Fact Checking the Fact Checkers at the Washington Post

imagesJust did this new blog post for the American Prospect.  Please read and share.

Fact-Checking Fact-Checkers on Privatizing Vets’ Health Care

In the debate over the future of the Veterans Health Administration (VHA), no concept has attracted more controversy than “privatization.” Since wholesale privatization of the VHA is deeply unpopular among veterans and their advocacy organizations, groups like the Koch brothers-funded Concerned Veterans for America (CVA) argue that they do not support “privatization” of the VHA. As the CVA’s “Fixing Veterans Health Care” report, published earlier this year explains, the group just wants to give veterans “the same degree of choice that is available to other Americans,” with the federal government paying the tab.

Last week, The Washington Post entered the fray. Writing for the paper’s “Fact Checker” column, reporter Michelle Ye Hee Lee gave Senator Jon Tester of Montana and Representative Mark Takano of California, both Democrats, three out of a possible four Pinocchios (signifying “significant factual error and/or obvious contradictions”) for suggesting that the CVA and Trump transition team members support VHA privatization. According to Lee, the CVA’s position does not constitute privatization because, the “CVA has not proposed a wholesale transfer of VHA’s services over to the private sector—which is what ‘privatization’ usually describes.”

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Will Trump Put VHA Staff at Risk

vhaHere is another important post from Beyond Chron.

When thousands of health care professionals at the Veterans Health Administration  (VHA) greet their patients every day at more than 1200 facilities around the country, the first thing they say is: “thank you for your service.”  Their own dedicated service to 9 million veterans is equally worthy of gratitude–and most of those benefiting from it freely express theirs as well.

Unfortunately, President-elect Trump, who never served in the military, doesn’t feel the same way about the care provided by the VHA’s 300,000 employees or show similar respect to their patients. In his recent campaign, Trump said mentally ill veterans for weren’t strong and “can’t handle it”(not to mention calling former Navy pilot John McCain a “loser” for being shot down in combat, badly injured, captured and then abused as a prisoner of war).

Trump also favors privatization of VHA services across-the-board. Congressional Republicans will now have an Oval office champion for their efforts not only to repeal “Obamacare,” but to begin the process of dismantling the VHA.  READ MORE

Will Trump Deliver for Veterans

perspective0221magBased on this election, here is a new post from the American Prospect

Will Trump Deliver for Veterans?

On the campaign trail, President-elect Donald Trump repeated one key promise: to “Make America Great Again” by increasing the country’s military might and supporting its 24 million military veterans. After all, he promised to raise money for veterans and said he donated a million dollars out of his own pocket to veterans’ charities.

But Trump showed his true colors long before Election Day. He finally wrote a personal check to one veteran’s group but only after four months when reporters shamed him into doing so. Trump dissed mentally ill veterans for being weak. Most famously, he called Senator John McCain, who was a Navy pilot during the Vietnam War, a “loser” after being shot down in combat, badly injured, captured, and then abused as a prisoner of war. Nevertheless, many veterans voted for Trump by a large margin.

That’s no great start for “veterans affairs.” But the mistreatment of vets could go from rhetorical to real. That’s because Trump favors some form of privatization of all Veterans Health Administration services, a long sought-after goal of congressional Republicans.  READ MORE

My Analysis of VA Commission on Care Final Report

This just appeared in The American Prospect

Report: VHA Care Commission Recommends Privatizing Some Services

(Photo: AP/Mark Thiessen)

The Veterans Administration Outpatient Clinic in Anchorage, Alaska

After almost a year of meetings and hearings, the Commission on Care has finally issued its report on the future of the Veterans Health Administration. “Care delivered by the VA,” the congressionally mandated report states, “is in many ways comparable or better in clinical quality to that generally available in the private sector.”

But with problems in accessing services, in variations in care, and in the managerial culture at various facilities, the commission believes that the major remedy lies not in outright privatization but in giving veterans more private-sector options, a finding that veterans groups fear may also weaken the decades-old system.

One of the commission’s most complex and potentially problematic recommendations involves the creation of a “VHA Care System,” that would integrate private-sector providers into a VHA-supervised network. The network would service only those veterans eligible for VHA services. Currently, about nine million veterans have been able to establish VHA eligibility; that is, they have health problems connected to their military service or a low-enough income to qualify for enrollment.

The commission recommended that veterans who are VHA-eligible would choose a primary care provider who, in turn, would refer them to specialists. These primary care doctors or specialists could work within the VHA or go outside the VHA to be providers who contract with the agency.

The VHA would be required to create a network that includes all providers who take care of veterans. The agency would have to screen and then contract with community or private-sector providers and ensure that those providers use information-technology systems that are compatible with the VHA’s networks. The VHA would also have to make sure that those providers understand military culture, and would be responsible for coordinating the care veterans receive and helping them navigate the system.

Coordinating care will not be easy. The commission found that veterans who are treated in the VHA do receive coordinated care while those with private plans, Medicare, or TRICARE receive care that is of “lower quality, threatens patient safety, and shifts costs among payers.”

The commission also suggests revising the byzantine VA eligibility requirements that deny benefits to veterans who were “dismissed from military service with an other-than-honorable discharge because of actions that resulted from health conditions (such as traumatic brain injury, posttraumatic stress disorder, or substance use) caused by, or exacerbated by, their service.”

The VHA needs more funding for competitive salaries, which will help recruitment and retention of professional staff.
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The VHA needs more funding for competitive salaries, which will help recruitment and retention of professional staff. Since there are nationwide shortages of certain health-care professionals, recruiting will not be easy.

The commission estimates that over the next few decades, about 40 percent to 60 percent of veterans will receive some, if not all, private-sector, health-care services. Treating fewer patients could significantly compromise VHA care if health-care providers cannot maintain their clinical skills.

Those developments could also discourage health-care professionals from working in or staying with the VHA, which could lead to closing some facilities. “Reductions in volume of care within VA facilities, and potentially adverse effects on quality” are not addressed, the report notes.

The commission’s recommendations are a product of a fractured political divide within the commission itself. Members who supported the VHA constantly fought with hospital-industry executives as well as representatives of the conservative Koch brothers–funded Concerned Veterans for America (CVA) and the so-called Strawman group, which advocated dismantling VHA. Darin Selnick and Stewart Hickey, commissioners who were both connected to CVA, refused to sign the final report. They viewed it as weak on privatization.

Two other commissioners had differing views. Michael Blecker, a Vietnam veteran and executive director of Swords to Plowshares, a San Francisco–based veterans organization, refused to sign the document because of serious concerns that the proposed health-care system “would threaten the viability of VA care for millions of veterans who rely on it.” However, Philip Longman, author of Best Care Anywhere: Why VA Health Care Would Work Better For Everyone, one of the few studies of the veterans health-care system, supports the plan with some reservations. He believes it could bring more veterans into the VHA system and improve the quality of care.

To provide a stronger system, Congress would have to allocate more funds to allow the VHA to hire the necessary staff to provide direct care and handle all the demands of integrating private-sector contractors into the veterans health-care system. Without these resources, the integrity of the VHA will be compromised and the agency would face blame for poor care that veterans receive.

The pending VHA privatization bills proposed by Senator John McCain, an Arizona Republican, and Representative Cathy McMorris Rodgers, a Washington Republican (supported by Representative Jeff Miller, a Florida Republican and chair of the House Veterans Affairs Committee), obviously would not give the agency that leeway. Neither would Donald Trump’s plan to give all veterans vouchers for use in the private sector, which would effectively eliminate the VHA. Announced Tuesday, the plan has already sparked outrage from veterans groups and unions.

The news media will also influence future perceptions of the agency. Mainstream media outlets like CNN that use headlines like “Billions spent to fix VA didn’t solve problems, made some issues worse” to describe the commission report help create a VHA-is-broken-beyond-repair narrative. Although The New York Times has been extremely critical of the VHA, its recent editorial opposing VHA privatization could turn what many veterans groups see as an anti-VHA bent in the national news media.

Finally, the commission report stresses that the VHA currently delivers some of the best care anywhere. Rather than just talking about teamwork, most VHA providers actually work in teams, communicate with one another on electronic medical records, and help patients avoid unnecessary and dangerous overtreatment. The VHA also provides some of the best services for mental health, rehabilitation, and homelessness in the country.

A plan that contributes to strengthening the VHA and improving the private-sector health-care system would be a positive development for veterans and all the rest of us. But if the deficiencies in the civilian health-care system begin to infect the VHA, millions of Americans will lose out.

The Plot Thickens

As you can see in this new post from Beyond Chron, we all need to care about what’s happening in DC about the Veterans Health Administration

Beltway Plot to Dismantle VA Healthcare

by Suzanne Gordon on March 31, 2016

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The San Francisco VA Healthcare System (SFVAHCS) now produces world-class research, and its hospital and clinics provide high quality care to thousands of veterans. The VA Palo Alto Health Care System has specialized services for veterans who have had brain or spinal cord injuries. Veterans Health Administration (VHA) facilities in Sacramento, Los Angeles and throughout California provide high quality care to thousands of veterans.

Unfortunately, inside the Beltway, a group of conservative ideologues and hospital executives want to dismantle the California – indeed the entire — VHA healthcare system and turn veterans’ healthcare over to the private sector.  Don’t think for a moment that this is just a crazy scheme concocted by a Koch brothers cabal meeting at some remote, invitation- only retreat for billionaires (the kind New Yorker writer Jane Mayer describes in her book Dark Money).   Instead, this is what seven of the 15- member Commission on Care on the VHA is pushing in Washington openly and aggressively.  The Congressionally mandated commission has been asked to propose strategies to deliver better health care to veterans over the next 20 years.

Last week, as I have previously reported in The American Prospect, some commission members found out that seven of its members produced a proposal — one they actually call “The Strawman Proposal” — arguing for the total elimination of the VHA. If the commission, as a whole, endorses this plan in their final report, which is expected in June, and our Republican led Congress adopts it, the VHA would no longer deliver direct healthcare services to veterans.  They would become patients of a fragmented and expensive private sector system with the government footing the bill, as it does under Medicare, and jointly with the states under Medicaid.

According to the Strawman faction, the VHA is “broken” beyond repair and fixing it requires a “bold, transformational approach.”  This right-wing Republican line on Capitol Hill and in the mainstream media has been shaped by the Koch Brothers funded pseudo-veterans service organization, Concerned Veterans for America. (CVA)  (For more on CVA and Koch Brothers role in this debate see Alicia Mundy’s great article “The VA Isn’t Broken, Yet,” in the Washington Monthly).

Two members of the Strawman group are Darin Selnick, who works for CVA and Stewart Hickey (who led Amvets, the veterans service organization (VSO), which parted company with three other large VSO’s because it supported CVA proposals to privatize the VHA).   Their allies in the group include three high level hospital executives who stand to benefit financially from VHA privatization: Delos Toby” Cosgrove CEO of the Cleveland Clinic, David Blom, president of hospitals in the Ohio Health System, and Marshall Webster Senior Vice President at the University of Pittsburgh Medical Center.

Other signers are retired Rear Admiral Joyce Johnson, an Obama appointee on the Commission, who directed the U.S. Coast Guard’s health and safety systems. Johnson reportedly supported the use of the insurance plan Tricare to replace the provision of direct healthcare services at the Coast Guard.  When Google failed to ill illuminate her position, and I emailed her to clarify it, she replied that, “Since I am currently serving on the VA Commission on Care,  it’s not  appropriate for me to be interviewed at this time.”

Finally there is retired Marine Corps General Martin Steele, who has argued that caring for mentally ill veterans within the VHA presents an obstacle to their reintegration into society.

The proposal they have crafted is an exercise in incoherence, denial, and magical thinking.  The group believes that private sector hospitals would be willing and able to  recreate VHA Centers of Excellence and other programs like the San Francisco VAHCS’s Center  of Excellence in Epilepsy or Primary Care Education or Palo Alto’s polytrauma, blind or spinal cord injury rehabilitation programs. It also believes the private sector could fulfill the VHA’s research and teaching missions.  As one San Francisco VAHCS researcher told me, “Can you see my eyes rolling?”

By providing private sector providers with financial incentives, they argue that hospitals, physicians, and other health care providers will produce the kind of integrated services that, even the authors acknowledge, are largely non-existent in the private sector.  In spite of all evidence to the contrary, they assert that the private sector can also be encouraged to provide veterans with the mental healthcare, housing, homeless, and programs the VHA currently provides to low income, indigent, and mentally ill veterans.  They thus blithely recommend dismantling what is, arguably, the only functioning mental health system in the country – the VHA’s.

An Independent Assessment of the VHA’s record on care delivery, mandated by the Choice Act, documents that the VHA outperforms the private sector on many measures, is equivalent on some, and marginally worse on only a few.  In spite of variability in the VHA system, the Independent Assessment repeatedly reports that the private sector healthcare system provides care with even more variability than the VHA.  Just last week, the Association of VA Psychologist Leaders posted yet another review of the scientific studies on VHA care which document similar outcomes.

In their document, the Strawmen justify their position on total privatization by pointing to the fact that the VHA is having trouble hiring new recruits to fill many staff vacancies because of the “stigma” attached to working at the VHA.  They also argue that the current VHA workforce suffers from “poor morale” and a “culture of fear.” Of course, VHA management practices could be significantly improved.  But if there is now a “stigma” attached to working at the VHA, a “culture of fear” within it, or demoralization among its current employees, that is, in great part, due to the bashing conservatives have unleashed in the media and Congress.

The way to remedy this problem is not to abolish the VHA but to set the record straight on its accomplishments and provide solutions to its real problems.  This is just what one veterans service organization, Disabled American Veterans (DAV) is trying to do now in a new social media campaign.  The campaign consists of short videos debunking various proposals to partially or fully privatize the VHA and then recommending real solutions that would improve VHA care.

Fortunately for the DAV and other veterans groups – The American Legion, and Paralyzed Veterans of America – that have already spoken out against the Strawman proposal, the Commission on Care has some members who are actually data-driven.  These include Michael Blecker, Executive Director of the San Francisco’s own Swords to Plowshares, David Gorman, a former executive director of the Disabled American Veterans (DAV), and Phillip Longman, senior editor of The Washington Monthly, and author of Best Care Anywhere: Why VA Health Care Is Better than Your’s.

They are receptive to proposals put forth by VHA Undersecretary of Health David Shulkin when he recently testified before the commission.  He proposes allowing veterans to use private sector providers when needed, while strengthening the VHA’s ability to deliver direct care as well as manage and coordinate any care veterans receive from private sector providers.

In his book as well as in his role on the commission, Phillip Longman has urged Congress to extend VHA care to all veterans (not just those with service connected disabilities and/or low incomes). He suggests that veteran’s spouses and their families should also be able to access VHA care and recommends establishing pilot projects that would allow non-veterans to purchase care in the system.   One group that could be included first are the over 200,000 non-veteran VHA employees who care for veterans but can’t access the high quality care they provide.  Just as most employees at Kaiser are covered by their own employer, VHA staff should be able to access the care VHA delivers if they so choose.

In the name of delivering what it calls “veteran centric” care, the commission’s pro-privatization faction want to squander the 70 -year investment that U.S. taxpayers have made in the largest and only fully integrated healthcare system in America.   While private sector hospitals and other providers talk about being patient-centered, few really are.  In spite of its many problems and the numerous obstacles it faces, the VHA has tried to create a truly veteran/patient centered system. Throughout California, many of us non-veterans who help pay for veterans’ care already know that having private health insurance is not the same thing as having access to reliable, affordable, high quality, integrated care.

Healthcare journalist Suzanne Gordon has authored 18 books, many on the problems of patient safety in the private sector healthcare system.  She is writing a new book on VHA healthcare and has spent the past year and a half visiting VHA facilities around the country.