Veterans groups not saluting McCain’s health care card

Both John McCain and Barack Obama agree with major veterans groups that the U.S. Department of Veterans Affairs (VA) system is broken.

The agency charged with providing medical care for veterans of the U.S. military has, for example, had difficulty providing proper care for new types of injuries incurred by troops in Iraq and Afghanistan. Concussive brain injuries due to roadside bombs have taxed the VA system, as has the psychological care needed for the alarming number of returning soldiers and Marines with symptoms of post-traumatic stress disorder. McCain offers “standing in line to get an appointment to get an appointment” as another example of the troubles both candidates say they want to solve.

Where the candidates disagree, however, is in some of the details of how they intend to accomplish the reform. The most notable division between the plans of Obama and McCain is the potential expansion of veterans care to the private sector. McCain’s plan calls for the use of a health care access card intended to allow veterans access to private doctors if they aren’t able to get into a VA facility in a timely manner.

It is a conservative tenet to redirect the functions of government to the private sector, such as the Republican-led effort to privatize many of the functions once carried out by the U.S. military. According to McCain, his plan will improve health care for veterans by making it easier for them to use non-VA hospitals:

Too many veterans are unable to obtain health care through the VA because of geographical constraints, unreasonably long waiting lists, or the lack of specialized facilities at local VA hospitals. John McCain will develop and enforce demanding new standards for veterans’ access to health care for injuries or illness related to military service: no more than an hour’s drive for care, routine care within a week, urgent care within 24 hours, and specialty care within a month.

The Traverse City Record-Eagle reported on problems veterans in northern Michigan have when the nearest special care they need is in VA hospitals in Saginaw or Ann Arbor.

Obama’s plan would improve the VA through funding rather than outsourcing. His plan also calls for an end to the 2003 ban on covering modest-income vets that has led to the denial of VA care to 1.5 million veterans — something that McCain says would risk “clogging the system.” McCain says he doesn’t oppose adding the banned veterans [Also known as Priority 8's] back into the VA roll, but says income tests to gradually absorb the group is the best way to do that.

From a March 2008 joint press release of the Senate and House Veterans Affairs Committees:

On January 17, 2003, the Bush Administration banned enrollment of “Priority 8″ veterans into the VA health care system due to resource constraints. Priority 8′s are non service-connected veterans who exceed a certain income cap, currently as low as $28,430 in some regions. VA estimates that as many as 1.5 million middle-income veterans have been denied, or are awaiting, enrollment into the VA health care system due to this restriction.

Another key issue being eyed for reform is the VA’s funding stream, which has been inconsistent, according to the Disabled American Veterans (DAV), a nonpartisan advocacy organization of disabled vets with more than 1.4 million members. As DAV asserts, it’s been 12 years since Congress approved a VA budget ahead of the VA budget year. The DAV says that if the funding stream can be corrected, the VA would be in a better position to take care of veterans needs in a timely fashion.

McCain has addressed the funding issue, but DAV has said it fears that McCain’s platform against pork-barrel spending and earmarks could place further roadblocks in the way of consistent funding.

What the DAV voices the most concern about the question of privatization.

Joe Violante, DAV national legislative director, detailed his concerns in an August article in the National Journal this way:

“The problem with contracting out [to private health care providers] is the costs are greater than it is for VA to treat individuals at VA,” Violante said. “So, if we send more veterans out into the private sector, we start increasing the costs for VA health care, which then forces VA to ration care to those individuals who are within the system. … We believe if we can correct the funding stream, VA would be in a better situation to take care of more veterans in a timely fashion.”

Violante also addressed a key area of concern with the McCain plan:

Violante would not speak directly to the value of McCain’s Veterans Health Care Access Card because he said that the senator’s public statements on the issue had been confusing. “At one point he had talked about VA focusing on combat injuries and combat disabled, and veterans looking for routine care would get this card to go elsewhere,” Violante said. “That’s kind of changed now from what I heard today. He’s basically talking about all disabled vets and indigent veterans being cared for by VA being able to get that card if they don’t have that access. But again, the details — it’s tough even talking to staff about it. They’re not really sure of the details. We’re still working it out, and we still continue to talk to them about our concerns about that type of talk.”

Violante has continued to report his concerns. From the News Observer, Oct. 31, 2008:

Violante … said details for McCain’s plan are sketchy, but that any attempt to move patients out of the VA “concerns us.”

As quoted in the August article in the National Journal, McCain denied that the card idea was tantamount to privatization:

“As today, as other occasions, I have stated in the plainest, most straightforward terms that the Veterans Health Care Access Card will expand existing benefits,” McCain said. “I don’t expect this to deter the Obama campaign from misrepresenting my proposals, but lest there be any doubt, you have my pledge: My reforms would not force anyone to go to a non-VA facility. That is my promise. They will not signal privatization of the VA.”

Still the DAV is not alone in its skepticism.

In an Associated Press article from this summer, VA Secretary James Peake spoke regarding the card component of McCain’s veteran’s platform:

After touring the Manchester VA Medical Center, VA Secretary James Peake also said he is against giving veterans cards to let them receive treatment at non-VA facilities.

“That’s called Yellow-Page medicine,” Peake said. “I think that potentially is dangerous, because I’m not sure the individual is necessarily the best consumer. It’s hard to be an educated consumer of health care.”

He said keeping veterans in the system improves care by keeping it coordinated.

Larry Scott of the private Web site VAWatchdog.org also opposes McCain’s access card program. In an August post on his blog he wrote:

For every veteran who opts for private health care, that is one less veteran using the VA … which means the VA would receive less funding. So it would “privatize” a great deal of VA health care and lead to the decline, or even the destruction, of the VA as we know it. The solution is not to offer private health care that would cost the taxpayers 25% to 100% more per visit or procedure, but to properly fund the VA to do the job it is supposed to do. The solution is mandatory funding for VA health care, something to which McCain is opposed.

Even though veterans groups were critical of McCain’s VA health care plan, all cited respect for the Arizona senator and his military service.

Michigan Messenger spoke to Kay Barnes at the McCain campaign headquarters in Farmington Hills today seeking more clarity on the specifics of Senator McCain’s health care plan for veterans, and she said:

“No one on staff here in Michigan, or anywhere else within the campaign that can comment on the specifics of Senator McCain’s veterans health care plan. I know he is in total support of the troops, and for a better economy. He really does support our troops.”

Michigan vets speak on health care

Michigan Messenger spoke with some area veterans to see if they had any reaction to either candidate’s plans for VA health care.

Navy veteran Eric Baerren of Mount Pleasant, a liberal blogger, spoke frankly about his concerns regarding his health, and treatment, should the need arise.

Baerren contracted tuberculosis in the 1990s — along with several hundred other sailors — while stationed off the coast of Bosnia. He received the positive test results the day his service ended. Military rules required that he receive a formal diagnosis before the end of that day in order to be eligible for health care for the illness.

Forced to visit a county health clinic due to the time constraints, Baerren saw a physician who “had to look up TB in a book because he had never treated anyone with the illness before.” Baerren left the clinic with only his formal diagnosis as required by the military and was able to begin his lengthy treatment with a VA facility. Should his TB become active again, his would be difficult to treat because it is possible that he is immune to many commonly prescribed antibiotics. Baerren says that the VA is his safety net and that the McCain plan’s unknowns “rather terrify” him. At the VA, there are specialists who have treated boatloads of sailors. They wouldn’t have to research first before knowing where to turn.

Another Navy man, “Charlie,” who didn’t want his full name used, is a Vietnam veteran from Saginaw who identified himself as a McCain supporter.

He lost both legs during his service. The VA “is very important to me” as a disabled veteran, Charlie said, but he declined comment on either candidate’s health care plan, and said that he and some fellow veterans were in continuing discussions on the topic.

Another Michigan veteran, Donald Bortz of Waterford — who also happens to be running as a Democrat for Oakland County commissioner — sharply rebuked the McCain plan. Bortz is under the impression that his friend who received a non-combat injury in Iraq would not receive the same treatment as a wounded-in-combat veteran. It is not clear that that is the case, however.

“I think it sucks,” said Bortz. “I think it sucks because McCain’s plan states that veterans who were injured in a noncombat situation will not be receiving the same care as those who were. I had a friend in Iraq who was injured because he was accidentally hit in the head with a 2×4. To say that he doesn’t deserve quality health care just because he wasn’t blown up is an insult to his service.”

Whichever candidate wins the election Tuesday, the plan that the winner implements is one that will have to meet the needs of not only current troops and veterans but a continued influx of returning vets. Changes in combat tactics, equipment and weapons like roadside bombs have spurred changes in the sorts of injuries more commonly seen.

For more on John McCain’s Veterans’ Care Access Card, see the full summary of his plan on his campaign Web site.

For more on Obama’s veterans health care plan, see the full summary on the Obama-Biden campaign Web site.