Evan Young, a retired army officer living in Arkansas, has reason to be upset with the Veterans Affairs healthcare system. Last year, when Splinter spoke to him, Young was in the middle of a lengthy battle with the VA over receiving post-operative care, laid up in bed for months on pain medication, and writing to his state reps for help. Today, while his immediate issues have been more or less dealt with, he’s still slamming out emails to the referral office, trying to find a doctor to do follow-up.
Young’s case may be a special one, insofar as he is the president and founder of the Transgender America Veterans Association and the operation for which he needed additional care was—and is—still considered by some Americans to be an affront to the flag. But in spite of all that, and Young’s nonchalant attitude towards being a political test case for the sprawling veterans’ health care system, today he speaks highly of the VA. “I love my VA here locally, you see other veterans, there’s camaraderie there,” he says.
The guys that are scheming to replace the VA with a private health care system, says Young, probably “don’t really care about veterans. This is just about putting more money in rich people’s pockets.”
This week, in another swift bit of capitol drama, President Trump removed Veterans’ Affairs head David Shulkin. He is to be replaced by Trump’s personal doctor—a man who, as one concerned veteran reminded me, once described the president’s health as being the result of excellent genes, “just like God made him.”
Ronny Jackson’s installation as the head of a 377,000-employee bureaucracy with more than 1,200 health care facilities has drawn criticism for a number of reasons, despite the attending controversy about Shulkin’s use of taxpayer money for his own travel. The doctor has no experience managing a large organization; his assertion that Trump, a man who regularly eats four McDonald’s sandwiches in a sitting, is the picture of health might lead one to believe Jackson is the truest of Trump sycophants. But the reshuffling—along with Shulkin’s New York Times op-ed this week framing his departure as the result of a power struggle over the privatization of the VA—is reviving concern that federally funded health care for the country’s 9 million veterans currently receiving care will soon be phased out.
Trump has characteristically muddled the issue, promising during his campaign to privatize the VA, and framing Shulkin’s departure as a move to give veterans “more choices.” Yesterday, a White House spokesperson covered for the president, telling Politico in an email there were “no plans” for privatization.
More telling are the comments from conservatives like Sarah Veradro, the executive director of the Independence Fund. “Obviously, as the White House physician, Admiral Jackson has the president’s trust, which will be vital in bridging the final barriers to getting real VA health care choice enacted into law,” she told the Army Times.
In Shulkin’s Times op-ed, he wrote of the “brutal power struggle” within the VA, and a private sector “already struggling to provide adequate care in many communities.” The industry, he wrote, “is ill-prepared to handle the number and complexity of patients that would come from closing or downsizing VA hospitals and clinics.” This latest privatization threat comes as rural states like Kentucky threaten to roll back or shrink Medicaid, effectively shuttering rural hospitals.
Since the announcement, veterans groups have expressed frustration with this unknown actor, and concern about the privatization efforts. Specialized care—for PTSD, for combat-related injuries, for Agent Orange-related diabetes, for military sexual trauma, for depression—will be increasingly hard to come by. Even in New York, a RAND report out this month found that private-sector doctors are wholly unprepared to treat former members of the military.
As Trump has begun to dismantle the Affordable Care Act by introducing private (and, often, predatory) alternatives to weaken the insurance pool, it’s likely we’ll see a similar chipping away at the VA. Among veterans themselves, there is concern that the “choices” offered by the new office will look a lot like Veterans Choice. Since a massive scandal hit in 2014 over veterans dying because of the VA’s excessive wait times for care, the program has allowed veterans who wait 30 days or more for care to use doctors outside the VA. Mariette Kalinowski, a former marine who worked with veterans in higher education programs for five years, says the Veterans Choice program is infamous for being difficult to navigate, and for surprise denials. The private-sector company that negotiates between hospitals and the VA, she says, engages in a lot of “shady back-and-forth.”
“Patients are being told, we’re not going to cover this elective part of the service” they had no idea they’d added, she says. Young has similar complaints about the program, having had to navigate it for his own care. “It took over a year of back-and-forth with the VA and the VA Choice program to finally understand that I couldn’t find any surgeon willing to accept the low-paying VA Choice” program, he says. “I know my case is out of the ordinary, but I can see how the low pay that the VA offers physicians will put veterans at the back of the line.”
Federally-funded healthcare for all veterans, despite the armed service’s reputation for conservative thinking, is a pretty radical idea: As one veteran told me last year, “Honestly, I don’t think a lot of people in the military realize just how socialist it is, that socialism is the entire lifestyle we’re living.”
Kalinowski, too, pointed to the more ideological issue at the heart of choosing to dismantle the existing VA structure, rather than reform it. “The VA can act as a template, as a litmus test, for true universal health care in America.”
“This community is used in a heartbeat by every politician during a campaign,” she says. “And then we are dropped as soon as the agenda turns.”