The American public is being bombarded these days with corporate media’s accounts of the VA health care system’s problems. But none of the commentaries goes to the heart of what is basically wrong.
To be sure, many media voices do make reference to the need for more funding. However, none of the references specify where the additional funding will come from.
Start with one basic proposition: The U.S. spent trillions of dollars on the Iraq and Afghanistan wars. But the projected budget for next year for VA health care is only $68 billion, a very small figure by comparison and one that is shockingly inadequate for what is needed.
Of course VA’s problems predate the Iraq and Afghanistan wars. As an example, the Inspector General’s 2001 report found that some VA patients had to wait 730 days to get an appointment. But the problem then, as now, was grossly inadequate funding for VA health care and grossly excessive funding for the Pentagon.
You can’t have both guns and butter. Resources are finite and priorities have to be set. The sacred cow of the U.S. budget has long been money for the military to enable it to help ensure that U.S. corporate investments around the world are protected and expanded.
The VA and Single-Payer Health Care
For decades, supporters of single-payer health care have lauded the Veteran Affairs medical system as an outstanding example of single-payer at work. Was our esteem for the VA centers misguided? Not at all, and even some of its most vociferous critics have acknowledged its virtues.
At the top of the list is the Wall Street Journal, Big Business’ favorite newspaper. In its May 23, 2014 lead editorial, the Journal states:
“The VA operates on a ‘global budget’ that Congress sets each year to provide veterans a guaranteed level of benefits. All veterans are entitled to free preventative screenings, immunizations, lab services and EKGs. Most are required to pay little to nothing out of pocket for medical appointments, hospital care and drugs.”
The same editorial notes “Ah, yes, the VA lacks the evil profit motive.”
Here is what Sam Foote, an internist who was a VA outpatient clinic director for 19 years, said in his article, “Why I Blew the Whistle on the VA”:
“Today’s VA health care system in general does a very good job in providing chronic care, and it excels in things like blood pressure and diabetes control. It has an excellent computerized records system from facility to facility across the nation.” (New York Times, May 24, 2014)
Though there is always room for improvement, VA centers around the country do provide quality care and millions of veterans have high regard for their services.
So what is the problem? Though adequate funding and staffing would make VA care even better, the problem is not primarily in the care but in the scheduling, i.e., the ability to access services when needed. And right-wing forces are exploiting the justified outrage of many veterans and their families over scheduling issues in an attempt to discredit all national attempts to guarantee comprehensive health care for all, with the plundering insurance companies eliminated from the system.
So it should come as no surprise that that same Wall Street Journal editorial cited above calls for privatizing the VA.
The Scheduling Issue
The VA today is overwhelmed with the additional number of patients it is obligated to treat. Two million, eight hundred thousand U.S. troops have served overseas since 9/11 and most of those with stints in Iraq and Afghanistan have returned home. But the rising tide of veterans seeking VA services also includes veterans of Vietnam and earlier wars. There are not nearly enough doctors, nurses, staff, facilities and resources that needed to be ramped up to take care of them, part of the 9.3 million of the nation’s 22 million veterans who are currently enrolled in the VA health care system.
Regarding doctors, a crash program is needed without delay to vastly increase the nation’s number of primary physicians. Financial aid should be provided to low-income and people of color communities, among others, to enable interested persons to become physicians.
Moreover, at a time when its protocol was to schedule appointments with doctors within 30 days of request, administrators found it difficult if not impossible to comply. So what was the solution? To shorten the time when appointments should be scheduled from 30 days to 14!
This would have been eminently reasonable so long as there were adequate numbers of physicians and support staff to comply with the abbreviated schedule. But given the shortage of personnel, funds and resources, it made a bad situation worse.
Here is how one nurse explained the dilemma that many VA staff members experienced: “Yes it is gaming the system a bit. But you have to know the rules of the game you are playing, and when we exceed the 14-day measure, the front office gets very upset, which doesn’t help us.” (May 24–25 Wall Street Journal ). In other words, either go along or risk losing your job.
Top VA administrators are receiving the brunt of the criticism. It’s no surprise that bad conditions here have bred bad actors and bad actions. Without defending their gaming the system and falsifying the records, we believe it essential to get to the root of the VA crisis and demonstrate where the fault basically lies and who should be held accountable.
To put things in perspective, there were 57,000 homeless veterans and 722,000 unemployed veterans in 2013 and things have not dramatically improved since then. You can’t blame administrators for this sorry state of affairs — as is being done with the VA — so who do you blame?
We say the answer is the federal government and the corporate-run major political parties which control that government. In short, it is the same gang that has allowed the crisis affecting veterans to worsen in so many ways over decades and that tolerates 50 million people living in poverty in the U.S. today. It is the same political establishment that has allowed unemployment compensation to expire for millions of long-term jobless and recently cut food stamp funding by $8.6 billion. It is a heartless and uncaring government which has a long history of underfunding human needs programs, including medical care for veterans, who are treated as cannon fodder and expendable upon returning home.
What Should Be Done?
The Labor Fightback Network endorses the following demands (slightly edited) contained in a statement issued by the Massachusetts Nurses Association:
We urge labor and community forces to join with us in placing these demands:
- Put an end to the privatization and outsourcing of necessary medical and support services within the VA. These practices have led to care that is not always top quality, higher costs and allegations of widespread fraud and abuse. We cannot allow our veterans to continue to suffer at the hands of private corporate interests who, the evidence shows, are placing a focus on profits ahead of the interests of veterans.
- Streamline access to the full range of medical, mental health and rehabilitative benefits in the transition from military to civilian life. If someone is found to be injured or disabled while in the service, there should be no delay in the delivery of all necessary services while entering the ranks of veterans.
- Restore the practice of full access for all veterans to the VA system for all necessary care. While we advocate for comprehensive, quality care for all in our society, veterans cannot wait for that worthy social goal to be achieved.
- Provide the funding necessary to expand capacity and hire personnel to provide this full access for all veterans. Cut the war spending that generated so many veterans with so many needs in the first place.
- Extend full collective bargaining rights to all employed in this system, those who provide or make possible high standards of care.
- Shine a light on the best that this system has traditionally offered, and raise the possibility of expanding this into a national health system, free of profiteering, serving all who dwell within our borders.
The Labor Fightback Network also continues to advocate the formation of labor-community coalitions to promote a program of action that truly reflects the needs and aspirations of the working class majority. Such a program could include redirecting war and military spending to ensure jobs for all; a minimum wage of $15 an hour; single-payer universal health care; an end to deportations; programs to eradicate poverty and end homelessness; defense of public education; rescinding anti-labor legislation and guaranteeing the right to organize; and expanding and improving safety net programs, especially Social Security, Medicare and Medicaid.
Labor cannot go it alone. We must forge stronger ties with our community partners if we are to make significant progress. Together we can mount sizable demonstrations in the streets and be heard.
In the final analysis, we must look elsewhere for political leadership. This means running independent working class/community candidates in support of the kind of program suggested above. It means laying the foundation for a workers’ party based on the unions and progressive community organizations, which can compete with the corporate parties in the electoral arena. The time to move forward on this front is now.