Trump signs suicide prevention executive order
From the VHPI blog:
Over the last two decades, as suicide rates in the U.S. have climbed 33 percent, the rates for veterans who use the services of the Veterans Health Administration (VHA) has remained relatively steady. This relative success in due in large part to the VHA’s state of the art, comprehensive approaches.
Even so, the majority of veterans who die by suicide were not recent users of VHA services. The critical need to reach these veterans is why the ‘President’s Roadmap to Empower Veterans and End the National Tragedy of Suicide’ Initiative is so critical. Like the VA’s new partnership with the National Shooting Sports Foundation and the American Foundation for Suicide Prevention, PREVENTS is an important step in the nation’s efforts to effectively tackle veterans’ suicide where it is most prevalent.
When VHPI submitted its analysis on the the VA’s National Strategy for Preventing Veteran Suicide in July 2018, we appreciated the innovative, public health ideas of the plan. PREVENTS elevates the National Strategy to the level of seriousness and attention it deserves. As a cabinet-level team collaboration between the VA, Departments of Defense, Health and Human Services, and Homeland Security, they’ll be better able to impact all veterans wherever they live.
As we noted in our analysis, the National Strategy’s shortcomings centered on its over- emphasis on community initiatives that could undercut effective VHA targeted efforts. When it was released last summer, the National Strategy never mentioned the need for new appropriations to pay for its public health outreach, leaving the likelihood that funding would be carved out of the VHA budget.
The danger of cannibalizing VHA resources and thus undermining its successful programs still remains. However, the President and VA secretary have hinted that Congress should consider allocating resources for a grant program to fund state and local suicide prevention efforts as part of PREVENTS. Will Congress be amiable to providing additional funding around veterans health as it rolls out the MISSION Act?
More on the Executive Order:
The “It’s Not Privatization!” talking points
Suzanne Gordon reports in The American Prospect about the public relations campaign being conducted by VA privatization deniers:
The VA’s Office of Public and Intergovernmental Affairs followed up with a press release reasserting that, “The former secretaries also pushed back strongly against predictable and false claims that the new standards amount to privatization of the VA.” VA leadership has also sent out a number of directives instructing VHA public affairs officers and staff to refute veterans’ concerns about VA privatization. A document entitled “Veteran Community Care (VA MISSION Act)—Eligibility and Access Standards,” obtained by the Prospect from several sources who preferred to remain anonymous, has a long section advising how to counter any questions from veterans uneasy about privatization. Staff are directed to respond with, “There is no effort underway by anyone or at any level to privatize the VA.”
In yet another set of talking points delivered to VA staff and public affairs officers, VA leaders claim that outsourcing more and more VHA care doesn’t constitute privatization because privatization only occurs with “the transfer of ownership, property or business from the government to the private sector.” It goes on to say, “There has never been a proposal to do this, not from the Administration, Commission on Care or from any Veterans organization, including Concerned Veterans for America.”
In asking staff to serve as a mouthpiece for the CVA, the VA leadership is taking yet another step toward an organization that has long been hostile to the VHA. Indeed, Darin Selnick, who has been a senior advisor to CVA, is now overseeing the implementation of the MISSION Act inside the VA. As one VHA staffer who preferred to remain anonymous said, “I don’t know if Selnick wrote this document or just edited it.”
CVA’s current executive director, Dan Caldwell, then published his own op-ed in which he indicated that opponents to the proposal are making false attacks and engaging in scare tactics, noting “It’s not about privatizing or destroying the VA.”
Then continuing their privatization denial, the VA’s spokesperson Curt Cashour announced in a February 23 article in Stars and Stripes that, “Privatization is a myth that has been thoroughly debunked.” As concern builds over Wilkie’s proposal, it is critical for veterans, veterans service organizations, legislators, and the public to understand that the VA’s narrow definition of privatization is erroneous. The vast literature on privatization makes abundantly clear that privatization is a spectrum of activities.
As sociologist Paul Starr has written, privatization involves “the contracting out of services formerly provided by government organizations to private producers.” This shift can involve, at one extreme, the wholesale auctioning off of public-sector activities to private businesses, as well as the gradual outsourcing of public services to private-sector providers, use of vouchers, and "privatization by attrition," in which a government lets public services run down.In transferring taxpayer money from public agencies to private businesses, privatization starves the public, and enriches the private sector.
Tellingly, privatization often involves a propaganda assault depicting government programs as broken beyond repair and government employees as callous or incompetent.
The FY2020 VA Budget Breakdown
From ConnectingVets.com:
Here’s how that mostly breaks down:
- $97 billion for discretionary spending, such as health care, benefits and cemetery funding. That's an increase of $6.8 billion over last year's approved funds.
- $123 billion in mandatory funding, which includes housing, compensation, pensions.
- $4.3 billion for IT investments, including a $200 million increase to renew an “aging network infrastructure.”
- $1.6 billion to continue to implement a new electronic health record (EHR) system between the VA and DoD, “by bringing all patient data into one common system.”
- $1.2 billion for breaking ground on a new hospital in Louisville, Kentucky, finishing construction at other medical facilities and expanding VA’s national cemeteries.
There's also $547 million for programs dedicated to women veterans, and $9.4 billion for veteran suicide prevention.
Big changes coming for military medical personnel?
A story from Kaiser Health News via ABC News:
The U.S. military is devising major reductions in its medical corps, unnerving the system’s advocates who fear the cuts will hobble the armed forces’ ability to adequately care for health problems of military personnel at home and abroad.
The move inside the military coincides with efforts by the Trump administration to privatize care for veterans. The Department of Veterans Affairs last month proposed rules that would allow veterans to use private hospitals and clinics if government primary care facilities are not nearby or if they have to wait too long for an appointment.
Shrinking the medical corps within the armed forces is proving more contentious and complex. In 2017, a Republican-controlled Congress mandated changes in what a Senate Armed Services Committee report described as “an under-performing, disjointed health system” with “bloated medical headquarters staffs” and “inevitable turf wars.” The directive sought a greater emphasis for military doctors on combat-related needs while transferring other care to civilian providers.
Details of reductions have yet to be finalized, a military spokeswoman said. But within the system and among alumni, trepidation has increased since Military.com, an online military and veterans organization, reported in January that the Department of Defense had drafted proposals to convert more than 17,000 medical positions into fighting and support positions — a 13 percent reduction in medical personnel.
VSOs brief lawmakers
Veterans’ advocates have been delivering presentations before joint hearings of the House and Senate Committees on Veterans Affairs for several weeks. Patricia Kime lists the VSOs’ priorities at Military.com.
Coming up on Capitol Hill
Joint Hearings of the House and Senate Committees on Veterans Affairs
House Committee on Veterans Affairs
Senate Committee on Veterans Affairs
It happened with housing. Is health care next?
Private sector contractors silenced military families who lived in substandard housing by requiring them to sign non-disclosure agreements. Could this be a preview of what happens with non-VA providers after the VA MISSION Act is implemented? From Military Times:
Privatized housing companies that are asking service members to sign agreements promising to keep silent about their poor housing conditions must immediately stop, Sen. Thom Tillis, R-N.C., told the service secretaries and service chiefs during a hearing Thursday.
“These organizations wave a non-disclosure agreement in front of them and say, if you sign this agreement, there may be a bonus or payment you’ll be entitled to if you don’t bring up what may be inadequate housing,” Tillis said, during a hearing of the Senate Armed Services Committee.
“I can’t imagine on any level why it would make sense to have a new tenant, these young kids, sign an agreement, not understanding the implications of it,” Tillis said, noting it could well be the first lease that service member has ever signed.
Military Sexual Trauma: A guide to recent news
- Last week, a U.S. Senator and Air Force veteran revealed she was raped by a superior officer. You can read the story at Military Times.
- Military Sexual Trauma (MST) is the result of sexual assaults, harassment, and/or unwanted sexual attention experienced by both women and men while in the military.
- MST is a risk factor for developing PTSD, as well as anxiety, depressive disorders, and alcohol and drug abuse.
- Because MST occurs in settings in which people are taught to depend on others for their very lives, people who experience such trauma may feel isolated, develop issues with trust, and have even greater difficulty adjusting to civilian life.
- At least 25 percent of women serving in the U.S. military say they have been sexually assaulted, and up to 80 percent have been sexually harassed.
- In 2011, women in the military were more likely to be raped by fellow soldiers than to be killed in combat.
- In 2017, the DoD received 6,769 reports of sexual assault involving service members as either victims or subjects of criminal investigation, a nearly 10 percent increase over the previous year.
‘Community care efforts have fallen flat’
An opinion on health care provided by the private sector and the VA at The Hill:
While it took a few years for the staff to stop asking where my husband was after I first started using the VA in the early 2000s, I can honestly say that hasn’t happened in over ten years. And yes, there are still odd male patients who persist in calling me honey or dear, but rarely in a lascivious way, and more in the grandfatherly manner many older generation males do, even in the private sector. I’ve experienced worse behavior at my private care doctors — I won’t go into the details of the civilian doctor who called me ‘little girl’ for two years — none of whom have implemented the bold, consistent anti-harassment campaigns that are visible on every TV monitor at the VAMC I use, or have clearly-defined women’s clinics (with privacy curtains and specially trained women's health providers!) should I need one, as well as the option to request a same-sex witness during my interactions with my health care provider.
Between my personal medical care and my direct observations of the care of the VA patient for whom I am primary caregiver, I’ve never been treated more thoroughly than at the VA. I’ve not had to explain the toxic exposures, the propensity for ailments common to our population, or even why I’m adverse to certain medications — mainly because my entire medical file is at their fingertips, with all of my specialists able to access it immediately and provide appropriate care and testing in one location.
I was excited about the opportunity to use VA Choice care when it launched — the D.C. VAMC is only 11 miles from my home, but anyone familiar with D.C. traffic will understand that is a 45-minute drive on a good day, and an hour and a half on a bad one. Choice seemed like a dream come true… till I tried to use it.
Badly managed from the start by half-trained contractors working on a hurried development / deployment timeline because of urgency imposed by Congress, it offered me nothing but frustration.
Quick Clicks
- Targeted Oncology: The VA’s genetic testing program could lead to more targeted cancer treatments for veterans
- The Wall Street Journal: Will hospitals be forced to release secret price lists?
- The Washington Times: Cerner’s Electronic Health Record modernization project is already over budget...and there is likely still a decade to go before it's complete
- CBS News: An in-depth look at the health care crisis in rural America, where about a quarter of all veterans live
- Stars and Stripes: The Government Accountability Office says VA contracting is at high risk for wasting taxpayer dollars
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