Trump vs. Biden: Who Got More Done for Veterans?

by Suzanne Gordon and Steve Early

Washington Monthly

Trump has mocked veterans and privatized their health care. Biden honors them but hasn’t challenged Trump’s privatization policies. Currently, they are moving more and more veterans to commercial healthcare. This rather than restoring VA healthcare to a better place for veterans to be and at a lower cost. Think of Medicare Advantage.

From mocking John McCain’s military service to disparaging American soldiers who died abroad as “losers” and “suckers,” Donald Trump has shown plenty of disrespect to veterans over the years. By contrast, Joe Biden consistently valorizes military service, including that of his beloved late son, Beau. So, it’s natural for Democrats to hope that maybe this time the majority of veterans won’t vote for Trump, as they did the last two times. But sadly, when it comes to veterans’ affairs, the contrast between Biden’s and Trump’s policy choices is not as stark as one might hope. 

To proclaim himself “the greatest champion the veterans ever had in the White House,” as Trump did last August in New Hampshire, the former president would highlight the VA Accountability Act of 2017 or the more impactful VA MISSION Act of 2018. The latter bill promised to reduce wait times at VA hospitals and give veterans greater “choice” of doctors by forcing the Department of Veterans Affairs to outsource more of its care to private-sector providers and medical centers. Since then, the 9 million former service members who receive VA-funded care have been the subject of an increasingly problematic privatization experiment. And many, along with the unions representing 300,000 VA employees, are not happy about it.

The MISSION Act has diverted about a third of the VA’s health care budget to the private sector. One result is that veterans must compete with nonveterans for access to care while also having to deal with the same lack of coordination most of us face when we try to navigate the highly fragmented commercial U.S. health care system. 

Another result is budget cuts inside VA facilities that are adversely affecting staffing levels, new hiring, and job conditions nationwide. For example, because of a $76 million local budget deficit, the VA Medical Center in San Francisco just terminated a scheduling system popular with nurses, after refusing to bargain about that decision. RNs now have to work an extra eight-hour shift with no additional pay, which is not helping nursing staff retention or recruitment. 

It might seem that the mounting failures of the MISSION Act would offer Biden and Democrats ample ammunition for attacking Trump and the Republicans. There’s one problem, however. The legislation passed with overwhelming bipartisan support, and Biden has done nothing to change course since he came to office. 

In 2014, President Barack Obama was stung by negative national publicity about appointment delays at a single veterans hospital in Arizona, which led to the forced resignation of his VA secretary. At the time, study after study showed that the VA, while far from perfect, was outperforming the rest of the U.S. health care system on metrics ranging from care coordination to adherence to evidence-based protocols. The system also enjoyed strong support from traditional veterans organizations such as the American Legion. But rather than defend the VA’s overall superior record, key Democrats joined with Republicans in calling for more outsourcing, the policy fix favored by the Koch brothers–funded Concerned Veterans for America. 

Biden’s pick to head the VA, Denis McDonough, has won applause for renegotiating VA union contracts. He also ended the Trump administration’s war on federal employees’ due process rights by settling a major class action grievance over unfair dismissals at the VA. Biden also signed the Promise to Address Comprehensive Toxics Act, which allots at least $400 billion over the next decade for health care and disability pay for former soldiers exposed to burn pits during their post 9/11 deployments in the Middle East or to chemical hazards elsewhere. About 1.3 million claims related to the PACT Act have been filed already.

But the administration did nothing to reverse the privatization of the VA health care system, including for burn-pit victims, and even took key measures to hasten it. In 2022, McDonough followed the advice of Trump-era consultants and recommended that some VA medical centers, inpatient units, emergency rooms, and outpatient clinics be closed or downsized. This would have forced even more patients to go outside the VA for treatment—even in rural areas where there are few (if any) mental health and primary care providers. Only the combined protests of veterans service organizations and their members, along with VA caregivers and their patients, stopped this plan.

When running for president in 2020, Biden vowed to achieve “the right balance between VA and community care” from outside contractors. But in office, Biden kept Trump’s policy of costly and unnecessary outsourcing on automatic pilot. Now, privatization threatens the VA’s ability to deliver high-quality, specialized care to patients old and new, including that big influx of veterans with health problems covered by the PACT Act.

Many front-line caregivers no longer have enough time to care for patients, supervise trainees (the VA helps educate 70 percent of the nation’s physicians), do charting, and try to coordinate with outside providers. As previously reported in the Monthly, McDonough could rewrite administrative rules, promulgated by his predecessor, that opened the floodgates of outsourcing far beyond what even some MISSION Act backers anticipated or wanted. But so far, he has refused to do this.

Which is not to say that the VA and veterans would fare better under a second Trump term. For example, GOP transition planners at the Heritage Foundation boast that under Trump, the VA became “one of the most respected U.S. agencies,” and accordingly vow to outsource even more of its care to commercial health care systems. Whether this vow might cause some veterans to rethink their support for Trump remains to be seen, but it would surely help if Biden would articulate how his administration will do better during a second term.