Privatization Won't Fix the VA

I just had this published in The Boston Globe

Privatization won’t fix the VA

By Suzanne Gordon

May 27, 2014

Veterans Affairs Secretary Eric Shinseki speaks with reporters on Capitol Hill in Washington earlier this month.

First it was Social Security, then Medicare and Medicaid, and then the public health care option under Obamacare. Now, in the wake of recent allegations that veterans hospitals put patients on secret wait lists, Republicans are calling for the privatization of the Veterans Health Administration, the nation’s largest public health care system which provides cost-effective and high quality care to 6.2 million veterans.

It is of course unacceptable if patients suffered as a result of any delays. But regardless of what went wrong at any VA facility, turning veterans over to private sector insurers and for-profit hospitals is not the solution.

With its salaried staff of nearly 280,000, the VA has long been a model for health care delivery. The VA’s 152 hospitals, 900 clinics, 300 mental health centers, and other facilities — many located in rural areas that the private sector ignores — care for more than 230,000 people a day. In a recent survey of veterans for the American Customer Satisfaction Index, patients rated the system’s services as equal to or better than private sector health care facilities.

One reason is the VA’s systematic efforts to improve quality care and patient safety. The VA computerized medical records long before private hospitals. The VA conducts widespread training on inter-professional communication and teamwork that decreases patient deaths and injuries due to the kind of medical mistakes and problems that kill over 400,000 patients a year. In 2007, the VA launched a successful initiative to dramatically reduce the dangers of one the deadliest hospital superbugs —methicillin-resistant Staphylococcus aureus.

The VA has singular expertise in the treatment of post-traumatic stress disorder. Many injured soldiers have returned from Iraq and Afghanistan with what is known as poly-trauma — PTSD plus traumatic brain injury and limb amputations. Few primary care physicians — or even specialists — have much experience treating such cases in the private sector. In fact, without the VA, vets would have trouble getting any primary care services given the serious shortage of primary care providers in this country.

Because the VA is a public entity, its facilities actually display greater accountability — and more transparency to patients and their families — than private health care systems. When veterans have a VA-related beef — or in-house whistle-blowers a tale to tell — they are quick to notify their elected representatives. Such complaints regularly trigger individual constituent service queries from members of Congress or, as is the case today, oversight hearings by House and Senate committees. (Good luck triggering a similar rapid response to patient or staff complaints in the private sector.)

The US Inspector General now has a task force probing the VA in Phoenix, which is accused of hiding long delays before veterans could see doctors. As Senator Bernie Sanders of Vermont, chairman of the Senate Veterans’ Affairs Committee, said, “It’s imperative that we uncover the problems that exist and address them boldly.” What’s already known is that the VA system in Phoenix cares for 80,000 vets, many of them older and with serious, chronic health conditions. If some waited too long to be seen, maybe it’s time for Congress and the White House to figure out how to free up funds to care for veterans who are living longer with more complex conditions.

Doing this would be far better for them and the nation than privatizing a system that is, in fact, a model for broader health care reform.

Suzanne Gordon’s latest book is “Beyond the Checklist: What Else Health Care Has to Learn from Aviation Teamwork and Safety.’’

Showing 6 comments
  • Bindu Desai

    You are correct Suzanne, there ARE problems at the VA but overall it is a superb model of what should be a NHS all across the USA. The loud cries are to prepare the public for privatization so that public moneys enriches those already wealthy beyond belief!

  • Deeanna Burleson, RN, MSN

    Suzanne, a great summary of the pros of the VA. I am a nurse with experience in the VA, DoD and private sector as a nurse, administrator, program evaluator (over 30 VAMCs) and a patient. I have been involved in national DoD/VA working groups so I know the lay of the land and the “feel” of the facilities. The VA Staff and leaders are very passionate about their patients (not always so in the private sector but they also have to survive a political organization. There are often inspections at the drop of a hat by a request of any given congressman. The VA because of the potential for media sensationalism is ripe for issues during the beginning of a political season. The VA health care system is very proactive which can be seen in their Transformation 21 initiatives. I only wish the same scrutiny and media blitz could occur for our many fragmented civilian healthcare centers. Those related physician practices have quotas on how many medicare or medicaid patients. It is not unusual to call for a medicare patient to be told it will be 6 – 8 months or there are just no slots available. The difference is there is not a requirement to report that to anyone for success, it just is. So, I have to say from all of my experiences as a VA Nurse, program evaluator and now, patient the care the Veterans receive are hands down better and more accessible than the private sector. I choose to receive my care at the VA. It is not perfect but is much improved over the private sector. We just do not hear how bad or fragmented the private sector really is.

  • Nancy Short DrPH RN

    The VA is stretched too thin and has lost sight of it’s core “business”. It’s business should be providing excellent care to all service members who have illnesses or injuries related to their service to the nation. It’s business and mission should not be as an academic teaching facility for physicians or to provide all possible treatments for all infirmities to aging veterans (I’m referring to non-service related infirmities). I read in today’s newspaper about a 93 year old veteran of WWII who waited 7 hours at a VA clinic for an appointment about cataract removal. The writer was incensed that this veteran was so poorly treated. I would suggest that this 93 year old should take his Medicare coverage and go to the private sector for care just like other 93 year olds. Free up personnel to care for those with service related illnesses and injuries! Free up ORs. Use scarce resources on service related problems only.

    To compound the stretching too thin …. within the past few years, the VA took on the mission of helping homeless veterans. This is a noble cause. I applaud the intentions. But the VA cannot be all things to all people who served in the military in the past 100 years. Until medical care of those with service related problems is a fine-honed system with outstanding outcomes, VA leaders should not distract from the core business with other foci.

    I know that this is an unpopular vision. As a nursing student in the 1970s, part of my training was in a VA Hospital. We must separate the “mission” of being an academic teaching hospital where resident education and research often take precedence over patient-centered care. We didn’t get here overnight and it’s going to take a long time to fix. Let’s avoid further conflict that require “boots on the ground” unless we can guarantee those “boots” that we have an excellent system to care for them should they require medical and rehabilitative care.

  • Meenal Mamdani

    Yes, the VA does deliver excellent medical care at a fraction of the cost that private hospitals would charge.
    That care could be improved further by limiting part time doctors at the VA. Invariably, these individuals spend less than the allotted time at the VA. Often these docs work at the adjacent university caring for paying patients, saving salary dollars for the university.
    VA docs spend a good portion of their time teaching students who do their clinical rotation at the VA. The university does not compensate the VA for this freebie.
    Another area is basic research for which some VAs have excellent facilities. Again, time for this is carved out of what is supposed to be clinical work time.
    If these issues can be improved, then the VA can be as good if not better than the private hospitals.

  • Toni Cordell

    No question there has been some sad situations at the VA hospital. When my husband was in a VA hospital in Syracuse, NY just before his death, I saw unacceptable care.

    One of my biggest frustrations was the two men attending him. I didn’t know their level of training, but they spoke with such a heavy accent that I did not understand them and they came from a culture where women were/are not respected. I couldn’t get straight answers to my questions when it was clear my husband was dying before my eyes.

    I made it clear I functions best with the truth, but couldn’t get that.

    God bless the hospice nurse who told me the truth when I got Carl home.

  • Bryson

    Olá Ico! Parabéns pelo programa, está cada vez melhor!Gostaria de peguntar o seguinte:1)O que você acha deste discurso que a Globo (leia-se Galvão Bueno e Reginaldo Leme), vem utilizando nas transmissões, quando a cada apresentação enfadonha do Schumacher, de que ele estaria apenas "se did?ntirvo"e2)Gostaria de saber, se existe alguma chance do Adrian Sutil, correr por uma equipe melhor em 2011? Pois gostaria de vê-lo provar do que é capaz, com um bom carro em mãos.

Leave a Comment