This past Memorial Day, Americans honored the many military service members who died for their country. Thanks to the strong programs of the Veterans Health Administration (VHA) – the health care system run by the Department of Veterans Affairs – there are fewer combat casualties as well as health problems related to the rigors of military service itself.
If Congress doesn’t act quickly to stop a plan crafted by the Trump administration and implemented by Biden’s VA Secretary Denis McDonough, we may mourn the death of VHA on future Memorial Days. March 14e, the secretary released a plan to close 18 VA medical centers, many of them in rural and other underserved areas. The secretary also proposes closing inpatient, mental health, emergency and other services at 37 additional facilities, as well as closing VA outpatient clinics.
The plan also includes a massive outsourcing of veterans’ care to private sector doctors and hospitals and mental health professionals who have little knowledge of veterans’ specific health conditions. Although the secretary did not forecast California for the most drastic shutdowns, his plan nonetheless threatens to increase the flow of veterans — and VHA funds — to the private sector. This will jeopardize the care of future cohorts of veterans who may find that the cannibalization of the VHA budget by private sector profiteers (20% of the VA budget is currently spent paying non-VA providers) will leave little left over for their needs, especially as they age.
The Secretary’s shutdown recommendations owe their existence to a section of the VA MISSION Act of 2018, which not only accelerated the outsourcing of VHA care to the private sector, but also mandated the creation of an Asset Review Board and a nine-member infrastructure responsible for deciding which VHA hospitals and clinics should be closed, rebuilt or redeveloped, and which replacement facilities should be built. `
The law also required the VA secretary — at that time, Trump’s Robert Wilkie — to conduct market assessments of the ability of VHA and private-sector providers to care for veterans now and in the future. coming. The consultants Trump’s VA secretary hired — Guidehouse — were given millions of dollars to do the job.
As reported by the VA’s Office of the Inspector General (OIG) and the Government Accountability Office (GAO), instead of presenting the VA Secretary with a high-quality product with accurate and up-to-date information, Market valuations are so flawed that they’re almost useless. Even Secretary VA McDonough admitted their serious shortcomings.
As the GAO report states, “VA’s approach to market assessments did not include steps to collect information about the quality of the VA’s data compiled from multiple sources. VA data or other steps to understand the limitations of the relevant data. As a result, VA is unable to communicate to external stakeholders, such as the AIR Commission, all relevant information on the quality of the VA data used in market valuations, including limitations affecting such data and resulting realignment proposals.
Despite the problems he acknowledged, McDonough used this flawed data to guide his own proposals to the AIR Commission. The Commission, whose nominees have not yet been confirmed by the Senate, will then review the recommendations and release theirs in January 2023. The President will then accept or reject them and the finalized list will be sent to Congress for consideration – vote negative. So if California congressional representatives don’t like what the final plan recommends for change in our state, they are denied the opportunity to change or amend the commission’s final decision.
And there’s a lot not to like about what the commission might have in store for the VHA in California. In Los Angeles, the secretary is proposing to replace VHA surgical and hospital medical care with that provided by private sector providers. In the post-Covid world, however, it is not at all clear that these providers will be able to accommodate veteran patients when they are already struggling to deal with non-VA patients.
This is especially true when it comes to providing mental health services, even in urban areas. In LA, mental health professionals who haven’t stopped practicing because of Covid-related burnout are being bombarded with requests from non-VA patients. There’s no way they can accommodate an influx of VA patients. In Silicon Valley, therapists are increasingly refusing to see patients who cannot pay out of pocket. In the Valley of Millionaires and Billionaires, a therapist can easily make $300 to $500 an hour and is not inclined to accept the hassle and pay rates offered by VA policyholders.
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In the Fresno area, the secretary’s plan recommends sending more patients to private sector mental health and primary care providers. The recommendations also propose closing outpatient clinics like the one at Fall River Mills in Shasta County. In the Reno area, the plan would close another clinic and send patients to Lassen County in California.
As with recommendations made to outsource care to provide sector providers across the country, the plan fails to take into account that long-standing shortages of mental health professionals and primary care have been exacerbated by the pandemic. The secretary also proposes using more California private-sector hospital services, even in areas where hospitals have already closed and more may do so in the future.
In San Francisco, the plan would reduce inpatient beds at the San Francisco VA Medical Center (thus making it difficult to manage any increase in patients due to another variant of Covid-19 or another pandemic of a different type). A new Community Living Center (CLC) or retirement home would also be built in Santa Rosa. Instead of sending nursing home patients who need inpatient care to the VA Hospital in San Francisco, however, the proposed CLC in Santa Rosa would serve as a source for the emergency rooms and inpatient units of the nearby private sector which studies show provide expensive care that is of low quality.
Across California, the secretary’s plan also hinges on sending more VA patients to private-sector nursing homes that are largely run by for-profit nursing home companies. Charlene Harrington, a professor emeritus at the University of California, San Francisco and a national expert on long-term care, calls the suggestion sheer madness.
“Sending VA patients to for-profit nursing homes makes absolutely no sense given that we know these nursing homes provide shoddy care. More than 200,000 nursing home residents have died during the Covid-19 pandemic due to understaffing and poor care. Harrington says a much better approach is for VA to build more of its own nursing homes. “The data shows,” she says, “that VA nursing homes provide much better care than those in the private sector because salaries and benefits are higher, there is better staffing and better training and therefore a more stable workforce, which means better quality care.
In California, Secretary McDonough is proposing much-needed improvements to facilities, such as renovating older medical centers and moving VA clinics closer to where veterans live. All of these dazzling promises of new construction, however, hinge on Congress allocating $220 billion over the next decade or more. Given the total failure of Congress to fund even regular maintenance of VHA facilities, it is highly unlikely that these new construction projects will materialize. Meanwhile, the MISSION law requires hospitals, health care facilities, and many programs and services to close before any new construction.
The whole AIR process has been so compromised by bad data and flawed recommendations that it should be stopped dead. Congress can stop the AIR process in two ways. The Senate can decline to hold confirmation hearings on Biden’s AIR Commission nominees, many of whom have conflicts of interest and favor privatizing VA.
If the panel members are not approved, the panel cannot meet and the AIR process would end. Congress could also pass a bipartisan bill — The Elimination of the AIR Commission Act — to repeal the AIR process that was introduced last week by Senators Joe Manchin and Mike Rounds. Whatever path is taken, Trump’s plan to dismantle the VHA should not be implemented by the Biden administration.
Indeed, the entire plan to outsource veteran care to the private sector should be reassessed and reversed and Congress should develop a much better way to ensure that the VHA infrastructure is well maintained and improved. This is the only way to truly honor military service members on upcoming Memorial Days.
Crossposted from BeyondChron