Privatization’s Four Ds are being used to Defund, Degrade, Demonize, and Dismantle VA Healthcare and Privatize it.
If you must know in order to understand why I would post this, I am a Vietnam era veteran. I use the VA healthcare system. I find the VA to be a valuable entity for all veterans. It goes beyond healthcare and provides help for education, buying a home, and other valuable services which would be costly to us if privatized. All of this I have used and found it to be valuable.
American Postal Workers Union President Mark Dimondstein frequently speaks about how privatizers undermine a public service that enjoys wide popular support. He calls it “The Four Ds” of privatization. First, Defund and begin the process of slow strangulation; then Degrade the service so that people who can afford to do so begin to look for alternatives in the private sector; next, Demonize the workers for the resultant failures; and finally, Dismantle and privatize the service.
The following critique of the book “Our Veterans” is taken from Mark Dudzic’s review. “Veterans Affairs at the Crossroads.” I apologize for not including a reference to Mr. Dudzic’s review which is shown in great detail.
Suzanne Gordon, Steve Early, and Jasper Craven latest book looks at the evolution of the VA and how it is playing out.
“Veteran’s Affairs at the Cross Roads:” Suzanne Gordon, Steve Early, and Jasper Craven latest book describes in grim detail how the current process is playing out in one of our largest and most hallowed public institutions—the Veterans Administration (VA). The book details how these forces impact the veterans it serves and the people who work there.
The book is a deep exploration into the world of millions of military veterans, from the demographic changes in the composition of the military to the traumas experienced by soldiers, their toxic workplaces and, most importantly, what happens to them after they leave the service. It provides important insights into how an institution intended to ease veterans’ transition into private life and provide needed medical and psychological care for them has been undermined by profiteering, market fundamentalism, and political dysfunction.
Like the Postal Service, whose mission is enshrined in the U.S. Constitution, provision for the public care and support of military veterans is one of the oldest federal commitments and can be traced back to a promise in President Lincoln’s Second Inaugural Address
“To care for him who shall have borne the battle.”
In many ways, it served as a template for subsequent federal programs that provide important safety net services for Americans. This commitment was at its most robust in the years following World War II when returning vets could access an elaborate network of transitional income support, medical care, fully paid college tuition, and low-cost home financing.
The book . . . provides important insights into how an institution intended to ease veterans’ transition into private life and provide needed medical and psychological care for them has been undermined by profiteering, market fundamentalism, and political dysfunction.
This “GI Bill of Rights,” together with the institutionalization of the labor movement and the consolidation of other federal programs providing retirement and income security helped give rise to a “golden age” for many working-class and middle-class Americans: a thirty-year period where real incomes were rising, and inequality was declining. For better or worse, the GI Bill’s housing loan subsidies supercharged suburbanization and private home ownership. The educational benefits sent almost 8 million returning vets to college and paid for their living expenses while they attended. This produced wide-ranging economic benefits. A 1988 congressional study estimated that every dollar spent on GI education produced $6.90 in increased economic output and additional taxes.
The unique and special needs of America’s veterans would be much better served if veterans’ advocates and their political supporters aligned their interests with other movements fighting to protect and expand public goods and services and striving to build secure lives for working-class Americans.
Of course, the massive racial inequities that defined the immediate post-World War II period ensured that Black veterans were never able to access the full range of services to which they were entitled. This was particularly true in housing, where both formal and informal residential segregation, deed restrictions, redlining, and other forms of financial discrimination resulted in huge disparities between Black and white veterans’ uptake of GI loans. Over the decades, even long after those legal barriers were removed, these initial inequities abetted de facto residential segregation, urban decay, disparate educational access, and a racial wealth gap.
While some have called the GI Bill “one of the worst racial injustices of the twentieth century,” the actual record is more nuanced. A 2021 Brandeis University study found that Black and white veterans accessed their GI benefits at similar rates and that average government spending on both groups was roughly the same. World War II-era Black veteran households have about 2.5 times the wealth of Black non-veteran households, almost exactly the differential as that between white veteran and nonveteran households. However, approximately forty years after World War II, Black veteran households held only 31 percent of the wealth of white veteran households (the comparable figure for non-veteran households was 28 percent).
The Rise of Neoliberalism
The post-World War II veterans’ programs thus illustrated the shortcomings and difficulties of attempting to graft universal social programs on a political economy where the color line acted as a determinant in the distribution of resources and opportunities. Things would only get more challenging in the neoliberal era, when a reactionary counteroffensive began to frame public goods and services as fundamentally inefficient and in need of privatization and commodification.
The attack on veterans’ healthcare is a case in point. Originally organized on the “national health service model” (facilities are publicly owned, providers are public employees, resources are allocated through comprehensive planning, and services are free at the point of service to all eligible participants), the Veterans Health Administration is the largest integrated health system in the United States with 171 medical centers and 1,113 outpatient clinics serving 9 million veterans. Many of its nearly 400,000 employees are veterans themselves (many are also union members—making it one of the largest unionized workplaces in the United States). It was designed to cater to the unique needs of veterans and has been a pioneer in diagnosing and treating veteran-specific diseases such as those caused by Agent Orange exposure, post-traumatic stress, and in-service sexual abuse. It has also been a leader in developing systems of comprehensive and preventive care focusing on treatment over a patient’s entire life cycle. Numerous studies have demonstrated how VA care consistently produces better health outcomes than privatized healthcare at a lower cost. Through price negotiation and other administrative procedures, the VA pays about half as much as Medicare for drugs and other pharmaceutical products.
Nonetheless, as the authors of Our Veterans show, despite superior outcomes and cost effectiveness, VA healthcare was too big and too lucrative a target to escape the attention of the free-market ideologues and healthcare profiteers. The Four Ds of privatization were unleashed. Insufficient funding gave rise to long waiting lists, staffing shortages, and the occasional service meltdown. Detractors, often linked to right-wing and free-market think tanks, pounced on every shortcoming, and made sure their allies in Congress and the press blew them out of all proportion. As in education and Medicare (where the Medicare Advantage program is rapidly privatizing another cherished public good), once the services began to degrade, the privatizers called for an expansion of “choice” that would allow veterans to seek care in the private sector. Beginning under the Obama administration with the CHOICE and MISSION Acts and expanding greatly under the Trump administration, veterans were encouraged to use private care options that often had longer wait times and inferior care than the pilloried “government care.” Dedicated VA workers were also demonized. With union bargaining rights sharply curtailed under Trump and workers being scapegoated for problems beyond their control, demoralization and staff turnover exploded. “Industry lobbyists,” the authors argue, “wanted so few obstacles to increasing their ‘market share’ among veterans that even Joe Manchin was concerned.”
The pandemic and the 2020 election results have slowed the privatization steamroller to a degree. But the future remains uncertain. The Biden administration has not taken any bold steps to de-privatize veterans’ healthcare. In 2022, the VA reported that “community care” (i.e., care not directly provided by VA facilities and employees) accounted for 44 percent of healthcare services.
The Erosion of Popular Support
Veterans are widely admired, and most Americans are deeply grateful for their service and their sacrifices. Unlike Ronald Reagan’s (and Bill Clinton’s!) fictional “welfare queens,” it would be hard for any public official to make the case that they are not worthy of the benefits that they receive. But military professionalization has taken its toll. In fact, the decline in the percentage of veterans in the adult population has pretty much tracked the decline in the percentage of private-sector union members. Veterans now constitute 7 percent of the adult population, down from 18 percent in 1980.
Like union members, their declining percentages come with a corresponding decline in political clout. The once robust Veterans Service Organizations—the American Legions, Veterans of Foreign Wars and the like—have become hollowed out and their remaining membership is mostly older vets from the Korean and Vietnam eras. Their politics were always problematic and the American Legion, in particular, has a long history of anti-labor activism. But these organizations combined a “we take care of our own” ethos with an elaborate network of social organizations and civic engagement that sustained a mobilized popular base to advocate for a strong and well-funded safety net to provide for veterans’ unique needs. As these mass organizations declined, they were supplanted by newer organizations organized on the NGO (non-governmental organization) model with professional staff and large funders.
Originally organized on the “national health service model” . . . the Veterans Health Administration is the largest integrated health system in the United States with 171 medical centers and 1,113 outpatient clinics serving nine million veterans.
Stepping into this void, the Koch Brothers created out of whole cloth a “grasstops” organization called the Concerned Veterans for America and, together with an army of political operatives, many of whom were also Koch-funded, helped manufacture a series of scandals based almost entirely on anecdotes, falsehoods, and misrepresentation. The attacks had their intended effect: according to a 2015 Pew survey, the VA’s favorability fell from 68 percent to 39 percent in just two years. Mainstream Democrats ran for cover or attempted to “triangulate” the crisis by ceding ground to the free market critics. Only Bernie Sanders and a few other stalwarts in the Senate and House prevented a full-scale dismantling and privatization of the VA’s public health programs by the free market extremists.
Can the VA Be Saved?
VA programs were originally conceived as universal public goods and services. As such, they share much of their DNA with other universal programs such as public education, Social Security, and Medicare. An important contribution of Our Veterans is to demonstrate that the assault on the VA is coming from the same place as the attacks on these other universal programs. Veterans’ advocates often have difficulty making this connection, however, because they view VA benefits as “earned” by the unique sacrifices made by veterans. The authors quote a Washington, D.C. veterans’ advocate who “gets angry when proponents of Medicare for All cite the VA as a good functioning model of single-payer healthcare. VA benefits belong to us, he explained, because we earned them. If other Americans want free higher education or VA-style medical coverage, they should enlist.”
An important contribution of Our Veterans is to demonstrate the assault on the VA is coming from the same place as the attacks on . . . other universal programs.
This attitude is not unlike that of sections of the labor movement who cling to their “union advantage” negotiated healthcare benefits despite overwhelming evidence that these programs are unsustainable and are undermining worker bargaining power. The unique and special needs of America’s veterans would be much better served if veterans’ advocates and their political supporters aligned their interests with other movements fighting to protect and expand public goods and services and striving to build secure lives for working-class Americans.
The authors of Our Veterans have taken a deep dive into a large and little understood corner of the social safety net. Their detailed depiction of how the forces of neoliberalization interact with the unique history, culture, and politics of this sector is an important contribution to our understanding of how working people are affected by these forces in all aspects of their lives.