, , , , , ,

An article in the St. Louis Post-Dispatch (4/14) lamented the fact that the local VA hospital was having trouble finding anyone to take the facility’s medical director position. The article cited two main reasons for this situation.

First, was the issue of pay. The Post-Dispatch pointed out that while a similar position in the private sector would pay in the vicinity of $349,000 a year, directors at the the VA have a salary range of $121,956 to $183,300. I don’t know about you, but I’m pretty sure that a salary of about half the going rate isn’t going to get many takers. We all know, too, that those who are willing to work for less might not be quite the very best talent that can be found.

Second, the article pointed out that there has been lots of publicity about shortfalls in VA service over the past couple of years, resulting in lots of heated rhetoric and excessive political meddling in the VA’s management . Nobody wants an underpaid job where oversight means your efforts to succeed will undermined by demogogues and micromanagers who seem to be looking for reasons to cut funding essential VA funding.

It is not really surprising that administrators at the VA are underpaid relative to the market. One need only look at the spending cuts that congressional Republicans wrung out of the Obama administration since 2010 to understand that more than administrative pay may have been compromised by the indiscriminate GOP budget ax – and at a time when the VA system has had to accommodate a large influx of wounded veterans returning from Iraq and Afghanistan. The most recent Republican appropriation was $1.7 billion below the amount requested by the president.

Given the state of VA funding, more is at stake than administrative salaries; a corresponding slippage in service levels would not be surprising. And there have indeed been reports of long delays in receiving service which, if the stories are to be believed have in some cases resulted in the deaths of those on the waiting list.

Nevertheless, despite the prevalence of such horror stories in the media, a large majority of veterans respond positively (pdf) to surveys about their care in VA hospitals (see also here). A report by Alicia Mundy in the Washington Monthly, “The VA is not broken – yet,” quotes from several recent studies that find “the VA still generally outperforms or matches the rest of the health care system on most measures of quality.”

How do we explain the apparent contradiction between surveys that report high levels of patient satisfaction and the widely disseminated stories of VA failures? Is it possible that the VA horror stories might not be true? Mundy tells us unequivocally that this is indeed the case. Kevin Drum succinctly summarizes her findings:

There were some problems in Phoenix, where employees had gamed the system for recording wait times. However, there was no evidence that this problem was widespread; there was no evidence that it caused any deaths; and there was no evidence that care had been compromised.

Mundy assigns blame for the false accusations to free-market Republicans, who abhor the VA as a bastion of socialism, along with health-care businesses that hope to profit if the VA medical system is privatized. In particular, she singles out the Concerned Veterans for America (CVA), a creation of – who else – the Koch brothers, as an important player in the effort to create a false sense of crisis at the VA:

… Seldom, however, has one of their investments paid off so spectacularly well as it has on the issue of veterans’ health care. Working through the CVA, and in partnership with key Republicans and corporate medical interests, the Koch brothers’ web of affiliates has succeeded in manufacturing or vastly exaggerating “scandals” at the VA as part of a larger campaign to delegitimize publicly provided health care.

The CVA smear provides cover for GOP fellow-travelers so that they can face down the numerous veterans groups that have reacted with horror at the suggestion that VA medical services may be privatized. They have also managed to stampede some of the centrist, red or reddish state Democrats – like our own Senator Claire McCaskill – who are perpetually trying to prove to closed-minded conservative constituents that they are open-minded enough to entertain criticisms of liberal institutions. right wing fantasies.

Mcaskill was gung-ho when it came to 2014 legislation to “reform” the VA system which gave us the ill-considered and unsuccessful Choice Card that allows veterans to get private care on the VA dime, as well as setting up a commission to make recommendations about further “reform.” Many of the members of this commission have a partisan bias against the VA; they include members from health care industries that stand to profit from privatization of VA services and the CVA itself. The only groups not represented are veterans organizations that strongly support the VA.

Although McCaskill has been more than ready to endorse the “broken VA” storyline, her actual proposals seem to have been modest and fairly reasonable and, to my knowledge at least, she hasn’t indulged in privatization rhetoric. There’s reason to hope she’ll pick up on the GOP con and will have the courage to resist it even though it seems tailor-made for certain noisy Missouri constituencies. We’ll need her if the VA, one of our government’s success stories, is to survive this most recent, dishonest onslaught. As the saying goes, “if you’re not at the table, you’re on the menu.”

N.B. I would suggest that you read the Mundy Report, and Paul Glastris’ response to conservative criticisms of the Mundy report. They’re all relatively short. If you’re interested in the political process currently underway, this Boston Globe article will be of interest, along with this article from The American Prospect