The Veteran Health Administration is the Best Healthcare Anywhere! (First report in a special series)

David William Pear
Senior Associate Editor

Luke Martin (Jon Voight), a wounded Viet vet, is a bitter guest of the VA in Hal Ashby's Coming Home (1978). Along with the press, much too often Hollywood has misrepresented the VA experience, denigrating its value.

[First Published by The Greanville Post.]

[dropcap]A[/dropcap]ccording to study after study the Veterans Health Administration (VHA) provides the best healthcare, has the best medical outcomes, and does so at the lowest cost of any other large healthcare program anywhere.  Its only mission is to provide the best healthcare.

The success of the VHA is owed to its being socialized medicine, and its dedicated doctors, nurses, medical personnel and employees.  The dedicated men and women of VHA prove that not everybody is motivated by profit.  In fact, most people are not.

The VHA is a federally-funded government healthcare system.  Unlike Medicare, Obamacare, and Medicaid it is not a health insurance program, which depends on the for-profit medial industry for healthcare.  At VHA the government owns the “bricks and mortar”:  the hospitals, clinics, etc.

VHA owns all the medical equipment.  It negotiates prices with suppliers and pharmaceutical companies.  All the doctors, nurses, medical staff and employees are government employees.  If that is not shocking enough to neoliberals, then consider that VHA employees are unionized by The American Federation of Government Employees (AFGE).

The plot to kill the Veterans Health Administration

In a sane world one would think that when something is so successful as the VHA, it would be embraced by the establishment as one solution to the nation’s healthcare crisis.  Instead the establishment has been trying to destroy VHA since its inception by President Lincoln in 1865.

BELOW: Reagan bloviating in 1981, presenting a medal of honor to Vietnam vets, whom he claimed were "real humanitarians in Vietnam." Behind their backs, he curtailed their services.

Over VHA’s 150 years it has had many ups and downs.  The current war against VHA began with President Ronald Reagan in 1987.  While Reagan was trying to kill the VHA, his soulmate in the UK, Margaret Thatcher had her daggers out for Britain's National Health Service (NHS).  Reagan was slashing VHA benefits even as he went around pinning medals on Vietnam era veterans.

Both the VHA and NHS have survived, but the war to kill them is still on.  The legendary journalist John Pilger is fighting now to save the NHS in the UK.  In the US, Veterans for Peace has taken up the challenge to save the VHA from privatization.  Many other legitimate veterans groups are also speaking out, and acting-out to save the VHA, such as  Veterans Say No to Privatization.

The VHA is setting a “bad” example for neoliberals.  All of the neoliberals’ privatizations of government enterprises, austerity for the middle-class and poor, and easy-money for the banks called “quantitative easing” have proved to be disasters.

After over 10 years since the Great Recession of 2008, failed neoliberal economic policies have worsened inequality, wages have been stagnant, and the US economy continues to sink in its ability to provide the basic necessities of life to the American people.  Obamacare turned out be an insurance fraud and a flop.

If the continued push of neoliberalism does not make sense, then it is because you do not recognize corruption.  Privatization of state-owned enterprises is a conspiracy between corrupt politicians and corrupt corporations to defraud the public.

Socialized medicine at the VHA works great, even according to NATO’s think tank the Rand Corporation.  In a 2018 study it admitted that the VHA did better than all other large US healthcare programs:

“VA hospitals generally provided better quality care than non-VA hospitals and the VA's outpatient services were better quality when compared to commercial HMOs, Medicaid HMOs and Medicare HMOs…Consistent with previous studies, our analysis found that the VA health care system generally provides care that is higher in quality than what is offered elsewhere in communities across the nation.”

So, study after study consistently finds that socialized medicine does best.  The only reasons they want to kill the VHA is so that corporations can raid its $200 billion a year budget, and to destroy a good example that makes neoliberalism and capitalism look bad.

The corporate lobbyists for the private healthcare and health-insurance companies have been circling Washington like vultures. They don’t care about veterans, and neither do the corrupt politicians.  All they care about are bribes and corrupt profits.

The mainstream media is part of the conspiracy to kill the VHA. Six major corporations own 90% of the mainstream media:  General Electric, Newscorp, Disney, Viacom, Time Warner and CBS.  Not only are some of these companies in the healthcare business, but they have interlocking boards of directors with other corporations that are.

The corporate mainstream media can be counted on to sensationalize any scandal, real or imagined, at the VHA.  They can also be depended on to not cover any good news about the VHA, such as the Rand Corporation study.  None of the mainstream media outlets covered the demonstrations of veterans across the country for “Veterans Say No to Privatization”.

ABOVE: The corporate mainstream media can be counted on to sensationalize any scandal, real or imagined, at the VHA. 

All veterans and their families should have access to VHA        

The politicians, capitalists, and patriots all say they love veterans.  It is a lie meant for war propaganda and to brainwash the public.  Wars are for profits, and the soldiers and veterans are cannon fodder.  As Henry Kissinger infamously said:

“Military men are just dumb, stupid animals to be used as pawns in foreign policy”.

Kissinger’s slip of the tongue was one of those moments when a power elite told the truth.  Not willing to be sacrificial pawns of US foreign policy themselves explains why so many warmongering neocons are chickenhawks.

All US wars have been based on lies.  US foreign policy and war goals are to protect the interests of US corporations.  Wars are not fought in the interest of the American people.  Wars are how capitalism raids the resources of the world for profiteers.  Wars make the American people less safe, not more.

Historically, veterans benefits were always viewed by the power elite as handouts.  After wars, veterans’ benefits are usually cut, as Ronald Reagan did in 1987.

Now with the US in perpetual war, veterans’ benefits are seen by the power elite as a necessary part of war propaganda, but still as just handouts to be snatched away if peace ever comes.  Even for current era Gulf War veterans, 80% of their claims for Gulf War associated illnesses are denied.  In 2016 the VHA had its budget cut by $690 million, depriving about 70,000 veterans of VHA care.

As it is, of the 20 million living veterans from all wars, only about half qualify for access to the VHA.  There is a priority system for qualifying for access.  Those veterans with a permanent disability from their military service are in a top priority.  For those with less than a 50% service-connected disability they must pay copays for VHA healthcare.  The copays are set by Congress, and are charged to veterans because of the mentality that VHA benefits are a handout.

Of the 10 million veterans that do not qualify for access to the VHA, it is estimated by the National Institute of Health that about 2 million have no access to healthcare coverage whatsoever.  The immediate family members of all veterans generally do not qualify for access to the VHA, either.

So, while the VHA provides excellent care for many veterans, there are many gaps where large numbers of veterans and their families are not eligible.  In a rational world where the VHA is recognized as the best healthcare alternative, has the best medical outcomes, and does so at the lowest cost, then it would make sense to expand it to all veterans and their families.

Capitalism is not rational.  It has only one priority, and that is profits.  Best medical practices, patient outcomes, and helping people do not fit the capitalist mold.  It is no mystery why making profits and the practice of medicine are a conflict of interest.  Under socialized medicine there are less conflicts of interest that put other interests ahead of providing healthcare.

Since VHA is not profit driven, it can focus on conservative medicine.  As the Hippocratic Oath says, “do no harm”, and it is a guide to VHA.  Unnecessary tests and procedures expose patients to harmful radiation and have other long-term risks.

Unnecessary surgeries and hospitalizations increase the risk of errors, infections and other complications.  It is estimated that hundreds of thousands of patients die every year due to medical errors and malpractice.  It may be higher when deaths from unnecessary treatments and medications are included.

Unnecessary surgeries, procedures and tests are recognized as a serious problem by the National Institute of Health,:

“Patient safety in surgery has historically suffered from a lack of physician-driven initiatives aimed at recognizing, preventing and mitigating medical errors and surgical complications…This unrecognized problem has escalated so far that medical errors currently rank as the 3rd leading cause of death in the United States… What do we mean by unnecessary surgery? We define this as any surgical intervention that is either not needed, not indicated, or not in the patient’s best interest when weighed against other available options, including conservative measures”.

It deserves repeating with emphasis:  Medical errors currently rank as the 3rd leading cause of death in the US.  A study at Johns Hopkins confirmedthe results of the NIH study.

Imagine a system that reduces medical errors, thus saving lives.  VHA has done it by following proven conservative medical practices, instead of the profit motive.  When the VHA’s preventive medical care is included, then the superior outcomes of the VHA are even higher than studies show.

How privateers are trying to destroy VHA Healthcare:

Highly publicized isolated scandals at VHA open the door for privateers to claim that VHA is a broken system.  While nothing could be further from the truth, the media and bribed politicians have been able to use VHA as a whipping-boy, a phrase that came out of slavery when Africans were literally “whipping boys”.  Capitalism has always seen human beings as a commodity to be exploited.

The Edward Hines Jr VA Hospital, near Chicago. Intended to be state of the art in most respects.

It is easy to convince the public, which has already been brainwashed that government doesn’t work, that the VHA doesn’t work either.  Oligarchs such as the Koch brothers, Walton family, and the Bill Gates of the world set up phony “non-profit” organizations to further their cause of profiting by privatizing VHA.  The oligarchs create phony veterans’ groups to go along with privatization, always called “reform” or “choice”.

Donald Trump used the VHA as part of his platform in his 2016 presidential campaign.  All during 2016, Trump’s stump speech repeated that veterans had long wait-times at VHA, and that the VHA could not get rid of overpaid, incompetent and lazy doctors.  His flag waving stump speech went like this:

"Four years ago, our entire nation was shocked and outraged by stories of the VA system plagued by neglect, abuse, fraud and mistreatment of our veterans…and there was nothing they could do about it. Good people that worked there, they couldn't take care of the bad people -- meaning 'You're fired, get the hell out of here”.

In a less flamboyant, but just as corrupt way, Barack Obama raided the VHA budget with a program of private for-profit healthcare.  In 2014 he signed the “Veterans Choice Program”.

Under Veterans Choice a veteran who lives more than 40 miles from a VHA facility and experiences over a 30-day wait-time to see a VHA doctor can see a private doctor instead.  The VHA of course picks up the tab.  Veterans Choice drained $5.2 billion from VHA.

Trump fulfilled his campaign promise by getting the VA MISSION Act of 2018passed.  The VA Mission Act is estimated to drain $55 billion from VHA over 5 years.

Under the VA Mission Act, veterans who have a wait-time of more than 14 days for an appointment, or must drive for over 30 minutes may seek private care.  Who doesn’t have to drive over 30 minutes unless they live next door to VHA facility?

Unmentioned is that according to the Government Accounting Office (GAO), wait times of for-profit private care for veterans would likely jump to 70 days.  At the VHA, the issue of wait-time is a phony issue.  A January 2019 study published by the Journal of the American Medical Association showed that the average VHA wait-time was 17.7 days, while the private-sector average was 29.8 days.

The privatization of VHA is all about profits and ripping off veterans.  It has nothing to do with the quality of care, the medical outcomes, the wait-time, or cost.  VHA beats the private healthcare platform in every category.

The VHA is a comprehensive, holistic, healthcare system

The Veterans Administration healthcare is the best healthcare anywhere because it is a comprehensive and holistic healthcare program.  It strives not only to treat sick and injured veterans, but to keep them well through preventive healthcare.

ABOVE: Note the double-edge slant used to report this news. Is it good? Is it bad? Are they praising or damning? At best they are casting shade on a moment that should be celebrated, begrudging the cost as if it was the fault of the VA instead of the corrupt politicians and capitalist system in which it is unfortunately embedded. This is typical of the media's posture toward the VA. They consider it "tough love reporting".  The continued attacks on the VA have an ulterior motive: to privatise it, or reduce its "public bill" drastically, as the ruling plutocracy knows America will be creating many more veterans, many seriously wounded, on account of its endless "wars of choice"

The VHA has a lifetime relationship with veterans.  So, VHA saves money in the long-run by keeping veterans healthy.  Veterans have better outcomes by staying healthy.  The VHA is on a mission to provide the best healthcare.

Preventive care is not profitable for private healthcare providers.  That is why for-profit healthcare and health insurance does not focus on preventive care.  Preventive care is not a big-ticket profit center for doctors and hospitals.  Since employee benefit plans change providers often, even HMO’s find preventive care unprofitable.

As an example, for a private practice cardiologists there is no money in advising a patient to eat healthy, lose weight, quit smoking, exercise, and take aspirin.  The VHA has preventive programs to help veterans with healthy eating, weight loss, smoke cessation, and physical fitness.  You will not find those programs even at the best of private HMOs.

Here is what one typical private cardiologist says, and you be the judge of the medical conflicts of interest in private healthcare:

“I put in over 200 stents per year. I work for a group of 4 cardiologist. The cost of a stent is anywhere from $1,500 to $3,000. The overall cost to do the procedure, what the hospital charges is anywhere from $16,000 to $22,000.”

Other private doctors approach healthcare the same as the cardiologist above.  The private healthcare industry makes its big money by doing expensive procedures, surgeries, hospitalizations, and ordering a lot of expensive tests, and writing prescriptions for expensive medicine.  There is no profit motive in conservative and preventive healthcare.

The doctors, nurses, staff and employees at VHA are salaried, so they are free to focus on healthcare.  There still are many dedicated doctors and healthcare professionals who go into medicine for the right reasons, instead of for a golden brick road to riches.

Important contributions to healthcare and reducing medical errors is VHA’s dynamic medical records technology, conscientiously following best medical practices, and providing preventive healthcare.  The VHA has no incentive to risk veterans’ lives by doing unnecessary procedures and irresponsible surgeries.

Veterans Health Information Systems and Technology Architecture (VistA)

The VHA was an early pioneer in electronic health records (EHR).  Four decades ago a group of VHA doctors working on their own time, and unauthorized, invented a computerized health record keeping system.  They named it Veterans Health Information Systems and Technology Architecture (VistA).

With VistA doctors, nurses and medical staff could keep veterans’ medical records on a computer network, instead of on the old-fashioned paper records.  On VistA a veteran’s medical records and medical history is updated with new medical information, doctors’ orders, hospitalizations, immunizations, lab work, x-rays, etc. and medications.  In the 1980’s VistA was revolutionary.  It was also open-source technology, meaning all health organizations could use it free.

VistA improved the efficiency of veterans’ medical treatment, reduced medical errors, updated preventive care needed, and provided for pharmacists to review all medication.  With VistA a veteran can go to any VA facility anywhere and get the same quality of follow up medical care.

Unexpectedly, VistA turned into a revolutionary medical research tool.  With long-term records of veterans, VHA was able to research which treatments had the best outcomes, track the cause of medical errors, reduce unnecessary surgeries, and isolate the source of hospital acquired infections.  VistA improved the development of best medical practices.

Decades later when the private healthcare industry caught on to EHR, their concern was to use it for billing.  That speaks volumes about the priority of private healthcare.  It has only been in the last decade that the private healthcare industry has started struggling with electronic medical recordkeeping.  The private sector is still struggling because most private healthcare is disjoined, scattered and ad hoc.  Private healthcare does not have a comprehensive medical record keeping capability.

In the 21^st century, private healthcare is still in the clipboard era, and healthcare providers expect patients to check off the boxes and fill in the blanks of their medical history.  Even HMO’s such as Kaiser Permanente, Cleveland Clinic and Mayo Clinic are trying to catch up to the VHA on EHR.  Even those private medical facilities which have comprehensive medical recordkeeping, they are using systems that were originally designed top-down for billing.

Many dignitaries from foreign national health care services beat a path to VHA, so that they could  emulate the VistA free open-source technology.  They came from Germany, France, Japan, and many other countries.  They still are coming.  In 2018 Open Source EHR Alliance (OSEHRA) announced that it is launching VistA internationally.

Sadly, VHA which invented VistA will not be a party to the international initiative.  The Trump administration has decided to scrap VistA.  Instead, the VHA will be privatizing its EHR-system with a commercial off-the shelf electronic health record keeping system.

The privatization of VHA electronic health records

The corrupt politicians and commercial IT vendors have succeeded in destroying VistA at VHA.  Trump and Congress have decided to spend billions of dollars from VHA’s budget on installing a top-down off the shelf commercial EHR.

In May of 2017 the Secretary of the Veterans Administration David Shulkin announced that the VHA is seeking to “build private-public partnerships to improve veterans’ care”.  A private-public partnership is where the public pays, and the privateers profit.  Said Shulkin at the announcement:

“Twenty percent of our system is running on out of date IT. And 75 percent of the IT budget is spent on just maintenance. Our legacy systems are old and crippling, while our schedule and maintenance systems are outdated.”

In June of 2017 Shulkin announced that VistA would be replaced with Cerner, a hybrid medical billing and EHR system.

In March of 2018 Shulkin resigned after the Inspector General reported that Shulkin was “improperly accepting gifts, misrepresenting travel plans, and using a VA worker for personal travel.”  Anyway, regardless of the corruption…

On May 18, 2018 the VA signed a no-bid $10 billion contract with Cerner.  Cerner is the same system that Trump’s Department of Defense gave a $4.3 billion no-bid contract to for an EHR-system, and it has been a disasterimplementing.  Cerner has already had 60% in price overruns for VHA, and it has not even started.  The original no-bid price tag has gone from $10 billion to $16 billion.

In explaining the price overrun, Executive Director of the federal government’s Office of Electronic Health Record Modernization John Windomtold Congress that:

“We have to have highly qualified subject matter experts to grade the implementation efforts of Cerner. Those people in the industry cost money.”

In other words, kaching-kaching, it is going to take years, many snafus and big cost overruns to get Cerna up and running.  The target date for a pilot program of Cerner is March of 2020, but don’t hold your breath or your wallet.

In July 2019, VHA announced that it would have to spend another $5 billion to transition VistA to Cerner:

"As the nationwide Cerner rollout progresses, VA will decommission VistA instances as necessary,"

Dr. Paul Tibbits, executive director of the office of technical integration in the VA's office of information and technology said at a hearing, adding:

"During the transition period VA must maintain VistA to ensure current patient-record accessibility and continued delivery of quality of care."

In 2019, the VHA reported to the GAO that from 2015 to 2017, the marginal cost of operating VistA was only $2.3 billion.  That is a big difference than the tens of billions of dollars being churned by the appropriately named Cerner.  The lower cost to VHA for VistA was because it is internally maintained.

For a fraction of the cost of Cerner, VistA could be updated.  It could also join the international initiative to take VistA international.  Can you imagine the advantages of being able to go anywhere in the world and healthcare providers have access to all of you medical records if needed?

Yep, as noted above, John Windom said about Cerner:

“Those people in the industry cost money”.

They sure do, and Niam Yaraghi of the Brookings Institution predicts that Cerner will be a failure:

“VHA’s legacy EHR system, VistA, has been ranked amongst the best EHR system by physicians… VHA was the pioneer of patient-mediated exchange solutions: their [My HealtheVet] Blue Button technology allows consumers to access a single, downloadable file with their available health data. It is disappointing to see VA adopting outdated solutions [Cerner] while the rest of the industry is finally implementing the exchange solutions [My HealtheVet] invented by VA many years ago.”

My HealtheVet

My HealtheVet is another information technology invented by the VHA.  It was launched in 2003 by VHA so that veterans can access VHA services and their medical records online by interfacing with VistA.

My HealtheVet empowers veterans to be proactively involved in their healthcare.  In 2018, My HealtheVet received the Top Public Sector Innovation Award.

With My HealtheVet, a veteran can get all of his medical records online.  He can review his appointments, make and cancel appointments, send and receive messages with any of his doctors.  He can contact all the departments of VHA, order prescription refills, add non-VA medicines to his records, and keep all sorts of healthy living and preventive healthcare journals.

With My HealtheVet, a veteran can share all of his medical records with trusted family and guardians, and with non-VHA health providers.  So, no matter where in the world a veteran may be, he can access his medical records for himself or for a non-VHA healthcare provider.

One example of a benefit of My HealtheVet is that for an aging veteran with dementia, he can have one of his trusted children keep up with his medical records.  She can make sure that her father takes the red pill in the morning and the blue pill at night.

The future of My HealtheVet is limited only by one’s imagination.  VHA has some damned good people with lots of imagination, too.

Save the Veterans Health Administration from privatization

Corrupt politicians, for-profit private healthcare businesses, peddlers of information technology companies, Wall Street financial institutions, pharmaceutical corporations, phony “non-profit” foundations, and the corporate mainstream media are conspiring to privatize the VHA.

The VA is now introducing hyperbaric chambers at many facilities, to treat special conditions, including PTSD.

The Koch brothers’ phony “Concerned Veterans of America”  and the other privateers say that they just want to give veterans a choice.  It is a lie.  They want to get a rake of the $200 billion public budget for VHA.  They have done the same with other government functions such as public education, transportation, infrastructure projects, prisons, and even military mercenaries such as Blackwater.

The neoliberal economic policies of capitalism have proven over and over that they are failures.  Capitalism is an unstable corrupt economic system.  Neoliberalism has destroyed nations and in the process it has ruined the lives of millions of people.  The only ones who have benefited from neoliberalism have been the profiteers.  As they got richer, the rest of humanity has gotten poorer.  The 18^th century capitalist experiment of Adam Smith has degenerated into neo-feudalism.

Socialism has proven over and over again that it is the best system for delivering the necessities of life such as healthcare, education, mass transportation, food security and vital infrastructure.  The success of socialism is why capitalist USA is always militarily attacking socialist countries.  The success of socialism is seen as an existential threat to capitalists.

The countries that have strong government social programs for human development rank at the top of the UN Human Development Index.  Those countries that are destroying their government social programs keep falling further behind.  The US now ranks at 24^th of the developed countries.  The trend is going further down.

The VHA has proven that it is the best healthcare model.  Socialized insurance programs such as Medicare in the US and Canada have proven that they are a good second-choice solution to the healthcare crisis.  The worst possible healthcare is for-profit insurance-based healthcare.  Neoliberals, capitalists and profiteers keep pushing the worst profit-driven healthcare system because they are greedy.

Veterans Healthcare for all

It is not VHA’s fault that many veterans are denied benefits or that it takes too long to process claims to qualify for veterans’ benefits.  Congress and the President deserve all the blame since they control access to VHA.  They are stingy because they still consider VHA benefits a handout.

The priority ranking and the benefit claims system should be eliminated.  All veterans should automatically have lifetime access to the VHA as soon as they are discharged from active military service.  All copays should be eliminated.  Only Congress and the President have the power to grant and fund expanding VHA benefits.

The privatization of healthcare is all about profits and ripping off the public.  It has nothing to do with the quality of care, the medical outcomes, the wait-time, information technology and cost.  VHA proves that socialized medicine beats the private healthcare platform in every category.

Expanding the VHA to cover all veterans and their families would help in tackling the healthcare crisis in the US.  Healthcare coverage like VHA should be considered a human right for everybody.

Source document (stripped): VHA the Best Healthcare Anywhere