Jul 12, 2022
When Joe Biden ran for president in 2020, he marketed himself as a pragmatist, eager to collaborate with Republicans and capable of bridging divides because of his long experience in the Senate and as vice president.
No VHA facility should be shuttered in any place where the nation's largest public healthcare system could serve veterans--and even non-veterans--in need of medical treatment.
Despite this resume, in late June Biden was rebuked by former Senate colleagues on both sides of the aisle. They came together, unexpectedly, to block his nominations to a presidential commission that the White House and Department of Veterans Affairs (VA) assumed would be un-controversial.
The Asset and Infrastructure Review (AIR) Commission was created by the VA MISSION Act of 2018 to help shape veterans' health care delivery. Rather than breaking with Donald Trump's agenda of downsizing VA hospitals and clinics and privatizing their services, Biden has generally taken the same approach.
His picks for the nine-member AIR Commission included few staunch defenders of the VA-run Veterans Health Administration (VHA). Instead, the proposed AIR Commissioners either had a history of being involved in outsourcing medical care for veterans and active-duty service members or they had ties to private health care companies eager to gain more "customers" previously served by the VHA.
On June 27, twelve Senators, include Veterans Affairs Committee Chair Jon Tester (D-Montana) sharply rebuffed VA Secretary Denis McDonough by announcing their "collective opposition to the AIR Commission process moving forward."
A Grassroots Backlash
In March, as the first stage of that process, McDonough proposed that dozens of VHA facilities be closed or downsized. He could offer little assurance of future funding for infrastructure improvements, like building new hospitals and clinics. So McDonough's recommendations to the AIR Commission unleashed a torrent of objections from VHA care-givers, their patients, and elected officials in states and cities threatened with a reduction in medical services. Opposition came from a diverse group, including the American Federation of Government Employees, which represents about 300,000 VHA employees, and the Republican governors of South Dakota and West Virginia.
Senate critics included members of both parties who had, with few exceptions, supported the MISSION Act, which created the AIR Commission. But now Tester, Senator Joe Manchin (D-W.Va.) and others accused McDonough of putting "veterans in both rural and urban areas at a disadvantage." They concluded that this poison pill from the Trump era was "not necessary for our continued push to invest in VA health infrastructure." They pledged to provide the VHA with "the resources, and tools it needs to continue delivering quality care ... now and into the future." The facility closing commission was effectively shut down before it could do any actual damage to a system serving nine million veterans.
Befitting the tangled politics of veterans' affairs--which we explore in a new book available August 5--AIR Commission boosters, from both parties, complained bitterly. "This decision is short-sighted and will hurt veterans by keeping them trapped in a broken and outdated system," said former Trump adviser Darin Selnick, a key figure in the Koch brothers-backed Concerned Veterans for America, which favors VHA privatization.
"Dissolving the commission does not help," agreed Robert Wilkie, Trump's second VA secretary and a CVA favorite. Bob McDonald, the West Point graduate and former Procter & Gamble CEO who headed the VA under President Barack Obama, claimed that Tester and his colleagues displayed "a total lack of courage." And McDonough himself, speaking through a deputy, vowed that he would continue to pursue infrastructure "realignment" so "our Veterans in the 21st century" are "not forced to receive care in early 20th century buildings."
Not a Boon to New Hiring
By designating numerous VHA facilities as shutdown targets, McDonough undermined his own agency's still lagging efforts to fill thousands of staff vacancies left open by Wilkie, who favored outsourcing over direct care.
As one VHA union rep in Coatesville, Pennsylvania told us, "We have a big sign outside our facility saying, 'Now Hiring,' and then people are reading news in the paper that our facility is about to be shut down. Why would anyone come and work here?"
Even without the AIR Commission, McDonough must still decide how to improve the VHA, including closing or refurbishing old facilities or building new ones. To do this, the Biden Administration should seek advice from experts in structural engineering, hospital architecture, and public health care delivery, not partisan advocates of privatization.
Some of the VHA's 1,200 facilities are indeed aging--just like hundreds of private-sector hospitals are. But many of the oldest facilities are being renovated, and all must pass accreditation and licensing provisions, or they would have been shut down. In addition, VHA outpatient clinics are often located in modern office building spaces that are leased from private landlords.
No VHA facility should be shuttered in any place where the nation's largest public healthcare system could serve veterans--and even non-veterans--in need of medical treatment. In many rural areas, already suffering from shortages of mental health and primary care providers, the VHA is often the only accessible option.
Secretary McDonough also needs to use his own rule-making authority to curb the costly and wasteful diversion of resources from direct care, inside the VHA, to outside providers. By McDonough's own admission, private hospitals, doctors, and other vendors now consume about 33% of the VHA's total healthcare budget, up from about 26% last year.
To maintain or renovate its existing hospitals and construct new ones to meet current and future needs, the VA also needs an estimated $70 and $80 billion in new capital spending. In Biden's initial infrastructure spending proposal in 2021, only $18 billion was earmarked for modernization of these facilities. By the end of last year, that proposed allocation was whittled down to $5 billion in the president's still-stalled "Build Back Better Act."
If the 12 Senators who just declared their "commitment to expanding and strengthening modern VA infrastructure" really want to help build back better, they better get moving fast. The VHA is about to have a big influx of new patients suffering from illnesses caused by post-9/11 burn pit exposure. Their myriad "service-related conditions" will hopefully become easier to prove when, as expected, Biden signs the Honoring Our PACT Act this month.
That legislation is the product of years of lobbying by advocates for the estimated 3.5 million former service members, who were exposed to toxic burn pits in Iraq, Afghanistan, and other "forever war" zones. Only an on-going community-labor campaign against VHA privatization will insure that the veterans' healthcare system is ready and able to serve them.
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