Forum to Save the VA with Nancy Pelosi

Nancy Pelosi and Suzanne Gordon V event 041317

 

Yesterday, I spoke about my new book at a wonderful forum in San Francisco on “The Threats to Veterans Healthcare” with Congressional leader Nancy Pelosi.  The session was sponsored by the Veterans Healthcare Action Campaign.  Other speakers included Michael Blecker of Swords to Plowshares, veteran Edgar Escobar, and Major General Mike Myatt. Over two hundred people came to learn more about how they can participate in the fight against VHA privatization–as patients, VHA staff members, and as union activists.  In fact, so many came that the room was over-flowing.  In the comment period, veterans spoke out from the floor with amazing stories about the importance of VHA care.  To learn more about these issues, please order my new book The Battle for Veterans’ Healthcare and check out the website of Fighting for Veterans’ Healthcare, where you will find an excellent analysis of how Choice may dismantle the VA. For U.S. Representative Pelosi’s remarks and more on our panel, click here and to see the video of the event, here

SG at Podium

Trump Assault on Healthcare. The Facts Need to Go Viral

maxresdefaultGiven the coming assault on health care in general — Obamacare, Medicare, Medicaid — and the Veterans Health Administration in particular, please view the following videos done by the Disabled American Veterans.  Please click, and then share.  We need to make stuff like this go viral.  It’s brilliant!!  They include the misguided proposals and then suggest workable proposals that would strengthen, improve, and reform the VHA not dismantle it.

Setting the Record Straight on VA Health Care Reform: Privatizing the VA
Setting the Record Straight on VA Health Care Reform, Centers of Excellence

Setting the Record Straight on VA Health Care Reform, Treating only Service Related Injuries

Setting the Record Straight on VA Health Care Reform, Let the Money Follow the Veteran

Setting the Record Straight on VA Health Care Reform: Turning VA into an Insurance Provider

 

New Blog Post on McCain VHA Bill — Bad News

mccainindexI just posted this on the American Prospect blog on McCain’s attempt to flimflam veterans by privatizing the VHA.

 

Tapped: The Prospect Group Blog

McCain Pulls a Bait-and-Switch on Vets

Almost as soon as Senator John McCain had finished working with Senator Bernie Sanders to craft the veterans’ health-care bill now known as the Choice Act in 2014, the Arizona Republican set out to renege on his promise that Choice would be temporary, and began floating plans to make it permanent.

Part of the Choice Act was the establishment of the Commission on Care, whose deliberations the Prospect has covered extensively. This week that Commission is meeting to hammer out its final report, which will include recommendations about what the VHA should look like in 20 years. Instead of waiting to see what the Commission mandated by his own bill recommends, McCain has once again jumped the gun. He is lobbying hard for a bill that would not only make the Choice program permanent, but would eliminate any restrictions on veterans’ access to private-sector health care.

McCain’s gift to veterans is a bill misleadingly labeled The Care They Deserve Act. The subject of hearings on Capitol Hill the week of June 23, the bill would make the Choice Act—a three-year experiment enacted following revelations of delays in care at VHA facilities in Phoenix and elsewhere—permanent. Choice allows veterans to seek care from private-sector health-care providers if they face more than a 30-day wait for an appointment, or trips of 40 miles or more to the nearest VHA facility.

Under McCain’s new plan, the nine million veterans eligible for VHA care would be free to use any private health-care facility or provider, for any form of service, with the federal government paying the tab—no questions asked. McCain has gathered seven other Republican sponsors for his bill, all of them pushing the new conservative narrative that the VHA is broken beyond repair. This, of course, ignores reports by a Choice Act-mandated Independent Assessment of the VHA, which documents that its veteran/patients actually receive better care, at lower cost, than millions of Americans who rely on private sector health care.

What’s wrong with The Care They Deserve Act? Just about everything, which is why many veterans service organizations like the Disabled American Veterans (DAV) and Vietnam Veterans of America oppose the plan, and why the VHA’s own undersecretary for health, David Shulkin, has proposed a more sensible alternative.

Economists advising the Commission on Care estimate that McCain-style privatization could triple the cost of veterans’ care to almost  $450 billion a year—money that would not be well spent. The VHA’s clinicians and other staff specialize in the complex health problems related to military service, and deal with patients who are older, sicker, and poorer, with more mental health problems that those cared for in the private sector. The average elderly patient in the private sector shows up presenting between three to five physical problems. The “co-morbidities” of a Vietnam vet, for example, can number from nine to 12. That’s why VHA primary care providers spend at least 30 minutes with their patients per visit, compared to the ten or 15 minutes allotted to patients in the private sector. Will private sector providers want to take the time to care for aging, sometimes homeless, often mentally ill, veterans? Even if they do, will they be able to detect the difference between ordinary type 2 and Agent Orange-related diabetes, or be equipped to parse the myriad symptoms of PTSD?

McCain’s bill promises veterans a choice between VHA and private sector care. In reality, it would ultimately erode choice by weakening the VHA option, putting the entire veterans’ health system at risk. The VHA’s current budget is determined by how many veterans use the system and for what services. If far more eligible veterans start using private sector health care, there will be less funding available for VHA services that are unavailable elsewhere, and for maintaining the agency’s highly specialized research and clinical expertise in military-related health problems. As funding for costly private sector care eats up more of the VHA’s annual budget, there will be hospital and clinic closings, along with VHA staff layoffs. To reduce expenditures on veteran health care, Congress may also be tempted to make eligibility for veterans’ health-care benefits even more restrictive than it is today.

If Congress wants to improve the VHA, it should embrace the reform proposals of Shulkin and those Commission on Care members who want to allow veterans access to private sector providers in networks coordinated by the VHA. With luck, this recommendation will appear in the Commission’s June report. Strengthening the VHA, and giving veterans the choice to see outside providers if necessary, would really give veterans the care they deserve.

 

 

Very Important Paper on Proposed Privatization of the VHA

I am posting this briefing sheet that just appeared on the Association of VA Psychologist Leaders and the Association of VA Social Workers websites. As I’ve noted before, some Congressmen and Senators propose to turn what was supposed to be a temporary program to deal with delays in access via the Choice program  into permanent programs that could ultimately lead to greater privatization of the VHA. These include: S. 1991, Senator John McCain’s Permanent VA Choice Card Legislation, H.R. 1604, the Veterans’ Mental Health Care Access Act proposed by Congressmen Tom MacArthur (R, NJ) and Beto O’Rourke (D, TX), and the Veterans Health Care Freedom Act (H.R. 3183) introduced by David W. Jolly (R, FL).

Most people don’t know that in spite of some problems with delayed access, the VHA consistently achieves better quality and better integrated-care than fee-for-service private sector treatment. Independent experts have recognized the Veterans Health Administration as one of the most successful healthcare systems in the country. The briefing sheet below astutely critiques the myths and distortions that are being publicized to promote VA privatization legislation. It’s an important read for anyone wanting to preserve high quality healthcare for veterans or interested in the future of healthcare in the United States.

Proposed Veterans Choice Card Program Expansion

Briefing Sheet

From the Association of VA Psychologist Leaders, Association of VA Social Workers, American Psychological Association and National Association of Social Workers

October 22, 2015

Background

 Many veterans wait unacceptably long times for appointments in the Veterans Health Administration (VHA). The Veterans Access, Choice, Accountability and Transparency Act of 2014 Choice Card Program was enacted as a three-year solution to address access problems for selected veterans. One year into that pilot, there are concerted Congressional efforts to expand the Choice Program, and make it permanent.

There are no additional appropriations in the Choice Card Program expansion bills; funding for expanding the Choice Card Program would come by siphoning allocations from VHA Medical Centers & Community Based Outpatient Clinics — downsizing the number of VHA providers and programs. The effect over time would be to dismantle the VHA system and privatize care for veterans.

The proposed expansion of Choice is predicated on popular myths, which are critiqued below.

Myths about VHA Health Care and Choice Program Expansion

Myth:

Quality of VHA healthcare is worse than in other healthcare systems.

In fact:

Independent evaluations have repeatedly found that VHA outpatient care outperforms non-VHA commercial, Medicare, and Medicaid HMO outpatient care on virtually every single measure of quality. VHA hospitals perform as good or better than non-VHA hospitals on most, but not all, inpatient quality measures.

Myth:

Veterans with mental health problems are getting inadequate VHA care.

In fact:

The 2011 RAND evaluation reported that the quality of VHA mental health care “is as good as or better than that reported for patients with comparable diagnoses who received care through private insurers, Medicare or Medicaid.”

Myth:

Delayed access in the VHA is systemic.

In fact:

Although excessive appointment delays exist in specific locations, the recent MITRE/RAND assessment found no system-wide crisis in access to VHA care.

Timeliness for mental/behavioral healthcare in VHA is as good or better than in commercial and public plans.

Myth:

The VHA is doing an inferior job addressing veteran suicides.

In fact:

In a recent national study of suicides between 2000 and 2010, veterans who used VHA services had reduced rates of suicide, while veterans not utilizing VHA had increased rates. Since its launch eight years ago, the 24-hour Veterans Crisis Line has answered more than 1.86 million calls from veterans and their family/friends; care coordination for callers is easier in cases when a veteran’s provider is in the VHA than in the community.

Myth:

Expanding Choice will provide veterans with new options without taking away existing ones.

In fact:

Although the 2014 Choice legislation continued the current level of VHA funding and tacked on extra allocations for three years of Choice, the new legislative efforts would pay for Choice Program expansion out of VHA funds. This will incrementally downsize the number of VHA providers and programs.

Myth:

Expanding Choice won’t harm healthcare education.

In fact:

70% of all physicians (as well as 40 other healthcare professions) receive part of their clinical training in VHA. Significant reductions in the number of VHA attending supervisors would disrupt healthcare education.

Myth:

VA healthcare is disjointed and unwieldy.

In fact:

Unlike fractured community treatment, VHA healthcare integrates concurrent physical, mental, behavioral and psychosocial problems, including homelessness and unemployment. Since 2012, 175,000 homeless veterans have been housed; 14,000 veterans participate yearly in VA Compensated Work Therapy programs.

Myth:

A substantial number of veterans with mental health problems avoid VHA treatment because they feel stigmatized receiving services at VHAs.

In fact:

Veterans benefit from the camaraderie of fellow veterans. There is no research that’s found veterans feel greater stigma receiving mental health care at VHAs.

Recommendations

 The VHA must fix its access problem. The best means to do so are:

 

  1. Increase funding to VA medical centers and community based outpatient clinics where staff/patient ratios are inadequate to provide timely access.

 

  1. Expand telehealth and telemental health services for rural and homebound veterans.

 

  1. Implement emerging VHA best practice access procedures.

 

  1. Oppose Choice Card Program Expansion legislation that siphons VHA funds into privatized care.

 

As 8 leading veterans service organizations stated September 16, 2015 in a joint Open Letter about privatizing VHA care:

“Eliminating the VA health care system – considering all that it has done in the past and all that it could be in the future – would inevitably endanger the health and well-being of millions of wounded, injured and ill veterans, an outcome that we cannot allow to occur… Giving veterans health savings accounts in lieu of access to a VA health care system would effectively diminish our nation’s sacred obligation to ‘care for him who shall have borne the battle…’ ”

 

 

Proposed Veterans Choice Card Program Expansion
Briefing Sheet
from the Association of VA P
sychologist Leaders, Association of
VA Social
Workers, American Psychological
Association and National Associ
ation of Social
Workers
October 22, 2015
Background
Many veterans wait unacceptably long times for appointments in
the Veterans Health
Administration (VHA). The Veterans Access, Choice, Accountabili
ty and Transparency
Act of 2014 Choice Card Program was enacted as a three-year sol
ution to address
access problems for selected veterans. One year into that pilot
, there are concerted
Congressional efforts to expand the Choice Program, and make it
permanent.
There are no additional appropriations in the Choice Card Progr
am expansion bills;
funding for expanding the Choice Card Program would come by sip
honing allocations
from VHA Medical Centers & Community Based Outpatient Clinics -
- downsizing the
number of VHA providers and programs. The effect over time woul
d be to dismantle the
VHA system and privatize care for veterans.
The proposed expansion of Choice is predicated on popular myths
, which are critiqued
below.
Myths about VHA Health Care and Choice Program Expansion
Myth:
Quality of VHA healthcare is worse than in other healthcare systems.
In fact:
Independent evaluations have repeatedly found that VHA outpati
ent care
outperforms non-VHA commercial, Medicare, and Medicaid HMO outp
atient care
on virtually every single measure of quality. VHA hospitals per
form as good or
better than non-VHA hospitals on most, but not all, inpatient q
uality measures.
i
ii
iii
Myth:
Veterans with mental health problems are getting inadequate VHA care.
In fact: The
2011 RAND evaluation reported that t
he quality of VHA mental health
care “is as good as or better than that reported for patients w
ith comparable
diagnoses who received care through private insurers, Medicare,
or Medicaid.”
iv
Myth:
Delayed access in the VHA is systemic.
In fact:
Although excessive appointment delays exist in specific locatio
ns, the
recent MITRE/RAND assessment found
no system-wide crisis in acc
ess to VHA
care.
v
Timeliness for mental/behavioral healthcare in VHA is as good
or better
than in commercial and public plans.
vi
Myth:
The VHA is doing an inferior job addressing veteran suicides.
In fact:
In a recent national study of suicides between 2000 and 2010, v
eterans
who used VHA services had
reduced
rates of suicide, while veterans not utilizing
VHA had increased rates.
vii
Since its launch eight years ago, the 24-hour
Veterans Crisis Line has answered more than 1.86 million calls
from veterans and
their family/friends; care coordination for callers is easier i
n cases when a
veteran’s provider is in the VHA than in the community.
Myth:
Expanding Choice will provide veterans with new options without taking away
existing ones.
In fact:
Although the 2014 Choice legislation continued the current lev
el of VHA
funding and tacked on extra allocations for three years of Choi
ce, the new
legislative efforts would pay fo
r Choice Program expansion out
of VHA funds. This
will incrementally downsize t
he number of VHA providers and pro
grams.
Myth:
Expanding Choice won’t harm healthcare education.
In fact:
70% of all physicians (as well as 40 other healthcare professi
ons) receive
part of their clinical training in VHA.
viii
Significant reductions in the number of VHA
attending supervisors would disrupt healthcare education.
Myth:
VA healthcare is disjointed and unwieldy.
In fact
: Unlike fractured community treatment, VHA healthcare integrat
es
concurrent physical, mental, behavioral and psychosocial proble
ms, including
homelessness and unemployment. Since 2012, 175,000 homeless vet
erans have
been housed; 14,000 veterans participate yearly in VA Compensat
ed Work
Therapy programs.
Myth:
A substantial number of veterans with mental health problems avoid VHA
treatment because they feel stigmatized receiving services at VHAs.
In fact:
Veterans benefit from the camaraderie of fellow veterans. Ther
e is no
research that’s found veterans feel greater stigma receiving me
ntal health care at
VHAs.
Recommendations
The VHA must fix its access problem. The best means to do so ar
e:
1. Increase funding to VA medical centers and community based o
utpatient clinics
where staff/patient ratios are inadequate to provide timely acc
ess.
2. Expand telehealth and telemental health services for rural a
nd homebound
veterans.
3. Implement emerging VHA best practice access procedures.
4. Oppose Choice Card Program Expansion legislation that siphon
s VHA funds into
privatized care.
As 8 leading veterans service organizations stated September 16
, 2015 in a joint Open
Letter about privatizing VHA care:
“Eliminating the VA health care system – considering all that i
t has done in the
past and all that it could be in the future – would inevitably
endanger the health
and well-being of millions of wounded, injured and ill veterans
, an outcome that
we cannot allow to occur… Giving veterans health savings accoun
ts in lieu of
access to a VA health care system would effectively diminish ou
r nation’s sacred
obligation to ‘care for him who shall have borne the battle…’ ”
ix
i
http://www.va.gov/opa/choiceac
t/documents/assessments/Assessmen
t_B_Health_Care_Capabilities.pdf

 

Proposed Veterans Choice Card Program Expansion
Briefing Sheet
from the Association of VA P
sychologist Leaders, Association of
VA Social
Workers, American Psychological
Association and National Associ
ation of Social
Workers
October 22, 2015
Background
Many veterans wait unacceptably long times for appointments in
the Veterans Health
Administration (VHA). The Veterans Access, Choice, Accountabili
ty and Transparency
Act of 2014 Choice Card Program was enacted as a three-year sol
ution to address
access problems for selected veterans. One year into that pilot
, there are concerted
Congressional efforts to expand the Choice Program, and make it
permanent.
There are no additional appropriations in the Choice Card Progr
am expansion bills;
funding for expanding the Choice Card Program would come by sip
honing allocations
from VHA Medical Centers & Community Based Outpatient Clinics -
- downsizing the
number of VHA providers and programs. The effect over time woul
d be to dismantle the
VHA system and privatize care for veterans.
The proposed expansion of Choice is predicated on popular myths
, which are critiqued
below.
Myths about VHA Health Care and Choice Program Expansion
Myth:
Quality of VHA healthcare is worse than in other healthcare systems.
In fact:
Independent evaluations have repeatedly found that VHA outpati
ent care
outperforms non-VHA commercial, Medicare, and Medicaid HMO outp
atient care
on virtually every single measure of quality. VHA hospitals per
form as good or
better than non-VHA hospitals on most, but not all, inpatient q
uality measures.
i
ii
iii
Myth:
Veterans with mental health problems are getting inadequate VHA care.
In fact: The
2011 RAND evaluation reported that t
he quality of VHA mental health
care “is as good as or better than that reported for patients w
ith comparable
diagnoses who received care through private insurers, Medicare,
or Medicaid.”
iv
Myth:
Delayed access in the VHA is systemic.
In fact:
Although excessive appointment delays exist in specific locatio
ns, the
recent MITRE/RAND assessment found
no system-wide crisis in acc
ess to VHA
care.
v
Timeliness for mental/behavioral healthcare in VHA is as good
or better
than in commercial and public plans.
vi
Myth:
The VHA is doing an inferior job addressing veteran suicides.
In fact:
In a recent national study of suicides between 2000 and 2010, v
eterans
who used VHA services had
reduced
rates of suicide, while veterans not utilizing
VHA had increased rates.
vii
Since its launch eight years ago, the 24-hour
Veterans Crisis Line has answered more than 1.86 million calls
from veterans and
their family/friends; care coordination for callers is easier i
n cases when a
veteran’s provider is in the VHA than in the community.
Myth:
Expanding Choice will provide veterans with new options without taking away
existing ones.
In fact:
Although the 2014 Choice legislation continued the current lev
el of VHA
funding and tacked on extra allocations for three years of Choi
ce, the new
legislative efforts would pay fo
r Choice Program expansion out
of VHA funds. This
will incrementally downsize t
he number of VHA providers and pro
grams.
Myth:
Expanding Choice won’t harm healthcare education.
In fact:
70% of all physicians (as well as 40 other healthcare professi
ons) receive
part of their clinical training in VHA.
viii
Significant reductions in the number of VHA
attending supervisors would disrupt healthcare education.
Myth:
VA healthcare is disjointed and unwieldy.
In fact
: Unlike fractured community treatment, VHA healthcare integrat
es
concurrent physical, mental, behavioral and psychosocial proble
ms, including
homelessness and unemployment. Since 2012, 175,000 homeless vet
erans have
been housed; 14,000 veterans participate yearly in VA Compensat
ed Work
Therapy programs.
Myth:
A substantial number of veterans with mental health problems avoid VHA
treatment because they feel stigmatized receiving services at VHAs.
In fact:
Veterans benefit from the camaraderie of fellow veterans. Ther
e is no
research that’s found veterans feel greater stigma receiving me
ntal health care at
VHAs.
Recommendations
The VHA must fix its access problem. The best means to do so ar
e:
1. Increase funding to VA medical centers and community based o
utpatient clinics
where staff/patient ratios are inadequate to provide timely acc
ess.
2. Expand telehealth and telemental health services for rural a
nd homebound
veterans.
3. Implement emerging VHA best practice access procedures.
4. Oppose Choice Card Program Expansion legislation that siphon
s VHA funds into
privatized care.
As 8 leading veterans service organizations stated September 16
, 2015 in a joint Open
Letter about privatizing VHA care:
“Eliminating the VA health care system – considering all that i
t has done in the
past and all that it could be in the future – would inevitably
endanger the health
and well-being of millions of wounded, injured and ill veterans
, an outcome that
we cannot allow to occur… Giving veterans health savings accoun
ts in lieu of
access to a VA health care system would effectively diminish ou
r nation’s sacred
obligation to ‘care for him who shall have borne the battle…’ ”
ix
i
http://www.va.gov/opa/choiceac
t/documents/assessments/Assessmen
t_B_Health_Care_Capabilities.pdf