VA Secretary Denis McDonough announced a plan to revamp VA health care facilities by closing and tearing down some, building new ones, establishing outpatient c...
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Last Monday, Department of Veterans Affairs Secretary Denis McDonough made public a plan for revamping the vast collection of health care facilities throughout the nation. VA proposes closing and tearing down many medical centers, building some new ones and establishing outpatient centers and moving more care to the private sector. The American Federation of Government Employees, which represents a couple of 100,000 VA employees, doesn’t like the plan, not one bit. For more on why that is, the Director of AFGE’s Public Policy department Jacqueline Simon spoke to the Federal Drive with Tom Temin.
Interview transcript:
Tom Temin: Ms. Simon, good to have you on.
Jacqueline Simon: Thanks for having me.
Tom Temin: Now, the AFGE was sort of dumping on the plan before it even came out. Did you guys see it ahead of time? Or did you just presume it was going to be terrible?
Jacqueline Simon: Well, both is the answer. It was placed in the MISSION Act of 2018 by the Koch Brothers’ very, very right wing privatizing organization. They call themselves the concerned Veterans of America. And they exist solely to try to advocate for dismantling the VA system and privatizing the whole thing. And they got a lot of what they wanted in that bill and the MISSION Act of 2018. We knew this commission was going to be a template for mass privatization, and that’s what it is. Different groups of AFGE members, geographically had some briefings prior to last Monday, and we had a couple of national briefings, partial briefings I should say, we certainly never saw the whole thing. Of course, we asked Secretary McDonogh to change what was in the plan. And he refused to do that. He’s kind of said different things to different audiences. He says he doesn’t like the law and wished he didn’t have to be doing it. But he’s carrying out a lot. But boy, is he carrying out the law in the worst possible way!
Tom Temin: Well, a lot of the plan, yes it does tear down some medical centers, like in Manhattan where there aren’t that many veterans around relative to what there were when that place was built. I’ve seen it. It’s a big building and a tall one. So is there no room to reorganize VA facilities or what’s the main objection that you have?
Jacqueline Simon: Well, the first objection, this thing was put together by a group inside the VA hired by Secretary [Robert] Wilkie, with instructions to take a wrecking ball to the system. It’s the same group of employees hired during the Trump administration who put this thing together. The first thing you have to know is that all the data they use to justify their recommendations, all 100% is pre-pandemic data, mostly from 2016 to 2018. I think that alone makes the recommendations faulty insofar as they’re on a foundation of data that is not just old, but turned out not to be very valid. One of the problems with using data from pre-pandemic times is that the market assessments that they did, they were measuring excess capacity in the private sector, and then they were evaluating and measuring in-house capacity. I want to take that apart in two different sides. So when you’re looking at the private sector, and what they called excess capacity in the private sector, I think all of us remember in New York City, among other places, hospitals overrun during the pandemic, patients on gurneys in hallways, auxiliary tents being put together at the last minute to try to help patients. VA has its fourth mission of public health and being available to the general public in times of emergency. The pandemic was certainly a time of emergency. The VA absolutely rose to the occasion and not only took care of the entire veteran population that needed it, but also took care of others as well. So I think that we found out that the so-called excess capacity in the private sector was more myth than fact.
OK, that’s one side of it. And then there’s measuring the in-house capacity of the VA. Now one of the most important criteria they use to justify closures was staffing levels. And you might recall that during the Trump administration, they deliberately kept more than 50,000 authorized positions unfilled as part of this privatization agenda. It was, starve the beast, starve the VA of resources, use all the resources that Congress appropriated for VA health care to give an open check to private sector providers. In the meantime, they didn’t hire in the VA, and left the VA understaffed. And that’s when they measured it, when it was deliberately understaffed. And now they’ll turn around and say, Well, we have to privatize because we can’t hire, we didn’t hire, it’s understaffed. So that data that really, really is the foundation for the justification for all the proposals is worthless. It should be thrown in the trash can.
Tom Temin: And let me ask you this, a lot of the plan relies on establishing a new type of facility, the MBOC, I think it’s called. It’s an outpatient type of facility that gives the main services surgery and psychoanalytic services and so on. That seems to be the way medicine is going generally, what’s the objection to that idea, so that if you have a same type of surgery, someone in the private sector or nonveteran would have, pretty much they, I think the example that came up was hip surgery used to be four days in the hospital for that. Now you’re four hours in a place and they practically send your home on a bicycle. Shouldn’t VA move to those contemporary ways?
Jacqueline Simon: Well, it’s funny that you raised the hip surgery example. During the George W. Bush era, when they wanted to privatize half of all federal jobs, including hundreds of thousands that were inherently governmental, the favorite example was lawn mowing. They’d say why should a federal employee burdened with all that unnecessary thing for a low life human being who does things like landscaping work and mowing the lawn? Why should that person have health insurance in a retirement plan in a federal job? That’s the kind of thing we need to outsource. And lawn mowing was their favorite example of what needed to be outsourced, when what they were really outsourcing to all of our detriment was vast amounts of the government’s IT infrastructure, and everything else anywhere near it. This gang is using hip surgery as their example. And in your description of what’s in this plan, they are not only closing many medical centers, they’re gutting many medical centers and the ones that aren’t on the hitless for outright closure this time, there will be another round, if this thing goes through, will be the remaining centers that they destroyed by taking away their emergency rooms, their ICUs, their surgery departments. Veterans do have more complex problems than needing hip replacements. Hip replacement is a real easy one for them to use, because it seems “Oh, sure, and it’s widely available in the private sector, why should anyone care where they get their hip replaced?”
But that’s not all that goes on in a VA hospital. And one of the things that anybody who knows anything about the veteran patient population knows that they present with uniquely complex issues, some the result of their service, illnesses and conditions that they acquired during their military service, and other things that have presented as they aged, their conditions exacerbated, whatever. And there are very complex, interconnected problems that this patient population presents with. They are unique in many, many ways. The private sector isn’t necessarily capable at this moment of treating veterans and definitely not capable of treating veterans in the way that they currently are treated in a VA hospital where it’s truly, truly integrated care. And so you lose that integration when you close down several departments within a medical center. So what’s on this page, if you’re doing a spreadsheet, and you’re somebody who couldn’t care less about the human beings, who will be affected by this, this could all be pieces of a puzzle that look just fine. But the human cost is gonna be horrendous. If they do this to veterans, veterans will suffer, veterans will die.
Tom Temin: Alright, so the plan is out. And now there’s the AIR [Asset and Infrastructure Review] Commission, which has to kind of get its legs under itself and get going to evaluate these things and recommendations. It’s a long process yet, what will AFGE be doing in the meantime, while this thing cogitates through the machinery?
Jacqueline Simon: Well, we’ve got to do a lot of different things. I mean, one of the things that’s undeniable in this, even as Secretary McDonough tries his hardest and twists himself into a pretzel trying to deny it. It is a destruction of union jobs. He says net net, you’ll have more jobs. Meanwhile, many, many, many union jobs will be destroyed. So that’s our number one job, of course, because we are the union is to promote and protect the interests of our members. Now, it’s not well known, but more than a third of the VA workforce are veterans themselves. They are users of the VA system. And another enormous portion of our membership are veterans, people who work as civilians from the Department of Defense, who work in law enforcement in the Bureau of Prisons, and DHS throughout DHS, TSA, Border Patrol, ICE. They have disproportionate numbers of veterans in those workforces, as well. Our membership is overwhelmingly veterans. And I’ve been in so many situations where a speaker will say all the veterans in the audience stand up and often, a handful of people stand up and you get some applause. In an AFGE gathering, when they say all the veterans stand up, more than half the room stands up. So we are not a VSO but boy, are we a veterans organization.
And so we are very, very, very interested in every level. So obviously, our job is to go through this set of recommendations with a fine tooth comb. We’ll be lobbying the commissioners, we’ll be lobbying the Congress, we’ll be participating in all the hearings that are held throughout the country. We will try to make sure that the commissioners hear about the human cost of these horrible recommendations, not only on the veterans but also on the VA workforce, and in the communities where these veterans facilities are located. I don’t think anybody can doubt that closing a medical center hurts a lot of small businesses, hurts the community. These are good union jobs that will be disappearing, families will no longer be able to afford to patronize local businesses and the effects will be across-the-board negative. There’s no good in this thing, I mean, in the closures. As far as building new facilities, improving existing facilities, repurposing aging facilities, we’re all for that, but we are opposed to the closures.
Tom Temin: Jacqueline Simon is director of Public Policy at the American Federation of Government Employees. Thanks so much for joining me.
Jacqueline Simon: Thanks for having me.
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Tom Temin is host of the Federal Drive and has been providing insight on federal technology and management issues for more than 30 years.
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