The recently passed VA MISSION Act has been billed as a boon to veterans because of provisions that would expand some services, some of which are outside direct health care delivery. While this seems to have convinced major veteran service organizations to support it, the MISSION Act will also bolster ongoing efforts to privatize VA health care delivery that all have publicly opposed. This suggests that they missed the obvious down side of the legislation and will likely withdraw their support when its consequences become apparent.
The MISSION Act creates a permanent Community Care program to replace the ostensibly temporary Choice program that currently refers VA patients to private providers. The new program will divert $22 billion over 5 years that could be used to address staffing shortages that have led to long wait times for care in some VA facilities. The case for investing more VA resources on private care is based on specious claims of pervasive problems in wait times and quality of care. In fact, the VA's record in both is exceptional.
There are many reasons why this is not common knowledge, not the least of which is propaganda from a group backed by those who would profit most from privatization. Highly misleading claims are being promoted by Concerned Veterans of America, a Koch brothers-funded organization with little veteran representation. Their strategy is to portray the VA as failing, making privatization seem a better alternative. What they don't mention is that the diversion of VA funds to pay for private care makes it impossible to address the problems they claim are inherent flaws of the VA. Privatization does, however, generate substantial profits for investors in the health care industry such as Koch Industries. The real motivation behind expanding outsourcing seems to be maximizing private profit, not helping vets get more timely or higher quality care.
The Choice program was introduced as a stopgap measure after the scandal over falsifying wait times at the Phoenix VA. Its stated intent was to improve wait times until the problem could be addressed. However, it has now expanded to the point that over 40% of patient visits are outsourced to the private sector. Under the MISSION Act, referrals will be significantly increased, with more patients being dumped on an overburdened system of private care that has already produced wait times longer than the VA.
Every dollar invested in private care ultimately comes from money necessary to fully fund and staff the VA. This diversion of funds results in fewer services and compromising the system of integrated care that only the VA provides, while the cost of private care is substantially higher than VA care. It is ironic that the Community Care program will require the hiring of large numbers of specialists merely to process referrals and provider billing. At the small facility near where I live, there will be 70 Community Care staff in a system that had less than 900 employees as of 2014. Just imagine the impact that hiring 70 new clinicians could have had!
Privatizing services will result in a degradation of care. Private providers have much less experience meeting the special needs of veterans. Shockingly, the VA is already referring mental health patients to the private sector, which doesn't meet the standards of the VA's cutting-edge suicide prevention practices. As someone who has been both a physician and a patient at the VA, I can attest that the problems the VA does have are not as serious as the flaws in the private health care system. I gave up using private insurance and now get my care entirely through the VA. As a result, I get fully integrated care in a system designed to serve vets. VA care consistently rates higher on key performance and patient satisfaction measures compared to private care, at significantly less cost. Neither the cost savings, the high quality of care or the integrated nature of the system would be possible in the private sector, where the need to generate profits precludes many of the features of the VA system.
Those who put their lives on the line for our country deserve the best care possible. Despite the propaganda about the quality of care at the VA, both objective measures and patient satisfaction ratings indicate otherwise. An essential feature of the VA system that leads to these outcomes is the integrated nature of services. Money taken out of the system and lost to the private sector is not available to fund the VA's comprehensive services and to fix problems such as long wait times at some facilities that are largely the result of inadequate staffing.
If we want to keep our promises to our vets, we cannot accept the stripping down of the VA to generate private profits. If you agree, contact your members of Congress and let them know that they need to take a closer look at what the MISSION Act will do to the VA and the veterans who depend on it.
Dr Staggenborg is a former VA psychiatrist and member of Veterans For Peace. This article may be reproduced, unedited and with attribution, without prior approval.