Slash the VA! Make our veterans pay for increasing corporate profits!

Given the heavy-handed, mean-spirited, cruel, anti-democratic, un-Constitutional, and penny-wise (maybe) but pound-foolish actions of the current GOP/Trump/Musk administration, it is hard to know where even to begin to discuss it. Certainly many, many intelligent and well informed people, including luminaries such as politician Bernie Sanders and historian Heather Cox Richardson, as well as many news sources such as the Contrarian (established by reporters and editors fired by or resigned from Jeff Bezos’ Washington Post and the New York Times). Even in the narrower realm of health, we have outrages like the vaccine denier and proponent of ineffective and even dangerous therapies, Robert F. Kennedy, Jr. heading the Department of Health and Human Services, and Mehmet Oz, RFK, Jr’s fellow traveler, nominated to head the Centers for Medicare and Medicaid Services, presumably so those services can continue to be slashed. And even more narrowly, in health and medicine and social justice – well, all of these actions and cuts tie to social justice!

So, let’s look at the Veterans Administration (VA). The VA is tasked with providing health care for our veterans, those who have served in the military, many of whom have suffered very serious, life-threatening injuries, physical and mental (of course not counting those never got to be veterans because their lives were lost). Veterans have also had higher rates of cancers and lung diseases linked to the use of burn pits (horrific incinerators used “in country” to dispose of garbage, waste, bodies, munitions, toxic materials, using jet fuel as the source of fire, running 24/7 close to camps). The death of President Biden’s son Beau was linked to burn pit exposure, and finally during the last administration Congress passed the PACT act (Honoring Our Promise to Address Comrade Toxic Exposure) to compensate and care for those veterans whose diseases were likely caused by such exposure, often called “the Agent Orange of the Gulf wars”.

The VA was already highly stressed by underfunding and understaffing due to previous cuts made by the pro-veterans-in-words-only GOP Congress and that stress was dramatically increased by the hundreds of thousands (at least a quarter million) claims under the PACT act. Amazingly the VA clinical operation, also very short-staffed, was able to continue to provide health care to veterans. Although there were many complaints of waits and slowdowns, they were in fact much less than the routine waits and slowdowns in the non-VA health care sector (anyone tried to get a doctor’s appointment lately?) and virtually every measure of quality has shown that the VA has outperformed the civilian sector. Of course, its mission is to provide health care for veterans, not to make a profit; this distinguishes it from the civilian sector in which profit is “Job One” and accessible, quality, effective health care a distant second. The NY Times’ recent article titled ‘Chaos at the V.A.: Inside the DOGE Cuts Disrupting the Veterans Agency’ notes that the VA

…treats 9.1 million veterans, provides critical medical research and, according to some studies, offers care that is comparable to or better than many private health systems. Even Project 2025, the conservative governing blueprint assembled by Trump allies, said the V.A. had transformed into “one of the most respected U.S. agencies.

Many of the VA’s successes, as well as its challenges, are documented by journalist Suzanne Gordon in journals including these in Jacobin, Veterans Starting to Mobilize, and the American Prospect.

Then came Trump, Musk, and DOGE. Under the banner of “cutting government waste” the already far-too-lean staffing of the VA is proposed to be cut by another 80,000 jobs! This will certainly result in major delays in accessing care, in lower quality, and unconscionable disservice to our veterans. It seems like heartless cruelty, and of course it is. But the nauseating thing is that while it certainly is not about cutting waste, it is not even about the heartless cruelty. It is about one thing: transferring “government” dollars – that is, YOUR tax dollars (not Musk’s, or his companies’, they don’t pay taxes!) – to private corporations. THAT is the goal.

Think about it. Slash funding and positions from the VA, which will naturally lead to complaints about inadequate service (even the VA can only do so much when cut not only to, but deep into, the bone) and protests from veterans’ groups and maybe even GOP members of Congress. So, what will they do? We don’t even have to guess – they’ll do their favorite thing and privatize it! Contract out the care of veterans to private corporations so they can have the wonderful experiences all the rest of us have in trying to access quality care. Of course, they won’t be able to, maybe even less than the rest of us, but heck, those companies will make a lot of money!

And that is the goal. It is not saving government money, it is about transferring it to private corporations, as acknowledged by Treasury Secretary Scott Bessent. This will cost more, be less efficient, and have lower quality. This is the consistent track record of almost every government service that has been privatized – they almost never either save money or work better, they put taxpayer money in private pockets. In health care, it is even worse; it is almost impossible to think of an example where privatization has not cost far more and had worse service, accessibility, and quality outcomes. If the funding is the same, it is always worse.

But, of course, this is not an accidental outcome, it is the intention. Privatization is sold as saving money, but it always costs more, and as increasing quality but it always goes down. What it is successful at is moving public dollars to the private sector. So, it doesn’t save money by eliminating waste, it eliminates basic care and then “solves” the problem by spending even more money! The heartless cruelty is not the goal; it is simply the byproduct. It hurts our veterans, but this is not a concern to the heartlessly cruel, non-empathic (Musk thinks empathy is “destroying Western civilization”) greedheads making these decisions.

Something can be done. Veterans can rise up and protest and contact their Congressional representatives. So can the various “veterans service organizations” (VSOs) including the American Legion, VFW, and many others. Maybe even some GOP Congresspeople will take the initiative and actually do something to help veterans instead of just flapping their gums! (OK, that may be a bridge too far…)

No way to run a business: the US healthcare system is not about caring for you!

The most distinctive and defining characteristic of the US healthcare delivery system is how poorly it serves people, and the number of hoops, obstacles, and downright obfuscation people need to work their way through to get care. The most important problem is that we have worse health outcomes and more premature death than any other industrialized country, and the excessive cost of achieving those worse outcomes (the only place where we’re #1!). But the sheer difficulty, pain, and low yield of going through the information needed to make the wisest decisions (actually wise, we will see, is virtually impossible in our system) takes a – completely unnecessary – toll on all of us.

The reason for this situation, very simply, is that the healthcare system in the US is not structured to deliver maximum health benefit, but to deliver maximum profit to the major players – and that is very few of us. It is absolutely critical to remember this core fact, because every other characteristic of our healthcare system derives from it. Worried about surprise medical bills when some of the doctors at your in-plan hospital are out of plan? Worried about paying for the wonderful new medicines advertised on TV that promise you cure for thousands of dollars a month? Worried about whether you can afford the premiums for the plans your employer offers, especially if you need to cover your family? Or the premiums for the better ACA-plans? Whether you can bet on your current health status, if it is ok, continuing into the future? Whether you can survive until you are old enough to get Medicare? And then, when you are, whether Medicare will cover enough of your bills, or if you need – and can afford – a Medicare supplement plan? How about choosing a “Part D” drug plan? Why are the websites and information so opaque and difficult? Is there any plan that is truly of value? And even if “of value”, can YOU afford it?

These questions just touch the surface. Then, you actually need to access healthcare services. Then it gets worse. Primary care doctor? Can you get an appointment? Use urgent care? Is your problem on the list of things that they can competently manage? Emergency room? Wait until you are so sick they have to take care of you? And what about those drugs…?

The specific problems that this system creates for individual people are often overwhelming, and become the focus of people’s lives when they do have chronic diseases or ongoing health needs. Politicians and their policy advisors who keep talking about addressing them one at a time are at least intellectually corrupt (setting aside the question of whether they are also financially corrupt) in believing that a patchwork of – patches – can make people, at least temporarily, think that they are doing something to help while maintaining a predatory structure. Let’s just look at a few recent examples and stories.

The Upshot in the NY Times recently had a piece on how the pandemic has increased the use of telemedicine, and how this might lead to better access to emergency care, citing a very positive study done by the Veterans Administration. The study shows, among other things, that same-day access to primary care can obviate the need for emergency care. Beyond that, having a regular source of primary care, and being able to get in when you need to, decreases hospitalizations and mortality. Of course, it is important to remember that the VA is (like the military) a single-payer health system and works better than the rest of US health care within the constraints of continually decreasing funding, part of a general Congressional and executive effort starve it for funding, specifically to ensure it doesn’t work as well as it could. Those same legislators then blame the VA rather than themselves for veterans not getting the best possible care, a tried-and-true tactic for evil politicians. Except the VA, and military health care, do work better than the private sector. (For more on the VA, see the excellent article “Shaping the Future of Veterans’ Health Care” by McCauley and Ramos in the New England Journal of Medicine, Nov 5, 2020, which requires a subscription.) The comments by the brilliant and incisive Dr. Don McCanne, found at the above link to the Upshot article, clearly makes these important points. And why can’t you get same day visits, or even prompt visits, with your primary care provider? Remember the key factor in all US  healthcare; it is usually not that your doctor is unwilling; it is that they also work for a corporation whose policies are about maximizing income and profit, not about improving your health.

In a recent conversation with a friend – also a senior citizen knowledgeable about health care policy, who was long on a medical school faculty and now lives in a relatively rural area – we discussed the best choice for a Medicare Part D plan. I noted that in 2020 I had assumed that my insurer would, absent my making a change, continue me in the lowest-cost plan as it had the two years previously. It didn’t; it automatically bumped me up to the highest-cost plan. With no added benefit, because of Catch-22 – I could never make my deductible, and thus have the plan kick in, because all of my drugs were “tier 1” and didn’t count (the calculators offered are only of use if you use high-tier high-copay drugs like those advertised on  TV). This year I made sure to change back to the cheap one, so I can pay $17.50 instead of $55 a month for no benefit. My friend agreed and will choose the same plan. But did note that if a family doctor and a health economist had trouble figuring this out, it might be hard for a lot of people! It is this characteristic of our health insurance system that makes the claims of those who advocate for private health insurance because it gives you, the consumer, “choice” are completely bunk. Almost no one can read, digest, understand, and utilize the information that is (sometimes) provided, in all different places, to get to a decision on what will work best for them. And, for the few who can, it usually turns out not to be very good! Remember: this is not some quirk, it is how our healthcare, and health insurance, system are purposely set up: To be confusing, opaque, and beneficial only for the sellers, not the consumers.

My friend and I also talked about several interactions he recently had with the health system his primary care doctor is part of. One involved his receiving (as an ex-smoker) a scanning CT scan and suggesting that they obtain an older one, from the medical school where he used to work, to compare the new one to. “We don’t do that,” he was told by the person at the other end of the phone. Another was about finding out how he could get documentation to be in an early group to get COVID-19 vaccination when it becomes available, given that he is high-risk not only by age but by having chronic diseases. They don’t do that either. These are unacceptable answers, as he told the office of the vice president he complained to, and who agreed to make things happen. This is not a flaw in the system; it is how it is structured, for everyone. Most people, you see, will not complain, and thus will, well, get screwed. But it saves the company money. This is a core way health insurers function. The higher the bill from a doctor, the more routine it is to just deny it, making the doctors work to prove they should get paid. Clearly, this is a particular issue for surgeons, who usually have staff who routinely fight with the staff of the insurance companies to appeal these denials.

There is an old saying that “this is no way to run a business” But, for most companies involved in health care – insurance companies, pharmaceutical manufacturers, long-term care companies, hospital systems, and increasingly large physician groups owned by corporations, it is the way they run their business. And it is a very profitable way to do it.

It is just no way to provide healthcare.