The woes of organized labor aren’t new to us. One of us (Steve) spent many years as a labor representative in the telecom industry, which has been downsizing its unionized workforce for 40 years, often issuing corporate announcements of significant pending “reductions in force” (RIF). When that RIF alarm bell goes off, the Communications Workers of America (CWA) and the International Brotherhood of Electrical Workers (IBEW) have repeatedly mobilized against looming cuts.

Through workplace mobilization, outreach to labor, community, and political allies, and direct negotiations with telecoms like Verizon or AT&T, these unions have often averted layoffs by securing early retirement incentives.

Are buyouts and early retirement offers cause for celebration or a reminder that management still wants to put heads on the chopping block?

That’s the question facing Department of Veterans Affairs (VA) employees after getting a modicum of good news from VA Secretary Doug Collins. Four months ago, a leaked memo revealed that Donald Trump’s administration wanted to shed 83,000 VA workers this year.

That downsizing of an agency that began the year with 484,000 employees triggered protests nationwide—by veterans’ organizations, VA unions, and patients and their families. Collins stonewalled critics and presided over VA contract cancellations demanded by President Trump’s Department of Government Efficiency (DOGE), which produced few savings. The former U.S. House member from Georgia denied that DOGE-driven job cuts might hurt care for nine million VA patients.

Headed in The Right Direction?

On July 7, Collins took a different stance, announcing that a 15 percent reduction in his agency’s workforce is no longer necessary since 17,000 VA employees have already left, and another 13,000 will do so by September due to “normal attrition” or the lure of early retirement or severance payments.

“A departmentwide R.I.F. is off the table,” Collins said. “As a result of our efforts, VA is headed in the right direction—both in terms of staff levels and customer service.”

However, a far better indicator of where the VA is headed can be found in Collins’ more consistent—but equally misleading—messaging about “making it even easier for veterans to get their health care when and where it’s most convenient for them.”

In the VA Secretary’s view, this means letting eligible veterans choose between highly qualified VA caregivers and referrals to a nationwide network of 1.7 million private-sector providers, whose performance has sometimes been inferior.

Collins’s proposed discretionary budget for FY 2026 favors the latter; it calls for a $14.4 billion increase in federal spending on outsourced care, a 67 percent hike from last year, and an unprecedented 17 percent reduction in funding for VA direct care. In addition, sources report that Collins also seeks Congressional approval to transfer $1.8 billion from the VA’s clinical care budget to boost spending on non-VA providers during the current fiscal year.

This ongoing defunding of direct care will eventually result in more staff reductions and facility closings.

Popular opposition to the threat of both under the Biden Administration helped derail a poorly conceived White House plan to review VA “assets and infrastructure” three years ago. But then Biden’s

VA Secretary Denis McDonough never used his rule-making authority to shore up financing of VA direct care by curbing costly and unnecessary patient referrals to private doctors and hospitals. So, under the second Trump administration, Collins picked up where McDonough, a chief of staff to Barack Obama, left off.

A Divided Reaction

Veteran advocates and other stakeholders in caring for the nation’s eighteen million veterans cheered Collins’s July 7 walk back to varying degrees.

While noting that “30,000 job cuts, even through attrition, risks degrading services, “American Federation of Government Employees (AFGE) President Everett Kelley called this lesser blow ‘a major victory.’” He urged other federal department heads “to follow Secretary Collins’ lead” and abandon their DOGE-driven RIF plans.

Kelley also pledged that, “if the administration continues down the path of privatization, mass layoffs, and unlawful reorganizations, they will hear from us again.”

The million-member Disabled American Veterans (DAV) declared itself “cautiously optimistic” about Collins’s action. The Iraq and Afghanistan Veterans of America (IAVA) hailed it as “a notable and encouraging departure from the previously discussed, much larger cuts.” In their statements, unlike AFGE’s, neither group mentioned ongoing privatization spurred by the VA MISSION Act of 2018. DAV, IAVA and other veterans service organizations favored its passage via a bipartisan vote that handed President Trump one of his biggest first-term legislative victories.

Other veterans’ groups, like Common Defense and VoteVets, remain far more critical of Collins. Common Defense national organizer Joanna Sweatt, a Marine veteran, “warned that Trump’s attacks on VA healthcare haven’t stopped.” On behalf of VoteVets, retired Army Major General Paul Eaton predicted, accurately, that the White House still plans to “demonize, downsize, and privatize VA care.”

As Robert Anderson, a Veterans for Peace member and VA patient in New Mexico, told the Washington Monthly, “the decade-long diversion of funds from the VA for privatization continues at breakneck speed… As a result of cutbacks and shortages, I hear some vets complaining that the VA can’t do anything right. And proving that to be true has always been the goal of the Republican jihad against ‘government-run’ healthcare.”

Russell Lemle, former chief psychologist for the San Francisco VA healthcare and co-founder of the Veterans Healthcare Policy Institute, praised the grassroots organizing and lobbying that resulted in fewer jobs being cut this year. “But the focus on the number 83,000 was always problematic,” he points out. “It set the stage for Collins to scale back his plans and, in the process, appear more reasonable and flexible than he actually is.”

A Roller Coaster Ride

A VA local union activist, who wished to remain anonymous to avoid management retaliation, agreed that “announcing big cuts and then implementing smaller ones results in everyone breathing a sigh of relief when we can’t afford to let our guard down.”

Lemle argues that staff reductions through steady attrition will still hurt the nation’s largest public healthcare system. “When backfilling a vacated position is slowed to a crawl or indefinitely suspended or, worse yet, a position gets removed from the organizational chart, you end up not having enough staff to serve veterans’ needs, which is a recipe for outsourcing more care to the private sector.”

The roller coaster ride that VA workers have been on since Trump moved back into the White House in January has left tens of thousands of talented, skilled, and committed healthcare professionals and support staffers wondering whether they have any future at the VA. “The administration’s message is look for a job elsewhere,” one former VA medical center director told the Washington Monthly.

VA defenders’ organizational challenge is maintaining morale in their ranks, while building on recent protest activity that attracted many previously unengaged veterans.

Saving the VA requires further resistance to Collins’s performative campaign against “waste, fraud, and abuse,” and the GOP’s longstanding goal of restructuring veterans’ healthcare delivery, via incremental privatization. Doing so will be an inspiration to other federal departments and their stakeholders. So no one is better positioned to display red state resistance to Project 2025—and broader disillusionment with Trump—than military veterans, their families, and the federal workers who support them.

The post VA Secretary Says No Department Wide RIFs, But It’s No Time to Cheer appeared first on Washington Monthly.

Earlier this month, Vietnam War veteran Paul Cox went to a Department of Veterans Affairs (VA) medical center in St. Louis to visit a sick friend. When he left the hospital, he encountered a woman handing out flyers in its parking lot. “VA workers are being fired,” her leaflet said. “This can hurt your care. This is an assault on the VA. Call or email your Senators and Representatives as soon as you can.” 

Cox, a leading Veterans for Peace (VFP) member and supporter of its Save Our VA (SOVA) committee, has distributed similar appeals on many occasions, often to support VA caregivers. So, the longtime VFP activist asked whether she was involved with a labor or veterans’ organization. 

It turns out, neither; she was acting on her own, Cox learned. Reading about President Donald Trump’s mass firing of federal employees, she became very worried about the impact on local VA care for her husband. She had typed the flyer herself, taken it to a copy shop, and began hand-billing other patients, staff, and family members. 

This grassroots response has become increasingly common since early March when plans for VA job cuts exceeding 80,000 positions made national headlines. Around the country, veterans—along with their caregivers, friends, family, and neighbors—have often reacted with shock and anger. 

They have picketed, rallied, called, and emailed Congress, and, where possible, confronted the few Republican representatives still willing to hold town hall meetings despite GOP leadership warnings to lay low. One feisty 80-year-old vet from Virginia even chained himself to a signpost near the White House as a prelude to coordinated March 14 protests. On that date, as Stars and Stripes reported, thousands gathered on the National Mall to defend VA jobs, services, and benefits. 

The administration’s opening salvo at the VA involved the blanket dismissal of 2,400 probationary workers, including many former service members. That group and new hires in five other federal departments just got a reprieve in the form of a reinstatement order issued by U.S. District Court Judge William H. Alsup in San Francisco on March 13. The administration is appealing. However, as Alsup warned the union plaintiffs in this case, the VA and other agencies still can downsize based on future Reduction in Force (RIF) plans that are “done right.”  

A Headquarters Leak 

A March 4 headquarters memo revealed that new Secretary of Veterans Affairs, Doug Collins, plans a RIF from 480,000 employees to 399,957, starting in August. This will return the agency’s headcount to what it was in 2019, and according to that leaked document, “eliminate waste, reduce management and bureaucracy…and increase workforce efficiency.”  

In The Hill, Secretary Collins pledged to do this “without making cuts to healthcare or benefits” and warned critics that “we will be making major changes. So get used to it.” 

On Capitol Hill, Democrats are warning of the consequences. “The VA,” says Mark Takano, a representative from California, “is on the precipice of destruction” from “a senseless reduction in force.” Takano, the ranking member of the House Veterans Affairs Committee, warns that the VA-run Veterans Health Administration (VHA) will be seriously disrupted—particularly for its hundreds of thousands of new patients with service-related conditions due to past toxic exposure in combat zones or on U.S. military bases. 

This enormous influx of disability benefit claimants resulted from the Biden Administration’s passage of the Promise to Address Comprehensive Toxics (PACT) Act in 2022. But, with a VA workforce likely to shrink by 20 percent, veteran advocates fear that will not be met, even with a projected ten-year allocation of $280 billion to fund this expanded coverage. 

As a New York Times investigation just confirmed, the VA’s initial job cuts this winter and its Department of Government Efficiency (DOGE)-driven cancellation of hundreds of agreements with outside contractors have already had a chaotic ripple effect. 

In the long term, the VHA’s role as a medical research powerhouse, a leading clinical education provider for healthcare professionals, and a backup public hospital system during pandemics or other emergencies will also be jeopardized. Veterans who have filed tens of thousands of disability claims with the VA-run Veterans Benefits Administration (VBA) will face longer delays getting them approved. 

Local Leadership Uncertainty 

One regional VA administrator contacted by the Washington Monthly (who asked not to be identified) described widespread uncertainty among their colleagues about how to plan for the looming cuts.  

“Are we following Office of Management and Budget (OMB) rules, or the rule of law, which requires that we follow certain guidelines, for example, people with the most seniority are the last to go, employees who are veterans are the last to go, employees with high-performance ratings ditto?” 

There is little confidence that Republican political appointees—eager to impress Elon Musk’s DOGE team and the White House by meeting their staffing headcounts—have a fundamental understanding of who is “mission critical” at the VHA and who is not. For example, many employees were illegally fired by the first Trump administration under the VA Accountability and Whistleblower Protection Act of 2017, which included housekeepers and food service workers. 

As one VHA manager asks, who will feed hospitalized veterans and keep facilities clean if you lay off support staff and don’t replace them? Who will change the sheets on patients’ beds or deep clean a room to prevent the spread of serious hospital-acquired infections like MRSA or Clostridium difficile (C-Diff)? 

Another VA official pointed out the adverse safety impact of Collins canceling many agreements with private-sector vendors. One contract covering the Togus, Maine VA Medical Center—since restored after a protest by Senator Angus King, the state’s independent U.S. Senator—was with a firm supplying a radiation safety officer. One VHA leader commented, “How can you safely deliver radiation if you cannot monitor how much you’re giving? How stupid can you be?”  

Telehealth Threatened 

One well-documented in-house strength of the VHA is its telehealth services. They can even help veterans with kidney problems—not for in-person treatments like dialysis but related meetings with their physicians. One clinician told the Monthly that telehealth is critical for veterans in states like Hawaii, Guam, Alaska, Montana, or Wyoming, with few nephrologists. Many VHA patients with mental health problems also use telehealth sessions to access therapists, who are in short supply in many parts of the country.  

Secretary Collins has claimed incorrectly that such services are equally available in the private sector. In fact, in telehealth, the VHA has a significant advantage over private providers because it can operate on a multi-state basis. In the private healthcare industry, if a doctor, nurse, nurse practitioner, physician assistant, or therapist treats an out-of-state patient, they must be licensed in both their state and the patient’s/ 

The VA’s “Anywhere-to-Anywhere” rule, implemented in 2018 and bolstered in 2020, allows “VA health care professionals to deliver health care in a state other than their home state of licensure, registration, certification, or other state requirement.” This permits doctors, nurses, psychologists, and other providers “to care for any of the VHA’s nine million patients, without regard to state licensing requirements which remain a legal obstacle to other healthcare systems wider use of telemedicine.” 

Claims Processing Delays? 

Even before the arrival of DOGE cost cutters, VBA staff members faced the challenge of processing new PACT Act-related claims based on 23 medical conditions, ranging from bronchial asthma to rare cancers, which are now considered presumptively related to either burn-pit and other chemical exposures in the military.  

VA officials fear that impending job cuts will make it harder for veterans to get medical exams, enabling them to join registries maintained for victims of Agent Orange, Gulf War syndrome, burn-pit, and asbestos exposure. 

A union-sponsored survey of several thousand VA staffers conducted in 2022 by the Veterans Healthcare Policy Institute found that most VBA respondents were experiencing unmanageable claims processing workloads. Even then, this was causing more than 60 percent to consider leaving their jobs. 

Most VHA participants in this survey said their facilities needed more frontline and administrative/support staff. However, vacancies were not being filled, and sufficient recruitment of new staff was not underway. More than two-thirds reported that their facility’s beds, units, or programs had been closed due to local staffing shortages and budget deficits, even in places with continuing patient demand.  

Life and Death Stuff 

Three years later, VHA managers—not just union members—foresee such conditions getting much worse, not better. They express particular concern about how cuts to research and direct care will adversely affect patients undergoing cancer treatment. 

Patients on clinical trials or even undergoing traditional cancer treatment at the VHA can’t just switch providers overnight. If there is no longer sufficient staff to provide care, their clinical trial will be ended, with no guarantee of its continuation outside the VHA. Outside the veterans/ healthcare system, there can be much longer waits just for an appointment with an oncologist, 

“This is life and death stuff,” a VHA administrator told us. “We don’t treat cancer because it’s benign; we treat it—and right away—because it can kill you right away.” 

One 50-year-old Army veteran who knows the need for timely treatment is Jose Vasquez, the New York City-based director of Common Defense, a progressive veterans’ organization.  

On March 6, his group held an emergency Zoom call on saving the VA with more than 350 participants nationwide. Many of the latter were surprised to see Vasquez appear on the screen lying in bed and dressed in a hospital johnny. 

“I am coming to you live from the Manhattan VA,” Vasquez explained. “I’ve just had surgery for pancreatic cancer, and the idea that the Trump administration would want to cut 83,000 positions and fire that many people from VA facilities is ludicrous. The VA just saved my life.”  

“It’s getting real,” Vasquez warned. “They’re coming after our veterans’ benefits, but we’re not going down without a fight”—a message echoed by other vets on the call. They pledged to bombard politicians and the press with their stories of life-changing experiences with VA programs and services. 

As Common Defense member Vedia Barnett, a disabled vet, told Time this month: “I am not just concerned for myself—I am terrified for our senior veterans. They will bear the brunt of this cruel decision… leaving our most vulnerable without the care they desperately need and deserve.’ 

The post Critics of VA Cuts Say, “This is Life and Death Stuff” appeared first on Washington Monthly.

Amid the alarm over President Donald Trump’s cabinet nominees who are under-qualified and self-styled disrupters, Veterans Affairs Secretary Doug Collins has a more reassuring resume. 

The former four-term member of Congress from Georgia is an Iraq war veteran with law and divinity school degrees. An Air Force Reserve colonel, Collins, the son of a Georgia state trooper, has ministered to fellow soldiers as a military chaplain. He also served stints in the Georgia State House and the U.S. House GOP leadership.  

At his confirmation hearing last month, no one questioned Collins’s ability to manage the federal government’s second-largest workforce and third-largest agency budget ($300 billion). On the Senate Veterans Affairs Committee (SVAC), only one out of 19 Republicans, Democrats, and Independents voted against him in committee (due to concern about his views on VA patient access to abortion). However, some of those Democrats voted against him on the chamber floor.  

The 77-23 vote to confirm the bespectacled 59-year-old was based partly on the nominee’s assurances that he would champion continuity rather than disrupt the nation’s most extensive public healthcare system. Senator Richard Blumenthal of Connecticut, the ranking member of SVAC, was one of many Democrats to vote for Collins. 

Collins’s promise to stay the course at the Department of Veterans Affairs (VA) by offering its nine million patients a choice between direct care in 1,350 VA facilities and referrals to private-sector hospitals and providers bolstered the support. 

But there’s still plenty of reason to worry about Collins. First, there’s the situation he inherits at the VA-run Veterans Health Administration (VHA), which is running out of money to fund further outsourcing of veterans’ care without inflicting fatal damage on its hospitals, clinics, and 300,000-person workforce (one-third of whom are veterans themselves). 

Of course, the incremental privatization of the VA is not new. This costly and unnecessary experiment began a decade ago under Barack Obama with strong Democratic support. It was greatly expanded during President Trump’s first administration and continued under Joe Biden, despite his professed opposition to privatization as a 2020 presidential candidate.  

But now the VA is back in the hands of hard-core Republican ideologues who favor wider implementation of the VA MISSION Act of 2018, one of Trump’s proudest first-term legislative achievements that Collins supported as a House member. The bill significantly accelerated the privatization of Veterans’ health care. On the campaign trail last year, Trump touted the MISSION Act-mandated outsourcing as a great system of “rapid service,” in which veterans “go to an outside doctor . . . get themselves fixed up, and we pay the bill.” Collins was a serious legislator, but he is also hard-core MAGA. He was Trump’s pick in the 2020 Republican U.S. Senate primary in Georgia, where he lost to Kelly Loeffler. He even penned a book about Democrats being obsessed with Trump. 

Collins and other Republicans assure veterans they can have the best of both worlds. They can continue to receive specialized, high-quality in-house care and exercise virtually unlimited “healthcare freedom” by going outside the VA at tax-payer expense. “At the end of the day,” Collins told SVAC members, “the veteran is getting taken care of,” and “there will always be the VA healthcare system” as “backup.” 

This last claim, though, is on a collision course with reality. Imagine how long Kaiser Permanente would remain in business if some 40 percent of its patients could freely seek “out-of-network” care while it pays the bill. Plus, VA hospitals and facilities need fresh funding just at a time when President Trump and Elon Musk are looking to slash budgets. 

According to a bi-partisan panel of experts, who sent their assessment to Collins’ predecessor, Denis McDonough, nearly a year ago in a report entitled “The Urgent Need to Address VHA Community Care Spending and Access Strategies,” referrals outside the VA have grown 15 to 20 percent per year and now involve more than 40 percent of its patient population.  

The cost of reimbursing for-profit vendors enrolled in the MISSION Act-created Veterans Community Care Program (VCCP) has also “dramatically increased—from $14.8 billion in FY 2018 to $28.5 billion in FY 2023.”  

As a result, “some VA Medical Centers are incurring community care spending deficits in the hundreds of millions of dollars and…consuming more than half of their clinical care budgets.” This has created an “existential threat” to the VHA, which, absent “new funding…will likely be forced to consider eliminating direct care services or closing VA facilities.” 

This review further noted that hospital closings would ” eliminate choice for the millions of Veterans who prefer to use the VHA direct care system for all or part of their healthcare needs.” Plus, the lesser-known but equally critical medical research, teaching, and emergency preparedness functions of the VHA, which benefit all Americans, would also be gutted. 

None of the healthcare experts on this McDonough-appointed panel, whose recommendations he sadly ignored, was against sending vets to private doctors or hospitals “when needed services are not readily available in the VA’s direct care system.” They questioned outside referrals that don’t result in more timely, accessible, or better care.  

The panel’s wake-up call has not stopped Congressional Republicans from ignoring problems with private-sector treatment. The journal Health Affairs just published the results of a new study showing that private sector medical services utilized by veterans are of “lower quality” than those offered at the VA. 

Last month, the Republican chairs of the Senate and House Veterans Affairs Committees, Senator Jerry Moran of Kansas and Representative Mike Bost of Illinois, teamed up to introduce the ACCESS Act of 2025. It’s an acronym for Assuring Critical Care Expansions to Support Service Members Act. 

According to Representative Bost, the ACCESS Act will “protect and preserve the intent of the MISSION Act and the VA community care program so that no bureaucrat can stand in the way of veterans accessing the healthcare they have earned—whether that is inside or outside the VA.”  

The legislation codifies and loosens patient referral standards developed during the first Trump Administration, which triggered a surge in costly and unnecessary outsourcing. Senator Moran claims the result will be “great flexibility” for veterans. 

Contrary to the claims of Republicans like Secretary Collins and the bill’s sponsors, veterans are not poised to enjoy the best of both worlds—VA direct care and private doctors. As the VA becomes more of a Medicare-style bill payer and less of a direct care provider, its latter function becomes increasingly unsustainable. That’s a problem Collins and the rest of Washington can’t easily square. 

The post Trump’s Sober Pick for Veterans Affairs Has His Work Cut Out appeared first on Washington Monthly.

Much media coverage of Pete Hegseth’s nomination as Secretary of Defense has focused, understandably, on controversial things he has said or done, along with his complete lack of administrative experience relevant to running a federal government department with a $920 billion budget and a workforce of three million.

But anyone in charge of the Pentagon also gets to oversee the Military Health System (MHS), which provides either private health insurance coverage or direct care for over 9.5 million service members, military retirees, and their families. As Defense Secretary Lloyd Austin noted in a recent DOD National Defense Strategy report, the MHS mission is to ensure that active duty personnel and their dependents are well-served by a skilled cadre of “medical personnel in uniform,” who number nearly 170,000.

Hegseth served as an ROTC-trained Army officer deployed to Iraq, Afghanistan, and Guantanamo Bay and is a longtime critic of “government healthcare,” claiming that it “doesn’t work.” So if Hegseth succeeds Austin, Pentagon officials trying to end a failed experiment with MHA privatization may find themselves ordered to march backward.

Rather than being upgraded and improved, the DOD’s network of military hospitals and clinics would remain under-resourced. And more of the MHA’s $61 billion annual budget would be spent on private insurance coverage that has failed to meet the needs of many service members and their dependents, particularly in rural areas.

During the first Trump Administration, Hegseth was a White House advisor who pushed the Department of Veterans Affairs (VA) to expand care outsourcing for nine million former service members. Trump’s first VA Secretary, a hold-over from Barack Obama’s administration, dragged his feet on implementing this ill-advised policy.

As a result, Dr. David Shulkin, an experienced hospital system administrator in the private and public sectors, was fired by Trump in 2018 after keeping him around for over a year. In his memoir, It Shouldn’t Be This Hard to Serve Your Country, Shulkin blames his downfall on Hegseth, who “never worked at the VA, knew nothing about managing a healthcare system, and had little understanding of the clinical and financial impact of the policies he was advocating.”

Hegseth does have a background as “a capable midgrade officer” who earned two Ivy League degrees and Bronze Stars, plus media experience ranging from writing for the Princeton Tory, a conservative undergraduate publication, to opining about military and veterans’ affairs on Fox & Friends Weekend where he’s a host. In any other Republican administration, this resume would qualify him as a Pentagon press secretary.

That Hegseth has instead risen to a cabinet pick is a testament to the continuing impact of the Koch Brothers-backed Concern Veterans for America (CVA). After a failed bid to become the GOP nominee in a 2002 Republican primary race for a U.S. Senate seat in his native Minnesota, Hegseth became CVA’s first CEO and a leading advocate for turning veterans care over to private doctors and hospitals.

CVA was an astroturf upstart in veterans’ affairs and an outlier in pushing VA privatization. Traditional Veterans Services Organizations (VSOs)—like Veterans of Foreign Wars, American Legion, Disabled American Veterans, or Vietnam Veterans of America—represent millions of veterans. Their members pay dues and elect their leaders.  They have local chapters and national conventions. They have roots in the community and provide valuable services to individual veterans who need help filing disability claims for service-related conditions, which qualifies them for VA care.

VSO lobbying victories include the passage of the PACT Act of 2022. This legislation made VA benefits and related medical coverage easier to obtain for nearly a million veterans, including many whose health was damaged due to burn pit exposure during post-9/11 wars in the Middle East. (President Joe Biden has often said that he believed his son’s death from a rare form of brain cancer was owing to his burn pit exposure while serving in Iraq as a member of the Delaware National Guard.) Hegseth initially applauded and then criticized the wars in Iraq and Afghanistan, a flip-flop characteristic of his career, although hardly uncommon. Still, as VoteVets co-founder Jon Soltz, an Iraq war veteran, told the New York Times two years ago, “I have been debating Pete Hegseth for years, and I can’t tell you what he stands for other than himself and his own ambition.”

With few actual dues-payers, no VSO-style membership service programs, and a political agenda bankrolled by libertarian billionaires, CVA helped pass few bills that benefited the nation’s 19 million veterans. Instead, during the Obama era, the media-savvy group became a battering ram against tax-payer-funded healthcare in any form, a longtime bête noir of the Kochs.

Hegseth became their most visible and effective mouthpiece in a wide-ranging campaign to discredit VA care and the Affordable Care Act (ACA). In 2013, CVA ran video ads warning, in Hegseth’s words, that all Americans would soon “face long wait times, endless bureaucracy, and poor service” if Congress expanded health care access by subsidizing private insurance coverage. The result, he claimed, would be billions of dollars wasted on “a nationalized health care plan that will bring the same bureaucratic dysfunction to the larger U.S. healthcare market”–as if the VA were a model for “Obamacare,” which it certainly wasn’t.

A year later, this propaganda offensive, closely coordinated with right-wing Republicans on Capitol Hill, claimed the scalp of retired four-star General Eric Shinseki, the Vietnam veteran who was Barack Obama’s first VA Secretary. Shinseki became the fall guy for a localized scandal involving misconduct by a few VA hospital managers in Phoenix. Their doctoring of data on medical appointment wait times—to earn bonus payments—led to CVA-amplified false claims that 40 Phoenix area vets had died due to delayed care. The result was that mainstream media packed journalism at its worst, and there was growing pressure for more out-sourcing of VA care despite its higher quality, lower cost, and greater accessibility than private alternatives.

On Capitol Hill, bi-partisan majorities passed the VA Choice Act of 2014 and, four years later, the VA MISSION Act. Both opened the floodgates for increasingly costly and disastrous privatization of the nation’s most extensive public healthcare system. CVA helped engineer the passage of each measure. After stepping down as CEO of Concerned Veterans of America ten years ago and becoming a Fox News commentator, Hegseth continued to advise President Trump on veterans’ affairs; other CVA alums served in official positions at the White House or VA headquarters in Washington.

Hegseth’s return to the conservative media eco-system of his college years has paid handsome rewards; he has become a multi-millionaire (despite two divorces) as a Fox & Friends talking head, paid speaker, and bestselling author of The War on Warriors, a tirade against what he calls a woke military. Like other high-paid former military officers, his benefit package in the private sector leaves Hegseth less likely ever to need the VA, federally subsidized insurance coverage obtained through the ACA, or, when he retires, Medicare, either in traditional form or via a Medicare Advantage plan. If confirmed, his pay as DOD Secretary will be a mere $246,000 per year, but with lucrative “revolving door” opportunities in the future, when and if he transitions back to the private sector from the Pentagon.

Meanwhile, enlisted personnel and veterans from poor and working-class backgrounds bear the brunt of failed CVA-backed experiments with the privatization of the Military Health System and the VA. Under Trump and Biden, the DOD was flush with money for military aid, expensive new weapons systems, and base maintenance worldwide. Nevertheless, the Pentagon cut healthcare delivery costs for its workforce, retirees, and dependents.

Military hospitals were closed, staff positions cut, and several hundred thousand more patients were shifted to TRICARE, a federally funded form of private insurance. Newcomers to the private sector soon reported having greater difficulty getting timely medical appointments or accessing care in areas of the country with a shortage of primary care providers and specialists.

The Pentagon found that contracting out left its hospitals and clinics “chronically understaffed” and less able to “deliver timely care to beneficiaries or ensure sufficient workload to maintain and sustain critical skills. After reassessing the situation, the DOD launched an effort to “re-attract” patients back to the MHS. As studies have shown, in-house care produces better outcomes at lower cost, with fewer racial disparities—an essential advantage for a patient population of nearly 40 percent non-white.

If Pete Hegseth becomes DOD Secretary by recess appointment or Senate confirmation, he will undoubtedly stop bringing TRICARE beneficiaries back into the MHS; efforts to rebuild the DOD’s in-house healthcare delivery capacity will also be halted.

And Hegseth will not be the only ideological foe of “government healthcare” in a high-level Trump Administration position. His fellow cabinet nominee, former Congressman Doug Collins, an Iraq War veteran from Georgia, will be eager to pick up where Robert Wilkie, Trump’s second VA secretary, left off with his privatization efforts in 2021. And, with the biggest impact, Dr. Mehmet Oz, the TV celebrity picked by Trump to run the Centers for Medicare and Medicaid, will further undermine traditional Medicare by replacing it with for-profit Medicare Advantage plans, on a more universal basis.

On all three fronts, these Trump appointees will weaken the public provision of healthcare that currently benefits more than 80 million people, making expanding such programs even more difficult.

The post Pete Hegseth’s War on Warriors appeared first on Washington Monthly.

“One of the failings that we have… is that not a single member of Congress from Missouri is a veteran, not any of them,”

—Lucas Kunce, Democratic nominee for the U.S. Senate from Missouri and a Marine Corps veteran.

In 25 years, only one candidate with military service, George W. Bush, has been elected president. Despite disappointing performances by Al Gore, John Kerry, and John McCain, both major parties have doubled their efforts to identify, recruit, and finance veterans to run for office, not just for the presidency but up and down the ballot.

Their preferred candidates have combat experience and can self-fund by tapping personal wealth or business connections acquired after serving as an officer, such as David McCormick, the former hedge fund titan, West Point grad, and Republican challenging Senator Bob Casey in Pennsylvania.

Few veterans-turned-candidates come from the working class. However, some do, like the Democratic and Republican vice presidential nominees, Tim Walz and J. D. Vance, as well as Ruben Gallego, the Democratic nominee for U.S. Senate from Arizona. On Tuesday night, Americans will watch Walz and Vance face off in the vice presidential debate, marking the first time veterans have been the vice presidential nominees of major parties since 1996 when then-Vice President Al Gore, who enlisted in the Army and served in Vietnam, faced Jack Kemp, the late NFL quarterback, Republican congressman, and Housing and Urban Development who was in the Army Reserve in the late 1950s and early 1960s.

When vets seek office, they often argue, as Lucas Kunce, the Democrat running for U.S. Senate from Missouri does, that Congress needs former soldiers because of their foreign policy and veterans affairs experience, their demonstrated record of public service and sacrifice, and their embrace of values like honesty, integrity, and respect for the Constitution—points that Vance and Walz may well make in their favor when they go under the klieg lights at CBS News which is moderating the debate.

Rival Service Candidates

Walz and Vance are a study in contrasts, of course.

While both come from modest Midwestern backgrounds, served as non-commissioned officers (NCOs), and used their GI bill benefits to attend state schools—Vance went to The Ohio State University, a flagship school, while Walz attended Nebraska’s Chadron State College—their trajectories dramatically diverged.

Born two decades after Walz, Vance famously attended Yale Law School, became a venture capitalist and protégé of right-wing billionaire Peter Thiel, amassed a small fortune himself, and then, with the help of a $15 million investment from Thiel, won a vacant U.S. Senate seat from Ohio two years ago.

By contrast, Walz picked up a master’s degree from Minnesota State University, Mankato, and became a high school teacher and football coach while serving in the Minnesota National Guard for 24 years. He was inspired to run for Congress in 2006 as part of the Wellstone Action campaign, named after the late progressive U.S. Senator, also from Minnesota. After winning the first of six House races—with crucial Democratic party support in a district that had been Republican for a century—he joined the House Veterans Affairs Committee (HVAC), often considered a low-status assignment spurned by aspiring politicians, eventually becoming its ranking member and one with a first-person knowledge of the VA health system.

Walz suffered hearing damage from his repeated exposure to artillery blasts during Guard training that began when he was 17. On the HVAC, he became a strong advocate for other veterans with service-related conditions, including those struggling with PTSD and depression.

Notably, in 2018, he was one of only 70 House Democrats opposed to the VA MISSION Act, later signed by then-President Donald Trump, which significantly accelerated the privatization of veterans’ care. Walz was prescient when he warned that it would force the VA to “cannibalize itself” by diverting billions of dollars from direct care delivery to reimbursement of private doctors and hospitals.

In contrast, the Vance campaign recently hailed the MISSION Act as “bipartisan legislation that expanded veterans’ access to quality care and cut needless red tape.” A spokesman for the senator said Walz’s vote against it was “not the kind of leadership veterans need in Washington.” And Vance recently said he’d like to see privatization taken even further.

Swift-Boating, 2024-style

Walz has discovered that running for office with military credentials offers little protection against partisan flak from fellow veterans. In early August, Vance, a much affronted former PR guy for the Marines, who spent six months in Iraq in a non-combat role recounted in Hillbilly Elegy, accused Walz of “stolen valor.” This allegedly took the form of the then-Congressman misspeaking (in a 2018 appeal for gun control) about the need to curb civilian use of “those weapons that I carried in war.”

As Walz has since explained, he handled plenty of weapons, but never in a combat zone, and when he deployed abroad in 2003, it was only in support of other troops being sent to Afghanistan. He has also tried to tamp down insider carping about whether he should properly refer to himself as a former “command sergeant major” or merely a “master sergeant,” a distinction lost on most non-veterans.

By late August, the Republican pile-on was joined by 50 other veterans serving in Congress. They denounced Walz for retiring from the Minnesota Guard in May 2005—before a deployment order was issued to his unit in August of that year—so he could run for Congress the following year. No notice was taken that Walz is part of the small minority of enlisted personnel who serve for two decades or longer instead of leaving the military after a much shorter tour like Vance.

According to Representative Brian Mast, the Florida Republican who chairs Veterans and Military Families for Trump and other signatories, Walz’s retirement was tantamount to “abandoning the men and women under his leadership.” This decision, Mast charged, reflected a “lack of honor,” a personal “unwillingness to lead in time of war,” and an alarming history of “blatant misrepresentations” throughout his “political career.”

Many of these same Republican House members were among the 35 former officers and NCOs who rejected the results of the 2020 presidential election and refused to certify Joe Biden as the winner. Three House GOP co-signers of the Mast letter—Eli Crane, a former Navy SEAL from Arizona; Cory Mills, a former sniper from Florida; and Clay Higgins, a retired staff sergeant from Louisiana—have trafficked in conspiracy theories about the failed attempt to assassinate Trump this summer. However, that hasn’t kept Higgins from serving on the House committee investigating that matter or from distinguishing himself this week with a rant about Haitian immigrants to the U.S., legal and illegal.

Integrity and Civility?

What made the Republican veterans’ denunciations of Walz worthy of note was not just its “Trump-Vance MAGA-2024” letterhead but how many signatories also belong to the “For Country Caucus.” According to its mission statement, this “bi-partisan” group was launched on Capitol Hill five years ago to “advocate for a less polarized Congress that works for—and is trusted by—Americans.” Since then, it has provided “its principled military veteran members with the opportunity to work together across party lines to pass thoughtful legislation on national security, veterans affairs, and national service.”

Everyone in the 30-member caucus, consisting of 16 Republicans and 14 Democrats, must take “the With Honor pledge.” This is a written promise “to serve with integrity, civility, and the courage to work across party lines.” Past and present caucus members have, in turn, gotten financial backing from a Super PAC called the With Honor Fund (or its successors).

This vehicle for post-Citizens United “independent spending” was launched with $22 million from Jeff Bezos, the Amazon founder and former CEO, and other members of his family, plus contributions from fellow billionaires like Howard Schultz, the former CEO of Starbucks, and Michael Bloomberg, the founder of Bloomberg News and former mayor of New York.

In 2018, With Honor spent more than $1.7 million on the re-election campaign of Representative Michael Waltz, an Army veteran from Florida who became a leader of the For Country Caucus. Waltz (with a “t” unlike the Democratic vice presidential nominee) just joined the MAGA attack on Governor Walz, led by a For Country caucus member and backed by its current Republican co-chairs, Representatives Mariannette Miller-Meeks of Iowa and Tony Gonzales of Texas. Miller-Meeks is a former Army nurse and doctor who uses her slot on the House Veterans Affairs Committee to help the private healthcare industry gain market share among VA patients via the MISSION Act.

Among Democrats in the caucus, Representative Jared Golden from Maine has been the most boldly bi-partisan during this election cycle. In the wake of Joe Biden’s disastrous debate in late June, the combat veteran of Iraq and Afghanistan, who is running in a district almost certain to go for Trump, declared that the former president “is going to win. And I’m okay with that.” Further adding to his profile in courage, Golden blamed Biden for running “a campaign to scare voters with the idea that Trump will end our Democratic system”—a “chattering class” notion that he rejected.

Who Shot Sheehy?

As the Democratic Party struggles to hold the Senate, there are six races where down-ballot service candidates could oust an incumbent or claim an open seat, with consequences for the legislative agenda of whoever becomes president (and shapes the future direction of the VA).

Like Vance and Walz, the vets in these battles range from conservative Republicans to progressive Democrats, with a rare labor-backed independent steering clear of major parties and their corporate backers in his Nebraska Senate race.

Trump weighed in early this year on behalf of three former officers trying to replace current Democratic officeholders in Pennsylvania, Montana, and Nevada. Koch-funded Super PACs also back all three as part of their $100 investment in 2024 candidates with right-wing politics and/or military experience.

The Keystone State challenger, McCormick, a West Pointer and Gulf war veteran who left his last private-sector job as CEO of the world’s largest hedge fund, Bridgewater Associates, with a net worth north of $100 million. He’s up against Bob Casey, a popular incumbent seeking a fourth Senate term who has maintained a modest lead in the polls while the presidential race remains virtually deadlocked

In Montana, Democrat John Tester, current chair of the Senate Veterans Affairs Committee, was also elected in 2006 along with Casey and Walz. A non-veteran, Tester is touting his role in the passage of the PACT Act two years ago, which has helped nearly one million post-9/11 vets gain access to VA benefits and care for ailments related to their burn pit exposure in the Middle East. Tester was also an architect of the MISSION Act, which helped Trump privatize VA care over the objections of vets in the House like Walz.

Tester now faces a strong re-election challenge from Tim Sheehy, a wealthy newcomer to the state who calls himself a “conservative outsider.” Sheehy is a 38-year-old Annapolis graduate, former Navy SEAL, and Afghan war veteran hailed by Trump as “an American Hero and a highly successful Businessman.” In a fashion helpful to the “career politician” he is challenging, Sheehy has muddied the waters about his military prowess via conflicting claims about whether a bullet wound he suffered was the result of combat duty abroad or self-inflicted during a later outing to Glacier National Park. Montana remains a GOP stronghold, occasionally electing a Democratic governor or senator. But Tester faces a tough fight.

There’s no such uncertainty about the war wounds of Sam Brown, an Army captain and West Point graduate running for the U.S. Senate in Nevada. His “near-death experience” with a roadside bomb in Afghanistan left him permanently scarred despite 30 surgeries over three years. With Trump’s blessing, Brown is trying to keep Democrat Jacky Rosen from winning a second term based on her being what the GOP calls “a Biden-Harris rubber stamp.”

On his campaign website, Brown points to his “starting a small business that stepped in when the VA fell short by providing critical medications to veterans in need of care” who were adversely impacted by “the inefficiencies of bureaucracy.” As a result, he’s “wholly committed to expanding on the VA improvements made by the Trump Administration.” He wants to ensure “that competition—not government—drives medical innovations that lead to better care and lower costs.” Rosen has been running well ahead of Brown, but the state is competitive, especially at the presidential level.

The Progressive Vet Alternative

Iraq war veteran Gallego, the House member for Arizona campaigning against former broadcaster and MAGA champion Keri Lake for the state’s open Senate seat, was not a fan of VA privatization under Trump. Like Walz, the former Marine and Harvard grad voted against the MISSION Act of 2018. He initially announced his Senate bid as a Democrat primary opponent of Kyrsten Sinema before she became an independent and decided not to run for re-election.

While on the Senate Veterans Affairs Committee, Sinema, who is not a veteran, has been an ally of VA privatizers in both parties, including Tester and Jerry Moran, the Kansan and ranking Republican on the committee. Unlike Sinema and Lake, his Republican foe, Gallego claims he “knows how important the VA is to Arizona veterans,” based on his personal experience as a patient “who has struggled with PTSD.” With backing from Common Defense, the progressive veterans’ group, Vote Vets, and many labor unions, Gallego pledges to improve the VA’s ability to meet former service members’ financial, medical, and social support needs. He’s opened up a solid lead against Lake, but Arizona’s presidential race is very tight.

In Missouri, a lawyer and like-minded Marine Corps reservist, Lucas Kunce, is challenging conservative Senator Josh Hawley. In addition to enjoying the advantages of incumbency, Hawley has recently rebranded himself as a right-wing “populist” critic of corporate power and selective friend of labor causes.

A 13-year veteran of active duty in Iraq, Afghanistan, and the Pentagon, Kunce grew up in a working-class family that was forced into medical bankruptcy. He is refusing to take any money from corporate PACs and federal lobbyists, lending credibility to his criticism of “Wall Street, Ag monopolists, Pharma and Big Oil.”

While serving abroad, Kunce had burn pit exposure and now uses the VA for his healthcare. He has been hammering Hawley for stalling passage of the PACT Act—a maneuver joined by 40 other Republicans—until widespread outrage forced a change in their position on the legislation. The problem for Kunce is that Missouri, once a swing state, has become ruby red. Trump won the state by 15 points in 2020. No Democrat has won statewide office since 2012.

In neighboring Nebraska, Navy veteran Dan Osborn is waging a surprisingly strong independent campaign against Senator Deb Fischer, a two-term devotee of Donald Trump. (Democrats declined to nominate a candidate, hoping Osborn could carry the seat.) A recent poll shows him up nine points in the state’s purple 2^nd district, where Kamala Harris is also ahead and seems likely to pick up a crucial electoral vote. Like Maine, Nebraska apportions its presidential electors by congressional district.

Osborn is no faux voice for “the working man,” like Vance and Hawley, both Yale law school alums. He’s a high school graduate who served in two state guard units after his active duty before working in a Kellogg’s cereal plant. He became local union president, led a successful strike, and then got fired for his workplace militancy. He now belongs to a building trades union and works in the boiler room of Boys Town, another iconic Omaha institution.

Osborn’s blue-collar agenda highlights the need for real labor law reform, minimum wage increases, paid leave, and vigorous rail safety enforcement.

The UAW, state AFL-CIO, and various public sector unions, including AFGE at the VA, back him. As he makes the rounds of veterans’ halls in Nebraska, Osborn criticizes delays in processing veterans’ disability claims and fraud and abuse by Pentagon contractors (who are big donors to his opponent).

But mainly, he blows the whistle on the gross under-representation of workers in what he calls a “country club full of Ivy League graduates, former business execs, and trust fund babies,” whether they’re veterans or not. According to Osborn, his opponent “like so many other Republicans and Democrats, has been bought and paid for corporations and billionaires,” which is why he favors election law reform and ending the filibuster.

The degree to which voters in Nebraska and other states embrace the idea that candidates from either party (or neither) are a better bet than their rivals because of past military service will be tested on November 5. However, as the resumes and records of 2024 service candidates confirm, many other factors determine candidate viability and desirability, not to mention what kind of future leadership they will provide if elected for the first time or again this Fall.

One thing is sure: there will be a vice president next year with a military background. Whether they use that unique position to fight further privatization of veterans’ health care or expand benefits for fellow vets is one of the many things that will be decided come election day. And with 60 percent of the country still holding the military in esteem, among the highest of any institution, there will be no shortage of former service members vying for public office, high and low, for years to come.

The post Democrats Hope Walz and the Party’s Military Veterans Have the Right Stuff appeared first on Washington Monthly.

Though Donald Trump’s presidency ended in infamy last year, the administration’s efforts to privatize the VA continue. This spring, the Senate will consider President Joe Biden’s nominees to a newly created panel, the Asset and Infrastructure Review (AIR) Commission, that will make weighty decisions about the future of veterans’ health care. Once seated, commission members will consider recommendations from Veterans Affairs Secretary Denis McDonough that include closing critical medical facilities and expanding public-private partnerships, thus increasing the privatization of VA services. Congress must do its due diligence in vetting the nominees, most of whom lack experience in capital and facilities management, have troubling ties to industry, or have expressed support for privatizing the VA. If it doesn’t, not only will veterans’ care suffer, but parts of the broader health care system may buckle as veterans’ facilities close. 

The nine-member panel owes its existence to the VA MISSION Act of 2018, which authorized Trump—and now Biden—to conduct a sweeping review to determine which Veterans Health Administration (VHA) hospitals and clinics should be closed, rebuilt, or repurposed, and what replacement facilities should be constructed. The law, which passed with a majority of both Democratic and Republican votes, enabled the Trump administration to divert billions of dollars from the VHA to pay for the outsourcing of veterans’ care to more expensive private doctors and hospitals. This partial privatization helped make the case for downsizing the VHA because some of its services were now, not surprisingly, less well utilized.

On March 14, McDonough offered his own proposals for the AIR Commission to consider before the panel issues its recommendations in January 2023 to the president and then to Congress for an up-or-down vote. McDonough proposes closing 18 VA Medical Centers, many in rural and other underserved areas. (VA Medical Centers are large facilities that may contain inpatient hospital units, outpatient services, residential facilities, and sometimes VA nursing homes, among other programs.) The secretary also proposes shutting down inpatient, mental health, emergency, and other services in 37 additional facilities. He insists that his plan will allow the VHA to serve its nine million enrollees better—many of them with lower incomes and complex health problems—as well as veterans who have yet to enroll in VA care. McDonough has also called for creating more private-public health care “partnerships” (translation: outsourcing VA care to the private sector) and embedding VA clinicians in private-sector hospitals. Yet these services are, as studies document, often of lower quality, more expensive, and also sometimes simply unavailable due to lack of primary and mental health care providers as well as closures of rural hospitals—all of which have been exacerbated by the COVID-19 pandemic. In addition, McDonough has advanced an ambitious project to construct outpatient clinics and facilities (many of them sorely needed) around the country. This plan, however, depends on Congress allocating more than $200 billion. If a VA facility closes or downsizes, there is no assurance that Congress will fund any new construction to replace it. 

Though some of the facilities McDonough has targeted for closure are old and need replacement, others are simply underused. Low-volume facilities could be used to serve veterans (plus their families and communities) if, as Phillip Longman and the Veterans Healthcare Policy Institute have advocated, VA enrollment expands to include veterans with other than honorable (OTH) discharges (who are currently unable to access VA health care), veterans whose incomes are too high, or veterans who have no service-connected disabilities. VA leaders making the market assessments that informed these recommendations said in a recent interview that none of these options was explored.

Another solution to the underutilization of VA facilities would be to allow community and family members who suffer because of the scarcity of care in the private sector to access services at a VA facility that might otherwise go unused. Expanding the VA patient population is in keeping with the system’s history of serving the general public during emergencies. It would prevent the further exacerbation of health care shortages in rural and underserved areas should the VA leave the area.

McDonough’s recommendations were not well received by unions, like the American Federation of Government Employees and National Nurses United, which together represent more than 300,000 VA workers, and Democrats and Republicans in states that face closures or termination of services. The Paralyzed Veterans of America organization has expressed “grave concerns” about the plan, while the American Legion has “welcomed the process” and urged the commission to use “compassionate efficiency as its north star for all its recommendations.”

A Stacked Deck

The AIR Commission is tasked with evaluating the secretary’s plan, which he himself acknowledges is based on out-of-date data that is also unvalidated and uncertain. Of particular concern, the secretary’s recommendations, as he has admitted, failed to consider the disastrous impact of the pandemic on American health care. Left out of calculations were the severe staffing shortages that have led hundreds of American hospitals to curtail or discontinue services or, in many cases, close altogether.  A recent GAO report also highlighted the data’s inaccuracies.  To remedy these significant shortcomings, the secretary says he has assigned a “red team” to collect new data for the commission. According to Alfred Montoya, the VA’s senior adviser and senior liaison to the AIR Commission, this data won’t even be available until October—maybe. This means that the commission, if confirmed, will be deliberating for months with incomplete data.

Biden failed to meet the May 31, 2021, deadline to appoint the commission. Therefore, the commission will have a very short period to be confirmed by the Senate, establish efficient working relationships, and hold mandated public hearings around the country. More importantly, it will need the expertise to evaluate thousands of pages of dubious and newly collected data and ask critical questions about current and future health care trends. It will need to make expert judgments about whether aging facilities can be renovated or should be demolished and consider the economic and patient care impact of a hospital, program, and service closures. To do this, the commission requires not only expertise in capital asset and facility management (including hospital architecture and structural engineering) but also an open mind about the VA privatization and outsourcing embedded in the secretary’s plan. 

However, shockingly for a commission on health care infrastructure evaluation, the White House’s nominees have little demonstrable experience in capital asset management or facilities assessment. 

Some have a strong pro-privatization tilt. Biden’s choice for AIR Commission chair is Patrick Murphy. He was the first Iraq War veteran elected to Congress and undersecretary of the Army in the Obama administration, but now brands himself as a “venture capitalist,” a “vetrepreneur,” and a “health care innovator” with “a wide range of business interests,” according to his website. 

In any Senate confirmation hearings, Murphy should be asked whether he has been paid (and how much) for consultant work with two companies that have a contract with the VHA and/or a big stake in VHA outsourcing. Murphy serves as an adviser to Northwell Health, which is, according to his website, “the largest health care provider for veterans in New York State outside the VA, with 23 hospitals and 700 outpatient facilities that serve more than two million people each year.” 

Meanwhile, McDonough has proposed closing down the Manhattan and Brooklyn VA Medical Centers, as well as cutting services at the Northport VA Medical Center in Long Island and outsourcing much of that care to the private sector. In New York City, as is true in many other large metropolitan areas around the country, the health care “marketplace” has become highly concentrated and dominated by only a few large corporate providers, which eliminates competition on cost, quality, and patient choice. If the Manhattan and Brooklyn VAs were to be closed, this would mean less competition and higher costs for everyone. Does Murphy have the expertise or inclination to consider these issues, particularly when the closure of the Manhattan and Brooklyn VAs and cuts in inpatient and surgical services at Northport could drive more business to Northwell?

Murphy also chairs the Government Advisory Board of the Cerner Corporation, which has been hired to improve electronic health record-keeping systems at the VA and the Department of Defense, despite its failings in the private sector. Murphy claims that his client is leading “the largest health care transformation in the VA’s history,” an initiative that will “create a more patient-focused experience for both veterans and active-duty personnel.” Last year, however, McDonough was forced to acknowledge that the $10 billion sole-source contracts awarded to Cerner by the Trump administration (and championed by the White House adviser and presidential son-in-law Jared Kushner) were “beset by cost overruns, delays, misrepresentations to Congress and a disastrous rollout at its first hospital.” Recent media accounts and VA inspector general reports confirm that more than a year after a disastrous deployment at its first hospital, the now $16 billion effort to modernize veterans’ medical records “still poses grave safety risks to patients, from medication errors to failures to safeguard patients at serious danger of suicide.” In early March, the system crashed in Spokane, Washington. Senator Patty Murray, a Democrat from that state, expressed outrage about patients being turned away. “This is about patient safety, and it needs to get fixed—period,” she said.

Slated to be vice chair of the AIR Commission is Jonathan Woodson, a major general in the Army Reserves and professor at the Boston University Business and Medical Schools. Woodson served as assistant secretary of defense for health affairs from 2010 to 2016 and oversaw TRICARE, the system of government-funded insurance covering private care for active-duty service members and their families. TRICARE is part of the Military Health System, which has its own network of VHA-like publicly funded facilities that deliver direct care. During his tenure, Woodson helped lead the “modernization” of the MHS, which led to the downsizing of its direct care capacity and expansion of private care. By 2021, this trend had reached the point where the DOD planned to close 50 military treatment facilities and shift another 200,000 patients into the private sector—a move slowed only by the pandemic-related swamping of hospitals used by civilians. 

A Parallel Outsourcing Trend

Proponents of outsourcing care for soldiers and their families argue that salaried MHS clinicians aren’t as “productive” as those in the private sector (a claim also made about VHA doctors and nurses). Yet, when active-duty troops were sent elsewhere, they became patients in a system that defines productivity as “filling hospital beds and performing lots of complex procedures,” as Arthur Kellermann, then dean of the School of Medicine at the Uniformed Services University of the Health Sciences, wrote in Health Affairs. In contrast, according to corporate thinking, keeping patients healthy has less “relative value.” Studies have found that patients treated by military doctors “got fewer procedures but had better outcomes,” Kellermann also explained. Importantly, he wrote, “the military health system does not have the racial disparities in care commonly seen in civilian hospitals.” 

A 2016 Government Accountability Office study similarly found that decisions to close military health facilities were based on inaccurate information about the workloads of MHS providers. Those decisions were also guided by inaccurate estimates of savings. “As a result,” the GAO concluded, “DOD’s cost savings estimate did not present a full and accurate picture of possible costs and savings.” 

Another Democratic pick for the AIR Commission is Joyce Johnson, who served as a rear admiral in the Coast Guard. In 2015–16, Johnson was part of a conservative, health care industry-oriented faction on an Obama administration advisory panel called the VA Commission on Care. Johnson and six other members met secretly to draft a proposal called “The Strawman Document,” which called for eliminating the VHA by 2035 and turning its taxpayer-funded functions over to the private sector. Due to the strong objections of other commission members and protests by veterans’ organizations, this remained a minority position.          

A particularly troubling nominee proposed by Republican House leadership is Christine Hill, who served as deputy assistant (and then assistant) secretary of congressional and legislative affairs during the George W. Bush administration. Hill currently serves as the Republican staff director for the House Committee on Veterans’ Affairs Subcommittee on Health. As one VA expert told us, “If Hill plans to take a leave of absence and then return to her House job, this violates the entire notion of an independent commission. You are essentially putting a member of the congressional staff on the commission.” The official suggested that the Senate should question “whose bidding she will be doing.”

Outnumbered for sure will be Michael Blecker and William Carl Blake. Blecker served in Vietnam and is executive director of Swords to Plowshares, a nonprofit group serving homeless veterans in San Francisco. As a Commission on Care member, he filed a dissenting opinion that warned, prophetically, that the commission’s “most significant recommendation would threaten the survival of our nation’s veteran-centered health care system as a choice for the millions of veterans who rely on it.” Blake is executive director of the Paralyzed Veterans of America and, like Blecker, advocates for veterans who depend on the specialized services of the VHA. A West Point graduate, Blake has firsthand experience with the VHA’s stellar spinal cord injury programs and, hopefully, will argue for keeping them embedded in a broader system of coordinated and integrated inpatient and outpatient care.

What Questions to Ask?

Regardless of their qualifications or political leanings, most commission members might not have the expertise to recognize that while some VHA facilities are old and do need to be replaced, the majority likely do not. A former director of the VA Veterans Integrated Service Network told us that commission members also need to challenge the assumption that the private sector is waiting to absorb VA patients. The former director advised that “Commission members need to ask probing questions about private sector bed capacity; about the availability of psychiatric beds for VA patients; and about private sector mental health services, particularly in rural areas.”

And what about the private sector’s ability to deal with homeless veterans or offer coordinated care to patients? A critical question is what price point private-sector providers will accept to care for VA patients. And what happens when the VA closes facilities? How will the price be jacked up then? Hopefully, the Senate will ask these nominees questions before approving the White House list. 

AIR Commission members who make the cut should ask granular questions about the secretary’s recommendations. They should also request the immediate provision of new and accurate information that includes reliable data about the impact of COVID on the private-sector health care system and the consequences of rural hospital closings. Most importantly, their deliberations should be informed by a deep understanding of the value of the VHA. The VHA is not just a collection of doctors and hospitals competing for profit. It’s a public good—which is why, for decades, it has fulfilled multiple social missions that serve not only veterans, but all of us. 

The post Democrats Are Stacking the Deck Against Vets appeared first on Washington Monthly.

On January 4, newly elected Virginia Governor Glenn Youngkin named several of his first cabinet members. Among them was fellow Republican Daniel Gade, his new commissioner of the Department of Veterans Services, who ran for the U.S. Senate from the Old Dominion State two years ago, but with less electoral success than Youngkin. The new governor hailed Gade as a man “dedicated to caring for our veterans, championing their concerns, connecting them with resources [and] getting them the proper care.”

On paper, Gade seemed well qualified for a job that involves working with veterans in a state where former military personnel benefit from roughly $3 billion in federal spending every year. A former Army lieutenant colonel, he was badly wounded and lost a leg while serving in Iraq. During his 20-year military career, he earned both a master’s and a doctoral degree in public administration, which enabled him to teach at his alma mater, West Point, and, more recently, at American University. Gade’s prior government service also includes jobs in the George W. Bush and Donald Trump administrations.

But a closer look at Gade’s resume and writings reveals him to be anything but a champion of veterans’ access to federal and state benefits. In fact, he is part of a growing Republican faction that strongly supports the privatization of the Department of Veterans Affairs. Worse yet, he also favors cuts in disability pay for the nearly 6 million veterans with service-related medical conditions.

In Gade’s view, delineated in his 2021 book, Wounding Warriors: How Bad Policy Is Making Veterans Sicker and Poorer,the VA has fostered a costly and unhealthy culture of dependence among veterans—a view embraced three months ago by Robert Wilkie, the Republican operative who served as Trump’s second VA secretary. At a Veterans Day event in Washington, where both Gade and Wilkie spoke, the latter, from his new perch at the conservative Heritage Foundation, accused his former agency of being overly “focused on getting veterans checks and not getting them well and getting them back into society.” Like Gade, he claimed that veterans service organizations (VSOs) encourage former military personnel “to play disability.” In other words, too many veterans—whether they served in combat zones or not—are getting undeserved compensation.

Nevertheless, in GOP circles locally and nationally, Gade is a rising star. And his new job in Virginia makes him a leading candidate to become VA secretary in any future Republican administration.

In Wounding Warriors, which he cowrote with the former Wall Street Journal reporter Daniel Huang, Gade launches an assault on the “disability-industrial complex.” In his telling, the VA, our second-largest federal agency by number of personnel, “robs veterans of their vitality,” privileges “lifetime disability and malaise over recovery in mental and physical health,” and spawns a “culture of entitlement” among veterans and a pernicious “network of enablers.”

These “enablers” include counselors from the Warrior Transition Units created by the Department of Defense to ease difficult military-to-civilian life transitions; VA doctors and disability claims processors; and volunteers from the American Legion, Disabled American Veterans, and Veterans of Foreign Wars, who help their fellow veterans apply for GI Bill assistance, health care coverage, and other benefits that are a major incentive for joining America’s all-volunteer military.

According to Gade and Huang, these federal departments collude with the VSOs to divert former military personnel “from paths of self-sufficiency” and steer them “down paths of dependency and dysfunction.” As a result, they write, many stay sick, rather than get better, and end up in “a quagmire of despair.”  

Central to such claims is the authors’ misleading assertion that the “the wars in Afghanistan and Iraq have been among the safest in American history.” That would certainly be a revelation to the hundreds of thousands killed in combat, including Afghans and Iraqis, along with the millions of U.S. service members who suffered from toxic exposures and debilitating injuries. As Gade and Huang see it, only a relatively small number of American troops died in these two conflicts (about 7,054). Back home, however, even as the overall veteran population fell by about a third, from 26.4 million to 18 million between 2000 and 2020, “the number of veterans receiving disability benefits nearly doubled.” 

Gade’s views should worry the roughly 780,000 veterans in Virginia. Only four other states have a higher percentage of veterans in their population, and only three have more active-duty troops and reservists. More than half of Virginia’s veterans served after 9/11, making them part of what Gade and Huang call “a generation that wants to be given everything even if they don’t deserve it.” 

In reality, the increase in VA disability benefit costs is not due to widespread scamming of the system. It reflects the collateral damage suffered by many participants in America’s twenty-first- century wars. As part of a military that deployed many of them multiple times, younger veterans were exposed to greater risk of harm than the draftees who mainly served a single of tour of duty in the killing fields of Southeast Asia six decades ago. What’s more, advances in medicine and battlefield triage since Vietnam have also ensured that severely injured service members are five times more likely to survive potentially fatal wounds than in previous wars. Those casualty figures have translated into a costly need to provide more long-term care and compensation, not less.

Between 2006 and 2015, the number of veterans requiring VA-provided mental health services rose from 900,000 annually to 1.6 million. As more women joined the military, more were subjected to sexual harassment, physical assault, and rape. They now carry the invisible scars of military sexual trauma, a service-related condition little noted by Gade and Huang. Veterans of all types, particularly people of color, experience higher-than-average rates of joblessness, homelessness, chronic pain, mental illness, and substance abuse.

Gade’s exclusive focus on combat injuries also ignores the fact that the Defense Department is one of the world’s worst polluters. Service members (and their families) risk the consequences due to their proximity to bases with toxic exposures. According to a report by the Pentagon, there are 126 military installations where the drinking water is contaminated. Equally disconcerting, since the first Gulf War, an estimated 4 million service members have been exposed to burn pits in Iraq and Afghanistan and other chemical hazards. 

Gade distinguishes those kinds of benefits claims from conditions like his own, which are “truly static and unlikely to improve—amputations, spinal cord injuries, etc.” He describes veterans being treated for post-traumatic stress disorder as “wannabes” because they tell their therapists “stories that sound a lot like a bad day rather than a traumatic moment.” There is little recognition in the book of what many mental health experts believe is a “suicide crisis”; according to recent data, roughly 20 vets a day take their own lives.   

According to Wounding Warriors, the VA simply doles out money to any vet who applies for it; in fact, hundreds of thousands of individual disability claims are denied every year, often leading to protracted and frustrating legal appeals. Ignoring that reality, Gade and Huang try to stick more of the blame on Congress—which, they write, foots the bill with no questions asked. In their view, both parties are driven by their own political imperatives to support veterans. The political right sees military service as the highest expression of patriotism, recognizes veteran support as important to its base, and would never oppose veteran-related spending. (That claim would be true only if it referred to knee-jerk congressional support for ever-bigger Pentagon budgets.) Meanwhile, the political left is deeply invested in the VA’s system as “a prototype of their desired single-payer system.”

In reality, as we note in a forthcoming book, few figures on the left—other than Senator Bernie Sanders—have embraced and defended the VA as a good working model of socialized medicine. At the same time, many centrist Democrats and conservative Republicans have become bipartisan enablers of VA privatization, a longtime goal of right-wing mega-donors like the Koch family, who don’t want taxpayer-funded cradle-to-grave care for anyone. 

Gade and Wilkie are not the only former Trump administration officials to question the cost and effectiveness of the VA benefits system. Before he was sacked by the White House in 2018 for not outsourcing more veterans’ care to the private sector, VA Secretary David Shulkin called, perhaps more tactfully, for new “thinking about benefits.” In Shulkin’s view, “we need more incentives for achieving wellness and independence.” Unlike Gade, however, Shulkin made clear that “this is not about taking away benefits. This is about making benefits work better for veterans.”

Gade is not likely to run afoul of Youngkin, as Shulkin, an Obama administration holdover, did with Trump. That means former soldiers in Virginia are about to get a four-year taste of conservative “tough love” in their own state. It will be a painful preview for what Republicans ultimately hope to do at the federal level. 

The post A VA Critic Becomes Virginia’s New Veterans Affairs Chief appeared first on Washington Monthly.

Two decades ago, Robert Reich penned an insightful account of his roller-coaster ride in Bill Clinton’s administration. His memoir, Called Locked in the Cabinet, chronicled his behind-the scenes jousting to push the Labor Department in a labor-friendly direction before he returned to academia for family reasons.

By the standards of the Trump era, Clinton’s own appointments of family and friends, like Reich, lack of organizational discipline, and sometimes chaotic White House decision-making style now look like model executive branch behavior.

Since January 2017, nearly a dozen of the president’s cabinet members have quit or been fired. David Shulkin, former Secretary for Veterans Affairs, is one of three with new book out about their experience. (The others include his more high-profile colleagues James Mattis and Nikki Haley.)

Like Reich, Shulkin faced many obstacles to fulfilling the mission of his agency. But his book mistakenly identifies “broken government” as the reason for the dysfunction. In fact, the “plight of veterans” has been worsened by a Republican president who’s done everything he can to prevent the Department of Veterans Affairs from better serving them.

Shulkin’s appointment was unusual for three reasons: He was the first non-veteran to become VA Secretary (most others have been former generals or officers of some type); he was the only under-secretary in a cabinet department under Obama that Trump promoted to the agency’s top job; and there was a a rare bi-partisan consensus around his nomination. He was confirmed on a unanimous Senate vote, earning him the presidential nickname, “Mr. 100 percent.”

In June, 2017, Shulkin proudly joined Trump at a White House signing ceremony for the VA Accountability and Whistleblower Protection Act, which made it easier to discipline or fire VA employees. While the act was heralded as a way of holding higher level administrators accountable for poor job performance, it ended up having its greatest impact on housekeepers, nursing assistants, and cafeteria workers.

Trump publicly reassured Shulkin that he would never hear the words “You’re fired!” like so many failed contestants on The Apprentice. But nine months later, he fired him via Twitter.

Shulkin’s access to his work email and phone were immediately shut off: “Three years of contacts, all my documents, all my photos…gone.” He was “treated like a leper,” he writes, not even “allowed back in VA headquarters to say good bye to my staff or to clean out my own desk.”

In his book, Shulkin portrays himself as an idealistic naif. By his own account, however, Trump’s summoning him for  an unexpected job interview in late 2016 gave him an advance taste of what decision-making would be like in the new administration. At Trump Tower, he found his future boss conducting “transition” business like the Mad Hatter at the famous tea party in Alice in Wonderland.

While various aides lurked about, bickering among themselves, Trump peppered Shulkin with random questions. Then, he would cut him off and answer those queries himself before his visitor could reply. At one point, Shulkin recalls, “Trump ruffled through a few papers on his desk and then looked up … as if actually seeing me for the first time. ‘You know, you don’t really fit the bill,’ he said. ‘The generals… now they fit the bill. But can they fix health care?’”

Lucky for Shulkin, he had the backing Ike Perlmutter, a major Trump donor, fellow billionaire, and CEO of Marvel Entertainment. Perlmutter was one of three Mar-A-Lago club members who had already positioned themselves to be key White House advisors on VA issues, even though none had ever served in the U.S. military or worked at the VA, like Shulkin had.  “Donald, he’s your guy,” Perlmutter told Trump, via speakerphone during Shulkin’s job interview. “I wouldn’t steer you wrong.”

Shulkin had found Obama to be “analytical, pensive, and at times appropriately cautious.” This approach, he wrote, ensured that VA “improvement initiatives were carefully planned,” but “also led to a slower adoption of change.”

That’s why Shulkin was initially attracted to the “tumultuous and frenzied environment” of the Trump Administration. As VA Secretary, he could “take more risks, move faster, and, in many cases, make more meaningful change.”

As a private hospital administrator before he transitioned into public service, Shulkin had plenty of experience handling wealthy board members like the three “Mar-A-Lago Amigos.” He apparently assumed their pesky phone calls and uninformed political meddling would be a manageable problem.

That proved not to be the case. The anti-VA bias of Trump’s friends in Florida was shared by his political appointees at the VA. These former Trump campaign workers or staff members of the Koch-funded Concerned Veterans of America (CVA) wielded great policy influence on Shulkin—and, even more on his successor, Robert Wilkie. “CVA was at the White House on a regular basis and showing up at meetings when I hadn’t invited them,” Shulkin reveals. “At every turn, White House staff made sure CVA was given a strong voice.”

CVA operatives like Darin Selnick lobbied for “unfettered VA patient access to private care” that would pave the way for “the dismantling of the government-run system set up to serve veterans.” The “politicals,” as Shulkin calls them, undermined and helped discredit him to further an “agenda which did not include having the VA succeed.”

By systematically outsourcing veterans’ care, Shulkin writes, the Trump administration will cost taxpayers billions of dollars more than originally projected while “simultaneously draining resources from the VA.” In the end, he predicts, veterans will be left “with fewer options, a severely weakened VA, and a private healthcare system not designed to meet the complex requirements of high-need veterans.”

Shulkin describes himself as neither “pro-privatization or anti-privatization,” but “simply pro-veteran.” Unfortunately, he helped provide useful political cover for Trump, because of his own personal ambition and penchant for “working more closely with the private sector.” On Shulkin’s watch, the percentage of the VA’s nine million patients who received some care outside of it increased from 19 to 36 percent, he proudly reports.

At the same time, he promoted the VA MISSION Act of 2018, which replaced the Veterans Access, Choice and Accountability Act. It was sold as a temporary, emergency measure to reduce VA appointment wait times and give veterans with too long a drive to the nearest VA facility the option of getting private care. In fact, it was part of a broader effort to fully privatize the VA over time.

Shulkin’s memoir suggests that he understood that. He describes lobbying against a proposal by Republican Senator Jerry Moran that would have enabled veterans “to visit a VA facility or a facility in the private sector whenever he or she wanted.” Shulkin told Trump that the approach favored by Moran “would put the VA system at risk of harm by diluting its delivery capabilities and cost the U.S. Treasury billions more each year.”

In response, Trump got Pete Hegseth, former CVA director and one of his favorite Fox News commentators, on the speakerphone. “We want to have full choice where veterans can go wherever they want for care,” Hegseth told the president.

As Shulkin notes, Hegseth had “never worked at the VA, knew nothing about managing a healthcare system and had little understanding of the clinical and financial impact of the policies he was advocating.”

Meanwhile, the VA secretary’s critical relationship with Perlmutter was fraying. To educate Trump’s billionaire friend about the VA, Shulkin took him on a tour of the veterans’ hospital in West Palm Beach. It was Perlmutter’s first ever visit to a VA facility. As he roamed the halls, he would ask patients: “Do you like it here? What don’t you like? What complaints do you have?”

When they gave positive feedback, Shulkin reports, Perlmetter seemed surprised: “Come on, tell me the truth,” he would reply. “I got the distinct sense,” Shulkin writes, “that Ike was perplexed to see the VA working so well.”

But when Perlmutter and two other Mar-a-Lago Club members flew to Washington for a White House meeting with Jared Kushner on the future of the VA, Shulkin was not invited. “The president is not happy with you,” Perlmutter informed him.

News reports at the time that Shulkin, his wife, several aides, and a security detail misused tax-payer funds on a work-related trip to Europe led to an investigation by the Inspector General, which further undermined his standing with Trump. (The author devotes many pages to rebutting the IG’s report, recasting the whole episode as an attempt by his political foes to frame him.)

They seem to have succeeded. Since Shulkin was fired in March 2018, his successor, Robert Wilkie, has favored the CVA approach. For instance, the VA’s new outsourcing rules allow wide access to private care without proper clinical criteria—the sort Shulkin says he would have demanded. “The blood drained from my face when I read the details,” Shulkin writes. “Access standards like this would provide millions of veterans with the ability to get care in the private sector and lead to the rapid dismantling of the current VA system.”

Shulkin does perform several public services in his new memoir. As he did in a New York Times op-ed piece after his firing, he exposes “the toxic and dysfunctional political environment” in Washington after Obama left office. He also applauds the many innovative and successful VA programs—which were developed prior to his government service— when he was running private hospitals and, by his own admission, knew little about treating veterans. (These VA “best practices” are showcased in a 2017 book called Best Care Everywhere, co-edited by Shulkin himself and published by the Government Printing Office.)

Despite the White House’s abominable treatment of him, Shulkin remains surprisingly eager to absolve Trump and his Mar-a-Lago cronies. In very unconvincing fashion, Shulkin claims that the president was “largely unaware of his political appointees’ scheming” and “does not realize the long-term implications” of the damage they’ve done to the VA.

In a chapter entitled “Getting It Right for Veterans,” the most criticism Shulkin can muster is this observation: “when you bring a chief financial officer’s or real estate mogul’s mind set into human services, you immediately face a contradiction.” Therefore, he proposes that the VA instead be given a new non-partisan governance structure, without anyone chosen because of their ideological orientation or commitment to anyone or anything beyond the best interests of veterans.

In his view, the VA should “remain a government entity,” but with “its own board composed of healthcare experts, veterans, and business leaders.” They should all have a fixed term of office of at least four years or more, he argues, to ensure a continuity of leadership.

Such proposals, however, didn’t even gain traction when recommended by members of a 2016 commission created under Obama. The most urgent task facing friends of the VA today—be they members of  Congress, veterans’ organizations, or care-givers—is to assist with whatever damage control they can during the remainder of the Trump presidency.

That includes resisting what Shulkin calls the “narrow and aggressive anti-government ideology” of those who will continue to call the shots at our second largest federal agency. At least until January 2021.

The post Public Service the Hard Way appeared first on Washington Monthly.