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Veterans Health Administration and Healthcare in the time of COVID-19

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Since my book, Wounds of War was published almost two years ago, I have continued to write about as well as to oppose efforts to privatize the nation’s largest healthcare system: the Veterans Health Administration (VHA). Now, as the nation grapples with the coronavirus pandemic, Congress, the media, and the public are suddenly discovering what I’ve experienced first-hand. A fully integrated, national healthcare system can not only deliver higher quality care but respond far more effectively to a global pandemic than a system that focuses on the provision of episodic, fragmented treatment.

The coronavirus crisis has laid bare the failures of a market-driven healthcare system, which has been unable to muster an effective response to the pandemic. The VA, on the other hand, has mobilized quickly to fulfill its first mission—to safely provide high-quality clinical care to veterans—as well as fulfill its fourth mission to serve as a backup to the civilian sector system in a national emergency.

The coronavirus crisis has laid bare the failures of a market-driven healthcare system, which has been unable to muster an effective response to the pandemic.

For more than a decade, countless studies have documented what I describe in my book. The VHA often delivers better care at lower cost than private hospitals and doctors. That’s because even hospitals and healthcare professionals who have the best of intentions are trapped in a system in which profit is the driver and competition – rather than collaboration – the rule.  Even as it struggles against staffing vacancies and chronic underfunding, the VHA is able to fulfill its multiple missions because of its many advantages.

Unlike the private sector, the VHA has long been a leader in global telehealth. As soon as the pandemic emerged, the VHA mobilized its giant telehealth capacity to move from in-person to virtual visits.  Veterans can continue their mental health treatments, physical therapy, and consult with physicians, nurse practitioners, and physician assistants —even tinnitus treatment – via telehealth. Income inequalities do not place poorer veterans at a disadvantage because the VA provides many patients with devices so they can send data to providers as well as meet with them from their homes.

The VA has also pioneered the use of tele-ICUs. The VA has three centers located in Minneapolis, Chicago, and Iowa City where doctors and nurses can consult, via telehealth and help with intensive care patients in other locations.  As of 2018, 17 VA medical centers had equipped ICU rooms with TV screens, cameras, and other telehealth equipment. Using telehealth ICUs cannot obviously solve the problem of a shortage of ICU beds or ventilators if a VHA facility is inundated with severely ill COVID-19 patients. But it can help with any staff shortages that result if nurses and doctors are put in quarantine because they’re at risk of developing the disease themselves.

The VHA has also been able to respond rapidly to the current crisis because staff is on salary rather than working in a fee-for-service system.  That means that the VA can cancel elective surgeries or delay non-urgent appointments without worrying about loss of revenue. “I feel very lucky to be working in the VA today,” one Chief of staff at a VA medical center told me. “I’m already on hair-trigger about to cancel total knee replacements or other elective surgeries. When I talk to colleagues in the for-profit sector, they are much more reluctant to do this because they will lose money.” While private sector hospitals have furloughed staff because of a decline in revenues, the VHA has not done the same.

Because our nation has not adequately planned for, or responded to, this emergency, VA staff have the same problems getting personal protective equipment as workers in private sector healthcare. Representing healthcare equipment manufacturers, the Chamber of Commerce, has actually lobbied against the use of the Defense Production Act to force companies produce more PPE because their bottom line would suffer. And under the Trump administration, the Federal Emergency Management Agency (FEMA) has actually sabotaged the VA by refusing to send needed PPE to VA facilities.

Because our nation has not adequately planned for, or responded to, this emergency, VA staff have the same problems getting personal protective equipment as workers in private sector healthcare.

When, however, they protest about lack of PPE, VHA employees, unlike those in the private sector, have not been fired but are instead protected because they are members of unions that represent VA workers, like the National Nurses United and AFGE.

When I wrote Wounds of War, my goal was to counter the steady stream of negative publicity from the nation’s media and right-wing ideologues inside and outside of Congress as well as in the Trump Administration. The VA is broken narrative has become so prevalent that even some of my most liberal and progressive friends—not to mention Rachel Maddow, the New York Times, and CNN—still believe the myths about the VA. As the nation emerges from this crisis and debates broader healthcare reform,  my hope is that the United States will finally have a real, national healthcare system—something that would look more like a VA for All.


Suzanne Gordon has written, edited, or co-authored twenty books. Gordon has been published in the New York TimesLos Angeles TimesBoston GlobeAmerican ProspectAtlantic Monthly, and Harper’s Magazine. Follow her on Twitter @suzannecgordon.


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