By Sandra Basu
WASHINGTON—In what he said was his “final major address” to the nation’s veterans last month, President Barack Obama defended his administration’s record on veterans’ issues and decried any suggestion that VA should be privatized.
He said that since he has taken office “we’ve made historic increases in veterans funding, the biggest boost in decades.”
When it comes to the future of veterans’ healthcare, however, he was especially blunt in his assessment.
“We cannot outsource and privatize healthcare for America’s veterans,” the president said. “Now, there are folks who keep pushing this. They don’t always come out and say the word ‘privatize,’ but you read what they say, that’s what they mean.”
Obama made his comments at the Disabled Veterans of America national convention last month. In defending the need for VA healthcare, he emphasized that “study after study shows that in many areas, like mental health, the quality of care at the VA is often better than in private care.”
“So let’s listen to our veterans, who are telling us, ‘don’t destroy VA healthcare,’” he said.
The Republican and Democrat presidential candidates have also waded into the discussion on VA’s future, with GOP nominee Donald Trump slamming the Obama administration for its handling of veterans’ healthcare.
“Our most basic commitment to provide health and medical care to those who fought for us has been violated completely,” Trump told veterans at the annual Veterans of Foreign Wars convention.
According to campaign materials, Trump supports opening up community care to all veterans, so that anyone eligible for VA healthcare would be able to bring in their ID card to any doctor or care facility that accepts Medicare to get care.
“The power to choose will stop the wait time backlogs and force the VA to improve and compete, if the department wants to keep receiving veterans’ healthcare dollars,” his campaign material stated.
Trump also released a 10-step Veterans Reform plan that he said was developed with Rep. Jeff Miller (R-FL), who chairs the House Committee on Veterans’ Affairs.
Among the issues this plan addresses is staff accountability at VA, a point of controversy among Republicans and Democrats.
“Under a Trump administration, there will be no job security for VA executives that enabled or overlooked corruption and incompetence. They’re fired,” his campaign material explains.
Trump’s campaign also cited ending “waste, fraud and abuse at the VA.”
“The days of $6.3 million for statues and fountains at VA facilities and $300,000 for a manager to move 140 miles are over,” according to information provided by his campaign. “The Trump plan will clean up the VA’s finances so the current VA budget provides more and better care than it does now.”
Democratic nominee Hillary Clinton, who also spoke at the annual Veterans of Foreign Wars convention, emphasized, however, that privatization is not the answer, echoing administration officials.
“We are going to reform it and make it work for every single veteran in America,” she said. “We will ensure access to timely, quality care; improve the coordination of care, which as you know is a huge problem still; improve care for women veterans, who are often underserved; tackle and at long last, end the epidemic of veteran suicides by expanding access to mental healthcare, erasing the stigma that still prevents too many from getting the help they need.”
Clinton’s proposal entails “strategically” purchasing private care “when it makes sense to do so.”
Examples include “some specialty inpatient or surgical procedures, expanded access to mental health and substance abuse treatment, or when the VA cannot provide timely access to necessary care,” her campaign explained.
Under her plan, VHA would redirect its resources.
“The VHA should focus its resources on what it can do best, particularly healthcare for service-connected conditions,” Clinton’s campaign material explained. “This is especially important in areas where veterans lack access to the necessary care outside of the VHA, such as prosthetics and traumatic brain injury.”
In addition, the Democratic candidate is advocating the establishment of a VHA strategic oversight and governance board.
“In line with the best practices of modern hospital systems across the country, the board will be empowered to provide oversight of VHA management processes, monitor accountability, promulgate best practices, and ensure the VHA remains true to its mission of putting veterans first,” Clinton’s campaign materials state. “This Board would include strong veterans representation.”
The future of VA healthcare will also be a topic of discussion on Capitol Hill this fall. The House Committee on Veterans’ Affairs was scheduled to discuss the recent Commission on Care report that provides recommendations for changes to VA’s healthcare system.
One of its proposals was that VA should expand access to outside care by establishing “high-performing, integrated health networks that include both VA and community-based providers who meet stringent VA credentialing requirements.” Veterans could then choose a VA or non-VA primary care provider from credentialed primary-care providers in the system.
VA Secretary Robert McDonald responded this summer that the proposal appears to be a “Trojan horse for privatization.” He said that the administration “totally” disagrees with the commission’s recommendation for opening that choice to all veterans “without regard to guidance or piloting from VA.”
In early September, Obama sent a letter to Congress on the Commission of Care proposals, saying he concurred with 15 of 18 of the recommendations. The president wrote, however, that he has “concerns with the Commission’s proposed governance structure for the VA health care system. The proposal would undermine the authority of the Secretary and the Under Secretary for Health, weaken the integration of the VA health care system with the other services and programs provided by the VA, and make it harder–not easier–for VA to implement transformative change.”
A facility-specific survey found that 138 of 140 VA facilities reported shortages of medical officers, with psychiatry and primary care positions being the most frequently listed.
When Terrence O’Neil, MD, retired as chief of nephrology at the James H. Quillen VAMC in Johnson City in December 2016, he left in his wake decades of work treating kidney disease—nearly 35 years in the Air Force and DoD, plus 11 more at VA.