Dr. David Shulkin's ouster as head of the Veterans Affairs Department suggests the forces seeking full privatization of veterans' healthcare now have the upper hand in Washington. Their ill-informed schemes must be thwarted.
Healthcare leaders across the country have an irreplaceable role to play in the coming months when Dr. Ronny Jackson's appointment to head the VA and legislation revamping the Veterans Health Administration come before Congress. They need to publicly address the important role that VA facilities play in their communities, especially their innovative programs for meeting veterans' special needs.
The private sector is in no way equipped to handle the traumatic injuries, long-term rehabilitation or mental health and substance abuse issues that so many veterans face. Leaders must speak out honestly and forcefully about their own inability to quickly, effectively or cheaply serve those patients.
The claim that healthcare leaders back full VA privatization, included in several news accounts about Shulkin's firing, is a myth. The list of signatories to the June 2016 final report of the Commission on Care, which endorsed wider use of private facilities but within a clinically integrated system under VHA coordination, included every major healthcare leader on the panel.
They included chairperson Nancy Schlichting, former CEO of the Henry Ford Health System in Detroit; Dr. Toby Cosgrove, former CEO of the Cleveland Clinic; David Blom, CEO of OhioHealth; and Dr. Marshall Webster, a senior vice president at UPMC in Pittsburgh. The final signers did not include panel member Darin Selnick, who served as director of public policy in the Koch brothers-funded Concerned Veterans for America and recently returned to the VA after overseeing veterans programs at the White House.
Prior to the final report's publication, Selnick and three of the healthcare leaders offered what became known as the "strawman" report. They proposed turning the $200 billion VHA into a CMS-style insurance company that buys all services from the private sector.
Schlichting insisted on holding an all-day session to explore that alternative. It was soundly rejected by the full commission.
"We don't have a safety net for vets, many of whom are poor and have complex needs," Schlichting told me after Shulkin's ouster. "These are people who can't get their complex needs met in the private sector."
Much of the commission's final report is now contained in bipartisan legislation sponsored by Sen. Johnny Isakson (R-Ga.) and Sen. Jon Tester (D-Mont.), who sit on the Senate Veterans' Affairs Committee. The bill was almost included in the $1.3 trillion budget bill signed by President Donald Trump.
Every mainstream veterans' organization—but not Concerned Veterans—has endorsed the centrist approach in the bill. As rumors swirled that Shulkin's job was in jeopardy, its sponsors defended the VA secretary as did House Veterans Affairs Committee Chairman Phil Roe (R-Tenn.). "He understands healthcare; he understands large systems. He's the right person," Roe told Modern Healthcare politics reporter Susannah Luthi.
In a New York Times commentary that ran the day after his firing, Shulkin highlighted the substantial improvements at the VHA since the wait-time scandal made headlines in 2014 and led to the creation of the Commission on Care. Wait times have been reduced, mental health services have been enhanced, the disability appeals process has been shortened, and veterans' trust in VA services has risen to 70% from 46% four years ago.
"It seems that these successes within the department have intensified the ambitions of people who want to put VA health care in the hands of the private sector," he wrote. "I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans."
It's now up to healthcare leaders to convince Congress, the American public and the 9 million veterans served by the VA that it's not what they want.