Support the Troops

July 04, 2018
Like most in Portsmouth, I look forward to our many Fourth of July traditions like the Naturalization Ceremony at Strawberry Banke, a harbor cruise on the Heritage, or the City's annual fireworks display. Many associate the outpouring of patriotism on this day with military service and elected officials often take the opportunity at events to pay tribute to our military personnel. However, the best way our leaders can honor those currently serving is by preserving and not privatizing the health-care they will receive from the Department of Veterans Affairs (VA) when they leave military service.

Out of our 20 Million veterans, about 9 Million receive health-care services from one of the VA's more than 1,200 hospitals, clinics, or telehealth Community Based Outpatient Clinics like the one at Pease. With a budget of almost $200 Billion and a workforce of around 385,000 employees, the VA is one of the largest providers of government services. The VA supports both veterans with service connected injuries and serves as a safety net institution for veterans that cannot afford private sector health-care. Not only does the VA have the expertise that most private institutions lack to identify and address complicated service-connected injuries like burn pit exposure, post-traumatic stress disorder, and Agent Orange related illnesses, many veterans appreciate the sense of comradery from their shared life experiences they enjoy at VA facilities. Providing these services is the cost of having a constantly deployed large standing military and the institution is appropriately a cost center not designed to make a profit. The VA pioneered evidence-based medicine, overall gets better outcomes at lower costs than many private health-care providers, and I personally have only had positive experiences receiving medical treatment at the Manchester Veterans Affairs Medical Center (VAMC). However, just like in the civilian sector, not all practitioners are as attentive as they should be, opioids can be overprescribed for pain management, and doctors, nurses, & mental health care professionals are difficult to attract to rural parts of the country.

The greatest experience I had as Congresswoman Shea-Porter's Veteran's Liaison was meeting then VA Secretary Eric Shinseki when he visited Manchester in 2013. I will always remember General Shinseki as the Vietnam War amputee that was forced into early retirement as the Army Chief of Staff for his February 2003 testimony to the Senate Armed Services Committee that postwar Iraq would require several hundred thousand soldiers. Ironically, Secretary Shinseki was forced to resign in 2014 over long wait times at VAMCs due to Iraq & Afghanistan veterans leaving military service, Vietnam Era veterans retiring & seeking VA health-care to supplement their Medicare, and the VA finally beginning to treat more Agent Orange related illnesses. Few politicians openly support VA privatization by name, but the private sector receiving VA funding to provide health-care to veterans began in earnest after Secretary Shinseki's resignation. Congress overwhelmingly passed the bipartisan VA Choice program that was meant to temporally allocate $10 Billion over three years for veterans that faced long waits or travels to receive medical treatment closer to home while the VA hired more physicians and improved their existing facilities. Since then, the Obama Administration continued to push for more flexibility on a range of community health-care programs, political operatives in the Trump Administration favoring further privatization forced out former VA Secretary David Shulkin who was the lone apolitical Cabinet member that transitioned from the Obama Administration, and Congress overwhelming passed the VA Mission Act that the President signed into law in June. Today, more than a third of all VA funded medical appointments take place in the private sector and the $52 Billion package does numerous good things, but it also authorizes any VA patient from the prior two years two walk-in visits that may require a co-pay at local private-sector offices, establishes how to dispose of outdated VA facilities, and changes VA health-care program funding from mandatory to discretionary.

Our officials cannot say they favor more private health-care options while being totally against privatization, like VA Secretary nominee Robert Wilkie did at his Senate confirmation hearing this past week in saying "My commitment to you is I will oppose efforts to privatize" while elaborating that there should be a balance between VA options and community appointments. Veterans Service Organizations like the American Legion, the Veterans of Foreign Wars, and the Disabled American Veterans have expressed serious concerns fewer veterans receiving health-care at actual VA facilities would result in less funding going towards needed improvements at VAMCs, budget cuts making existing programs less competitive, and recruiting the 33,000 open full-time positions even more difficult. Worse, these organizations are rightfully fearful that the Trump Administration is being influenced by Charles and David Koch's Concerned Veterans for America (CVA). Given the Koch Brothers' desire to deconstruct the administrative state and the size of the VA's budget, it was no surprise that the CVA seized on the wait time crisis to issue a 2015 report calling for converting the VA's health-care services into a government-chartered nonprofit to compete against private-sector companies for federal funding. Independent commissions have determined that full privatization, replacing VA health-care with private health-care vouchers, would cost an additional $50 Million a year to meet veterans' specialized health-care needs in addition to veterans having to make copayments. Like all vouchers, that $50 Million a year private sector windfall would have to come from somewhere, most likely the VA's remaining budget. Instead of further privatization, additional funding could go towards many needed improvements to the existing VA health-care system including modernizing aging infrastructure, enhancing hiring authorities, and restructuring its bureaucracy.

Unlike the Fourth of July's fanfare, the fifteenth anniversary of the Iraq War was unceremoniously marked this year without any major observances, Mission Accomplished signs, or Welcome Home Parade's like the one Portsmouth held in 2012. Since America's ill-conceived invasion of that sovereign country, Congress has funded our all-volunteer military going to war against Libya, Yemen, and most recently Syria without any congressional authorizations. It is the responsibility of these elected leaders trumpeting these misadventures and not the private sector to ensure that our new veterans and all our existing veterans receive the health-care they deserve.