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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Great New Article on the VHA by Paul Glastris

Please read and share this great new article that appeared on the Boston Globe blog by Paul Glastris.

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Special interest groups want to privatize the VA and nobody is paying attention

 

Should America’s veterans receive health care at hospitals and clinics run by the federal government, as they have for more than a century? Or should they be treated by private doctors and hospitals, with the US Department of Veterans Affairs (VA) picking up the tab?

This enormously important question will be discussed, and perhaps decided, at meetings on Monday and Tuesday of the Commission on Care. That’s a federally chartered group that is writing binding recommendations on the future of the VA.

If you’ve never heard of the Commission on Care, you’re not alone. Virtually none of the mainstream news outlets have covered its public hearings, which have been going on since the fall. This despite the fact that the VA health care system, with 300,000 employees and a $65 billion budget serving more than 9 million patients, is the federal government’s second largest enterprise after the Department of Defense.

The reason Washington is even considering such a radical restructuring of the VA has to do with widely publicized reports in 2014 that 40 veterans in Phoenix died waiting for first-time appointments with VA doctors. These reports led to bipartisan legislation mandating the creation of the commission. But as investigative journalist Alicia Mundy reveals in the Washington Monthly, the reports turn out to have been baseless allegations cooked up by a Koch brothers-funded group, Concerned Veterans for America (CVA), and key Republicans lawmakers who ideologically favor the outsourcing of VA health care.

Soon after the law was passed, the VA’s inspector general’s office published a report based on an exhaustive review of VA patient records. The report concluded that six, not 40, veterans had died experiencing “clinically significant delays” while on waiting lists to see a VA doctor. Of those six, the IG could not confirm that any vets died as a result of waiting for care. (Think of it this way: People die every year waiting in grocery lines, but that doesn’t mean they died because of waiting in grocery lines.) There were certainly problems at some VA facilities. The waiting list numbers were definitely being gamed by VA personnel struggling to keep up with unmeetable performance metrics. The “death wait” allegations, however, were bogus.

But wouldn’t vets receive swifter and better quality care from private hospitals and doctors than from a big bureaucracy like the VA? Actually, no. The law that set up the commission also mandated that $68 million be spent on independent research into the VA’s functioning. The researchers concluded that despite many problems, including plunging morale and a wave of retirements, the VA performed “the same or significantly better” than private sector providers on a wide range of quality measures. They also found that average waits for VA doctors were shorter than wait times for doctors in the private sector.

Given all this, you’d think the commission would easily conclude that outsourcing VA health care to the private sector makes no sense. But that’s not how Washington works. It just so happens that four of the 15 members of the commission are executives with major medical centers that stand to gain from the outsourcing of veterans’ care. Another works for CVA, the Koch brothers-backed group, and yet another for an organization allied with CVA.

Last month these six commissioners plus a seventh were outed for writing a secret draft of the commission’s recommendations — in which they call for full privatization of the VA by 2035 — in possible violation of the Sunshine and Federal Advisory Committee Acts. This revelation infuriated the other commission members. It also led prominent veterans groups, including the American Legion and Veterans of Foreign Wars, to send a letter to the commission chair slamming the secret draft and expressing their united opposition to privatizing the VA.

Amazingly, none of these traditional veterans groups have seats on the commission. Indeed, a big reason the outsourcing push has gotten as far as it has is that the veterans groups allowed themselves to be sidelined politically. Now, finally, they are fighting back.

While they don’t have votes on the commission, the groups do have 5 million members. Several of their leaders will also testify at this week’s commission meetings. So the meeting will likely be an epic showdown between pro- and antiprivatization forces that could profoundly influence the commission’s final recommendations, due out in June. Hopefully, someone from the media will be there to tell us what happened.

Paul Glastris is editor in chief of Washington Monthly.

 

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.

Jeff Miller Interferes on Commission on Care

This was just posted on the American Prospect blog.  It shows how far the Right will go to rig the outcome of what are supposed to be independent deliberations.   Sadly, no Democratic Senators or Congress members have complained about this.

House Veterans Affairs Chairman Blasts Health-Care Commission Member

The VA Commission on Care, the 15-member bipartisan body created by Congress to make recommendations about the future of the Veterans Health Administration (VHA), has been meeting for months and plans to publish its findings in June. Until this week, Congress had not interfered with the commission’s supposedly independent deliberations.

That all changed on March 14 when Republican Congressman Jeff Miller, the House Veterans’ Affairs Committee chairman and a staunch advocate of privatizing the Veterans Health Administration, wrote an angry letter to the commission chairwoman Nancy Schlichting. In this unprecedented missive, Miller personally attacked Phillip Longman, a commission member who has advocated not only preserving but strengthening the veterans’ health-care agency in part by eliminating its cumbersome eligibility requirements, and expanding health-care services to veterans’ families.

Miller accused Longman, a Washington Monthly senior editor and author of a sympathetic appraisal of the VHA, Best Care Anywhere: Why VA Health Care is Better than Yours, of personally editing a recent article by former Wall Street Journal reporter Alicia Mundy. Mundy criticized Miller for his singular focus on VHA wait times and his insistence that 40 veterans had died because they were waiting for care. She also detailed the role that Miller and other congressional conservatives have played in the Koch brothers’ campaign to privatize veterans’ health care. Mundy warned that private hospital systems, which have representatives on the commission, are “circling like vultures over the idea of dividing up the VA’s multibillion-dollar budget.”

Miller said Longman helped spread “blatantly false propaganda in an attempt to minimize the wait-times scandal at the Department of Veterans Affairs” through the Mundy magazine article. Longman “either believes the article’s false claims or he—as an editor of the piece—signed off on them knowing they were untrue,” Miller wrote. He warned the commissioners “to take anything Longman says with an extremely large grain of salt.”

A subsequent Washington Monthly blog post by Paul Glastris, who actually edited Mundy’s article, rebutted Miller’s claims about patient deaths and other issues.  Longman, who is a part-time staff member at the magazine, also reviewed Mundy’s piece but did not edit it. (However, members on the commission, which includes health-care industry executives, veterans’ advocates, and a representative of the Koch brothers-backed Concerned Veterans for America, can continue to perform their professional duties as long as they do not claim to be acting on behalf of or speaking for the commission.)

Veterans advocates say that Miller’s tirade was the first time any of them could remember a congressman attacking a commission member.

Retired Army captain Steve Robertson, a former Senate Veterans’ Affairs Committee staff director, told The American Prospect that, in his 30 years working on veterans issues, he couldn’t “recall a member of Congress ever instructing members of a commission or advisory group to ignore one of their members.” Robertson said, “Miller is way out of line.” Another representative of a major veterans service organization who did not wish to be identified, called Miller’s letter an attempt to “intimidate an independent commission and politicize their recommendations”

One week later, Miller appeared before the commission and continued his critique of the agency. In his hour-long comments, Miller had nothing good to say about the VHA. He ignored the findings of an independent assessment commissioned by Congress that found that the VHA delivers care that is often superior to the private sector. When commission member Michael Blecker of San Francisco-based Swords to Plowshares tried to defend the VHA’s model of integrated care and worried that many veterans would fall through the cracks of a private health-care system, Miller barely let Blecker finish his comments. The congressman argued that the VHA is “holding veterans inside” the system and must allow them to move into private sector care. Miller concluded by encouraging the commission to offer “bold ideas” on overhauling the system in their upcoming report.

The congressman may want to “empower veterans,” as he terms it. But moving them into a private health-care sector that has primary care physician shortages, coordination of care difficulties, serious wait-time challenges, and hundreds of thousands of deaths due to preventable medical errors poses risks that the commission can ill-afford to ignore.