I would like to use Veteran Healthcare. However, the backlog is months out. So, I go to the outside for care. It is not that I want to do so. This last go-around for my back was a disaster. I met the surgeon who was good. She decided it might be better to go for epidural shots instead of surgery. A month later and I am back to see a PA and then a doctor.

They want to treat me for blood pressure, cholesterol, and weight. My blood pressure is typically 110/68, Cholesterol is around 120, and my weight says I am overweight but not at the extreme. 10# and I am home free. I brought a recent blood test in. They wanted to do a new one. I objected to it and everything else other than a platelet test. Not a word about my back and right leg being numb.

This is what Suzanne and Steve are referring to with outside care for Vets. Going to the outside is akin to Medicare Advantage ordering more tests than needed. There are reasons why they do so.

How Walz Can Help Harris Woo Vet Voters

by Suzanne Gordon and Steve Early

The American Prospect

Amid the rhetorical fog of their game-changing presidential debate on June 27, Donald Trump and his then-opponent dealt with the Department of Veterans Affairs (VA) only in passing.

Trump claimed that, after he vacated the White House, “crazy Joe Biden” simply abandoned his policies of giving eligible veterans the “choice” to remain inside the VA health care system or seek treatment outside it. According to Trump, VA patients were able to “get themselves fixed up” in private hospitals and medical practices, rather than waiting “three months to see a doctor.” The results were “incredible,” and earned his administration “the highest approval rating in the history of the VA.”

Amid his general befuddlement, Biden didn’t point out two things. One, outsourcing has been a disastrous experiment that has led to out-of-control spending on private care and left the VHA with a projected $12 billion budget shortfall for fiscal year 2025. And two, Biden didn’t abandon these policies at all: There has been more privatization of veterans’ care under his administration than Trump’s.

Biden instead pivoted to talk about the PACT Act of 2022, which enabled many more post-9/11 vets to file successful disability claims based on their past exposure to burn pits in Iraq and Afghanistan. Over the next decade, the PACT Act authorizes hundreds of billions of dollars in additional spending for these claims; military veterans are “a hell of a lot better off” as a result, Biden said.

This brief, typically unilluminating exchange left unaddressed the rather dire position of the Veterans Health Administration (VHA), which operates the nation’s largest public health care system and provides high-quality and specialized care for nine million former service members. As a “Red Team” review committee of experts warned VA Secretary Denis McDonough in a report leaked to the Prospect last spring, “the increasing number of Veterans referred to [outside] providers . . . threaten to materially erode the VA’s direct care system,” leading to mass closures of VA clinics or certain services and “eliminating choice for the millions of Veterans who prefer to use the VHA direct care system for all or part of their healthcare needs.”

The dramatic and energizing midsummer switch at the top of the Democratic ticket has made it possible to imagine a more substantive debate about the past, present, and future of VA care. Particularly since both parties are now fielding, as their vice-presidential candidates, military veterans who have personally used VA-dispensed benefits to attend college.

If Kamala Harris and Tim Walz win in November, there will be a major opening for “not going back” to what Harris has called the “failed policies” of Trump’s first term. This has been reworked by the Heritage Foundation in its infamous Project 2025. The tough part for Harris, if not Walz, will be acknowledging that this also means curbing, not continuing, the disastrous bipartisan experiment with VHA outsourcing embraced by the Obama, Trump, and Biden administrations.

Walz to the Rescue

Any optimism about addressing what the Red Team called an “existential threat” is based on the personal bio—and, hopefully, post-January portfolio—of Harris’s running mate.

Before becoming governor of Minnesota, Tim Walz was an Army National Guard member for 24 years who used GI Bill benefits to attend a state college, and then become a public-school teacher and union member.

Walz ran for Congress in 2006 after Vietnam veteran John Kerry’s failed bid for the presidency two years earlier. After winning the first of six House races, he joined the House Veterans’ Affairs Committee (HVAC)—a low-status committee assignment spurned by many aspiring politicians.

Walz was well positioned to advocate for fellow veterans with service-related conditions because of the hearing damage he suffered due to repeated exposure to artillery blasts during National Guard training exercises. He also won applause for co-sponsoring a bill named after a Marine veteran who killed himself in 2011 after long struggles with PTSD and depression. The Clay Hunt Suicide Prevention for American Veterans Act, signed into law in 2015, kept the VA focused on the challenge of reducing suicide rates among former service members.

If the VA becomes part of Walz’s vice-presidential portfolio, he could help engineer much-needed personnel and policy changes.

Walz eventually rose to become ranking Democrat on the Veterans’ Affairs Committee. In 2018, he joined just 69 other House Democrats in opposing the VA MISSION Act, one of Donald Trump’s proudest legislative achievements and the basis for his 2024 campaign pledge to make VA “patient choice” more widely available.

Walz warned, accurately, that MISSION Act outsourcing would force the VA to “cannibalize itself” by diverting billions of dollars from direct care delivery to reimbursement of private-sector providers. This incremental defunding of VHA hospitals and clinics now threatens to leave them in what Walz called a “can’t function situation.”

This is exactly what has transpired, with serious manpower shortages and red ink throughout the VHA. Walz was absolutely right, and he should take that good judgment into office if he wins.

In contrast, a campaign spokesman for Sen. J.D. Vance recently hailed the MISSION Act as bipartisan legislation that “expanded veterans’ access to quality care and cut needless red tape.” Walz’s opposition to it was “not the kind of leadership veterans need in Washington,” the spokesman said.

A VA Union Ally

Walz’s role as ranking Democrat on a then Republican-led HVAC is fondly recalled by the American Federation of Government Employees (AFGE), which represents VA employees in his home state. During his first run for Congress, Walz reached out to then-AFGE vice president Jane Nygaard, who discovered that “he’s not someone who just says something to make you happy, he actually takes action.”

According to Nygaard, “when we had issues with the St. Paul VA, which had bad management and low staffing, Congressman Walz listened to the union. He got the Federal Mediation and Conciliation Service involved and we ended up having a three-day retreat with upper management. Eventually, upper leadership retired and labor relations improved.”

The one bad mark on Walz’s union report card is his vote in favor of the VA Accountability and Whistleblower Protection Act of 2017. This Trump-era effort to strip VA workers of their due process rights in disciplinary cases was challenged in court by AFGE. To his credit, VA Secretary Denis McDonough ended a five-year legal battle over implementation of the act by reaching a deal with the union last year. Thousands of unfairly fired workers became eligible for reinstatement or back pay, at a total cost estimated to be hundreds of millions of dollars, according to the Federal News Network.

Other workers or managers terminated for “grievous misconduct” were not covered by the settlement. On the campaign trail, Trump has promised to “fire every corrupt VA bureaucrat who Joe Biden outrageously refused to remove from the job.” He has also threatened to arrest any Harris-Walz supporters in the VA, which would include many of the nation’s veterans.

Fixing the VA in 2025

If the VA does become part of Walz’s vice-presidential portfolio—and his biography is prominently mentioned on the veteran policy section of Harris’s issues page—he could help engineer much-needed personnel and policy changes. That first requires finding suitable replacements for McDonough, now scheduled to leave in January, and his undersecretary for health, Dr. Shereef Elnahal.

As chronicled in the Prospect since 2021, McDonough has spent his term in office placating privatization fans in Congress, downplaying the disastrous impact of outsourcing, and refusing to reverse Trump-era patient referral rules, despite having administrative authority to do so. Meanwhile, his deputy, Elnahal, did not provide strong or innovative leadership at the VHA, while making mistakes that gave Republicans an easy political target.

If they win, Harris-Walz transition planners need to recruit a better team at the top. During the Clinton administration, Marine veteran Jesse Brown, the first African American VA secretary, was tasked with undoing 12 years of Reagan-Bush damage to the agency. Brown hired and empowered fellow veteran and public-health expert Dr. Kenneth W. Kizer as undersecretary for health, to lead what the Harvard Business School called the largest and most successful “turnaround” in U.S. health care history. (Kizer came to the aid of the VHA again recently as chair of the Red Team, whose urgent recommendations to McDonough have been largely ignored since last spring.)

On the website’s policy section, Harris and Walz promise “end[ing] veteran homelessness, investing in mental health and suicide prevention efforts,” and “expanding economic opportunity for military and veteran families.”

Any new administration must also tackle Veterans Benefits Administration. VBA critics say this part of the agency still suffers from serious understaffing and lack of training for those who assess veterans’ service-related conditions to determine their benefit eligibility.

“Because claims raters aren’t given sufficient time to understand veterans’ complex disability claims,” one Gulf War veteran explains, “this results in mistakes, which in turn creates long delays and a tsunami of appeals.”

Platform Differences

To do anything different at the VA than Biden did, or Trump before him, Harris and Walz first have to win in November. They can help boost veteran voter turnout, particularly in battleground states, by zeroing in on the skimpiness of the GOP’s plan to “Take Care of Our Veterans”—all 48 words of it!

This lone paragraph, buried in the Republican platform adopted in Milwaukee, leads off with immigrant bashing. The party pledges to “end luxury housing and Taxpayer benefits” for border-crossers and “use those savings to shelter and treat homeless Veterans.” In addition, a second Trump administration will “expand Veterans’ Healthcare Choices, protect Whistleblowers, and hold accountable poorly performing employees not giving our Veterans the care they deserve.”

The equivalent Democratic Party platform statement is far more substantive. It covers veteran homelessness and suicide, PACT Act implementation, improving mental health programs, new services for female veterans, support for family members caring for VA patients, and cracking down on scams targeting veterans who file disability claims over their toxic exposures.

“Going forward,” the Democrats declare, “we will strengthen VA care by fully funding inpatient and outpatient care and long-term care, and by upgrading medical facility infrastructure.” The adverse impact of Biden administration outsourcing on funding for all of the above is not mentioned. The platform also reminds voters that, as president, Trump “pushed to cut funding for veterans’ benefits.”

Tying Trump to Project 2025

The best way to drive this last point home is by tying Trump to the VA-related recommendations of Project 2025. As Iraq War veteran and Pennsylvania Rep. Chris Deluzio points out, that Republican playbook “takes dead aim at veterans’ health and disability benefits.”

In August, Deluzio warned readers of Military.com that his Republican colleagues on the HVAC have often “sided with corporate interests to outsource care” for VA patients. And now their presidential transition planners at the business-backed Heritage Foundation want to refer even more vets to “costly private facilities, a fiscally reckless move that … has ballooned costs for the VA.”

According to Deluzio, the “ultimate endgame of these plans—to dismantle the VA’s clinical care mission—should send shivers down the spines of America’s veterans and those who want them to have the best care.”

On the campaign trail, Republicans are, per usual, diverting attention from that “endgame” by positioning themselves as defenders of “patient choice.” At a mid-August event at a VFW hall in Western Pennsylvania, J.D. Vance referenced the very real health care access problems of “our veterans living in rural areas.” He assured his invitation-only crowd that if “those who put on a uniform and serve our country . . . need to see a doctor, we got to give them veteran’s choice to give them that ability to see a doctor.”

On Capitol Hill, conservative Republicans in the House and Senate have been laying down their own cover fire for Trump and Vance by pressuring McDonough to stay the course on “community care”—the preferred congressional euphemism for privatization—until their team takes over again in January.

In less coherent fashion, Trump made similar points during an August 26 speech to a Detroit convention of the National Guard Association. The former president accused the Biden-Harris administration of gutting his many “VA reforms” related to “choice” and “accountability,” and hailed VA outsourcing as a great system of “rapid service,” in which patients “go to an outside doctor . . . get themselves fixed up and we pay the bill.”

According to these MISSION Act defenders, “community care is more cost-effective than VA’s direct care system”—despite all evidence to the contrary. It also doesn’t provide care that is suited to the particular needs of veterans.

Between now and Election Day, it will take a lot more truth-telling and plainspokenness by people like Walz and Deluzio to counter the steady drumbeat of disinformation directed at veterans. And it will take the commitment to a new way forward to roll back the bipartisan damage of privatization.