VA prizatization update w/ Suzanne Gordon and Jasper Craven - Ep 159

This is Fortress On A Hill, with Henri, Danny, Kaygan,

Jo vonni, Shiloh, and Monisha

Henri (2): welcome everyone to Fortress On A Hill, a podcast about U.

S.

foreign policy, anti imperialism, skepticism, and the American way of war.

I'm Henri.

Thank you for being with us here today.

We are here to talk to Suzanne Gordon and Jasper Craven.

of the Veterans Health Care Policy Institute to talk about a whole

bunch about what's happening in VA policy right now, VHA mostly.

gonna talk about privatization.

We're gonna talk about the huge differences and actually could be seen

as even more negatives between The predecessor, VA Secretary, Robert Wilkie,

and the current one, Dennis McDonough.

Did I say that right?

McDonough?

Yes, McDonough.

Henri (2): So, Jasper, Suzanne, welcome to Fortress On A Hill.

How are you both doing this morning?

We're good.

Yes.

Henri (2): So, the impetus for this discussion was, going through some things

about project 2025 and specifically the, policy changes that it touches on.

it's important to remember, that Project 2025 is a version of something

that not only the Heritage Foundation, but lots of other private think tanks

have been doing for a long time.

The Heritage Foundation, specifically, since 1980, is

a right leaning institution.

not all of its recommendations are adopted or even seriously considered,

but what we're going to discuss today is some of the most important

aspects that are touched on by Project 2025 as we see them, along with a

few foreign policy aspects as well.

So, Suzanne.

Let's start by talking a bit about privatization.

can you tell us, what's your take on the current staffing shortages that the

VHA is trying to deal with right now?

and, tell us about the 23 billion opportunity up for grabs, please.

Well, I think that, right now, and Jasper can

really come in and help on this.

The basic privatization picture is that in 2014, they passed something called

the Veterans Choice and Accountability Act, which began outsourcing

veteran care to the private sector.

based on whether you had to wait a certain amount of time for an

appointment at the VA or drive a certain amount of miles to reach a VA.

And that was supposed to be a temporary program.

It was supposed to give the VA money, unfortunately not enough money.

The VA needed 21 billion to deal with staffing and other issues and

the TRACE Act gave it 6 billion.

So that means.

That it needed, you know, another, how many billion, God, I can't add, I

can't, I'm, you know, Jasper, help me.

14, roughly.

so it, you know, if you're looking at this as a shell game, you know,

they keep forgetting that they needed 14 more billion than they

got, and this was supposed to be a law that sunsetted after 3 years.

And it was supposed to be temporary.

And basically it was a compromise between Bernie Sanders and John McCain.

And John McCain almost immediately said, Oh, you know, I was actually wasn't

being serious about it being temporary.

And then when Trump came in, They not only made it permanent, this option of

going to the private sector, but they made, put it on steroids and they created

this Veterans Community Care Program, which essentially allowed veterans

to go to private sector providers through a separate VA set up called

the Veterans Community Care Program.

And Trump's VA secretary, Robert Wilkie, created eligibility standards

for this program, this Veterans Community Care Program, that guaranteed

a huge amount of outsourcing.

So, any vet who had to wait more than 20 days or drive more than 30 minutes to a

primary care mental health appointment could go to the private sector.

And any vet who had to wait more than 28 days.

drive more than 60 minutes could go to the private sector

for a specialty appointment.

So, I mean, just think about your own experience.

how long do you have to wait in the private sector for

a primary care appointment?

Well, I mean, how can you even find a private primary care

provider in the private sectors?

PrEP sector, much less get an appointment with them.

How long does it take to get a dermatology appointment?

I mean, I just had a little spot on my cheek.

I tried to get my dermatologist to look at and it's like a four

month wait in the private sector.

So basically, rather than, I mean, it would have been VA had taking a

look at each particular healthcare market and said, okay, we're going

to see what the wait times are in the private sector and, and, and we're

going to match those or even best them.

I mean, even if you could get a dermatology appointment in 3

months, as opposed to 4 months or 8 months or whatever, but no, they

set these very unrealistic wait time and drive time standards.

And that guaranteed that, you know, now, it's something like 40 percent of

VA care is given in the private sector.

I think it's, something like they have 1.

7 million providers that they're supposed to oversee.

And here's the other thing that is really extraordinary is not only is the

VA supposed to pay for these people to go to the private sector, it's supposed

to coordinate the care that the private sector delivers, even though there's

no requirements that the private sector coordinate care with the VA.

and so it's a kind of a nightmare.

you have to get medical records back.

and there's something like 12 million appointments or something.

So imagine getting records back for 12 million appointments, and coordinating 1.

7 million providers and so forth.

it's A logistical nightmare and the VA, of course, fails because it's

supposed to be both an insurance company paying for care and a health

care system that, provides care.

And so what we're seeing is that there's not enough money to hire staff.

They have now a 15 billion budget shortfall.

there's, not enough money.

Congress isn't giving them enough money to hire.

rebuild their infrastructure, renovate.

So even if they had the money to hire staff, they need something like 20, 000.

we don't even know how many people they actually need to deal

with the demand that they have.

And all this money, 30 percent of their clinical care budget,

over 30 percent is going out of the VA to pay for private care.

And then as you asked, Henry, the VA Secretary and his Undersecretary for

Health, Sharif El Nahal, have come up with schemes to spend something like 23

billion in 10 years and, 14 billion in 10 years to get, higher contract rates.

workers to come in and deal with staffing shortages and consultants

to hire those people and then more consultants to, advise them on innovation.

So you basically have, patients pouring out of the VA system and money pouring

out of the VA system and that's not good.

Henri (2): the vast majority, I'd say, you know, what is it, at least like 99

percent of the doctors that you just referenced have no training with the VA.

they have no veteran care specific knowledge.

they're just normal practitioners.

Well, and it's not, it's doctors, nurses, physical therapists,

psychologists, and the, you know, veteran, veterans, as you know, because you are

one, Henri, have very specific health care conditions, whether it's mental

health, or, or physical health, right?

And you have to know about how to distinguish between the two.

You have to understand, about prostate cancer and diabetes

created by Agent Orange.

You have to be able to help veterans sign up for the registries

and sign up to get compensation.

These private sector clinicians know nothing about this stuff.

Most private sector mental health professionals are not trained to

treat PTSD at all, much less combat related or military related PTSD.

They don't know what military sexual trauma is.

They've never heard of it and they are not required.

In order to participate in the Veterans Community Care Program, Congress has not

required them to have any training in veteran specific health care conditions

and mental health conditions, military culture, or anything, that is required

of, intensely required of VA providers.

I mean, we just passed the PACT Act, which Jasper can talk more about,

which is giving care to people exposed to toxins since World War II, and VA

has, in anticipation of millions of veterans coming in who suffered these

exposures, done huge trainings, and VA providers and staff are required

to take these trainings, and they don't require these private sector

providers to take these trainings.

I mean, suicide prevention is another huge issue among veterans.

So the VA.

Every employee in the VA gets at least an hour of suicide prevention training.

Every employee, including, the receptionist, including the transport

worker, the dentist, whatever, not just mental health professionals, and they

get screened for suicide prevention.

This is not required in the private sector.

Well, because they don't really care about the quality of care, they just

care about the bucks leaving the VA because these laws were designed by

people who want to privatize the VA.

Henri (2): that was actually the PACT Act was the next thing I was going

to, ask about, Jasper, in terms of the PACT Act, since it got signed,

what has kind of been the status of his implementation, especially

considering the budgetary constraints that, Suzanne is talking about?

Yeah, well, there was initially a more, ambitious version of

the PACT Act on the table in Congress that would essentially allocate more

money for more conditions and, adequately, fund benefits for veterans sickened by

toxic exposures dating back decades.

you know, what passed was still a good bill.

there was a lot of money, allocated for this expanded, slate of, Sicknesses,

disabilities, however, there has not really been an adequate buildup in

staff within the Veterans Benefits Administration, and no real support

for this network of accredited claims agents who, are historically employed

by congressionally chartered veteran service organizations like the American

Legion or the VFW that help veterans navigate the morass of regulations

and paperwork to ensure that they're properly, sketching out, Their service

history and making strong claims to secure the right disability rating.

so the money's there and a lot of people have been helped.

I think the Biden administration does deserve some credit for moving pretty

quickly to, dole out a lot of money to veterans who've been waiting for a really

long time for the benefits owed them.

and, you know, that's involved in some cases cutting back on

all of the stringent rules and regulations for proving a disability.

but, as is so often the case in the world of veterans, many entities,

for profit entities, see dollar signs with all of this money.

And so, there's really emerged in the last few years, but especially so

since 2022, for profit, agents that are helping, or oftentimes not really

helping veterans get their benefits.

The Legion and the VFW simply do not have the number of accredited

claims agents to help the population.

It's this massive crush of new claims and these organizations have been in

decline for a while, their membership is declining, their revenues are declining,

the number of accredited agents that can connect to veterans through posts at

the local level is declining, accredited claims agents are accredited through

the VA's Office of General Counsel.

they face really intense oversight.

They're very well briefed on all the regulations.

They're, given, ongoing courses to ensure that they are

aware of changes in statutes.

and if they mess up, they can be punished.

They are the only people that are supposed to help veterans with their

claims, but there's sort of this weird loophole in the law that has allowed

these unaccredited players to step in and basically claim that they're not

helping process claims, they're just sort of like coaching in a generalized

sense, and so by asserting that, they say that they're not in violation of the

law, many veterans are submitting really weak claims because the people helping

them don't know what the hell they're talking about, and then, if the claim

does go through, these companies are taking a really big slice of the resulting

disability award, this is a multi billion dollar industry that has sort of popped

up overnight, and so, a lot of That money that was allocated through Congress for

veterans is being gobbled up by these for profit actors and not making it to the

veteran and their family to support them.

So, there really needs to be Legislation passed, to reel these guys

in, to reimpose criminal penalties over these unaccredited actors.

There's, some legislation floating around, but because these companies have taken

in so much money, they now have very savvy, lobbyists in Washington, they're

dropping hundreds of thousands of dollars to oppose these bills, and so the prospect

of reform at this point is not great.

Henri (2): Are there, do either of you know of any places That

kind of separate the wheat from the chaff, between companies that

genuinely help veterans in that way that are like, for example, I got.

Both my social security and my VA disability, my 100 percent

through also, and they worked with me for years and years.

They were very professional.

They, you know, and I did have to give them a portion of my back pay.

but, from the sounds of it is that these guys are, there is no comparison in

terms of doing what you do, you know, how they're describing coaching versus

actually being accredited, understanding the policies and not sending off.

Bullshit claims, wasting the time and the money of veterans who I'm sure

they're, they're, and the reason I ask is there's gotta be quite a few folks out

there that are just confused about it.

You know, if you're a 60 or 70-year-old veteran and you're trying to file a claim,

especially a claim based on stuff that happened way back when, and now you've

wasted this time and money on these folks that are not accredited, not supposed

to be doing what they're doing, but like you said, because of the loophole

of the law, that they can't be stopped.

Yeah, I mean, it's a really good question, and to be completely

honest, there is not a centralized repository, what every veteran should

do initially is connect with the local VSO if they can, even if they're not

a member, and see what the resources are, the free resources are for them.

oftentimes they will be able to be connected with a, accredited

agent through one of the VSOs.

The other.

The thing is that a lot of states, especially those with big

veterans populations, like Texas and California, have state VAs

essentially, and those VAs often employ accredited agents that can help.

So even if you're not a member of a VSO, you can get that help.

and you know, basically the rule of the road is that Veterans should not need

to pay anything for their initial claim.

Sometimes if a claim is denied, you go to an accredited lawyer and they charge

something and there's, you know, the rates are heavily regulated, but there

should hopefully be a path for most veterans still to find an accredited

agent Just really want to emphasize that veterans should do as much groundwork

as they can with their state veterans affairs office and with local VSOs.

because should be resources for them and, you know, I would really urge them not to

go with these for profit companies because there's no oversight and the results

are often, quite negative for veterans.

Henri (2): Thank you.

Thank you for that.

So, I wanted to touch on a different part of Project 2025, and this is something

that's been ongoing for years now in terms of the policy and trying to change it.

But the way that Project 2025 couches.

The idea of, benefits for transgender veterans and abortion services, that it

has become such An albatross around the neck of the VA in that way, that they're,

trying to provide all of these different services and that through just sheer

bullshit political means they have been able to, mess with the ability of veterans

to be able to get that kind of care.

And of course, that's not, that's not new for, the transgender veteran community

or for women veterans either in terms of care that things have always, you know,

that, that it's, Something that has slowly changed, but only has only gone so much.

And so, Suzanne, I'm, I'm wondering what your thoughts are on this.

do you think that the conversation is worth it?

Or do you think that the fight currently being had is worth it?

Or do you think it's just a lot of noise?

GMT20240730-174812_Recording_separate2: Mean the fight around abortion

and transgender, care?

Henri (2): pertaining to the VA,

Well, I think that what veterans have to consider is

that if you're a veteran who is, finds it appealing, That the Project

2025 folks are against abortion or against providing transgender care.

If you find that appealing, I would think again.

Because that is part of a much larger agenda and that is, if you don't need

an abortion or don't think you'll ever need one, and if you're not transgender

or if you're opposed to that, Your view is being distracted to focus on these

things that you don't agree with while, they're going to pick your pocket.

I mean, these people are like the pickpockets in David Copperfield,

you know, like they're, I

Suzanne Gordon (3): mean, Charles Dickens, for

those who don't know the reference, you know, they're very

well organized and they're going to pick your pocket while you're looking in a

direction and what the real threat is, you know, There's a tremendous threat

obviously for women who need abortions and also who need appropriate care if

they've had a miscarriage or whatever, you know, and can't get care because that

involves those kind of drugs and services.

But I think the real issue that folks need to think about is, what Project 2025 plans

for access to health care And compensation for service connected conditions, because

these people, don't want to give veterans, compensation or, service connected

disability ratings for many conditions that folks have, like, Wilkie and allied

himself with this guy, Daniel Gade, who's the head of the, Department of Veterans

Affairs for the state of Virginia.

And he wrote this book about, I can't remember what it's called.

I have to look it up, but I can do that in a minute.

But, it's called Wounding Warriors, How Bad Policy is Making Veterans Sicker

and Poorer, and so Wilkie and Gade and this whole, Project 2025 crew contend

that the VA, is infantilizing veterans by giving them all this comprehensive

care and, you know, that there really is no such thing as PTSD, and people

who have PTSD are really just having a bad morning, you know, and, you

know, And I mean, it's shocking.

people should read the book, because this is really what these

folks have in mind for veterans.

They really want to limit the kind of service connected disabilities

that are considered disabilities.

And they also want the VA, they don't want the VA to compensate for them.

And so this could cost veterans, you know, 000 a year.

So while you're worrying about the very few people who could get an

abortion, they're picking your pocket for 40, 000, and they're going to

prepare to take away your benefits.

They want to take away, health care services Because they want the VA to only

care for service related disabilities.

So what does that mean?

That means that Joe Smith, you know, in Iraq, got his arm amputated, And the

VA will take care of his amputated arm.

But if Joe Smith gets diabetes later in life, not because of a toxic exposure,

but just because he gets diabetes or has hypertension, they will not

take care of the hypertension, or diabetes, which could really affect

his amputated arm or leg or whatever.

this is where the VA was.

Free 1994.

You know, they would only take care of service connected disabilities, and

they wouldn't take care of any other problem that the veteran had, and the

reason why the VA is such an excellent healthcare system is that now it takes

care of everything, and these people don't want the VA to take care of everything.

They also want VA providers to meet, Department of Defense health care

system standards of productivity.

But, and this is very important for vets to understand, the Department of

Defense takes care of largely healthy people because you can't get in.

To the military, or you shouldn't be able to get in if you have a

whole bunch of health problems.

Now, and if you get these health problems, like an amputation,

they kick you out, right?

They medically discharge you.

So you're dealing with healthy people, largely.

The VA deals with people who have, you know, 6, 7, 30 presenting problems,

what we call comorbidities, right?

You know, I mean, you could talk about your own problems, Henri, you know, you

are not some 18 year old, they go into the military and they spit them out

with all kinds of problems and you don't even have to be in combat to have, you

know, back, neck and shoulder problems or PTSD or, traumatic brain injuries.

we're learning how just firing these weapons, repeatedly can

give you a traumatic brain injury.

I think that veterans really need to understand what's in store for them if

Trump is reelected, and that is they will have less access to health care.

They will not have access to comprehensive health care.

they may have no access to health care if certain kinds of service

connected, disabilities are, wiped out.

They won't get compensated.

It's going to be a disaster.

not to mention if there are veterans who work at the VA I mean, Trump views them as

sadists and cruel and, out to get veterans as opposed to out to help veterans.

he's the one who's out to get the veterans and the folks in the VA

are the ones who want to help them.

You mentioned about pre 1994, the VA and the idea of them, you know, slivering down

exactly what kind of a benefit somebody could get I was so thankful when I got

out of the military that my initial rating was 50%, and by that, that meant

that all my care could come from the va.

Henri (2): And so if, if all my care, if I'm so injured,

and again, it's only at 50%.

so there are lots and lots of folks that never, that don't ever make it to

a hundred percent, but still need all of that care and they need whole healthcare.

It can't be something where, like you said about an amputee that we're not

dealing with these other things that are common conditions that might come

with that, or even just general quality of life, helping somebody maintain a

certain living standard when it comes to it health wise and making it that

much more difficult like going back to where we started from this is that,

you know, like women veterans deserve to be able to have all of their.

Obgyn care and anything that they need for that, potentially, including

abortion services to be included.

That would all be part of whole health.

The idea that they would disinclude it just seems farcical

and horrifying on its face.

Well, I think that, over the past, since 1945, particularly

46, the American public has.

Invested billions and billions of dollars into creating a comprehensive

health care system for veterans, and it delivers stellar health outcomes,

it is really, it's not just a medical system, it's a health care system, so

veterans get help with homelessness, with legal problems, and housing with

economic problems, with vocational rehabilitation, cooking classes,

meditation, you name it, the VA offers it.

Now, you may have to drive to get to those services, but if you

live in rural America, you have to drive to get any service, you know.

And the VA is willing to do telehealth and if you don't have a laptop or an iPad

or an iPhone, they'll give you a laptop or an iPhone so you can do telehealth.

And so I just think it's tragic that, veterans don't appreciate

what the taxpayer has done for them.

People don't understand that the VA cannot run a insurance company where

they pay for exorbitant costs from the private sector or care that is not veteran

centric and often of lower quality.

Veterans need to really make a choice and somebody needs to tell them that

America will not pay for two separate healthcare systems for its veterans.

It's too much.

It's a bad business model.

There is no choice.

Health care system in the world or in the country, where if you go out of

network, that somebody else pays for it.

And I think really what veterans need to understand and somebody needs to have

the courage to say to them is you've got this great health care system.

If you want it to be better, if you want it to provide more care in more

places, then stop stealing money from it to give it to somebody else who

doesn't know how to care for you and doesn't really care about you, you know.

And I mean, we're now giving 36 billion, you know, the 36

billion is only clinical care.

We're paying these Third party insurance companies, TriWest and Optum, they're

getting, I don't know how much it is now, Jasper, almost 200 billion

dollars to administer this system.

Imagine what you could do with close to 500 billion dollars If the VA got

it and not the private sector, and who is going to say that to veterans?

I hope at some point, Kamala Harris, if she wins, says that to veterans.

I hope that VSOs and groups like the one we belong to, Veterans Health Care

Policy Institute, say this if we get new Democrats in office, because they've

been continuing the privatization policies in sort of a privatization

light form that Trump and others.

in the conservative movement have, initiated.

Henri (2): You know, just like with the DOD budget, it's not about the expenditure

of hundreds of billions of dollars.

It's where it ultimately ends up going.

I mean, because they'll spend it.

Robert Wilkie, Donald Trump, all those are perfectly happy

to spend the money, but where it actually ultimately ends up going.

it really makes it a different question.

so I think, it's a good time to wrap up our discussion for today.

was there anything that you either you guys wanted to jump

in on before we, sign off?

I think we covered a lot of the sort of most pressing topics here.

really when it comes down to it, and this is a point I, will scream until the cows

come home, what is happening right now and what has been happening over the last

decade since the Choice Act was passed is the buildup of intense corporate power

Over the Department of Veterans Affairs.

It's a similar phenomenon to the military industrial complex.

And for many decades, the VA was sort of immune to those trends for

a number of reasons, including the fact that the VSOs were some of the

most powerful forces on Capitol Hill.

But since they are on the decline, all of these Corporate and ideological actors

are coming out of the woodwork and they are attempting to profit in massive ways

from the VA budget and also to basically shift attention away from all of the good

that the VA does because the truth of the matter is, is that The VA system is

the one that should be expanded out into the civilian sector, rather than having

this incredibly flawed private system creep into the VA and disrupt what is

the best healthcare system in America.

And so, you know, the stakes are very

Oh, Jasper, you, you kind of disappeared entirely.

I did.

You disappeared at stakes.

Maybe you should finish my sentence, Suzanne, because we're so simpatico.

Yeah, I'm I mean, I was just gonna say that the stakes are incredibly high.

The stakes are about not only the future of veterans health care, but of health

care reform at large in this country.

yeah, and, and I, I think, I'm really glad Jasper brought that up because,

you know, I think the VA touches on larger issues, and the, the threats to

the VA, both ideological and corporate.

Exists because American capitalism doesn't want a government

health program that works.

And so we have this amazing health system that could be a model for

the kind of health care that all of us should get that, that many

people get in other countries.

And it's really a superior model.

And so I think that This issue of saving the VA, expanding the VA, improving the

VA, is not just about helping veterans, but about how the VA serves the nation

and allowing it to continue to serve the nation through its teaching,

research, and emergency preparedness missions, but also how it can serve

the nation by being a model for health care reform activists For Who, want

to give, promote models of government run healthcare systems that work.

And you don't have to go to Taiwan or Scandinavia or Canada to find

a healthcare system that works.

It's around the corner.

And the reason why so many ideological ag are, are attacking it.

It's not just because they can get public money for private, to

serve private profit, but because they don't want a competition.

You know, Secretary McDonough is always into this neoliberal idea of

competition, but American capitalism doesn't want to compete with a government

run system and lose, which it is doing.

And so they prefer to destroy the government run system that

has won the Super Bowl, the World Cup, the, World Series, etc.

And, you know, veterans have a winner and they should stick with the winner and

they should be going to their political representatives to get them To fund the

winner even, you know, more efficiently and effectively than is happening now.

So, I think, you know, Jasper and I, being simpatico, we agree that, the

stakes are not just for veterans and their families and their communities,

but for the entire country.

Henri (2): thank you.

Thank you both for laying that out so well.

it's something I think that everybody, you know, that.

The many veterans I know that listen to this podcast I hope all of us take

that stuff to heart to understand that we are, for lack of a better phrase,

soldiers in this fight, if we want, the VA to stay strong, to continue serving

veterans in the way that it does, we have to advocate for ourselves and say those

kinds of things to our representatives

I know that I'm going to be.

Cared For Better, and that it's going to fit into a system of overall care

where my doctors do actually talk to each other, Suzanne Jasper, thank you

so much for being here today, folks makes sure that you go online and visit

the Veterans Health Policy Institute.

They have a lot of policy papers and resources on a whole host of different

VHA related topics and also on some other.

Health topics, not specific to the VHA, but it's all good stuff.

Suzanne, what is, the website for the PHBI?

It's veteranspolicy.

org.

And please consider signing up for its newsletter if you want

to keep up with, what's going on in the veterans healthcare world.

Thank you.

Henri (2): Absolutely.

And, thank you to everybody for joining us today here on Fortress On A Hill.

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