More on the VA “Scandal” That Wasn’t

Last Friday, the Washington Monthly released a major investigatory piece by Alicia Mundy about the 2014 VA “scandal”—the one in which scores of veterans were said to have died as a result of lengthy wait times to see VA doctors. Mundy’s story shows that these allegations were baseless–that they were cooked up by a Koch brothers-funded group, Concerned Veterans for America (CVA), and key Hill Republicans in order to stampede Washington into passing legislation in 2014 to outsource VA care to private sector providers

Our story has been widely discussed, by Kevin Drum of Mother Jones and others. I hope you’ll take the time, if you haven’t already, to read the whole thing. It’s one of the most astonishing tales I can remember of how nearly the whole of Washington, including the press corps, got a story exactly backward (one of the few who got it mostly right, by the way, is Bernie Sanders).

It is also a classic example of the dynamic driving the current presidential contest—of the working class GOP base (in this case veterans) being sold down the river by the conservative Washington political class to advance its free market ideology and enrich its corporate cronies. Turns out that independent research mandated by that 2014 legislation not only undermines claims about dozens of veterans dying because of wait times, but also shows that the VA provides the same or better quality care than does the private sector. Yet many of the members of the commission set up by the legislation to make the outsourcing decisions are representatives of the very same private sector providers who stand to gain billions of dollars in contracts at the expense of quality care for veterans.

As you might imagine, our story hasn’t gone unnoticed by those pushing the outsourcing agenda. Earlier this week, Rep. Jeff Miller (R-FL), chairman of the House Committee on Veterans Affairs, co-sponsor of the 2014 legislation, and one of the chief promoters of the “scandal,” sent out a letter complaining that our story “contains a number of completely false statements about the nature and severity of the VA’s wait-time scandal.” Several conservative websites wrote stories based on his accusations, so it’s worth addressing those charges point by point.

First, Miller takes issue with our contention that the original claim he made, that 40 veterans died as a result of lengthy wait times for doctor appointments at the Phoenix VA, turned out to be unsubstantiated. As evidence he quotes a report by the VA’s inspector general: “From our review of PVAHCS electronic records, we were able to identify 40 patients who died while on the EWL during the period April 2013 through April 2014.”

That’s an accurate quote, and we link to the report in our story. But Rep. Miller doesn’t quote the rest of the passage from the report, which says this:

OIG examined the electronic health records (EHRs) and other information for the 3,409 veteran patients, including the 40 patients reflected above in PVAHCS’s records, and identified 28 instances of clinically significant delays in care associated with access to care or patient scheduling. Of these 28 patients, 6 were deceased.

In other words, after an exhaustive review of patient records, the VA’s inspector general found that six, not forty, veterans had died experiencing “clinically significant delays” while on wait lists to see a VA doctor. Of those six, the IG is very clear that it could not say with certainty that any died as a result of waiting for care. From the IG report (emphasis mine):

During our review of EHRs, we considered the responsibilities and delivery of medical services by primary care providers (PCPs) versus specialty care providers (such as urologists, endocrinologists, and cardiologists). Our analysis found that the majority of the veteran patients we reviewed were on official or unofficial wait lists and experienced delays accessing primary care—in some cases, pressing clinical issues required specialty care, which some patients were already receiving through VA or non-VA providers. For example, a patient may have been seeing a VA cardiologist, but he was on the wait list to see a PCP at the time of his death. While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.

What the IG is saying is that the fact that a veteran was on a wait-list when he died does not mean that he died because he was on a wait-list. As we point out (accurately) in our story: “In other words, the reality behind the headlines had little, if any, more significance than the fact that people die every day while waiting for an appointment to see their tax accountant or lawyer.”

Second, Miller argues that data we cite from a VA audit of wait times–showing that “For the VA system as a whole, 96 percent of patients received appointments within thirty days”—is “inherently flawed and therefore unreliable.” In support of that contention he again quotes from the IG report, which says “VHA’s audit, directed by the former VA Secretary in May 2014 following numerous allegations, also found that inappropriate scheduling practices were a systemic problem nationwide.”

That, too is an accurate quote; as we note in our story, “there was evidence of specific VA employees in Phoenix and other facilities using unorthodox scheduling practices to make wait times look shorter than they were.” (We also point out that this behavior wasn’t new; IGs have been criticizing such behavior at the VA since the George W. Bush administration.) But note that in the passage Rep. Miller quotes the IG is questioning the accuracy of the VA’s scheduling system, not the reliability of its audited data. In fact, it is Mr. Miller, not the IG, who is arguing that the audited figures we cite are unreliable.

Third, Rep. Miller calls “completely false” Mundy’s conclusion that “In short, there was no fundamental problem at the VA with wait times, in Phoenix or anywhere else.” He bases his contention on the same IG report as well as several press accounts. Our story acknowledges and confirms the scheduling problems the IG details. But we also compare the VA’s performance to that of the rest of the non-VA health care system. This paragraph from our story is vital to understanding our point that there is “no fundamental problem at the VA with wait times”:

Across facilities, veterans waited an average of just six and half days from their preferred date of care to see a primary care doctor. As a point of comparison, consider that a private survey taken at the time by the consulting firm Merritt Hawkins showed that in fifteen major medical markets across the country, non-VA patients seeking a first-time appointment with a family practice doctor had to wait an average of 19.5 days. Access is much more limited in most rural areas. Though precise comparisons are not possible due to data limitations (unlike the VA, most private health care providers aren’t required to make their performance numbers public), a recent study by the RAND Corporation has found that, given certain reasonable assumptions, “wait times at the VA for new patient primary and specialty care are shorter than wait times reported in focused studies of the private sector.

That RAND study was commissioned by the very 2014 legislation that Rep. Miller co-sponsored. RAND’s findings underscore our point: wait times aren’t a fundamental VA problem — they’re a fundamental health care problem.

Finally, Rep. Miller takes umbrage at the fact that one of the members of the Commission on Care his legislation mandates is Washington Monthly senior editor Phil Longman. A number of the conservative media stories accuse the magazine of failing to disclose that Longman was the editor of the Mundy story. The truth is that Longman was not the editor of the story. I was. Longman—who is the author of the definitive book on the modern VA and a lecturer in health care policy at Johns Hopkins–was consulted numerous times as the story progressed and contributed mightily in terms of ideas and information to the author, Alicia Mundy, and me, consistent with his role as a part-time staffer at the magazine. In the body of the story we fully acknowledge his position at the magazine and his role on the commission. The commission is very fortunate to have him as a member. Other members of the commission, however, also spoke with Mundy at length during her reporting of the story, as did numerous Hill staffers. Mundy reached out to Rep. Miller’s office for an interview but received no reply.

Paul Glastris

Paul Glastris is the editor in chief of the Washington Monthly.