The PBS Docu-Drama on VA Healthcare

In early November, PBS aired a program it’s billing as a ‘documentary.’ But unless there is some critical post-production editing, VA: The Human Cost of War is anything but an honest portrayal of the nation’s most successful and largest coordinated health care system.

While the film has big ambitions, promising to explain how the VA “came into existence, how and why it has changed over time, how it has come to be broken in critical ways in recent generations and how it may be reformed going forward” it conveniently cuts from scene to scene, absorbing some facts while discarding others to fit its predetermined narrative. And although it promises to be comprehensive, it fails to cover even a sliver of the VA’s real story in its less-than-an-hour runtime.

The film will be released at a particularly perilous period for America’s veterans. Congress is currently deliberating whether to further shave away Veterans Health Administration resources and critical care programs in order to outsource services to the for-profit healthcare industry.

A veteran and Fighting for Veterans Healthcare board member was invited to an advance screening in Los Angeles and reports that the film left her head spinning. How had the production team gotten it so wrong?

Here are five big ways the film misses the mark upon the first viewing. The film:

1. Employs a simple narrative to explain the incredibly complex wait list scandal

VA: The Human Cost of War only examines the wait list crisis through the lens of salacious media reporting. What was the cause of so many veterans waiting for care? According to the film, we’ll never really know.

It never mentions crucial elements to the whole story. It never: 

  • Highlights the chronically high number of VA caregiver vacancies which left fewer doctors with more patients.
  • Mentions the unrealistically high standards VA set for itself that pushed medical centers.
  • Questions why Congress did not provide the VA with the resources it needed (and requested) as American troops were deployed in the War on Terror.
  • Explains the role of politically-motivated organizations like the Koch Brother Network-funded Concerned Veterans for America (CVA) that pounced on the scandal in an explicit effort to defeat Democratic lawmakers at the polls.

The unprecedented politicization of America’s veterans is rarely mentioned in mainstream media that reference CVA. But don’t be fooled – one longtime military reporter said “In my 37 years covering veterans’ issues, I have never seen veteran issues used more cynically or politicized more thoroughly than during the past several years”

That’s not all that filmmakers failed to put in their docu-drama.

2. Ignores the Reality Behind Veterans’ Suicide

The film latches on to a well-known and tragic statistic: on average, 20 veterans die every day due to suicide.

It never mentions that the VA’s approach to preventing suicides is more comprehensive than is commonly found in the community, that the VA’s innovative clinical use of suicide predictive analytics has no community counterpart, or that veterans who receive care from the VA are far less likely to commit suicide than veterans on the outside. According to data from 2014, rates for those outside the VA continue to skyrocket.

The film also ignores that nearly every Veterans Health Administration employee is trained to recognize potential warning signs. No matter where you get care in the VA, whether it’s your physical therapist or primary care physician, at-risk veterans rarely go unnoticed or untreated.

And, more cynically, the film focuses on one tragic story of a veteran to propel the action forward.

3. Misrepresents Who Decide Which Veterans are Eligible for VA Care

The Department of Veterans Affairs is tasked with reviewing and approving or denying health care claims and service for veterans. They’re instructed to rule on the side of veterans as often as possible, but they don’t make the rules.

VA eligibility is largely determined by two bodies: the Department of Defense and the United States Congress.

When a veteran leaves the military, their discharge status determines who is eligible for veteran benefits. Veterans who have received a ‘less than honorable’ discharge are often excluded from getting the help they need. That’s true even if their discharge was because of behavior directly related to the trauma experienced on the battlefield.

Congress could remedy the situation if it wanted, but would be forced to allocate funding to care for many more veterans than are currently served. Lately, Congress has tried to correct past inaction, but you could say it’s a work in progress.

4. It Doesn’t Show the VA’s Unique Care Model

To make matters worse, the film’s casual explanation of the VA’s three distinct services does a disservice to the coordinated care model that’s unique in American healthcare. Their attempt at an apples-to-oranges comparison leaves the viewer distraught and plays to our culture’s obsession with supposed bureaucratic dysfunction.

Most Americans are forced to compete for health care – whether we recognize it or not. We compete for appointments, are forced to choose between different drugs because of cost, and have to choose between our preferred doctor and that which insurance says we can visit. And, this process often takes days, weeks, and more often than not, months. And most of us fill out the same form, over and over.

At the VA, the coordinated care model ensures that veterans have access to a team of doctors that actively engage each other on individual cases. If the VA’s primary care physician determines the veteran needs to see a cardiologist, that veteran will often be able to simply walk down the hallway for their next appointment.

One of the major problems of the current VA Choice program is that care is incredibly difficult to coordinate once the private sector gets a hold of a veteran.

5. There’s No Comparison with Non-VA Care

If the film wanted to make an apples-to-apples comparison, it should have looked beyond the VA. There is not a single instance in the film where the VA is seriously measured against the private sector.

Here’s what they missed:

  • Wait times at the VA are better or as good as those in the private sector.
  • Health care at the VA is better or as good as that in the private sector.
  • The VA is able to negotiate lower prescription drug prices than the private sector, leading to more savings for the patient.
  • One in five patients at the VA sees a physician on the same day they make an appointment.
  • For patients with cardiac conditions, the mortality rate at the VA is lower than it is in the private sector.
  • Because of its integrated care model, diabetic patients at the VA are care for and coached to care for themselves. They respond significantly better than diabetic patients than those on private insurance and on Medicare, who are left to navigate the complications of diabetes on their own.
  • Medical errors in American hospitals are the third leading cause of death behind cancer and heart disease.

This list may be expanded upon a repeat viewing of VA: The Human Cost of War. But one thing is for certain – to date, the mainstream media has rarely captured the full scope of veteran’s health care system. When watching, you may want to keep a copy of this book and this magazine article, next to your remote.

October Legislative Roundup

Below you’ll find a list of bills and important resources introduced in the U.S. Congress since our last Mission Critical News Report:

U.S. Senate

Bill No. – S. 1723

Title: Strengthening Veterans Health Care Act of 2017
Click Here for the Bill’s Text
Sponsor: Sen. Bernie Sanders (I-VT)
Cosponsors: There are no cosponsors

What would the bill do, if passed?

  • Allocate $5 billion to the Department of Veterans Affairs specifically to hire more doctors. nurses, and other medical professionals

What’s the overall impact on veterans?

  • The VA has struggled with more than 30,000 vacancies over the last few years
  • By committing funds specifically to hire more staff, the agency would be able to address its highest priority — developing capacity to deliver timely and high-quality care to veterans and their families
  • This bill is supported by Disabled American Veterans (DAV)

Bill No. – S. 1881

Title: Prioritizing Veterans Access to Mental Health Care Act of 2017
Click Here for the Bill’s Text
Sponsor: Sen. Joni Ernst (R-IA)
Cosponsors: John Cornyn (R-TX), Chuck Grassley (R-IA), Thom Tillis (R-NC)

What’s the overall impact on veterans?

Although stating it is “breaking down barriers to access” the bill doesn’t actually address any barriers to offered care. However, it does break down VA’s ability to manage utilization and control costs. In so doing, it would erode VA’s funding to provide care.

Private-sector mental health providers are often not trained to handle veterans’ complex issues.
Surveys report that private sector therapists do not use recognized best practices in treating veterans’ mental health problems.

U.S. House of Representatives

Bill No. – H.R. 3459

Title: VA Staffing and Vacancies Transparency Act of 2017
Click Here for the Bill’s Text
Sponsor: Rep. Anthony Brown (D-MD-4)
Cosponsors: Rep. Peter DeFazio (D-OR-4), Rep. Denny Heck (D-WA-10), Rep. Barbara Lee (D-CA-13), Rep. Madeleine Bordallo (D-GU-At Large), Rep. Charlie Crist (D-FL-13), Rep. Eleanor Holmes Norton (D-DC-At Large), Rep. Sanford Bishop Jr. (D-GA-2), Rep. Robert Brady (D-PA-1), Rep. Stephen Lynch (D-MA-8), Rep. Brian Higgins (D-NY-26).

What would the bill do, if passed?

This bill would require the Secretary of the U.S. Department of Veterans Affairs (VA) to post the number of job vacancies at the VA and report to Congress on what steps the Department is taking to reach full staffing capacity.
It is estimated that 34,000 VA positions are currently vacant, with little push to fill them

What’s the overall impact on veterans?

  • This bill would help address the chronic understaffing across the Veterans Health Administration.
  • It would allow Members of Congress to be continually aware of the critical needs at the VA.
  • It would build capacity for VA to offer care, rather than have to send veterans out to the community where care is more expensive.

Bill No. – H.R. 3874

Title: Accountability for Quality VA Healthcare Act
Click Here for the Bill’s Text
Sponsor: Rep. Derek Kilmer (D-WA-6)
Cosponsors: Rep. James Renacci (R-OH-16), Rep. Mark Amodei (R-NV-2), Rep. Susan Brooks (R-IN-5), Rep. Salud Carbajal (D-CA-24), Rep. David Joyce (R-OH-14), Rep. Mike Kelly (R-PA-3), Rep. Raja Krishnamoorthi (D-IL-8), Rep. Seth Moulton (D-MA06), Rep. Donald Norcross (D-NJ-1), Rep. Scott Peters (D-CA-52), Rep. Kathleen Rice (D-NY-4), Rep. Bradley Schneider (D-IL-10), Rep. Dan Newhouse (R-WA-4), Rep. Daniel Webster (R-FL-11), Rep. Stephanie Murphy (D-FL-7), Rep. Peter Welch (D-VT-At Large), Rep. Lou Barletta (R-PA-11), Rep. John Rutherford (R-FL-4), Rep. David Valadao (R-CA-21), Rep. Andy Barr (R-KY-6)

What would the bill do, if passed?

  • The bill directs the VA Secretary to make certain improvements relating to inspections of Department of Veterans Affairs medical facilities and improving care for women.
  • The Secretary would also be forced to evaluate the organizational structure of the Veterans Health.

Other Resources: Is the VA Being Privatized?

Fighting for Veterans Healthcare has also posted on its website Suzanne Gordon’s document ‘How to Privatize the Veterans Health Administration – A Checklist.’

 

Panel of Experts Examines Potential Privatization Disaster

The American Federation of Government Employees (AFGE), an AFL-CIO-affiliated union that represents Law Enforcement Officers, Defense workers, VA caregivers, and workers at nearly a dozen federal agencies, held a Privatization Roundtable on Capitol Hill in Washington, D.C.

The panel addressed creeping VA privatization to more than 100 Congressional staffers, reporters, and interested citizens. Representatives Julia Brownley (D, CA-26), Mark Takano (D, CA-41) and Anthony Brown (D, MD-04) all stopped by the make remarks and pledge their support for the VA and their opposition to VA privatization. Sen. Bernie Sanders was supposed to appear but was forced to cancel because of a budget meeting.

On the Panel:

  • Iraq and Afghanistan Veterans of America (IAVA) Research Director Jackie Maffucci who moderated the panel
  • Psychologist and Association of VA Psychologist Leaders (AVAPL) representative Thomas Kirchberg,
  • Disabled American Veterans (DAV) Deputy National Legislative Director Adrian Atizado
  • Veteran, registered nurse at the Memphis VA Medical Center, and AFGE Local 3930 President Kathleen Pachomski
  • Veteran, Federal Correctional Worker, and AFGE National Bureau of Prisons Union President Eric Young
  • Suzanne Gordon, Author, Journalist, Patient Advocate, and Board Member of Fighting for Veterans’ Healthcare

Outsourcing Veterans’ Eligibility Claims

Kirchberg discussed attempts by VA’s leadership to outsource the Veterans Benefit Administration’s Compensation and Pension hearings. These hearings are held when veterans make claims for eligibility for VA services and compensation for service connected problems and pensions.

The hearings have traditionally been conducted by VA psychologists and medical staff. These experts rigorously conduct the hearings and understand the complex conditions and problems from which veterans suffer.
Now, in the name of easing the backlog of claims at an agency — the Veterans Benefit Administration has been chronically under-funded and short staffed — they are being farmed out to Lockheed Martin, a defense contractor with no expertise in veterans’ health problems.

Kirchberg eloquently stated that the Comp and Pen evaluation is the face of the VA for many veterans. Often, the hearings are the first time they tell their story to a stranger. That stranger, he argued, should be someone knowledgeable about military health problems.

Kirchberg worries that new contractors hired to do the job will cut corners, take less time with veterans, and be involved in box-checking exams where compassionate attention is sacrificed for processing more claims.
While claims must be evaluated, the question is by whom? If these claims aren’t carefully evaluated, then there will be more costly appeals and more delays in getting needed care to veterans.

Veterans Caring for Veterans

Pachomiski spoke eloquently about her commitment to deliver high-quality care to veterans. She also receives care at the VHA.

Young went beyond condemning efforts to privatize the VA. He also described the denial of due process rights to federal employees — but as a Navy veteran who receives care at the VHA. He has been treated for kidney problems and hypertension that threatened his life and the VHA saved him time and again. He would, Young said, never get care anywhere else.

Click here to watch Suzanne Gordon’s presentation.

Finally, Suzanne Gordon spoke about the salami strategy of privatization that she outlines in her “Ten Ways to Kill the VHA” document. Gordon who is a journalist writing about VHA healthcare, not a veteran, concluded her remarks by holding up the FFVHC Save Our VA bumper sticker. “I am not a veteran,” Gordon said. “But I consider the VHA my VA. I pay for it as a taxpayer. I benefit from its research, teaching and models of clinical care. It is my VA, our VA, even if we are not veterans. Congress,” Gordon asked the group and the political representatives in the building in which the forum was held,” Please, Save Our VA.”

Unanimous Support for $5 Billion VA Funding Bill

All the panelists supported Bernie Sanders “Strengthening Veterans Health Care Act of 2017“ which would allocate $5 billion to the VA to hire more doctors, nurses and other medical professionals to fill these vacancies and ensure that veterans continue to get the best care in a timely manner.

They also supported a bill put forward by Representative Anthony Brown. The VA Staffing and Vacancies Transparency Act of 2017 would require the Secretary of the U.S. Department of Veterans Affairs (VA) to post the number of job vacancies at the VA and report to Congress on what steps the Department is taking to reach full staffing capacity. It is estimated that between 35,000 and 50,000 VA positions are currently vacant, with little push to fill them.

Atizado also spoke at the roundtable and raised DAV’s concerns about and opposition to privatization.

Partnering for Veterans’ Healthcare

FFVHC has been sharing information and ideas with the Texas Vets Care for Health Care group, which is made up of VA stakeholders and state and local representatives of VSOs in Texas.

The group, which shares the mission of FFVHC, has held meetings with Congressional representatives and outlined their opposition to proposals to defund or dismantle the VHA. The group has given out 3000 FFVHC style brochures at the Dallas VA Medical Center and is also distributing FFVHC’s I Love My VA bumper-stickers and recording videos about the excellent care the VHA delivers.

Charlynn Johns, founding President of Battle-Buddy Info and advisor to VA stakeholders believes that, “Our efforts are invigorated and energized by combining resources and truth on messaging.” In the spirit of the Alamo, Johns says “We are together in the fight!”

Will Business Interests Trump Veteran Safety?

A recent VA Office of Inspector General (OIG) report highlights the challenges of collaborating with community providers who offer medical care through Choice. Overdose deaths among veterans are elevated when compared to the civilian population, and the OIG reviewed opioid prescribing to determine the risk for patients receiving care within and outside the VA system.

They reported increased risk when patients are prescribed opioids from community providers. Veterans with chronic pain and mental health disorders (63 percent) are at particularly high risk.

The OIG identified several factors for the elevated risk. Stringent opioid prescribing and monitoring guidelines for VA patients may conflict with practices in the community. The risk is exacerbated when information about opioid prescriptions and other medical conditions is not shared between VA and non-VA providers. In addition, VA providers do not routinely check the Physician Drug Monitoring Program (PDMP) database before prescribing, and community providers do not necessarily have access to VA information.

The OIG recommended that all non-VA providers:

  • Are held to the same Opioid Safety Initiative guidelines
  • Include a medical history and a complete and current list of medications in all requests
  • Submit opioid prescriptions directly to a VA pharmacy for dispensing and recording in the patient’s electronic health record

It has been suggested that community providers should not be held to the same standards as the VA, because it would discourage participation in Choice.

What’s Next for the VA?

After significant lobbying on the part of Veterans Service Organizations (VSOs), an effort to fund the Veterans Choice Program that would have furthered eroded Veterans Health Administration (VHA) services, failed. Nine VSOs signed a letter to the Chairs of the Senate and House Veterans’ Affairs Committees protesting efforts to provide funds to private sector providers without adequately funding the VHA. Congress heeded these protests and passed a bill that would provide $2 billion for the Choice program until the end of fiscal year 2018 and $1.4 billion for the VA. Although this was a definite victory for those who support the VHA, the fight is not over.

Support to Limit VA’s Mission Gains Ground

FFVHC representatives in Washington, D.C. met with Senate and House Veterans Affairs Committee Staff during the August Congressional recess. In terms of proposals for Veterans Choice Program 2018 renewal, they learned that it appears that the idea to “Make Choice Cards Universal” is losing support but that “Limit the VA’s Core Mission to Foundational Conditions” and “Allow Choice Eligibility Based On A Composite Community Standard Metric” is gaining ground.

As FFVHC identified in our recent policy analysis, both of these ideas, if implemented, would hasten privatization of the VA.

Bill to Prevent VHA Funding Crisis

Senate Veterans Affairs Committee Ranking Member Jon Tester (D-MT) has developed a draft ‘Veterans Community Care Program” bill which aims to ensure that expensive, outsourced veterans’ care in the community does not bleed VHA dry. Every dollar increase in Choice allocations would be matched by a dollar increase in VHA. The VHA would continue to control utilization. Surveys would be required yearly of veterans’ satisfaction with, and time waiting for, care received via Choice and VHA.

$5 Billion to fill 45,000 Vacancies?

Senate Veterans Affairs Committee Member Bernie Sanders has introduced the The Strengthening Veterans Health Care Act of 2017. This bill would allocate $5 billion to the VA to hire more doctors, nurses and other medical professionals to fill these vacancies and ensure that veterans continue to get the best care in a timely manner.
These are the only proposals to “Strengthen the VA” (with more funding). They have yet to garner sufficient support to get beyond their respective Committees. Expect a contentious battle when Congress takes up the issue now that they’re back from recess.