March 31, 2018—President Trump’s firing of the Secretary of Veterans Affairs David Shulkin on March 28, is an ominous sign that proponents of privatizing the medical care system for veterans are gaining the upper hand. Should privatization occur, it would be a violation of principles which were part of the American System approach to governing from the earliest days of the Republic.
Former Secretary Shulkin himself, who came into the Veterans Administration as Undersecretary under Obama and was appointed Secretary in the early days of the Trump Administration, has been outspoken on his resistance to privatization. In an oped published in the New York Times the day after his firing, he wrote:
The advocates within the administration for privatizing V.A. health services … saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans….
The private sector, already struggling to provide adequate access to care in many communities, is ill-prepared to handle the number and complexity of patients that would come from closing or downsizing V.A. hospitals and clinics, particularly when it involves the mental health needs of people scarred by the horrors of war. Working with community providers to adequately ensure that veterans’ needs are met is a good practice. But privatization leading to the dismantling of the department’s extensive health care system is a terrible idea. The department’s understanding of service-related health problems, its groundbreaking research and its special ability to work with military veterans cannot be easily replicated in the private sector.
Indeed, despite the well-publicized problems of the VA system, its network of 170 Medical centers and 1063 outpatient centers provides an indispensable source of high-quality, affordable care to the more than 9 million veterans in the United States. The Veterans Administration came into being in 1930 as a response to general neglect and unrest, and under FDR, the commitment to Veterans was seen as part of the renewed commitment to providing for the General Welfare of all, as the Preamble of the Constitution demands.
From the Beginning
But the honorable tradition of caring for the nation’s veterans goes back much further. Alexander Hamilton’s concern for veterans animated all his proposals for financial reform. The first Marine hospitals, dedicated to the care of injured seamen, were established during the Revolutionary war by the states; the first one to be owned by the Federal government was in Virginia (bought from the state in 1801). Others were established in port cities along the East Coast.
In 1798, President John Adams signed the seminal legislation for the national system of medical care for veterans, the Act for Relief of Sick and Disabled Seamen. That act is considered to be the founding of the nation’s system of public health, as it acknowledged the responsibility of the Federal government for the welfare of those who fought to create the nation. It followed the example set by Congress in providing a pension system for servicemen as one of its first acts under the Constitution.
In the post-Civil War period, the system of marine hospitals established in 1798 was put under the supervision of the Washington, D.C.-based Marine Hospital Service, under a supervising surgeon, the first “surgeon general.” Over the next decades, the purview of the Service gradually expanded into dealing with civilians as well—the uniformed Public Health Service we see today.
From the very beginnings of this nation, care for sick and disabled military veterans has been seen as a moral obligation which spurred the creation of resources to care for those who sacrificed for their country. This is just the contrary of those today who seek to cut expenditures to fit a budget, an approach that would have prevented this nation from ever rising to prosperity. It’s the morality of that American System approach we need again today.