Suzanne Gordon

Suzanne Gordon is the Senior Policy Fellow at the Veterans' Health Care Policy Institute, as well as a journalist and co-editor of a Cornell University Press series on health-care work and policy issues. Her latest book is The Battle for Veterans' Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care. She has won a Special Recognition Award from Disabled American Veterans for her writing on veterans' health issues, much of which has appeared in The American Prospect. Her website is www.suzannegordon.com.

Recent Articles

The VA Is Privatizing Veterans’ Health Care While Launching a Campaign to Deny It

Acutely aware that its privatization plan has little support among veterans, the VA has launched a PR blitz to obscure what it's doing. 

AP Photo/Jose Luis Magana Veterans Affairs Secretary Robert Wilkie testifies before the House Appropriations subcommittee on Capitol Hill in Washington. T he Trump administration’s multipronged effort to privatize the VHA and push millions of veterans out of the VA system remains deeply unpopular among American veterans. But rather than adjust its proposals to meet the needs and wishes of veterans, the administration has a better idea: deny that the changes—which include funding private care at taxpayer expense—amount to privatization at all. Over the past several weeks, VA Secretary Robert Wilkie and his advisors from the Koch brothers-funded Concerned Veterans for America (CVA) have launched a PR offensive refuting critics who contend that the agency’s plan to funnel money to private care will lead to VHA privatization. In multiple press releases, Wilkie adamantly denied that channeling millions of veterans—and billions of taxpayer dollars—to private-sector health care providers...

Inside the Administration’s Plan to Push Millions of Veterans into Private-Sector Health Care

The VA's plan to implement the recently passed MISSION Act could seriously imperil veteran health care—and push the department even further toward privatization. 

Alex Edelman/picture-alliance/dpa/AP Images Secretary of Veterans Affairs Robert Wilkie testifies during a hearing to examine the implementation of the VA MISSION Act before a joint House of Representatives and Senate Committee on Veterans Affairs on Capitol Hill. O n January 30, Robert Wilkie, the secretary of the Department of Veterans Affairs unveiled a plan that could push millions of veterans out of VA care and into the private sector. Wilkie’s announcement follows the passage of the VA MISSION Act of 2018, legislation that gives Wilkie broad latitude to develop guidelines allowing far more veterans to get private-sector care at taxpayer expense. Critics, including veterans organizations and Democratic members of Congress, have warned the plan could seriously weaken veteran health care and move the VA perilously close to privatization. As my colleague Jasper Craven and I predicted, Wilkie’s plan is to expand private-sector access for veterans currently at the VHA. But instead of...

Trump Administration Moves Forward on VA Privatization

Under the guise of reducing veteran suicides, the Trump administration has released a plan that could radically reshape veteran care in the United States. The stated goal is to expand mental health services for newly transitioned veterans, the proposal, which administration officials approved on May 31, contains provisions that could starve the Veterans Health Administration of needed resources, add impossible burdens to already struggling VHA staff, and privatize veteran mental health care by outsourcing it to non-VA providers. As studies have consistently shown, such private-sector providers are ill equipped to address veterans’ complex needs. 

Released on May 3, the Joint Action Plan represents an outline of how the Departments of Veterans Affairs, Defense, and Homeland Security propose to implement an executive order President Donald J. Trump signed in January. The order called for providing all service-members transitioning out of the military—about 245,000 a year—with 12 months of free mental health care. The impetus behind the plan—preventing veteran suicides—and a number of things in it are praiseworthy, even essential. But according to a careful analysis by the Veterans Healthcare Policy Institute, the plan could actually jeopardize the stellar suicide prevention and mental health programs that the VA has long pioneered.

The action plan stipulates that transitioning service-members will have access to 12 months of mental health benefits. Service-members must also be informed that they don’t have to seek help from the VHA and are free to go to private-sector mental health providers, if they are, for any reason, not interested in VHA care. The plan calls for some VHA oversight of these private-sector providers, but provides no funding for staff needed to monitor their care. 

The danger is that VHA veterans could be cared for by providers who may not understand their specific problems or provide evidence-based treatment for them. As studies have documented, private-sector care falls well short of the public sector in treating veterans. Unlike the care delivered at the VHA, which is well-coordinated, veteran care in the private sector would be uncoordinated and their providers largely unaccountable. Even worse, the funds to pay for expensive care in the private sector will come directly from the VHA budget. Without new congressionally approved allocations, the VHA will be forced to cannibalize existing programs to pay for the mandates.

Such threats come at a time when the VA system is already plagued by underfunding and understaffing. On June 14, 2018, the VA Office of the Inspector General (OIG) issued a report that once again highlights the problems created by Congress’s long-standing failure to fully fund and staff the Veterans Health Administration. Its detailed, facility-by-facility list of staff vacancies includes the mental health professionals needed to serve a growing number of veterans with serious mental health and substance abuse problems. (Seventy percent of facilities had shortages of psychiatrists and 40 percent of psychologists.) 

 The Joint Action Plan does not require that the Defense Department or others provide transitioning service-members with information about the high quality of programs the VHA has developed to deal with complex mental health problems. This kind of education is essential because any current or future problems the VHA faces provide fodder for right-wing critics—like Fox and Friends—as they churn out a steady stream of anti-VHA stories designed to convince veterans that the VHA can never serve their needs. Neither conservative nor liberal media do much reporting on the many innovations the VHA has pioneered in the delivery of integrated primary care, mental health care, or suicide prevention. Yet as studies have shown, the VHA has a far better track record on these issues than the private sector. 

The Joint Action Plan doesn’t even call for measuring whether newly discharged service-members receive such information. It does, however, recommend measuring how quickly department personnel are trained on the referral process to community-based support resources.

The plan’s defects don’t end there. Without offering additional funding, the plan requires the VA to train outreach workers and peer support staff, who then must repeatedly contact all 245,000 transitioning veterans. Staff will also have to provide care for an estimated 32,000 veterans each year. Finally, the VA will have to evaluate the success of all these and other programs.

Yet the plan does not suggest conducting an assessment of how many new VHA staff would need to be added, and thus funded, to accommodate these new caregiving and outreach responsibilities. Because twice as many veterans receive mental health treatment compared with ten years ago, VA mental health staff are already overwhelmed by their high caseloads. A recent report on VA mental health care from the National Academies of Science, Engineering, and Medicine said that the VHA’s mental health-care system could be a model for the nation but that it was plagued by shortages of staff and clinical and exam space, which had created high staff burnout and turnover. Trying to accommodate thousands of new patients will lead to increased burnout and delays, which, absent attention to increased staffing, will fuel demands to outsource more and more care.   

Because the Joint Action Plan claims that its provisions will advance the laudable mission of preventing veteran suicide, it may receive support from Congress and some Veterans Service Organizations. Like the recently passed VA Mission Act, the VA Accountability Act, and many other recent measures, it is rife with intended consequences. As advocated by representatives of the Concerned Veterans for America—a Koch brothers’-backed group whose representatives now advise the VA and White House—it is, in fact, just another step down the slippery slope of VHA privatization.    

With Shulkin Out, Veterans Need to Mobilize to Stop VA Privatization

Trump's new appointee to head the Department of Veterans Affairs will likely do little to oppose the privatization of veterans' health care.

(AP Photo/José Luis Magaña)
(AP Photo/José Luis Magaña) David Shulkin O n March 28, the day after President Trump fired him, David Shulkin, the outgoing secretary of veterans affairs, took to The New York Times to warn of the creeping privatization that has long plagued the Veterans Health Administration (VHA). The Prospect has lamented Shulkin’s efforts to outsource more care to the private sector as well as his failure to strongly and effectively defend the VHA in the media and congressional hearings. Nonetheless, Shulkin is to be commended for now warning that “privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.” After getting rid of Shulkin, Trump’s new appointees to the Department of Veterans Affairs (VA) will certainly not oppose—and may actively promote—the dismantling of the agency. “The bad guys think they have won,” Rick Weidman, executive director for policy and legislative affairs for the Vietnam Veterans of America...

Studies Show Private-Sector Providers Are Not Ready to Care for Veterans

As Congress moves ahead with plans to outsource more and more veteran health care to the private sector, three high-profile studies should urge lawmakers to pump the brakes. The studies, published in recent weeks by RAND Corporation, Federal Practitioner, and the National Academies of Science, Engineering and Medicine, spotlight serious flaws in private-sector veterans’ care compared with the VHA, from suicide prevention to overall health care. In so doing, the reports underscore a critical fact: Despite their best intentions, few private-sector physicians, hospitals, mental health, and other health-care professionals have the knowledge, experience, and skill to provide the level of care veterans need and deserve.

Perhaps the most damning of those studies comes from the RAND Corporation. In a report entitled “Ready or Not?” researchers examined whether private-sector health professionals in New York state had the “capacity” and “readiness” to deal with that state’s 800,000 veterans in need of care. Such patients, the study noted, are on average older, sicker, poorer, and far more complex than the ordinary civilian-sector patient.   

The conclusion? Only 2 percent of New York state providers met RAND’s “final definition as ready to provide timely and quality care to veterans in the community.”

While the majority of providers said they had room for new patients, less than 20 percent of them ever asked their patients if they were veterans. Fewer than half used appropriate clinical practice guidelines to treat their patients, and 75 percent didn’t use the kind of screening tools commonly deployed in the VHA to detect critical problems like PTSD, depression, and risk of suicide.

Most providers had no understanding of military culture and less than one-half said they were interested in filling such knowledge gaps. Mirroring a similar study conducted by the VA and Medical University of South Carolina in 2011, RAND found that New York state providers had little understanding of the high quality of VHA care. Informed by media reports rather than medical journals, they had a negative view of the VHA and would be unlikely to refer eligible veterans to the VHA for needed care in programs in which the VHA actually excels.

Echoing the RAND study, another report by VA psychologist Russell Lemle in the Federal Practitioner warns that in the private sector, the quality of integrated mental health care for veterans lags significantly behind the VHA. Every VHA medical center, Lemle reports, has at least one trained suicide prevention coordinator who directs care for veterans at high risk for suicide. The VHA has also developed an algorithm to identify the veterans who are at the very highest risk of suicide and notifies their provider of the risk assessment, enabling preemptive intervention and expansion of services to the veteran. This and other programs explains why the rate of suicide of veterans not using the VHA increased by 38 percent between 2001 and 2014 while only 5 percent for those using the VHA. For veterans who had a “mental health or substance use diagnosis, the rate decreased by 25 percent.”

Finally, for veterans returning from the Iraq and Afghanistan conflicts, a prestigious National Academies of Science, Engineering and Medicine report released just four weeks ago found VHA mental health care to be “comparable or superior to that in the private sector.” The majority of veterans who accessed the system had “positive experiences” and appreciated VHA staff’s “respect toward patients.” This was despite serious shortages of mental health staff, as well as clinical and exam space, and confusion about how to access care—all of which could, and should, be improved. When veterans were asked whether needed services were provided in the VHA, 64 percent said they were. When they were asked about services they’d received in the private sector, only 20 percent said they got needed services.   

These studies should be a wake-up call to Congress. Countless reports have documented that there is little excess capacity—and a huge shortfall of knowledge—in the private sector when it comes to veteran health care. Until studies document the opposite—that the private sector’s doctors, nurses, hospitals and other health-care providers can match what the VHA does routinely—lawmakers should hold off on privatization efforts. Rather than spending money for more expensive private-sector care of lower quality, Congress should instead be working to strengthen the excellent care the VHA gives by providing funding to remedy any staff and resource deficiencies as well as to address management problems at the top.  

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