Public sector workers face many privatization threats. But one of the biggest labor-management fights over outsourcing is now occurring, nationwide, at the largest public healthcare system in the United States.
Run by the Department of Veterans Affairs (VA), the Veterans Health Administration (VHA) serves 9 million veterans in 1,300 hospitals and clinics around the country. Its patients include former soldiers who are low-income, who have service-related medical conditions, or who recently returned from combat zones.
More than 300,000 VA staff members are represented by the American Federation of Government Employees (AFGE), National Nurses United (NNU), the Machinists-affiliated National Federal of Federal Employees, or the Service Employees International Union (SEIU). This makes their employer one of the most heavily unionized healthcare systems in the country.
As we document in a new book, these federal workers provide specialized treatment that is far better coordinated and more cost effective than care in the private healthcare industry. The VA conducts medical research that benefits all Americans and also plays a major “teaching hospital” role in training thousands of new doctors, nurses, and other healthcare professionals.
All VA care-givers are salaried, rather than being paid on a “fee for service” basis. VA medical centers don’t spend billions of dollars on advertising, marketing, or executive compensation like for-profit hospital chains do. And vets who qualify for VA care don’t have to deal with the mountains of paperwork—and financially burdensome out-of-pocket payments—required by most private insurers and even Medicare.
The privatization threat
Five years ago, conservative Republicans and corporate Democrats in Congress took a sledgehammer to this model healthcare system when they passed the VA MISSION Act of 2018. As implemented by Donald Trump—and, sadly, by Joe Biden as well—this legislation has siphoned billions of dollars away from the agency’s direct care budget and steered that money toward private doctors and for-profit hospitals often less well prepared to treat veterans.
The VA has been partially converted into a Medicare-style payer of bills submitted by outside vendors. The powerful private interests which gained this new $33 billion a year federal revenue stream want to preserve and expand it. They include some of the same for-profit firms trying to undermine traditional Medicare coverage by steering almost half of all seniors into Medicare Advantage plans.
The adverse impact of costly and unnecessary outsourcing of veterans care has been documented most recently by the Veterans Healthcare Policy Institute, based on a national survey of AFGE members. In a report called Disadvantaging the VA, Oregon veterans like Keegan Miller and Henri Henrickson describe their positive experience with the VA as patients. And local union activists like AFGE Local 2157 vice-president David Bump call for reversal of multiple Trump era policies and practices that make serving veterans more difficult.
About one-third of the VA workforce is composed of former service members, which fosters a unique culture of solidarity between patients and providers that exists nowhere else in U.S. healthcare. VA union members, their patients and families, and veterans organizations came together last Spring to defeat an ill-advised White House plan to downsize many VA facilities, particularly in already underserved rural areas.
Despite that important political victory, piecemeal privatization of veterans’ healthcare continues, making on-going community-labor organizing to “Save Our VA” more important than ever, in Oregon and other states.
Steve Early and Suzanne Gordon are co-authors of a new book is called Our Veterans: Winners, Losers, Friends and Enemies on the New Terrain of Veterans Affairs from Duke University Press. Early is a longtime labor journalist, and Gordon is co-founder of the Bay Area-based Veterans Healthcare Policy Institute. They can be reached at [email protected]
