewhat uncomfortable existence, poised between America's instinctive hero-worship of the military and its traditional love of private business and markets. Until quite recently, veteran worship won out even among conservatives, who would criticize the VA but stop short of dismantling it for fear of insufficient levels of Supporting The Troops.
No longer. Now most conservatives in Congress, prompted in large part by a Koch brothers-funded astroturf group, are gunning for veterans' health care. They want American vets dumped onto the private market, where they will unquestionably receive worse care than they currently do.
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The Washington Monthly (full disclosure: where I previously worked) has the goods, in a cover story investigation of the campaign against the VA. The major organization behind the push is the Concerned Veterans for America, a group purporting to represent the hordes of veterans who have been harmed by the VA and want it privatized. In reality, it's an astroturf campaign funded by the Koch brothers, who have an unshakable hatred of all government welfare programs. But all the major veterans service organizations — such as the American Legion and Veterans of Foreign Wars — do not want privatization, and the VA consistently ranks highly in satisfaction surveys.
More importantly, the CVA's case against VA care is utter garbage. As Phil Longman (a health care policy expert and author of a book on the VA) writes, any question about health care quality must be qualified with "compared to what?" Though the agency has its share of problems, some serious, it has consistently either matched or outperformed every other part of the American health care system, including Medicare and Medicaid, particularly on problems particular to veterans, like traumatic brain injury, addiction, and PTSD.
Some locations have struggled with wait times, particularly in retiree-heavy locations where many aging vets have moved and, due to lack of appropriations, the VA has been unable to expand capacity. But even here the privatization crowd has overstated its case. Rep. Jeff Miller (R-Fla.), who has been chair of the House Veterans Affairs Committee since 2010, announced to great fanfare in 2014 that he had found as many as 40 vets in Phoenix who may have died while waiting for care. However:
An exhaustive independent review of patient records by the VA inspector general uncovered that six, not 40, veterans had died experiencing "clinically significant delays" while on waiting lists to see a VA doctor, and in each of these six cases, the IG concluded that "we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans." […] Those who showed up on waiting lists usually turned out to have been waiting for a routine visit with a primary care doctor rather than facing an urgent health care problem. Moreover, among those shown as waiting to see a primary care physician, many turned out to be already under the active care of a VA or non-VA specialist. In only 28 out of the more than 3,000 patient cases examined by the inspector general was there any evidence of patient care being adversely affected by wait times. [Washington Monthly]
The thing to remember is that the American health care system basically sucks. It's inefficient, cumbersome, psychotically expensive, and constantly kills people. Sure, the VA could stand to improve its wait times, but a RAND Corporation study found that private market wait times were considerably worse. Something similar is true of virtually every indicator of health care delivery.
Still, the largely manufactured 2014 scandal ended up creating enough political momentum for Congress to pass a law mandating some free-markety "reforms" and creating a commission to study the VA and propose changes, which are to be implemented automatically so long as they are "feasible." Big medical centers, slavering at the prospect of devouring some of the VA's $163 billion budget, naturally got four out of 15 commission seats. The CVA and another Koch-backed group each got a seat. So it's not so surprising that some of the other commission members recently caught seven of their colleagues secretly preparing a plan to fully privatize the VA by 2035, as the American Prospect reports. This included legally questionable closed-door meetings with Rep. Miller and Speaker of the House Paul Ryan.
The commission is supposed to take empirical research into account, but it's patently obvious conservatives are just looking for a rubber stamp on their privatization plan. The fix is in.
Rep. Miller was outraged by the Monthly story, and raised numerous quibbles (easily dispatched by Monthly editor Paul Glastris). But the reality of what is happening here is pretty obvious. Rich conservatives don't like a functioning government program and so are trying to destroy it. Veterans will be grossly harmed. All that stands in the way is the massive pile of studies demonstrating VA effectiveness, and whatever lingering shreds of actual concern for veterans still remain.
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