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Comment of the Day: Shulkin is Removed to Make Way for Privatization of the Veteran’s Administration

2018-03-29

It has been my greatest professional honor to serve our country’s more than 20 million veterans. Almost three years ago, I left my private sector job running hospitals and came to Washington to repay my gratitude to the men and women who put their lives on the line for our country.

I believe strongly in the mission of the Department of Veterans Affairs, and nothing about my political experience in Washington could ever change that. I also believe that maintaining a strong V.A. is an essential piece of the puzzle that is the United States’ national security system: We can only expect our sons and daughters to risk their lives and fight for our freedom if we can keep our promise to care for them when they return home broken, injured or traumatized. There is no excuse for not holding up our end of the bargain. The mission set forth by President Abraham Lincoln to care for those who have “borne the battle” is a sacred duty that I will remain committed to always.

During my tenure at the department, we have accomplished a tremendous amount. We passed critical legislation that improved the appeals process for veterans seeking disability benefits, enacted a new G.I. Bill and helped ensure that we employ the right people to work at the department. We have expanded access to health care by reducing wait times, increasing productivity and working more closely with the private sector. We have put in place more and better mental health services for those suffering from the invisible wounds of war. We are now processing more disability claims and appeals than ever before and, for the first time, allowing veterans to see the status of their appeals by simply logging on to their accounts. Unemployment among veterans is near its lowest level in years, at 3.5 percent, and the percent of veterans who have regained trust in V.A. services has risen to 70 percent, from 46 percent four years ago.

It seems that these successes within the department have intensified the ambitions of people who want to put V.A. health care in the hands of the private sector. I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.

Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington’s political polarization). Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.

The private sector, already struggling to provide adequate access to care in many communities, is ill-prepared to handle the number and complexity of patients that would come from closing or downsizing V.A. hospitals and clinics, particularly when it involves the mental health needs of people scarred by the horrors of war. Working with community providers to adequately ensure that veterans’ needs are met is a good practice. But privatization leading to the dismantling of the department’s extensive health care system is a terrible idea. The department’s understanding of service-related health problems, its groundbreaking research and its special ability to work with military veterans cannot be easily replicated in the private sector.

I have fought to stand up for this great department and all that it embodies. In recent months, though, the environment in Washington has turned so toxic, chaotic, disrespectful and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve. I can assure you that I will continue to speak out against those who seek to harm the V.A. by putting their personal agendas in front of the well-being of our veterans.

As many of you know, I am a physician, not a politician. I came to government with an understanding that Washington can be ugly, but I assumed that I could avoid all of the ugliness by staying true to my values. I have been falsely accused of things by people who wanted me out of the way. But despite these politically based attacks on me and my family’s character, I am proud of my record and know that I acted with the utmost integrity. Unfortunately, none of that mattered.

As I prepare to leave government, I am struck by a recurring thought: It should not be this hard to serve your country.

Dr. Shulkin was one of the very rare holdovers from the Obama administration that Mr. Trump allowed to continue in place– however, that oversight has been corrected as Mr. Trump’s “policy” of “privatization” has reached into the VA.  In particular, the drug companies don’t like the fact that the VA negotiates (and plays hardball) with them over drug prices.  Most important to Mr. Trump is the fact that Dr. Shulkin seems to know what he is doing and wants the VA to continue to function– personal acquaintance, incompetence, and a demonstrated desire to destroy the agency which is controlled being the main factors  that Mr. Trump looks for in an agency head.

Responses from the comment-ocracy at the New York Times web site:

Mike Iker
Mill Valley, CA

My wife was a VA hematologist / oncologist for many years. She loved her patients and her medical practice. From what I could tell, they loved her and the many other doctors who served them. My dad was a vet who relied on the VA for his care in the last decades of his life. He couldn’t say enough good things about the care he received and he could not have been prouder of his daughter-in-law.

My wife retired before the 2016 election and started full time at the university hospital where she previously held only an academic role. My dad died earlier than that. My wife could not be happier that she does not have to walk past the portrait of Donald Trump when she goes to work to see her patients. My mom says that had my dad not died earlier, seeing Trump elected would have done him in.

So, ask yourself: As Trump has selected cabinet secretaries whose main objective is the destruction of their agencies, why should the VA be different? Excellent medical care for vets is not particularly different than excellent environmental care for our general population or excellent consumer protections or increased access to health insurance. When your goal is to make sure that citizens are poorly served by their government while your real constituents get rich, your primary challenge is lying about it long enough to get the dirty work done before the citizens catch on and boot you out of office.

E. Sol
Portland

When the government hands control of the VA over to for-profit companies, it creates serious gaps in accountability and transparency. Even the current publicly operated VA has challenges because most institutions tend to resist reform. When a for-profit company runs the VA, this inherently closed nature functions to shield the activities of an entity whose primary duty is to deliver value to its shareholders.

This lack of accountability is especially dangerous because of the horrifying record of abuse and neglect in the hands of private industry. Just look at the private prison system. Last year, for example, the Justice Department’s inspector general found that private prisons with federal prison contracts delivered deficient medical care, had higher levels of violence than regular federal prisons, and misused solitary confinement as overflow space.

For these reasons, we should all staunchly oppose privatization of the VA, and we must continue working to expose the harm to human rights caused by the Trump administration’s embrace of companies who place profit over all else. We must remain accountable to our military veterans and our governmental representatives must ensure veterans receive continued and improved care through the public VA system.

James Krause, MD
St Petersburg FL

Many years ago when I was in private practice I had the opportunity to discuss privatization of the VA with Ned Powell who was Under Secretary of the VA under Clinton. I felt that was the way to cheaper and better care. I was in Washington about 2 years ago on other business and having worked in the VA for the preceding 10 years I had to meet him to give my apology. I was wrong, plain and simple. This is a coordinated system dealing with a unique population that for many reasons is more complicated than what I saw in private practice. Outcomes are tracked and a very good electronic medical record which is shared throughout the country makes treating our mobile population a coordinated event. New patients are tested for a variety of problems when they enter the system and a prescription system alerts of drug interactions and allergy problems.

F.Douglas Stephenson, LCSW, BCD
Gainesville, Florida

Expanding government-paid private care for military veterans outside the VA is a top priority for groups funded by the Koch bros. The Koch-backed Concerned Veterans of America has pushed for legislation, but most other major veterans organizations opposed it. The Koch brothers’ perpetual goal is to reduce the role of government & the need to pay taxes to support it. Privatization should be stopped from wreaking havoc on our V.A. health care delivery system.

The V.A.is the largest hospital & healthcare system in the U.S., & is the closest working model to a national single payer health insurance system . The V.A. is the only system that negotiates directly with pharmaceutical companies over drug prices, & is a comprehensive resource for veterans seeking all types of care: mental health, physical health issues, physicians/medicine/ nursing/social services/social work/ clinical social work/ clinical psychology and more. The VA is a great example of the public sector working well by providing quality care for the people that use it, and it saves lives.

A 2016 RAND Corporation analysis found that the VA provides good quality care compared with other health systems, usually in a timely manner. The V.A. cares for some of our sickest patients with the best results at the lowest cost with the highest patient satisfaction.  The key to maintaining and improving V.A. healthcare and social services is to fully support, fund & staff the VA.

Daniel K
Los Angeles, CA

While I’m sure this has happened and will continue to happen in certain cases. As a physician working in both the private and VA setting. I would say access to care in the VA is much much higher than in the private sector. When I see a veteran, I often order labs, CT scans, and do procedures on the same day I see them. This sort of access is rare in the private sector and greatly depends on the type of insurance one has.

Generally speaking, the delays for referrals, tests, procedures for many HMO or other managed care patients (so called Obamacare) is much worse.

(photo courtesy of pixabay.com and skeeze)

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