Secretary of Veterans Affairs David Shulkin was fired this week, after which he wrote a New York Times editorial in which he said the reason he was forced out was because he opposed the Trump Administration’s plan to privatize health care services provided by the V.A.
One could observe that part of the reason he did this was to draw attention away from the fact that he is under fire for a controversial taxpayer-funded trip to Europe. That’s been in the news for months now, though, and as far as graft among Trump cabinet officials goes, he’s an amateur. I think it’s pretty safe to say that, had he not opposed V.A. privatization, he’d still have his job regardless of how badly he betrayed the public trust.
Let it also be said that whatever it was Shulkin did, it pales compared to the betrayal of trust that the privatization of the V.A. would represent.
To be clear, the V.A. has its problems. My brother is a war veteran who depends on the V.A. for the entirely of his medical care. Between what he has told me about his experience and what I have read about the experiences of other veterans, and based on publicly available information about the performance of the V.A., it is clear that the system remains rife with inefficiency, incompetence and waste. While some V.A. facilities provide excellent care — and while veterans and veterans groups overwhelmingly back the V.A. and have a favorable opinion of it — too many veterans still face long wait times for medical care, assuming they can even cut through the red tape required to get medical care. Part of this is due to all-too-familiar government inefficiency. A lot of it is due to sixteen straight years of war creating a massive population of sick, wounded and disabled veterans taxing a system that was not prepared to deliver medical care on such a scale and with such complexity. It’s also worth nothing that the V.A. is not unique when it comes to red tape, inefficiency and expense in medical care. We have a healthcare crisis as a nation that is not limited to caring for veterans.
For years politicians, both Republicans and Democrats, have paid lip service to funding and reforming the V.A. healthcare system, and there is no shortage of ideas on how to address its problems. Many of the ideas — indeed, some of the best ones — do involve participation of the private sector. This is particularly useful in the case of illnesses, injuries and disabilities that are not specific to veterans. Things like wellness services, health maintenance and other routine medical care. Ideally, under any set of arrangements, the V.A. and its expertise in treating veterans will prioritize care for those suffering the complex consequences of military service, be they battlefield injuries, both physical and mental, and longterm care unique to those who fought and served in wartime duty. Its mission in this regard should not be compromise. At the same time, we as a nation owe our veterans comprehensive medical care, and a veteran in need of blood pressure medication, a prescription to treat a case of the flu or routine outpatient surgery should not have to go without or wait months for care. To the extent private medical services can be utilized to fulfill the V.A.’s mission, it absolutely should be.
I do not suspect, however, that the V.A. privatization scheme Trump and his fellow Republicans have in mind is so limited.
Most privatization schemes floated by Republicans are cash grabs for the donor class. Initiatives which serve the decades-long Republican agenda of rendering the government an ineffective appendage of private enterprise with the ultimate aim being to reduce or eliminate taxes on the wealthy, free the business community from regulations that interfere with its ability to make money and to subsidize the private sector with public funds. The examples of this, both aspirational and already occurring under Republican leadership, are legion. We’ve become so used to the dynamic that it hardly registers to most people anymore.
To the extent Republican plans to privatize the V.A. track this model — and I would bet a great sum that they do — they would represent a new level of irresponsibility. Indeed, the idea is obscene.
Obscene because the one thing upon which even the most arch-conservative Randian fanboys can agree is that it is the responsibility of government to wage war. It is most serious and the most morally and ethically-fraught endeavor a nation can undertake and it is one that must, necessarily, be taken by a nation as a whole. That goes for both the waging of war and the paying of war’s consequences, be they economic or moral. The prospect of outsourcing the payment of those consequences to private business — especially private businesses who have paid to influence the decision to do so and who engage in a rent-seeking, profit-grabbing manner, which is an utter certainty under this president — is moral depravity.
Just as it is the nation’s responsibility to wage war, it is the nation’s obligation to care for those it sends to fight, kill, die and be damaged in those wars. The buck must stop in the public sector, not be shifted to the private sector. While there is a role for outsourcing medical care to private practitioners and hospitals, management, funding and, above all else, responsibility for the care of sick, wounded and disabled veterans remains a public obligation from which we can never walk away.
Fund and staff the V.A. and its hospitals and clinics, whatever the cost. Take responsibility for a generation — now two generations — of veterans who we, as a nation, have taken advantage of and who some wish to forget. Do not use the V.A. to further the Republican dream of marginalizing, scapegoating crippling and, eventually, eliminating government services for the public of which it is comprised and to which it is accountable.
