How Veterans Are Losing the War at Home

All other vets would have the “option to seek private health coverage,” using funds the VA might have spent on their care, had they chosen it. (How that would be calculated remains one of many mysteries.) The venerable VA operates America’s largest health care system, with 168 VA Medical Centers and 1,053 outpatient clinics, providing care to more than 8.9 million vets each year. Yet under this plan that lame, undernourished but extraordinary and, in a great many ways, remarkably successful version of single-payer lifelong socialized medicine for vets would be a goner, perhaps surviving only in bifurcated form: as an intensive care unit and an insurance office dispensing funds to free and choosy vets.

Such plans should have marked Concerned Veterans for America as a Koch brothers’ creation even before its front man gave the game away and lost his job. Like those pain foundation doctors who became self-anointed opioid experts, veteran Pete Hegseth had made himself an expert on veterans’ affairs, running Concerned Veterans for America and doubling as a talking head on Fox News.  The secretive veterans’ organization now carries on without him, still working to capture — or perhaps buy — the hearts and minds of Congress.

And here’s the scary part: they may succeed.  Remember that every U.S. administration, from the Continental Congress on, has regarded the care of veterans as a sacred trust of government. The notion of privatizing veterans’ care — by giving each veteran a voucher, like some underprivileged schoolboy — was first suggested only eight years ago by Arizona Senator John McCain, America’s most famous veteran-cum-politician. Most veterans’ organizations opposed the idea, citing McCain’s long record of voting against funding the VA.  Four years ago, Mitt Romney touted the same idea and got the same response.

That’s about the time that the Koch brothers, and their donor network, changed their strategy. They had invested an estimated $400 million in the 2012 elections and lost the presidency (though not Congress).  So they turned their attention to the states and localities.  Somewhere along the way, they quietly promoted Concerned Veterans for America and who knows what other similar organizations and think tanks to peddle their cutthroat capitalist ideology and enshrine it in the law of the land.

Then, in 2014, President Obama signed into law the Veterans’ Access to Care Through Choice, Accountability, and Transparency Act. That bill singled out certain veterans who lived at least 40 miles from a VA hospital or had to wait 30 days for an appointment and gave them a “choice card,” entitling them to see a private doctor of their own choosing.  Though John McCain had originally designed the bill, it was by then a bipartisan effort, officially introduced by the Democratic senator who chaired the Senate Committee on Veterans’ Affairs: Bernie Sanders.

Sanders said that, while it was not the bill he would have written, he thought it was a step toward cutting wait times. With his sponsorship, the bill passed by a 93-3 vote. And so an idea unthinkable only two years earlier — the partial privatization of veteran’s health care — became law.

How could that have happened?  At the VA, there was certainly need for improvement.  Its health care system had been consistently underfunded and wait times for appointments were notoriously long.  Then, early in 2014, personnel at the Phoenix VA in McCain’s home state of Arizona were caught falsifying records to hide the wait-time problem.  When that scandal hit the news, Concerned Veterans for America was quick to exploit the situation and lead a mass protest.  Three weeks later, as heads rolled at the VA, Senator McCain called a town hall meeting to announce his new bill, with its “hallmark Choice Card.” His website notes that it “received praise… from veterans’ advocacy organizations such as Concerned Veterans for America.”

That bill also called for a “commission on care” to explore the possibilities of “transforming” veterans’ health care.  Most vets still haven’t heard of this commission and its charge to change their lives, but many of those who did learn of it were worried by the terminology.  After all, many vets already had a choice through Medicare or private insurance, and most chose the vet-centered treatment of the VA. They complained only that it took too long to get an appointment. They wanted more VA care, not less — and they wanted it faster.

In any case, those choice cards already handed out have reportedly only slowed down the process of getting treatment, while the freedom to search for a private doctor has turned out to be anything but popular.  Nevertheless, the commission on care — 15 people chosen by President Obama and the leaders of the House and Senate — worked for 10 months to produce a laundry list of “fixes” for the VA and one controversial recommendation. They called for the VA “across the United States” to establish “high-performing, integrated community health care networks, to be known as the VHA Care System.”

In other words, instead of funding added staff and speeded-up service, the commission recommended the creation of an entirely new, more expensive, and untried system. Then there was the fine print: as in the plan of Concerned Veterans of America, there would be tightened qualifications, out-of-pocket costs, and exclusions.  In other words, the commission was proposing a fragmented, complicated, and iffy system, funded in part on the backs of veterans, and “transformative” in ways ominously different from anything vets had been promised in the past.