Veterans Health Administration is the largest integrated healthcare system in the country. The author of “Wounds of War” says It is a model we can draw upon for the country, but the corporate media deems the VHA as failure that should be privatized. Why?
URUJ SHEIKH: Welcome to The Real News. This is Uruj Sheikh.
Nearly 9 million people are dependent on the VHA, the Veterans Healthcare Administration, the largest integrated public health care system in the United States. The VHA is operating under increasingly difficult conditions, including intense public scrutiny. Why does the government want to privatize the care to veterans? Whose interest does that serve? Veterans, or the private sector healthcare?
Senior Policy Fellow at the Veterans Health Care Policy Institute, patient advocate, and author Suzanne Gordon says the VHA, tasked with a challenging patient population, consistently outperforms the private sector in providing care for veterans. Joining us on Veterans Day to discuss her new book Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans is Suzanne Gordon.
Thank you so much for joining us, Suzanne. You spent 32 years studying the private sector healthcare, and about six years studying the Veterans Administration. Could you give us a big picture view of the VHA? Help us understand how expansive it is, the type of care that veterans receive there, and your observations of how the system functions.
SUZANNE GORDON: The VHA is the third- is one of three agencies in the Department of Veterans Affairs. It’s the largest. It’s the Veterans Health Administration, and has about 300,000 employees, a third of whom are veterans, doctors, nurses, clerks, social workers, PTs, OTs, psychologists. It delivers care for veterans from discharge from the military till they die. And it’s all over the country; it’s the largest healthcare system in the country. It’s the only publicly-funded, fully integrated healthcare system in the country. And not all veterans are eligible for VHA care. You have to have a service-connected disability or low income. So that means of America’s 20-ish million veterans, 9 million are enrolled in the VHA, and about 6 million of those depend exclusively on the VHA for care. Some of the others in that 9 million may go to private sector care on occasion.
URUJ SHEIKH: And when you say that it’s the largest integrated public healthcare system in the U.S., what do you mean by that?
SUZANNE GORDON: That means that if you’re a veteran, you could move from Boston to San Francisco. You’d have the same electronic medical record. You could go there and- more or less- no questions asked. I mean, you show your VA card and you could get care, get appointments, and get similar care, care of the same quality. I mean, you’ll have, for example, the Boston VA Medical Center you’ll have incredible PTSD care, and you go to San Francisco VA Medical Center at Fort Miley and you’ll have fabulous PTSD care. You can get care in rural areas. Even places where they have very few private healthcare providers in rural areas, the VA provides access via telehealth because they have a huge system.
Care is also integrated on the unit level, so if you go to see your primary care provider and you say, I’m feeling blue, or I’m having bad dreams, or insomnia, they’ll recognize that could be PTSD. They won’t just refer you to a mental health practitioner and you have to find one who accepts your insurance and who will pay for your treatment, and then you have to make an appointment which you may or may not go to. They’ll walk you down the hall to introduce you to the psychiatric nurse practitioner, who will talk to you right there on the spot and begin to talk with you about your issues. Same is true of pharmacists, who might help with insulin, or help you figure out how to take your medications; a dietitian who could help with diet.
This kind of integration is pretty unknown in the private sector. You have individual, isolated pods of providers not really interacting with one another and not really bringing the patient in, and you have fragmented care.
URUJ SHEIKH: Right. What most people are used to in the private sector is sort of an appointment system, right-
SUZANNE GORDON: Exactly.
URUJ SHEIKH: Where you have to travel pretty far between your appointments, to go to a cardiologist, or go to a podiatrist.
SUZANNE GORDON: Right. So I have a, I know an Iraq veteran who’s 30 years old. He’s been told he has the body of a 60-plus year old. He has 16 different problems. He gets one stop shopping for all those problems at the VHA. And he told me, if I had to go around San Francisco to visit this doctor and that doctor, I’d be in a ditch.
URUJ SHEIKH: So this is very different from what we hear on corporate media about Veterans Affairs. Could you talk a little bit about why that disparity exists? What you say in your book is that there’s unbalanced reporting, and that spreads misinformation. So could you talk a little bit more about that?
SUZANNE GORDON: Sure. My colleague Jasper Craven and I at the Veterans Health Care Policy Institute did a long report on the media and the VA. A version of this was published in the Washington Monthly. And we analyzed media coverage of the VA. And It’s often sensationalized. It takes a small problem in one facility- the VA has 1,700 different facilities- and it amplifies it and make it seem as though that problem is throughout the whole system. It doesn’t follow up on … So it talks about wait times, and then doesn’t, problems- it doesn’t follow up with stories later, discussing the fact that the VHA has actually remedied a lot of the wait time problems. And it tends to entirely focus on negatives.
So, the VHA is doing all kinds of clinical innovation. I mean, new treatments that don’t depend on opiates for chronic pain that veterans have, that are really important for resolving the opioid crisis. New ways to deal with end of life care. New treatments for dementia. New treatments for patients who can’t be discharged from hospitals, because they’re aggressive and demented and they can’t be sent to nursing homes. This is a big problem in American society. Epilepsy that is actually not really epilepsy but psychogenic, it’s caused by trauma. It’s not real epilepsy, and they’re trying to use very specific treatments to remedy that problem.
None of this makes it into the mainstream media. So they tend to cover only on the negative. They often misunderstand why the negative is happening. And they never focus on the positive. Very rarely. And I think that’s because the Koch brothers, the conservative ultra- they’re not even conservative, they’re really ultra-libertarian, Koch Brothers. And the hospital industry and a lot of other people who want to really capture the billions of dollars in the VHA budget are really encouraging this kind of skewed reporting, and also this kind of oversight, skewed oversight, in Congress.
One of the other reasons why you hear about problems in the VHA is because you have- it’s the most transparent healthcare system in America. If there’s problems at Hopkins Hospital, it could be resolved with a suit, and you’ll never find out about that. We can never learn about- learn from it and learn-
URUJ SHEIKH: Why can’t we?
SUZANNE GORDON: Because you will sign a nondisclosure agreement with your settlement. The VHA is completely transparent. They have an Office of the Inspector General that inspects the VHA and looks at problems, and puts out public reports. So the media tends to glom onto these problems, and never says, wait a minute, this is the largest healthcare system in the country. What are some of the other things it’s doing? And that is not true about how the media covers private sector hospitals and institutions.
URUJ SHEIKH: Right. So how how does that differ?
SUZANNE GORDON: Well, the media will cover a problem in a hospital- you know, the United States healthcare system, private sector hospitals kill about 200,000-400,000 people every year from preventable errors. The media never covers, never asks with the VHA, compared to what? If somebody died in a VHA facility, does that compare with the private sector? If there are wait times in VHA facilities, how do they compare with the private sector? And then-
URUJ SHEIKH: And part of that is because the numbers aren’t there for the private sector? Like, the VHA is required to report wait times.
SUZANNE GORDON: But the private sector doesn’t.
URUJ SHEIKH: But private sector there’s no consolidated source that would kind of count the wait times across the system.
SUZANNE GORDON: Right, and hospitals, and private- and practices don’t report wait times, so we don’t really have very good data. There’s a company called Meritt Hawkins that looks at wait times in some markets, but we have absolutely no idea from reported data, except with the VHA, what the wait times are in, let’s say, a rural area for a dermatology appointment.
So you could say- for example, this happened in Vermont, rural Vermont, where under the Veterans Choice Act a veteran was told that if he had to wait for 40 days for an appointment for dermatology, he could go to the private sector. He was sent to the private sector. But nobody bothered to discover that in the private sector the wait time was eight months. And he wasn’t told, you have a choice of 40 days or eight months. And there are not a lot of- there are many areas that are kind of care deserts. You know, like we have food deserts, we have care deserts. In the past 10 years, 90 rural hospitals have closed. They’re expected to close 700 more in the next decade. There’s no maternity care. There’s no psychiatric care. So the VA, if they close VA facilities in many areas, people will literally be without healthcare, because the VA may be the only thing there.
URUJ SHEIKH: So the federal government, Trump’s plan to improve the VA, is to create more opportunities for veterans to choose where they get their healthcare from. They challenge, sort of, accusations of trying to privatize the VA system. So could you, could you talk a little bit more about that? Is the VA being privatized?
SUZANNE GORDON: Yes. Department of Veterans Affairs Secretary Robert Wilkie says he is not privatizing the VA. He is about to come out with standards of eligibility for private sector care under the newly passed VA Mission Act that will effectively privatize the VA.
SUZANNE GORDON: How will it do that?
SUZANNE GORDON: Because if you say that- so, one of the standards they’re considering is drive time. And they’re considering if you have to drive more than 30 days- excuse me, 30 minutes for a primary care or behavioral health appointment, you can go to private sector. If you have to drive more than 60 minutes for specialty care, an oncologist or an open heart surgery, you can go to the private sector. Well, I mean, in Baltimore, where I live, in rural areas, who doesn’t- practically every appointment you go to, depending on traffic, you have to go from, spend more than 30 minutes in your car. That would open the floodgates; practically every veteran would be eligible to go to private sector care. And since every dollar- currently as it is now, every dollar that’s taken to pay for private sector care comes from the VHA budget, and private sector care is more expensive, for often lower quality. You will starve the VA of resources. You will see staff layoffs, facility closings.
This is all a very carefully constructed plan, I think, the VA Mission Act, to close the VA. And so nobody wants, nobody in Washington who is for privatization of the VA says, we want to shut down every facility, and auction off all the equipment, and lay off all the providers tomorrow and all the staff tomorrow.
URUJ SHEIKH: Right. We’re seeing a slow erosion.
SUZANNE GORDON: It’s a slow erosion. And it’s actually not going to be so slow if they enact eligibility standards under the Mission Act for care that really allows almost anyone to go out and get care from private hospitals and doctors and others.
URUJ SHEIKH: I did want to kind of jump to the national context of all of this. And healthcare is such a big issue, and was one of the leading issues, if not the leading issue, in the midterm elections. And we hear that Medicare for All can’t work. But in your book you argue that the VA system is a model that we could base our entire healthcare system on. Could you talk more about that?
SUZANNE GORDON: Absolutely. So, right now there are people who are fighting for improved Medicare for All. And that’s great. That would deal with the payment issue, who’s going to pay, and it would eliminate insurance companies that take quite a bit of every healthcare dollar for marketing and profit and CEO salaries and add nothing to healthcare. But Medicare is a payer usually paying to a fee-for-service system, which is an inefficient and very expensive way to pay for healthcare.
The Veterans Health Administration is a payer and a deliverer of care. And so that’s really quite different. That’s more like a Scandinavian health healthcare system, for example. And the people who say that we can’t afford Medicare for All or we can’t have it are people who are prescribing when they really are describing. And they don’t want it because they represent drug companies, and medical equipment companies, and doctors, and hospitals, and insurance companies that don’t want any curbs on their power to divert dollars away from patients and towards profit.
URUJ SHEIKH: So why is protecting veterans’ healthcare so separate from the Medicare for All fight?
SUZANNE GORDON: Well, I think it should be fused, because I think that the veterans healthcare system is a national health program in our own country. We don’t have to go to Canada or France or Germany to see the extraordinary outcomes and extraordinary dedication of caregivers to mission rather than profit, and to creating better health outcomes through coordinated care. All we have to do is go to a local VHA facility, and you’ll see that happening. It’s also a public health system. It doesn’t just deliver, you know, knee replacements, and prescriptions, and doctor’s appointments. It has residential programs for behavioral health problems. It has homeless programs to prevent veteran homelessness. It has an outreach program to make sure that veterans don’t end up in jail. It helps people with housing and with employment. There are many veterans resource centers on college campuses to help veterans adjust to civilian life. There is no private sector for-profit healthcare system in this country that can replicate what the VHA does.
URUJ SHEIKH: Well, unfortunately we’re out of time. There’s so much that we could talk about and so much I would love to talk to you about, but I look forward to having you on here again. And thank you so much for working on this book and for being here. Suzanne Gordon, author of Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans.
And I’m Uruj Sheikh. Thank you for joining us on The Real News Network.