|Hasta la vista, our David|
But in recent months, a group of conservative Trump administration appointees at the White House and the department began to break with the secretary and plot his ouster. At issue was how far and how fast to privatize health care for veterans, a long-sought goal for conservatives like the Koch brothers.
Shulkin handed his opponents ammunition with some ethics screw-ups on a trip to Europe, the kind of grifting that is not exactly unheard of in this administration. But some folks in the administration wanted Shulkin gone. And this week, he was gone-- replaced by a physician who had won Trump's loyalty (for the moment) and who has zero experience in running a huge, complex bureaucracy like the VA.
Yesterday, Shulkin turned up in the pages of the New York Times with an explanation that will seem familiar to followers of the education debates:
I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They 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.
That's one of the big issues in privatizing any government function-- somebody is going to make a bunch of money, and somebody in government will get to decide who the money-maker will be. That doesn't have to involve corruption, but it certainly makes crony capitalism simple to implement.
Shulkin recognizes issues other than neglecting the primary mission of the institution in favor of rewarding one's buddies. There's also the matter of the private sector's ability to get the job done:
Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.
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.
What Shulkin misses here is that a privatized system is not interested in taking care of all the patients. The first step in making privatized veteran care profitable is to figure out which of those 9 million veterans you don't want to serve. It would be impossible for the private sector to replicate the VA system (which, in fairness, has not always worked super-well itself), but the private sector won't even try-- it will simply try to grab the parts of the system that can be handled profitably and dump everything else. That's how profitability in the free market works-- by serving only those "customers" who can be served profitably.
All of this is, of course, another version of the push for privatization in education. The biggest difference here is that there's somebody at the federal level who's wiling to call out the privatization scam, instead of a series of cabinet level officials trying to enable the privatization agenda.