Wayne O'Leary

Inconvenient Postwar Truths

The first thing to understand about the healthcare scandal at the Department of Veterans Affairs (VA) so outrageous to the conservative political establishment is this: its members are largely crying crocodile tears. Republicans suddenly discovered the shameful treatment of America’s ailing veterans when it became obvious that calling attention to long-festering VA problems was not only politically expedient, but an ideal way to pummel the Obama administration and Democrats in general.

Patriots of the far right were shocked (shocked!) that long waiting lists were standard operating procedure at VA medical centers in many places and that vets occasionally died while awaiting scheduled care (though not necessarily from service-related ailments or because of the imposed wait times themselves). They were also indignant about certain pressured hospital administrators routinely falsifying waiting lists to make patient backlogs appear smaller and improve critical performance reviews.

None of this should have really surprised or agitated the GOP vigilantes, since it was largely of their own doing. Warmongers in the Republican party couldn’t wait to get us into the Middle East conflicts responsible for producing the latest generation of veterans needing ongoing specialized healthcare. Once the wars began to wind down, however, their concern for the wounded, as expressed by the money they’ve been willing (or unwilling) to spend on service-related medical needs, waned. For sequester-loving GOP budgeteers, there’s been an obvious reluctance to match enthusiastically funded foreign interventionism with commensurate postwar responsibilities in the area of veterans’ health.

The VA, or more properly the VHA (Veterans Health Administration), dates back to 1930, when it was established as the medical arm of an independent federal agency called the Veterans Administration. Since a 1989 reorganization, it’s been part of the cabinet-level US Department of Veterans Affairs under the leadership of the Secretary of Veterans Affairs, a position lately held by retired Gen. Eric K. Shinseki until he was sacrificed as the most obvious high-level scapegoat for the department’s current travails and missteps. Ultimately, Shinseki was the victim of bureaucratic budgetary shortfalls and expanding constituency demands beyond his control.

The VHA is a massive operation — testimony to our endless wars — with 250,000 employees, including 18,000 doctors, and a $57 billion budget; it annually serves 6.5 million veterans though a nationwide network of 152 hospitals or medical centers, 820 outpatient clinics, and 126 nursing homes. Of these facilities, 26 have been implicated in the present controversy, most prominent among them a medical center in Phoenix, Ariz. In addition, an estimated 300,000 vets, many of them retirees living in fast-growing and underserved Sunbelt states, have been subjected to disability-claim backlogs of up to four months.

For all that, the VHA retains the loyalty and affection of the vast majority of its clientele; it ranked ahead of private-sector hospitals and health systems in quality service and customer satisfaction, according to a variety of surveys over the past decade. One of my late uncles, a World War II Air Force veteran, used the then-VA system throughout his adult lifetime; he was a conservative Republican contemptuous of the federal government and its “socialist” ways, but he loved his own socialized medicine. He felt entitled to it and wouldn’t countenance any reduction in its benefits. Privatization? Forget it.

That a relative handful of VHA facilities have been compromised is still too many, but the conclusion critics on the right have eagerly drawn, that the offenses prove the failure of government-run healthcare as a concept, is false. Suggesting the VHA, along with Medicare, should be privatized or its services voucherized is ideological posturing. The VHA’s model of public healthcare certainly has flaws, but they’re correctible; it’s private, market-based healthcare that really doesn’t work, as the American experience has proven, time and again.

Ask the British. Great Britain’s National Health Service (NHS), created by a Labour government in 1948 over the fierce objections of private health interests, is a mirror image of the VHA: hospitals owned and run by the government, doctors on public salary, patients treated free of charge or nearly so, and the entire system supported by taxes. And its popularity has never been in doubt. A succession of postwar Conservative party prime ministers — Churchill, Thatcher, Cameron, and others — never even considered repealing it; that would have been political suicide. The extent to which Britons revere their socialized medicine was marked in 2012, when opening ceremonies at the London Olympics included a prideful salute to the success of the NHS.

This is not to suggest our own mini-version of socialized medicine should receive a pass for the managerial transgressions of those who cut procedural corners to meet admittedly impossible treatment quotas and either advance professionally or protect their positions and pay grades, unconscionably victimizing veterans in the process. On the other hand, the VHA has never been able to fully discharge its mandated duties because the system lacks the resources to handle its steadily increasing workload — a workload complicated by changes in the nature of modern warfare.

For instance, in Iraq and Afghanistan, many of those who would have died on the battlefield in earlier wars were saved, but only to face long, expensive recoveries. Moreover, there is a growing backlog of aging veterans from prior conflicts like Vietnam entitled to lifetime care for service-related and non-service-related health problems alike, whose ranks are steadily augmented in a country on a more or less permanent war footing.

A public-health institution like the VHA requires appropriate government funding, and Congress has seldom provided it. Since the VHA scandal broke, the fiscal neglect of the department has been cast into bold relief — doctors putting in 13-hour workdays, a shortage of primary-care physicians and nurses, scheduled appointments outpacing available doctors, patient overloads, low pay incentives, and so on. Inevitably, this has led some administrative personnel to game the system, but it shouldn’t detract from a public-health network that overall has performed admirably despite grudging support from those doling out the money.

As the saying goes, you get what you pay for, and a Republican-dominated Congress hasn’t wanted to pay. Given the means to carry out its mission, however, the VHA remains an impressive model for the design of a national healthcare system — and not one just for veterans.

[Editor’s Note: The Senate belatedly adopted the broad contours of a bill by Sen. Bernie Sanders (I-Vt.) that increases VHA funding for more doctors and additional health facilities, and eases backlogs by allowing veterans to see private physicians. As we go to press, the bill appears to be stuck in a conference committee as House Republicans object to the cost.]

Wayne O’Leary is a writer in Orono, Maine, specializing in political economy. He is the author of two prizewinning books.

From The Progressive Populist, August 1, 2014