No Pandemic-Related Pause? VA Privatization Leaves Veterans Waist Deep in Another Big Muddy 

Photograph Source: Brianmcmillen – CC BY-SA 4.0

“Every time I read the papers
That old feeling comes on;
We’re waist deep in the Big Muddy
And the Big Fool says to push on.”

– Pete Seeger, 1967

Half a century ago, 60,000 Americans and more than three million Vietnamese lost their lives in the foreign policy quagmire known as the Vietnam War.

Nothing captured the futility of U.S. intervention better than the memorable refrain of Pete Seeger’s “Waist Deep in the Big Muddy.” This metaphoric song never mentions Vietnam, because the lyrics tell the story a World War II training mission involving soldiers, loaded down with equipment, who are ordered to ford a muddy river in Louisiana.

The captain leading his men deeper into the treacherous current brushes off warnings from his sergeant, calling him a “Nervous Nelly.” As the dark water rises around them, “the big fool” in charge insists that everyone “push on” because “we’ll soon be on dry ground.”

Finally, the captain goes under himself and drowns. His sergeant orders the trainees to abandon the crossing, with no further casualties. (In the real-life Parris Island incident that inspired Seeger’s song, six Marines died under similar circumstances and the platoon leader responsible was later court-martialed.)

Waist Deep was not just a big hit among civilian opponents of the Vietnam War. It also resonated among GI’s because so many had been put in personal danger by unpopular officers acting with much certitude but little concern for their well-being.

The real “big fool” in Seeger’s musical parable was, of course, President Lyndon Johnson, then leading the U.S. ever deeper into the “big muddy” of Vietnam. Johnson’s repeated escalations of the war greatly increased its total loss of life, until he himself was forced to reverse course and abandon a planned re-election bid in 1968.

There’s another “big fool” in the White House now, actively seeking re-election. One of his proudest achievements is outsourcing medical care for veterans, which has steered many toward private hospitals now overwhelmed with coronavirus patients.

Another Big Muddy

How did veterans of Vietnam and other wars end up in the “big muddy” of VA privatization?  Two years ago, President Trump persuaded a bi-partisan coalition in Congress to pass the VA MISSION Act of 2018. It authorized a costly expansion of outsourcing by the Department of Veterans Affairs (VA), which provides healthcares for nine million former military personnel.

Under the guise of giving VA patients more “choice” and speeding up their doctor appointments and hospital treatment, the Trump Administration has spent hundreds of millions of dollars on private sector providers, while refusing to fill an estimated 44,000 to 50,000 vacancies among VA care-givers.

Before he was fired for not implementing privatization fast enough, Trump’s first Veterans Affairs Secretary, Dr. David Shulkin, boasted that the percentage of VA patients who received some outside care increased from 19 to 36 percent on his watch.

Shulkin did try to fend off proposals by Kansas Republican Jerry Moran who wanted every veteran “to visit a VA facility or a facility in the private sector whenever he or she wanted.” Shulkin warned Trump that Senator Moran’s approach “would put the VA hospital system at risk of harm by diluting its delivery capabilities and cost the U.S. Treasury billions more each year.”

Quicker Care Elsewhere?

After Shulkin was fired by tweet in 2018, Trump replaced him with a former Republican staffer from Capitol Hill. Unlike Shulkin and his predecessors, Robert Wilkie had no experience running any big private or public sector organization, much less the federal government’s second largest agency.

Until he appeared to waiver recently, Wilkie’s main virtue was his reliable promotion of further privatization.  With Shulkin gone and the MISSION Act passed, Wilkie developed new rules for outside referrals that lacked proper clinical guidelines. As Shulkin has warned, these “access standards” could “lead to the rapid dismantling of the current VA system.”

As the current pandemic spread, however, even a cabinet secretary with no healthcare background was bound to notice that lines are getting longer and hospital wards more crowded and hazardous in the private sector. Getting a quick appointment with your primary care provider, dentist, or eye doctor is not easy for anyone at the moment, much less  new patients from the VA.

In addition, veterans are generally older and already less healthy than the patient population of most private healthcare systems. In order to be eligible for VA care, they must be low-income or have some service-related condition. Many have ailments that make them more vulnerable to contracting COVID-19 in the community or being hospitalized with a severe case of it.

So, not surprisingly, Wilkie informed the House and Senate Veterans Affairs Committees that the VA was proposing “a temporary strategic pause in the MISSION Act access standards for 90 days, or until the soonest possible time that routine care resumes.”

A Temporary Pause?

The response from privatization hawks, in and around the Trump Administration, was reminiscent of hostile right-wing reactions to Lyndon Johnson’s “strategic pauses” in the bombing of North Vietnam in the late 1960s (for publicity or negotiating purposes).

Influential Republicans weighed in with predictable outrage. “I have serious concerns with the V.A. putting a temporary pause on community care,” said Jerry Moran (R-KS), now chairman of the Senate Veterans’ Affairs Committee, in a New York Times. interview. “At a moment like this, vets deserve MORE health care options—not less,” tweeted Pete Hegseth, a Trump confidante, Fox News commentator, and former director of the Koch-funded Concerned Veterans of America (CVA)

Nate Anderson, his successor at CVA, urged the V.A. “not to proceed with any policy proposal that would limit the ability of veterans to access care in the community.” And Congressman Phil Roe (R-TN), the ranking Republican on the House Veterans Affairs Committee, demanded to know “how and why V.A made this decision.”

Eager to avoid Shulkin’s fate, Secretary Wilkie had an underling quickly clarify in the Times that there would be no real “pause,” just closer scrutiny of requested referrals for non-emergency care “on a case-by-case basis for immediate clinical need and with regard to the safety of the veteran.” The White House offered additional assurance that Donald Trump was “not stopping or pausing” MISSION Act implementation but just “ensuring that the best medical interests of America’s veterans are met.”

One of those veterans is Bay Area VA patient Paul Cox, who  doubts that Trump has his personal safety or best interests in mind. “Only conservative ideologues who care more about their pet privatization project than the well-being of veterans would continue to push the VA in the wrong direction in such dire times,” says Cox, who served in Vietnam and now assists the Veterans Healthcare Policy Institute.

As Denny Riley, a 75-year old Air Force veteran points out: “If you defund something so that it doesn’t work adequately for the people, then you can point at it and say, ‘See, it doesn’t work,’ and send these people to private healthcare, and that’s a total boondoggle.”

As part of its coronavirus stimulus package, Congress just authorized a long overdue infusion of $20 billion for VA hospital expansion, equipment purchases, and other expenditures—leading Riley to believe that, “in this particular situation, the VA will outshine private healthcare.”

That won’t be the preferred outcome of true believers in the MISSION Act, who remain committed to marching as many veterans as possible into the “big muddy” of private healthcare. Count on them to out-source as much VA care as they can, under any circumstances, for as long as possible, even in the face of now obvious risks.