Unless you’ve been living under a rock, you’ve probably heard the debate: should the Veterans Health Administration, the largest integrated health network in the country, embrace or push way partial privatization of its health services?

It’s a fiery debate that has forced many to take a side, but what’re the underlying problems that have sparked such a debate, and why is it happening now? In this blog we’ll explore some of the untold details behind this issue so that you can be well-informed for your next argument with your co-workers at lunch.

Getting Context: Story Time!

The news story that sparked it all. We all remember that fateful week in May, 2014 when reports of a 115-day wait time for patients was discovered at the Phoenix VAMC. Not only that, but waitlists were being falsely reported to improve performance reviews for the hospital. There were even reports that some 33 veterans died while on the waiting list, which in the end were found to be unrelated. Still shocking news nonetheless.

It’s hard to forget the ensuing media frenzy of 2014, and how the US Department of Veterans Affairs was never to be the same. Whistleblowers from VA medical centers all across the country exposed internal problems in the system, by June 2014 the VA had more negative press than it could’ve imagined; there’s even an extensive Wikipedia page now documenting the entire tumultuous year (great for a midnight Wikipedia dive).

This of course led to politician’s from all sides offering their own solutions, by which point the presidential campaigns for the 2016 elections were underway — and we all remember how intense it that got.

But before we get to that, we need to define some vocabulary, namely the VA Accountability Act and Whistleblower Protection Act — both direct legislative outcomes of the 2014 scandal.

The VA Accountability Act allows for the Secretary of Veterans Affairs to demote, fire, and suspend almost any VA employees for misconduct or performance reasons.

Timeline: Introduced February 11, 2014; passed May 21, 2014.

The  Whistleblower Protection Act protects VA employees from reprisal or retaliation from superiors given that they report misconduct or “whistleblow” to hire-ups.

Timeline: Signed into law April 10, 1989, All Circuit Review Extension Act (extending rights to whistleblowers) passed September 26, 2014.

The 2016 Election and the VA

Yeah, we have to talk about it. Take yourself back three years to Spring of 2016, when the Republican and Democratic Primaries were in their full swing. What a time to be alive (not).

The Clinton and Trump campaigns were diametrically opposed on most issues, including VA Healthcare. Quick refresher:

Clinton’s response to the internal problems in the VA was to revitalize and restructure the VA health system while maintaining its size and its status as the primary healthcare option for veterans.

Trump supported modernizing the VA Health system by allowing veterans to seek out-of-network care (Community Care), leading some to believe that he wanted to completely privatize the system. His ambiguity on the matter left many on edge, however it was clear his plans would include privatization to some extent.

Intermission: Other Rising Concerns for US Healthcare

Before we get into VA Healthcare post-2016, we need to talk about another problem the entire US Healthcare System is facing: a shortage of medical professionals. According to the Association of American Medical Colleges, after collecting data in 2015, 2016, and 2017, there will be a shortage of between 40,000 and 120,000 medical professionals by 2030. The shortages are largely due to an aging baby-boomer population.

This shortage hasn’t left the VA health system untouched, in fact the VA already has a 12% vacancy rate among medical professionals,  49,000 vacancies of 420,000 jobs in February this year, up from 8% of 2017. This has left a tremendous strain on caregivers in VA centers around the nation, and has led to widespread third-party recruitment efforts (such as EGA Associates, the sponsor of this blog!).

Check out our Locum Tenens blog to find out one of the most interesting effects of this shortage!

Interested in a career change? Get into medicine!

BackTrack: The Trump-Era

We all know who won the 2016 election, and with that win came an ambiguous VA Health agenda that left many nervous. There was no clear direction or plan that the Trump Administration had laid out.

Democratic lawmakers have since accused their Republican counterparts of purposefully not filling vacant positions, while making it easier and easier for patients to get out of network care.

It’s no secret that privatization is on the Republican agenda. Let’s explore two ways they’re pushing in this direction:

  1. Relaxing barriers for the Veterans Choice Program (VCP) eligibility
  2. The Mission Act

The VCP is a program in which veterans can receive care from non-VA community providers at the cost of the VA. Previously, veterans had to be at least 40 miles away from their VA provider, or have a wait time over 30 days to be eligible for the VCP. The new rules proposed by the Trump administration would make it easier for veterans to participate in the program by allowing them to use it given they are more than a 30-minute drive away from their VA provider, or have a wait time over 20 days.

The MISSION Act, passed in June 2018, among many changes, allocates federal spending on the VA’s Community Care programs from mandatory to discretionary. This means that funding for Community Care programs will be on the hot seat every year, and at a cost of some 8 billions dollars a year. Remember how the government shutdown this year was stalled by funding a 5 billion dollar border wall? The act promotes privatization in many other ways, read here.

The overall trend right now for VA Healthcare is privatization, and while some love it, others hate it.

“Picking Up where the VA has Failed”

Many opponents of these privatization changes feel powerless in the face of a quickly changing VA health system. As thousands of positions stay vacant, the underlying lack of manpower behind the operations of the VA Health System appears to be taking a toll on everyday operations.

For some veterans, seeking out-of-network care is more than just about transportation time and costs, it’s a personal choice stemmed from years of cultural trauma surrounding the VA health system.

For Anuradha Bhagwati, a former Marine Corps captain,  (check out her NYTimes response), the culture surrounding the VA often comes off as hyper-masculine. Anuradha was being treated for military sexual trauma; however, she felt that the VA environment was oftentimes counterproductive in its efforts; she was regularly mistaken for being a medical professional or the spouse of a veteran and felt uncomfortable with several interactions with doctors there.

For Anuradha, receiving Community Care outside of the VA became a possibility when her appointments were backed up 6 weeks, and she loved the care she received. To her, the option of getting care outside the VA wasn’t just more convenient, it was essential to her well-being.

It’s no secret that US military veterans have some of the highest rates of suicide among any demographic, with an approximate 20 suicides per day. It was found that between October 2017 and November 2018, 19 suicides occurred on VA campuses. Militarytimes has a great article focusing on two specific cases: both were men who were seeking PTSD treatment.

If Anuradha’s story tells us anything, it’s that getting care for PTSD and other military-related trauma can sometimes be more effective and efficient in community care centers than in VA medical centers simply because of their change-of-pace. It can be relieving for some to get a non-military health evaluation and be treated as a non-military civilian, and there’s no reason not to try it, especially given the current circumstances.

“Don’t Fix it if it ain’t Broken”

For many, the partial privatization of VA Health Care is seen as unnecessary and inefficient.

A 2014 Rand Report found that VA care is better than non-VA care in 83 different measures of quality, out-scoring non-VA care in 45 categories. VA care excelled in outpatient procedures but lacked in inpatient procedures.

Many have also praised the modern Electronic Health Records system of the VA, citing its reliability and versatility across the entire VA system. That being said, the system is currently going through a long and expensive overhaul that’s receiving a lot of criticism. There was also an incident in 2018 where a 50-year old computer system failed to administer benefits to G.I. bill recipients (facepalm).

To state the obvious, the VA is also an inexpensive alternative to aging Americans who may not yet be old enough to receive Medicare and who are do not have their own health insurance plans. Take that away, and veterans could be left with little or no options, exacerbating the homeless veterans situation. The VA is very much an economy-of-scale solution, take the scale away, and the economy part will disappear too.

There’s also been a push in recent years to increase the quality of care for women veterans. Women veterans are currently the fastest-growing demographic of veterans in the country, with the current 2 million women veteran population expected to double by 2040. Every VA center now has at least one women’s health primary care provider, and the VA has set up a women’s veteran call center, as well as possible compensation for military sexual trauma. An astonishing 1 in 4 women veterans has experienced military sexual trauma.

To state the obvious: sometimes fixing something is much simpler than completely destroying and rebuilding it and that’s the narrative of many who still believe that the VA independently can fix its problems.

It’s also a myth that veterans are flocking out of VA health systems with the new community care programs. In fact, in 2018 34% of VA appointments were outside the VA health system, a drop from 36% in 2017.

We hoped you learned a thing or two surrounding this debate, there’s a lot more to talk about and explore, so look out for a possible sequel post. Should the VA open its arms to privatization? Should the VA fall back on its previous model without privatization? Drop a comment below!

This blog was written drawing from a lot of sources! Check a few of them out directly below! NYTimes Donald Trump Is Getting It Right on Veterans CareNYTimes Saving Veterans’ Health CareMilitaryTimes ‘Setting us up to fail’ — VA blasted over unfilled health care positionsClearanceJobs Opinion: Veterans Want Autonomy in Healthcare Choices.