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Another False Koch-Backed Fantasy

Darin Selnick Again Fudges the Facts

Darin Selnick, a long-time advisor for the Koch-funded Concerned Veterans for America and former Trump veterans’ affairs official, is a tireless foe of the Veterans Health Administration (VHA). He’s an equally avid proponent of VA privatization. His positions often reflect an astonishing ignorance of how the private healthcare system actually works. This was exemplified in Senate testimony last month , during which Selnick displayed ideological fantasies that bear no relationship to the realities of American healthcare.

The hearing in question concerned Trump-era private sector access standards imposed as part of the 2018 VA MISSION Act. The hearing featured Senators grilling VA Secretary Denis McDonough on his new Congressionally mandated report on those standards. Selnick largely echoed Republican attacks on McDonough, who has proposed only a small but important change in those rules that would allow telehealth delivered by the VA to be counted as access. Apart from that, he declined to change Wilkie’s most VA crippling drive and wait time access standards.

Even though McDonough has done almost nothing to reverse the Trump era privatization policies of which Selnick was a key architect, Selnick still went on the offensive against the Secretary in his testimony. He specifically (and inaccurately) contended that the VA’s decision to close the MISSION Act website and put up a Choose VA website was somehow a symbol of VA’s nefarious desire to entrap veterans inside the VHA. He roundly dismissed McDonough’s legitimate concern that sending veterans outside the VHA to the private sector could cripple the nation’s largest healthcare system and have negative impacts on rural hospitals. This, he claimed, was proof positive that VA “is more concerned about maintaining its facilities and staff, rather than ensuring veterans receive timely care, whether inside or outside VA.”

Here Selnick seemed to confuse the VA with the private sector health care companies that he so ardently champions. The kind of systems he favors prioritize their own needs – for profit –over the needs of their patients. The VA, on the other hand, is mission – not profit — driven. VA leaders are concerned about maintaining facilities and shoring up staffing levels not because they want to boost some institutional bottom-line or spike an already exorbitant CEO’s salary. They simply know that maintaining and improving infrastructure and hiring staff is the only way a healthcare system can continue to deliver high quality care to patients.

Selnick has apparently failed to read the reams of studies that show the VHA delivers care that is far superior to the private sector providers that make up the Veterans Community Care Program (VCCP). This important point was emphasized in the hearing by two genuine healthcare experts, Carrie Farmer, a senior policy researcher at the RAND corporation, who specializes in military and veteran healthcare, and Joy Ilem, the national legislative director of the Disabled American Veterans (DAV).

Farmer’s testimony (as well as a recent RAND report on the VCCP), highlighted many problems associated with outsourcing and reminded the committee of some basic healthcare facts, namely that “it is critical that discussions about veterans’ access to care always consider care quality. An appointment available tomorrow that provides poor care could be worse than waiting for good care.”

Farmer further underlined the fact that the VA “typically provides care that is equal to or better than care from the private sector. However, we know very little about how VA-delivered care compares with VA Community Care. VA tracks and reports on dozens of quality performance measures and makes much of the data publicly available through its Access to Care website … Equivalent data are not available for VA Community Care.”

Ilem offered an equally important warning about the continued outsourcing of veteran care through the VCCP:

If this trend continues, it could endanger the ability of VA to sustain the critical mass required to provide a full continuum of care to all veterans who choose and rely on VA for their care. This shift is especially concerning because new research discussed below confirms that VA health care on average outperforms private sector care for quality, cost as well as timeliness. Therefore, wait times and wait time access standards must be evaluated and implemented in the overall context of how they will lead to better health care outcomes and a stronger VA health care system.

Selnick has long claimed to be concerned about veterans’ access to timely care. So why isn’t he troubled by the disturbing set of facts around private sector access? According to recent studies, VCCP providers don’t, in fact, ensure timely care to veterans but have wait times that are longer than those at the VA.

To avoid confronting this truth, Selnick performed some pretty complicated mental gymnastics. He accused the VHA of fudging its wait-time data, when in fact VA is the only healthcare system in the United States that bothers to collect and post wait time data. In so doing, Selnick offered his most astonishing whooper: “The health care industry and providers in the VA community care network do not measure wait times. There is no need to measure them since private sector patients have full choice of all providers and can change providers if they are not satisfied with their wait times.”

Private sector patients, of course, do not have an endless choice of providers. They are limited to those who are in the network created by their insurer – if that is, they are lucky enough to have job-based insurance coverage. If they don’t like their providers, they can’t just hop out of network, unless they have the money to pay the often-astronomical fees that out of network providers will charge. Patients are also limited by the supply of doctors, nurses, mental health professionals, etc. Critical shortages of primary care providers (PCPs), for example, mean private sector patients can’t just doctor shop if they don’t like the PCP that’s in their network. In fact, they’re lucky to find a primary care provider of any sort today, because the pandemic has pushed thousands out of practice, turning what was a primary care crisis into a primary care catastrophe.

If patients live in rural areas, they may have no choice of provider at all since most of America has severe shortages of medical specialists, primary care providers, and mental health professionals. Before he makes another comment about timeliness of care in the private sector, Selnick would do well to consult the Rural Health Information Hub’s website, which offers a bleak, data-backed picture of what’s really going in a flyover of the country.

To buck up on more healthcare basics, he could also read relevant articles in journals like JAMA, the New England Journal of Medicine, Health Affairs, or The New York Times. The grey lady, for instance, just published a heart-wrenching article about the crisis in pediatric hospital care.

Turns out, hospitals across the country are eliminating pediatric beds and pediatric intensive care units. Why? Because kids are getting healthier? No, because taking care of adults is more profitable. According to Dr. Daniel Rauch, an expert quoted in the article and the former chief of a pediatric unit at Tufts Medicine that was shuttered over the summer, “They’re asking: Should we take care of kids we don’t make any money off of, or use the bed for an adult who needs a bunch of expensive tests? If you’re a hospital, that’s a no-brainer.”

So, hospitals are converting pediatric into adult beds and making it almost impossible for critically ill children to get the care they need. When there are no facilities or beds available to you, it’s pretty hard to exercise your consumer choice and leave a hospital you don’t like or that has a long wait time to find another that’s more hospitable to the sick.

Rather than heeding the advice of an ideologue like Selnick, lawmakers must instead consider the wise council of true veterans advocates like Ilem, who concluded her remarks by pointing out that, “the best way to reduce wait times is not by expanding veterans’ access to non-VA care, but instead by increasing the capacity of the VA health care system.”

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