Another Look at the VA, in the Midst of a Pandemic
This is the first in a two-part series that looks at the Veterans Health Administration (VA) and its role during the pandemic. Part One looks at the often-unrecognized strengths of the VA and examines the Trump Administration’s myriad attacks on the VA. Part Two will look at the serious consequences of those attacks during a pandemic, and how unions and community coalitions are fighting back. Finally, it will consider the implications for a national health care system in the U.S. -Editors
The current crisis has made painfully clear the deficiencies in our fragmented and profit-oriented health care system. As millions lose their jobs, the folly of basing access to health care on employment has never been more obvious, and the need for universal health care has never been more evident.
While many of us are calling for Medicare for All, it’s also a good time to take a second look at a national health care system that actually exists here in the U.S.—and has worked remarkably well (that is, except when it is severely underfunded, understaffed, and under constant attack by privatizers and union-busters): the Veterans Administration.
ROBUST BUT LITTLE-KNOWN
The Veterans Health Administration is one of three branches of the Department of Veterans Affairs (DVA). It provides a full range of health care services to 9 million veterans at 170 hospitals and 1,000 clinics nationwide. It also runs strong, well-respected medical research and education programs; about 70 percent of all U.S. physicians trained at a VA facility at some point in their education.
Other branches of DVA are the Veterans Benefits Administration (VBA) and the National Cemetery Administration (NCA). A “fourth mission” of the VA is as a backup national health system during emergencies (like a pandemic).
Almost 400,000 people work within DVA, the vast majority of those at VA. Over one-third of them are veterans themselves, with a special dedication to serving other veterans. It is a unionized workforce, represented by several unions, of which the American Federation of Government Employees (AFGE, my union) is the largest.
A slew of independent studies, such as by the Rand Corporation and Dartmouth researchers, consistently demonstrate the quality of VA care. A recent large survey by the Veterans of Foreign Wars (VFW) showed that more than 90 percent of veterans who use the VA would recommend it to others. The wait times for appointments are good these days: more than 93 percent of appointments are scheduled within 30 days, and many sooner than that. Most care is provided without cost. The VA negotiates the best wholesale drug prices in the country, and patients with VA coverage are less likely to skip medications because of cost than other insured Americans.
Award-winning health care journalist Suzanne Gordon has spent years studying the VA. Her conclusion: the VA is a remarkably effective and well-run health care system, providing care which is usually superior to the private sector, and at a lower cost. This is particularly impressive knowing that VA patients tend to be older and sicker than the general population.
Although the media often focuses on VA problems and scandals, Gordon argues that these problems, while often inexcusable, are not unusual for large health care systems, especially under-resourced ones. And problems at the VA show up on the public’s—and Congress’—radar, in ways that problems at your local hospital don’t.
Gordon’s extensive interviews with veterans, family members, and VA caregivers in Wounds of War: How the VA Delivers Health, Healing and Hope to the Nation’s Veterans (2018) flesh out a picture of the VA’s innovative programs in areas such as post-traumatic stress disorder, homelessness, vision loss and spinal cord rehabilitation, military sexual trauma, and much more. No private institutions provide a comparable degree of full scope, well-coordinated care, or specialized veteran-centric services.
Suzanne Gordon’s VA is also the VA I know. For 15 years, I worked as a nurse practitioner in a VA hepatology clinic, specializing in Hepatitis C virus (HCV) care. My clinic provided excellent care to many veterans, some of whom had been considered too sick or high-risk to be treated elsewhere.
Unlike private health care systems, the VA implemented broad-reaching programs to find, test, and offer antiviral treatment to veterans with HCV when screening tests first became widely available in 2000, and again years later when superb new treatments came on line.
ATTACKED BY TRUMP
The VA has been providing high-quality health care, with a focus on patient care, not profits. This is known to veterans and health policy experts, but seems to surprise pundits and the media, and to be ignored by the Trump administration.
Corporate privatizers, politicians looking to cut the size and scope of government, and an astroturf group funded by the Koch Brothers, Concerned Veterans of America, have significant influence in this administration. Their attacks on the VA come straight from the right-wing playbook, with three basic prongs:
1. Severely understaff.
Even before COVID-19 hit, the VA had almost 50,000 staff vacancies, the vast majority within VHA, in the fall of 2019. The number had been climbing for years, creating short staffing in the best of times, and filling these vacancies has been a low priority for leadership until the coronavirus hit. A recent expose by Gordon and Craven details the extent of this understaffing crisis.
2. Privatize and outsource veterans’ care.
Why not fill staff vacancies and strengthen the VA, you ask? It’s a familiar story: under-staff a public agency, then complain publicly that it is failing, and proceed to privatize its functions.
The recent push to increase outsourcing began in earnest in 2014, during the Obama administration. After a well-publicized wait-time scandal at the Phoenix VA, the 2014 Choice Act was passed to provide additional funding for the VA. Instead of directing all the funding to strengthening the VHA, it established a three-year pilot program approving veterans for private care if they lived more than 40 miles away from, or had to wait more than 30 days for an appointment at, their local VA.
The Choice Act was extended, in spite of overpayments, disorganization, and third-party boondoggles until the bipartisan passage of the 2018 VA MISSION Act. This Act has further loosened the guidelines for outsourcing veterans’ health care, and turned this into a large permanent program.
As more of the VA budget goes to pay for more expensive (and much less accountable) private care, less money is available for the VA itself, leading to an increasingly fragmented and weakened system.
3. Bust unions and attack federal workers’ rights.
The adamantly anti-union and anti-worker Trump administration has acted repeatedly to weaken the rights of federal workers and attack their unions:
- The 2017 VA Accountability Act removed many due-process protections from VA workers, and led to an unprecedented number of firings.
- Executive Orders: Trump’s three illegal and punitive Executive Orders (EOs) in May 2018 directly attacked federal employees and their unions: limiting official time, kicking unions out of their offices, and further reducing progressive discipline and collective bargaining rights. One example: they reduce seniority rights during RIFs (reductions in force). After an injunction preventing their implementation was lifted last fall, these EOs were broadly implemented in February 2020. Union challenges to the EOs continue in the courts.
- Collective bargaining: refusing to bargain in good faith. In early 2019, VA demanded to open negotiations with AFGE on its national contract. Many of the agency’s outrageous demands parallel Trump’s Executive Orders. In June and in December, members of Congress formally complained about this process to VA Secretary Robert Wilkie. Impasse in negotiations would push the process to the Federal Services Impasse Panel, stacked with a crew of intensely anti-labor appointees. AFGE continues to challenge the agency’s demands: filing national grievances, and court cases, including one challenging the legitimacy of the current FSIP.
- Federal shutdowns and hiring freezes have deeply affected morale.
- Official time for union officials in Title 38 positions (i.e, RNs, physicians and certain other clinicians) was completely eliminated in 2018.
- Outsourcing will reduce the size and strength of the unionized federal workforce.
For years, AFGE, National Nurses United (NNU), and other unions representing VA workers have been fighting tooth and nail against staff vacancies, union-busting, and privatization.
They have been joined by the Veterans For Peace SAVE OUR VA campaign, which has mobilized veterans and community supporters around the country to join the fight with rallies, leafleting, social media, lobbying efforts, and public town halls (often with Gordon). Last year, a Bronx SAVE OUR VA town hall also featured Rep. Alexandria Ocasio-Cortez, who was widely quoted as saying: “If it ain’t broke, don’t fix it.”
Other major Veterans Service Organizations (like the American Legion and the VFW), who supported the 2018 Mission Act, are now concerned about the Act’s lack of accountability, and also want to be sure that the VA itself is protected and strengthened.
Part Two will look at the serious consequences of those attacks during a pandemic, how unions and community coalitions are fighting back, and the implications for a national health care system in the U.S.
Betsy Zucker is a member of AFGE Local 2157, health care activist, and retired VA nurse practitioner from Portland, Oregon.