What if we told you that an island of socialized medicine already exists in the United States? And that it delivers better care to its nine million patients than the U.S. healthcare industry provides for rest of us. Would you be surprised that the same politicians and powerful private interests that seek to discredit and defeat Medicare for All are also trying to undermine this alternative to the status quo?
The alternative under threat is the Veterans Health Administration (VHA), the largest public healthcare system in our country. Run by the Department of Veterans Affairs (VA), the VHA is like the National Health Service in the UK. VHA care-givers are not a collection of physician practices or specialty services reimbursed by private insurers, Medicare, or Medicaid, on a “fee for service” basis. All VHA doctors, nurses, therapists, and other professional and nonprofessional staff are salaried.
They provide high quality care that is better coordinated and more cost effective than in the private sector. The VHA doesn’t compete with other hospital chains, by spending huge sums on advertising and marketing. Instead, it serves as a backup system to overwhelmed non-VA facilities during local or national crisis situations like the Covid-19 pandemic. The VHA also plays a major “teaching hospital” role in training thousands of new doctors, nurses, and other healthcare professionals.
In 2018, corporate Democrats and conservative Republicans took a sledge hammer to the VHA when they handed Donald Trump one of his biggest legislative victories, the VA MISSION Act. As implemented under Trump and now Joe Biden, this legislation has siphoned billions of dollars away from the VHA’s budget and directed that money toward private doctors and for-profit hospitals often less well prepared to treat military veterans.
As the VHA is starved of needed funding, staffing levels will decline and its direct care capacity will be eroded. Then, its nationwide network of public hospitals and clinics will be ripe for facility closings and piece-meal dismantling. Under the guise of saving taxpayers money and giving veterans more “choice,” bi-partisan supporters of privatization—who are also foes of Medicare for All—want to turn the VHA into a poster child for the failure of “government-run health care.” As Paul Sullivan, a Gulf War combat veteran and former deputy secretary of the California Department of Veterans Affairs, points out, “The forces against quality healthcare for all Americans know that a fully funded and staffed VHA would set a shining example for the national healthcare they bitterly oppose.”
Why VHA is Worth Defending
DSA has already been fighting privatization of Medicare as we fight for Medicare For All: the MISSION Act is another neoliberal theft of a legacy program. Medicare for All advocates like Bernie Sanders and Alexandria Ocasio-Cortez well understand this: Two years ago, Ocasio-Cortez joined forces with Veterans for Peace (VFP) and RNs who work at a veterans hospital in the Bronx to hold a protest meeting against privatization in her own district. And Sanders has long championed veterans’ health care improvements, in Vermont and nationally when he was chair of the Senate Veterans Affairs Committee. Far more DSA members should get involved in this on-going struggle because the two biggest VHA unions—American Federation of Government Employees (AFGE) and National Nurses United (NNU)—need many more local allies in what is both a labor and healthcare reform campaign.
The VHA has about 120,000 union members, making it one of the most heavily unionized healthcare networks in the country. One third of the VHA’s 300,000 staff members are veterans themselves. This helps create a unique culture of empathy and solidarity between patients and providers that has no counterpart in American medicine. Due to multiple collective bargaining relationships, the VHA must pay more attention to the kinds of occupational hazards that are widespread in healthcare work, particularly in private-sector hospitals without unions. The VHA was the first and remains one of the few US healthcare systems to install the kind of lift equipment that helps nursing staff avoid debilitating and often career-ending back, neck, and shoulder injuries.
Thanks to the MISSION Act, the VHA has been partially converted into a Medicare-style payer of bills submitted by other healthcare providers. During his campaign for the presidency, Biden supported this outsourcing trend, a stance un-like Barack Obama’s criticism of Medicare Advantage during his 2008 bid for the White House. After Obama was elected, of course, he did nothing to end this partial privatization of traditional Medicare, which now takes the form of for-profit Direct Contracting Entities embraced by both Trump and Biden. The powerful private interests which acquired a new federal revenue stream, from Medicare, have fought to preserve and expand it—just as private hospital chains and medical practices are now seeking more MISSION Act-created “customers” among veterans.
Discrediting Public Provision
The fact that most veterans, and their organizations, prefer public provision of their care creates a challenge for would-be privatizers of the VHA. Along with the rest of the U.S. public, former military personnel have been the target of a well-funded disinformation campaign, about both VHA care and its place in any future Medicare for All system. Republicans, who never find fault with the Department of Defense, fixate on any VHA failings, real or imagined. Democrats, who rarely challenge Big Pharma, for-profit hospital chains, or commercial insurers, often join that right-wing criticism of the VHA’s handling of veterans’ many difficult mental and physical problems (while rarely crediting the Pentagon as the source of them). As we show in a forthcoming book, this political dynamic has helped shape media depictions of the VHA as an always “troubled,” “dysfunctional,” or “scandal ridden” federal agency, whereas the DOD is rarely described in these terms regardless of how many costly, wasteful, or failed wars it has waged.
Ironically, conservatives also falsely claim that making existing single-payer coverage for seniors into a universal program would eliminate the specialized care for veterans that Trump did so much to undermine. “Medicare for All Threatens Veterans Healthcare!” was the banner headline of a typical op-ed piece placed by Koch Brothers-funded operatives like Darin Selnick. A Trump advisor on veterans affairs and an alumni of the pro-privatization Concerned Veterans for America, Selnick warned readers of The Hill that Medicare for All would “dismantle the VA” and “undo the progress that has been made improving veterans’ health care — especially in regard to increased access outside the VA.”
In similar fashion, Robert Wilkie, the Republican ideologue who became Trump’s second VA Secretary, attacked Bernie Sanders during the latter’s 2020 campaign for the presidency. In a Breitbart News interview on the eve of Super Tuesday primary voting in March two years ago, Wilkie warned that, if Sanders-style “socialism became the coin of the realm, the care that was promised for warriors would disappear.” Of course, this allegation was not supported by the actual language of Sanders’s Medicare for All bill. It preserves VA coverage for nine million veterans while creating a single-payer system for all Americans, including the other ten million men and women ineligible for VA care because of their military discharge status, income level, or lack of a proven service-related condition.
For their part, too many single payer activists have “swallowed the right- wing propaganda aimed at discrediting the VA,” says Mark Dudzic, longtime coordinator of the Labor Campaign for Single Payer. According to Dudzic, some fail to cite the veterans’ healthcare system as a positive model for fear of harming the cause or because they’re simply unfamiliar with its actual functioning. In contrast, he believes that “using the example of the VA will help the public understand that government involvement in healthcare can be a positive good.”
Jason Kelley, a VHA pulmonologist and PNHP member, agrees with Dudzic that “it’s important for single payer advocates to know as much about the VA–and how well it works–as we know about the Canadian and other international healthcare systems.” As Kelley asks, “If veterans who go to the VA for emergency care live twice as long as those who go to private sector hospitals because of the VA’s coordinated care, shouldn’t we all be able to benefit from that model?” In fact, at the medical center where Kelley has spent much of his career, his fellow Vermonters are now benefiting from VHA services. Since late last year, the veterans’ hospital in White River Junction has opened its doors to non-veterans in response to a critical shortage of in-patient treatment options for mental health patients in the state, a common problem in rural areas. “The VA has an enormous amount of skill and experience in the area of mental healthcare,” says Emily Hawes, Vermont’s commissioner of mental health. “We are fortunate that they are willing to help us out.”
The fight to save VHA’s ability to help veterans—and the rest of us—in the future depends very much on “Save Our VA” campaigning becoming better integrated into the larger single payer movement. And that larger movement must do a better job explaining and defending a health care system under attack by the same political forces (and their wealthy donors) who want to undermine Medicare and prevent it from covering everyone else.