For the last year, Veterans Affairs Secretary David Shulkin insisted the VA would not be privatized on his watch. Now, thanks to a Koch-supported coup at the top of the second-largest department in government, his watch has ended — and the battle over privatization persists.
For years the Koch brothers have been hovering around the Department of Veterans Affairs and its $186 billion budget like vultures surrounding a carcass. The billionaires have been pushing a radical legislative agenda, using the front group Concerned Veterans for America. Their goal is to dismantle the Veterans Health Administration (VHA) — the only system of socialized medicine in the United States — to the benefit of for-profit providers.
So, one can only imagine the glee felt in the Kochs’ offices on Thursday when the president finally sent Shulkin packing. The VA Chief had retained the support of most Veterans Service Organizations (VSOs), which generally are opposed to privatization of the VHA, but it was not enough to save his job. This is a strong indicator of the Kochs’ influence over the Trump administration on veterans’ issues.
Experts and advocates now fear that Ronny Jackson, the White House doctor and Trump’s pick to replace Shulkin, will rubber-stamp the Koch agenda. “I think [Jackson] will be a puppet that will put the VHA and the VA on a starvation diet,” said Suzanne Gordon, a journalist and author who covers the VA, in an interview with Democracy Now.
Among the legislation the Kochs are pushing is the Veterans Community Care and Access Act (S.2184, which was introduced by Sens. John McCain and Jerry Moran), the Veteran Empowerment Act (HR.4457, introduced by Rep. Doug Lamborn), which seek to privatize much of the VHA, and the Vet Protection Act (HR.1461), which would weaken the rights of VA employees.
Passing this legislative agenda would radically remake the VA in the Kochs’ image. Can anyone stop it from happening?
Privatization of VA Enters Mainstream Debate
Shulkin’s firing brought one silver lining for those seeking to preserve the VHA. The drama surrounding the firing — and the curveball appointment of Trump’s physician to replace him — has elevated the issue of the privatization of the VHA into the national debate.
Shulkin did not go quietly after his dismissal. He penned an op-ed in The New York Times and appeared on shows like “Meet the Press” to pointedly explain why he was removed.
“They saw me as an obstacle to privatization who had to be removed,” Shulkin wrote in the Times. “That is because 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.
“His ringing defense of the VA in the New York Times is very important for people to read. I’m sad that [he] didn’t articulate that kind of defense earlier,” Gordon said. “But the fact that he’s [speaking out on privatization] now is really to be commended.”
Shulkin’s language was not very different from that of Sen. Bernie Sanders, who said at a news conference in Vermont, “The firing of Shulkin has everything to do with the administration’s desire to privatize the VA, and I think that that is a disastrous idea.”
This has led to a rare public discussion of VA privatization — and the role of the Koch brothers in advancing the cause — in the dominant media. Jackson’s confirmation hearings could provide more chances to educate the public about the Koch’s war on the VHA. Democratic opponents will have a chance to step up and confront Jackson on these privatization efforts in public.
The fact that Trump chose his own White House doctor to replace Shulkin only adds to the media’s interest in the pick. It seems likely that the process of replacing Shulkin will take place with a much wider audience than it would have if Trump had made a less controversial decision.
“We know nothing about what Dr. Jackson stands for and what his vision is for the VA,” Sanders said of Jackson on CBS’s Face the Nation.
Koch-Approved Legislation: Exploitation of Choice
This mysterious physician, however, may well end up running the largest health care system in the United States.
So, what do the Kochs have planned for the new VA chief? They do not make you search hard for these answers. In Concerned Veterans for America’s statement responding to Shulkin’s firing, they celebrate that the “distractions” are over and quickly pivot to their legislative agenda.
“Concerned Veterans for America’s grassroots leaders flew in from around the country earlier this month and held nearly 100 meetings with legislative leaders to discuss the group’s policy agenda,” the statement reads.
It then lists its legislative agenda. The top two bills it is pushing would, to varying degrees, fundamentally alter the VHA through privatization: the Veterans Community Care and Access Act (S.2184) and the Veterans Empowerment Act (HR.4457), which is sponsored by Rep. Doug Lamborn, a Republican from Colorado.
These two pieces of legislation must be considered in the context of the 2014 VA Scandal, when VA employees were accused of falsifying records about long wait times. After the wait-time scandal, a bipartisan agreement called Veteran Choice Act of 2014, allowed veterans who do not live near a VA clinic, or are subject to long wait times, to seek care at a private provider.
There was no real opposition to this plan, which created the Veteran Choice Program, and it was supposed to be an emergency measure. “This particular program was authorized as a temporary fix in the midst of a crisis,” said Allison Jaslow, executive director of Iraq and Afghanistan Veterans of America, in an interview with The Atlantic. “We always viewed it as an experiment.”
This experiment, however, has turned into the primary means by which the GOP is trying to privatize the VA. The program was set to expire this year, but Trump extended it in April and December 2017. Now GOP legislation, supported by the Koch brothers, would, as Nikki Wentling of the Stars and Stripes reported, “overhaul the controversial Choice program and create a network of community medical providers that veterans could use at taxpayers’ expense.”
The more radical of the Kochs’ two bills is Lamborn’s legislation, which was introduced in November. The Veterans’ Empowerment Act, as Wentling describes, “mirrors a proposal from the conservative group, Concerned Veterans for America, which is part of the Koch brothers’ political network, to create a government-chartered organization to operate a new veterans health insurance system.”
The bill drew immediate resistance from opponents of privatization, such as the Veterans of Foreign Wars (VFW). “We hope that it has absolutely no chance of becoming law,” said Carlos Fuentes, legislative director for the VFW, in response to Lamborn’s bill.
The Kochs, who, according to The Wall Street Journal, are spending millions to influence this debate, praised the bill. In an op-ed for The Hill, Dan Caldwell, executive director of Concerned Veterans for America, said the bill would ” truly expand veterans’ health care choice in an effective and sustainable way.”
The Veterans Community Care and Access Act (S.2184, which is sometimes called McCain-Moran) is similar to the Lamborn bill but not quite as militant. Unlike with the Lamborn act, under McCain-Moran the VA is maintained “as a gatekeeper to private-sector treatment,” Wentling reports, whereas the VA can be bypassed entirely under the Veterans Empowerment Act.
“The bill would require the VA to use objective data on healthcare demand to set standards for access and quality, and to identify and bridge gaps in veterans’ care — whether in VA or community facilities,” according to a press release from Moran about the bill.
“It is as if they want the VA staff to serve as billers for the private sector,” Gordon told Truthout.
The McCain-Moran legislation goes well beyond the accommodations made for rural veterans as envisioned by the Choice program. Some estimate that “McCain-style privatization” could triple the cost of veterans’ care to almost $450 billion a year.
Both the Lamborn and McCain-Moran bills also overlook the possibility that the private sector is not ready for the specific health needs of veterans, according to a Rand Report published in March, which studied New York State providers. The report found that private providers knew “little about the military or veterans” and are “not routinely screening for conditions common among veterans,” among other critiques.
“These bills have lots of nice words, about empowerment, or choice, but what those bills do is hurt veterans,” said William Attig, executive director of the Union Veterans Council, AFL-CIO, in an interview with Truthout. “There is a lot of money for some to make by farming out services to the private sector, but what the VHA needs is to be fully funded, not privatized.”
The Kochs’ attack on the VA is also an attack on federal employees and public-sector unions. Their legislative agenda includes the Vet Protection Act (HR.1461), which makes it easier to fire employees and tries to weaken public sector unions.
Concerned Veterans for America says the bill would involve monitoring “the amount of time VA employees can devote to union activities during work hours and ensure clinicians are doing the work the VA hired them to do — care for patients.”
The law is an attack on the collective bargaining rights of federal employees at the VA, according to the National Federation of Federal Employees.
“This legislation does not help veterans or taxpayers. Rather, it serves only to weaken federal employee unions,” the union said in response to the proposal.
The Fight Ahead
These big legislative efforts are ongoing, as are other acts of “stealth privatization,” such as hiring freezes, and plans laid out in the Trump VA budget, which undermine the VA without an act of Congress. These practices are likely to continue.
From a wider-angle lens, the goal of the Koch brothers is not just to pass these bills to dismantle the VHA, but to undermine the very idea of government-run health care.
However, while the Kochs have enormous resources invested in their effort to dismantle the VA, there is organized resistance from most Veterans Service Organizations, as well as from progressives like Bernie Sanders, who seek to defend government-run health care on principle.
With the Koch brothers’ role in trying to privatize the VHA now a matter of national debate, the best way to maximize opposition to their agenda is to make sure the US public knows who is most hurt by it: veterans.