By Bob Bonner

April 4, 2018

The author worked 17 years in the VA system as a nurse. For twelve years he was a top officer  of Local  2028 of the American Federation of Government Employees (AFGE ) in Pittsburgh, PA.

In a Tweet, on March 28, 2018 Veterans Affairs Secretary, David Shulkin, was removed from his position by President Donald Trump. Shulkin, appointed Undersecretary of Veterans Affairs by President Obama, was named to head the agency after Trump’s election. Many believe Trump now wants to fill the position with a more zealous advocate of privatization. Trump has since nominated Ronny Jackson, the White House physician to the position.

he stakes in the defense of a public VA system are great. The system is vast. There are about 20 million US veterans. The VA employs 378,000 people. Moreover, it is the most prominent example of single- payer, public health system in the US. As such, the VA earns the hatred of the far-right, notably the Koch Brothers, who are determined to prevent the emergence a national, single-payer health care system.

No Canonization Yet, Please
Shulkin had claimed to oppose privatization. But he pursued an agenda that would have accelerated transfer of VA care to the private sector. When questioned by US Senator Patty Murray, D-Wash., about the lack of any plan to strengthen the VA, he replied that the VA should not be privatized but added, “You make a system stronger by giving your patients – your customers – more choice. That’s how I believe every company has improved its product.” Senator Murray countered by pointing out that by giving patients the option only to leave the system, he was robbing it of resources.

Shulkin now claims he was removed because of his opposition to privatization. His opposition was lukewarm at best. He had recently proposed privatizing profitable VA care activities. Nor should his ties to health care profiteers be overlooked. Jasper Craven has reported that Shulkin had attended an “August summit in the Hamptons hosted by hedge fund manager, Steven Cohen, a major Trump supporter with a shadowy business past….” Cohen’s Veterans Network has begun offering private mental health care to veterans.

Trump — who has stated that he wanted to see 90% of veterans care privatized—as well as the Concerned Veterans of America (CVA), the bogus “advocacy group” founded and funded by the right-wing billionaire Koch Brothers, and Congressional opponents of the VA and all public health care, were pushing Shulkin to ramp up the rate of privatizing care. Shulkin gave these forces ammunition by portraying the VA as “broken.” He gave ammunition to his opponents when he
was cited by the VA Office of the Inspector General for improper use of funds to finance a European trip for him and his wife.

Thus, before we bestow sainthood on Shulkin, we should recall the former health care executive has millions of dollars in healthcare investments and stock options, and his ethics agreement illustrates possible conflicts of interest with five health-related companies, including Imacor, which has contracted with the VA in the past.

A Playbook for Privatization
Award-winning journalist and author, Suzanne Gordon, has published a checklist on how to privatize the VA. She explains it includes a range of actions to create the perception that public sector systems do not and can never deliver quality services.

1. Portray the public system as broken, or beyond repair.
2. Portray the private sector system as the solution to any quality or service problem.
3. Blame the public system on its employees or administrators rather than complex social problems or political decisions.
4. Create draconian accountability measures and standards that deprive employees of their workplace rights.
5. Create a shame-and-blame workplace that demoralizes the public sector workplaces.
6. Attack public sector unions as obstacles to “reform”, progress, or delivery of high-quality services.
7. Starve the public system of needed resource and appropriate staff.
8. Fail to adequately maintain and improve infrastructure and provide needed equipment and renovate or construct needed facilities.
9. Shift public funds to the private sector system.
10. Produce an erosion of services and respond to service users complaints by arguing for further privatization.

Supporters of privatization have executed this script perfectly with the aid of an obedient, corporate media trumpeting any problem arising in the public sector, portraying every problem as systemic, ignoring the calamities of the private sector which has given the US the most expensive and ineffectual health care model in existence. The third leading cause of death in the US is medical error!

A Personal View of the Bipartisan Privatization Drive
As a former Veterans Administration nurse and American Federation of Government Employees (AFGE) local union president, I have had a front-row seat as this travesty has played out.
From Bill Clinton’s “reinvention of government”, through George W. Bush’s efforts to lock out veterans, impose initiation fees, and increase co-pays with the sole intent of pushing veterans away from the VA system, to Barack Obama’s appointment of Proctor and Gamble CEO, Bob McDonald, to VA Secretary. Obama appointed privatization advocate, Cleveland Clinic CEO, Delos Toby Cosgrove, to the Commission on Care in 2014. Presidents and members Congress of both major parties have been actors in the privatization drama. Budgetary neglect and staff shortages were, and are, facts of life in the VA, regardless of the party in power, spanning decades.

This Commission on Care included Darin Selnick, then a paid CVA consultant, now White House advisor . It also included Stewart Hickey, of AMVETS (American Veterans), who broke with the Coalition of Veterans Service Organizations because of its support for CVA.

In 2003 the CARES (Capital Asset Realignment for Enhanced Services), was announced by then Secretary, Anthony Principi. Principi was, and is, a contractor later forced to repay the government over $2 million. His company, QTC, had overbilled the government. His corporate health care connections are too numerous to list here but include Pfizer, Cleveland Biolabs, Mutual of Omaha, and as of 2016, Principi Group. He knows how to shrink the public sector. He chaired a BRAC (Base Realignment and Closing) commission in 2005.

The CARES Commission resulted in the closing of the 162-acre Pittsburgh , Pennsylvania Veterans Administration mental health and substance abuse facility at Highland Drive at exactly the time the White House was planning to invade Iraq. The closing was supported by both parties and included the Democratic Congressman representing the district. Six other mental health hospitals were on the hit list.

Local VA nurses and providers and veterans service organization reps, voiced our concern for the needs of returning veterans. Our opposition to the loss of the hospital went unheeded. The hospital, which once housed 1,000 patients, was moved to the ten- acre University Drive site and mental health care reduced to 43 beds! The agency admitted in response to a lawsuit filed by the American Civil Liberties Union on behalf of the Coalition of Veterans Advocates that it did not consider the impact on veterans when deciding to shutter Highland Drive. CARES implementation in Pittsburgh was pushed by former Senator Arlen Specter at the urging of disgraced former VISN Director, Michael Moreland who covered up a Legionnaires epidemic in order to collect a $62,000 bonus.

It should be noted that Moreland actually caused or contributed to the tragedy by his destruction of the VA Special Pathogens Lab and trashing of approximately 10,000 rare isolates, enraging the scientific community in Europe and America. Testing was then contracted out and an expensive and destructive chlorine system was implemented with the expected degradation of plumbing and ongoing contamination issues. Moreland once boasted to Pittsburgh Business Times, that he contracted out one third of his budget. He got his bonus and retired but was seen in the VA Pittsburgh site some time later as a representative of a contractor, Shipcom, which was to replace the inventory control system. Shipcom was a non health care outfit that worked okay in ship yards but which placed patients at risk in hospital settings.

In 2014 we watched the announcement of the aforementioned Commission on Care to determine the future of the VA. The commission was composed of six members appointed by Congress and three by the White House. Health care industry reps were among the presidential appointees and remarkable by their absence wee the representatives of the traditional VSOs, DAV, VFW, American Legion, Vietnam Veterans, et al. As noted earlier, Selnick of CVA and Stewart Hickey of Amvets were members.

Phillip Longman, author of the book, Best Care Anywhere: Why VA Care is Better Than Yours, found himself on the committee, he believes as a result of, writing the book. He tells Suzanne Gordon in her book, The Battle for Veterans Healthcare, that the Republican appointees were predictably hostile to the VA but was surprised to learn that many of the Democrats were equally antagonistic. He claims one even put forth a plan that aligned perfectly with the Koch plan while others pushed agendas that would have effectively privatized the VA. Seven members secretly penned a proposal that would have privatized the VA by 2035. Selnick and Hickey were secretly meeting with Jeff Miller, R-Fla., Chairman of the House Committee on Veterans Affairs and US House of Representatives Speaker Paul Ryan. Miller was Koch-supported and Ryan is an long-time enemy of the VA. Speaker Ryan knows how to fund wars and corporate tax cuts but he draws the line on health care.

Longman, who supported not only maintaining the VA, but expanding care which drove Miller to unleash a personal attack on him. So much for an independent commission.

Despite the leanings of its members the commission’s final report stressed that the VA delivers some of the best care anywhere. The media which had been fixated on the wait time issue in Phoenix, was silent. No Veterans Service Organization was asked to speak when the report was presented on the Hill.

Study after study demonstrates VA care is equal to or better than care delivered in the private sector. The VA was evaluated by the MTRE and RAND corporations under a legislative mandate of the Choice Act and found VA care as good as or superior to private sector care. The silence from the media is deafening.

The VA remains 39,000 staff short. It remains underfunded. Pittsburgh alone is 8 psychiatrists and 91 RNs short, in a city of hospitals and universities. Why are Congress and the media not shouting with righteous indignation? Shulkin was in the process of a multibillion dollar contract to replace the VISTA electronic system with Cerner . Users report VISTA to be efficient and warn that Cerner would introduce a host of major problems.

The Choice Program should not be considered voluntary as 77% of VA employees claim patients are being pushed into the private sector. Private providers, HealthNet. Org. and Tri West are responsible for running the program. An Office of the Inspector General audit for the years 2014-16 found VA overpaid administrators by $39 million dollars, made 224,000 payments in error, and another one million payments late. Tri West was founded by David McIntyre, a former John McCain staffer before being awarded $2.5 billion dollars to administer part of TRICARE (which provides care for military retirees and their families), then called CHAMPUS under Bill Clinton in 1996. He lost the contract in 2012 but was resuscitated by the VA to run part of Choice.

CNN reports said that Choice spending of “billions to fix the system didn’t work, made some issues worse.” Privatization doesn’t work. It certainly doesn’t work for veterans as complaints about not being able to schedule timely appointments, being charged for visits or expensive co pays, and the problems that arose from a system unprepared to provide care for veterans. The Inspector General’s Office has documented $89 million dollars in fraud and abuse and over $4 billion in cost overruns. In addition, $15 billion in taxpayer money has been diverted to the private sector when the VA is critically lacking in staff and capacity.

I have personally seen the work of VA providers that have no incentive to order unnecessary tests or procedures, no incentive to perform surgeries or infuse toxins in the final weeks of life. They are salaried employees whose only concern is patient welfare and outcome.

I have personally seen the effects of privatizing and they were not good. Nobody is proposing in-sourcing (bringing work back in-house) which would be better quality, lower in cost, and merit higher patient satisfaction. VA pharmaceutical costs are as much as 70% lower than in the the private sector.
VA Pittsburgh closed its laundry which was staffed mainly by veterans, over one-half combat-disabled, and outsourced the work to a private contractor. Linens disappeared, shortages were frequent, and material often came back filthy and contaminated with feces.

Our ambulance service was contracted, the vehicles sold, and the cost rose astronomically over four years. It was costing us $250,000 more when I left in 2007 and the contracted service is not reliable in terms of when they will respond to a request for patient transfer. This remains an issue.

The Pittsburgh VA ended a liver transplant partnership with the University of Pittsburgh Medical Center because VA patients were continually receiving inferior organs. Where was the media on this issue?

Our food service was dismantled and contracted out with an expected decrease in quality and patient satisfaction, an increase in skin breakdown, and of course uncontrolled cost.

To watch the feigned displays of concern for our veterans in the face of efforts to force them to a system that is not able to care for them, not ready to care for them, and has given the US the worst care in the developed world is maddening. To deliver veteran patients to a private sector health care system where medical error is the third leading cause of death says plainly that we care more about money than veterans care.

Attend any sporting event and you’re likely to see jet flyovers, paratroopers, people standing for the national anthem, cheers for “our hometown heroes”, and hear the “USA!” chants. Everybody does their two minutes of flag waving but fails to see the need to fight for a budget that adequately funds a veterans health system that outperforms the private sector, despite treating patients that are older, poorer, and with more complex conditions than the average private sector patient. They walk outside and are blind to the homeless vets living under the bridges, panhandling in the path to their cars, many suffering with PTSD and substance abuse.

In addition, we have all benefited from VA healthcare and not only because they saved us a fortune in care and pharmaceutical costs. The VA is also dedicated to teaching and research. Their work with blind patients and spinal cord injury is recognized as exceptional. Their work with Post Traumatic Stress Disorder and Traumatic Brain Injury is groundbreaking. They have the best mental health care in America.

It was Janet Stout at the Pittsburgh VA that discovered the source of Legionnaires disease. The VA proved the Shingles vaccine to be safe and effective. It was the VA that demonstrated the correlation between Albumin levels and skin breakdown. &0% of US physicians have trained in the VA. About 62,000 medical students and residents are in VA hospitals in any given year, 23,000 nursing students, and 33,000 other health care professionals train in the VA. The VA has 1800 educational partnerships.

Veterans have paid dearly for their service in America’s unending war for global domination. Many are driven to military service by poverty, unemployment, even homelessness. They have suffered physical, mental, and spiritual injury, lost limbs, friends, comrades. If you believe they can get the care they need and deserve in private sector settings, you can remain silent and continue voting for those that respect profit above all else.

It was an honor and a privilege to care for veteran patients as a nurse and to be part of the fight for better staffing and adequate funding and capacity as a union representative. As a human being and health care advocate I would be devastated a the loss of the only fully integrated health care system in the country, not only for veterans, but for a nation on this planet that seems to be rotating in opposition to the rest of the world.

The VA system is not broken. It needs to be funded, staffed, and preserved. Save the VA and extend single-payer health care to all Americans.