Suzanne Gordon on VA Care versus Private Health Care – Corporate Crime Reporter


Which delivers better outcomes – health care through the Veterans Administration or through the private health insurance system?
Most Americans would say that the private health care system delivers better outcomes.
Suzanne Gordon says – not true.
Gordon is the author of Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans (Cornell University Press, 2018),
Gordon says that more than a decade’s worth of scientific studies have established that the Veterans Health Administration (VHA) delivers care that is not only equal, but often superior, to that available in the private sector. 
“Although studies have consistently documented that veterans with cancer, hypertension, diabetes, renal failure, and mental-health problems get better care from the VA than non-veterans with private insurance or Medicare, this data trail was missing one piece of evidence,” she writes. “There was no apples-to-apples study that compared the outcomes of veterans getting care from the VA with care veterans receive in the private sector.”
A study last year filled in the blanks. 
“The study categorically demonstrates that veterans who get their care at the VA live longer during and after a medical emergency than those receiving non-VA care,” Gordon wrote. “This trend holds not just for the VA system overall, but at every single one of the 170 VA hospitals.”
While private hospitals spend millions promoting their brands, there is no equivalent public relations campaign touting the advantages of the VA system, Gordon says.
“Since 2010 or 2011, the Koch brothers and the hard right has focused on trying to amplify and sensationalize the bad press on the VA,” Gordon told Corporate Crime Reporter in an interview last month. “They use the bad press to push for the privatization of the system. They were helped in that regard by a problem in Phoenix, Arizona in 2014. There was a performance standard imposed that could not be met at a couple of VA centers there. There was a scandal and a whistleblower came forward and the Koch Brothers and the group they were backing Concerned Veterans for America began an assault saying the VA is broken beyond repair. They want to make sure that the news is bad. And the VA has not dealt with that well by matching a counteroffensive about all of the good news that my book and many other studies show about the superiority of their care.”
“The other problem is that the VA is the only publicly accountable health care system in the country. That means that everything that happens makes the front page of the Washington Post or the New York Times. And the stories are never contextualized.”
A VA nurse in West Virginia was just convicted of killing eight veterans at a VA center in Clarksburg. That got a lot of press in West Virginia.
“There are a lot of killers out there in the private sector,” Gordon said. “The most prolific serial killer in America was a nurse named Charlie Cullen. He killed more than 200, maybe 300 patients in private sector hospitals in New Jersey and was passed around from hospital to hospital like a pedophile priest.”
“After the VA Phoenix scandal, President Obama wanted to nominate the head of the Cleveland Clinic Toby Cosgrove to be head of the VA to replace Eric Shinseki.  Cosgrove declined largely because of a story that came out in Modern Healthcare about Cleveland Clinic’s terrible patient safety record and that they almost lost their Medicare funding. And during all of those years where they had these terrible safety problems, Cosgrove made bonuses of something like $500,000 a year.” 
“The problems we see in the VA go on in the private sector. The problem is that you have these watchdogs thankfully who are watching over the VA – Congress, the media, the inspector general, the GAO.” 
“There was a story by Dave Philipps that made it to the front page of the New York Times in January 2018 about this tiny critical access VA hospital in Roseburg, Oregon.” 
“The fact that in Burlington, Vermont, you couldn’t get seen for a sleep apnea problem in the private sector for eight months, that never made it to the front page of the New York Times.”
“You have a big double standard when it comes to the VA.”
In your book, you write about the Johns Hopkins study which calculated 250,000 deaths per year in the private sector health care system from medical errors.
“We know that the American health care system kills between 250,000 and 440,000 people a year. In 1998, the Institute of Medicare published a major study on this – To Err is Human. And the figure has not budged. The VA patient safety record is much better. Leading experts on patient safety, people like Don Berwick and Lucian Leape, recognize the VA as a shining star in the system.”
“When I was writing Wounds of War, and even now when the wrecking ball has hurt the VA very badly, the care you get is better than the private sector.”
You wrote an article recently in the American Prospect titled – Biden’s VA Secretary Proposes Shutting Down Dozens of Facilities. 
Why would he do that?
“Because I don’t think Denis McDonough appreciates the national gem that is the VA. I don’t think he gets it. He gives lip service to it. But he doesn’t understand that promoting the VA is important. You have to deal with the assault on the VA head on, by helping people understand what an important system it is.”
“There was a study that came out on ER care. They compared veterans that receive care in VA ERs to those who have Medicare and go to a private sector hospital. Ambulances take you to the nearest ER. In one study, they showed that veterans who went to VA ERs had a twenty percent reduced mortality rate. Another study found a 46 percent reduced mortality rate.” 
“The VA took weeks to promote that study and put it on their website. They never really pushed it out. There was a recent study of the Trump sponsored VA Mission Act. That has accelerated the use of private sector care for veterans. The study looked at the strain this places on VA providers who had to try and coordinate care with an uncoordinated private sector. The VA wouldn’t let the lead investigators speak to the press about it. She called me and I helped her get it out a little bit.”
“McDonough doesn’t understand the problems of the private sector. He worked for Obama and he’s a big promoter of the ACA. He’s not in health care. His deputy secretary is from the National Collegiate Athletic Association. There is nobody at the VA at the top who understands.”
Why would Biden appoint such a person? 
“Because I don’t think Biden gets it either. Their attitude toward the VA is – just don’t make problems. It’s not proactive, it’s not positive. They are corporate Democrats.”
You write this: “It’s not often that national unions representing around 250,000 VHA workers and right-wing Republicans like South Dakota Gov. Kristi Noem and Staten Island Rep. Nicole Malliotakis issue simultaneous denunciations of privatization. But that’s what happened in the wake of McDonough’s facility-closing recommendations to the VA Asset and Infrastructure Review (AIR) Commission, a panel just nominated by President Biden.”
“First, Democrats defunded the police,” Noem said in a statement. “Now, they are defunding our veterans by recommending closures and downsizing of VA facilities across the country.”
“They are saying Biden is betraying veterans. It is tragic and mind boggling, but not surprising,” Gordon said.
If an inner city hospital in Philadelphia is taken over by private equity and they convert it to high end condos, you have no recourse because it’s in the private sector. 
But in the VA, there is public accountability. If Biden proposes closing down VA hospitals in South Dakota, you pound on your Governor and get results. 
“Any serious or small problem, you can go to Congress and there is an investigation. Or there is an inspector general report. Or the GAO does a study. Veteran service organizations put pressure on the system. You can’t put that kind of pressure on private sector providers.”
“At the VA in Palo Alto, I was at the polytrauma unit. They see veterans with multiple problems. If Johnny didn’t get their PT on time, Johnny’s mommy and dad would call their member of Congress and they would look into it. If you are in the private sector and you don’t get your PT on time and you call your Congressman, they will just laugh. They have no authority over private sector doctors and hospitals.”
“All of these private hospital systems spend millions of dollars on advertising telling the public they are number one in this and number one in that. The VA does hardly any of that. When was the last time you saw or heard an ad touting the VA as the better system? That doesn’t happen and it will never happen. Congress will never allow them to try and compete with the private sector.” 
“This has a history. In the 2000s, the VA transformed itself into the wonderful system it is today. And they were getting all of these great articles in the Wall Street Journal and Business Week and Forbes and Harvard Business Review.”
“Bush came in and said – this is no good. We have the VA competing with and showing up the private sector. Our ideology is that the government can do no good and the private sector can do no harm. They started shutting down this access to the press. Obama further centralized it. Trump had no interest in promoting the VA. And now we have Biden, whose secretary doesn’t get it and doesn’t promote the studies showing that the VA has better outcomes.”
Former Congressman Ron Dellums would introduce a bill every two years that would transform our entire health care system to a VA type system. Yet it hasn’t been introduced since. Why not?
“The idea has been coming back. Single payer doctors like David Himmelstein and Steffie Woolhandler are now supporting it. They now say Medicare for All is not good enough because the health care system is being taken over by private equity. It is being so corporatized that if you don’t have a national system like the VA, we are not going to get to where we want to be. It’s just out of control.”
Where does Bernie Sanders stand on VA for All?
“I don’t know. I haven’t spoken to him about it. There are some who argue that we can’t even get Medicare for All. This is too big of a reach.” 
“But to begin with, we need to stop the movement to privatize the VA.”
[For the complete q/a format Interview with Suzanne Gordon, see 36 Corporate Crime Reporter 23, June 6, 2022, print edition only.]

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