Trump vs. Biden: Who Got More Done for Veterans?
I am a veteran and like other veterans we try to use the VA. Recently I have been conversing (emails) with Steve Early and explaining to him I was finally taken in by the VA. And why? I spent over 2+ years of time at Camp Lejeune while going back and forth to Cuba for 4.5 months each time. So, I qualify under the recent Pact Act. I and others were showering in tainted water and drinking it. I have a blood disorder in which my platelets disappear and it name is mentioned in the act’s qualifications.
My experience . . . So I try to arrange a doctor visit with the hospital for back stenosis. The clinic is booked until October. The alternative is to go outside under VA authorization. I get in to see a surgeon who says she would have to make an erector set out of my back. She recommended shots to numb(?) the nerves(?).
For the last 4 weeks I have been going back and forth with each side. I asked for the authorization from the VA to use the outside doctor and it was sent to me on Monday. Supposedly, this was sent to the outside Doc twice before. Last Friday, I gave the outside doc’s nurse the authorization number. Today, I called them and said I can supply the paperwork also and I can bring it to them or email it.
Bottom line is the care was faster when the VA was fully staffed. Trump’s plan of shifting care to the outside is not working.
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 servicemembers who receive VA-funded care have been the subject of an increasingly troubled 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.
Every time my company (more than one of them in fact) went to outside providers for services that had been performed by employees they cost more and provided worse service. In one case it was so much worse that the contract was cancelled. The employees always assumed someone was getting a kickback because the companies never seemed to learn.
Jane:
The grass is always greener when observed from a mile away. It is only when you get there, you begin to notice the number of bare spots in the green. Cost reduction is important as well as progress. Important only when it is actual or when if provides more of needed “essentials.”
The problem is, as you write above, that BOTH systems for healthcare just totally suck now. (VA and private) All the issues you are describing with the VA system is the same in the private system. I am still a current military member (Army) who goes to a military installation for health care, but I know people that are retired who use the VA, and civilian friends who use private, and I am hard pressed to hear anything good or positive from both groups. What has happened to healthcare over the years in general that we have gotten to this point? Staffing shortages abound, long wait times, hassles with insurance companies, referral nightmares, etc. Something somewhere is broken, would be a great project for a good journalist to do a deep dive to see where we went wrong.
the main driver in ‘private’ health care failures is that its become a business that is focused on financial metrics not on the care of patients, it used to be a battle between insurance companies and providers, but now the finance folks have taken over a large portion of the medical providers, and they battle to cut their costs and improve profits (like a buy a hospital and then sell off the land the hospital sirs on and then reduce the medical reduce spending on medical technology and doctors and nurses). course they also charge the hospital(s) for ‘services’ the owner provides, and invest in technology to deny claims (seems one company set up technology that would deny a claim in mass, then patients would appeal and the doctor doing those appears spent maybe 30-45 seconds to review ad denying them again
Robi:
I did not use healthcare much when on active duty. There was no need to for me other than shots or being sick. That is a third element. It is pretty apparent the VA is short of staff and purposely done so. McDonough is responsible for such. Each time I went, they were professional in their approach and appeared to know what they are doing. Then too, I do not roll easily.
The two groups (commercial and VA) do not communicate well. The civilian side does not understand the VA process. To short cut it, I asked for a copy of the VA paperwork. With that, I can now have input and can direct the civilian side and supply what they need. If I had not been involved with healthcare, I would have been dumbfounded by it all. On site at the VA, I have found the care to be the same. If I show up at a commercial hospital and tell then what is going on, I am admitted. I also bring a small suitcase with essentials. The same would happen at a VA facility or I would be redirected via a phone call. There is no question about admitting me. I know I am going to stay. This happened during the Covid scare also. I was in and out of U of M within a week. Normally, it would be at least two weeks.
Staffing is an issue on the commercial side and access justifies their pricing. I also have Medicare coverage, supplemental (Plan N), and pharmaceutical. Total cost is approximately $400/month and it keeps increasing.
On the commercial side of healthcare, there is a purposeful shortage of doctors, etc. On both sides the costs of pharma is purposely high and well beyond cost. When I have an issue, Rituxan works for me. Four does equate to ~$100,000. Next step would be shots of NPlate which is more expensive. So far, the cancer drug Rituxan works. Insurance picks it up as well as Medicare.
Why bother? It is an alternative for me and the disorder can be traced back to Camp LeJeune water.
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