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VA nominee debacle may distract from the agency’s 3 major problems

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The White House has withdrawn the nomination of its physician, Adm. Ronny Jackson, to be secretary of Veterans Affairs.

Jackson is best known for his fulsome report on Trump’s health following an annual physical in January 2018.

His nomination came into question after allegations surfaced that he abused subordinates, created a hostile work environment, was drunk on the job, and freely passed out prescription pills including Ambien, Provigil and Percocet. The allegations came from various sources, including a summary prepared by Democratic Senate staff.

Now, whoever gets that position will have the task of trying to manage an agency that has long been in crisis. Nevertheless, the VA has pioneered evidence-based medicine and, overall, gets better outcomes at lower costs than many private health care providers. The VA has 360,000 employees and a US$186 billion annual budget.

As someone who has studied government budgets and the organization of government agencies, I believe the next secretary, like his predecessor, will have to address three major problems if the VA is to be effective in meeting the needs of the millions of veterans who depend on it for their care.

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1. Funding

First, the VA is funded much less generously than private medical providers. That means VA doctors earn substantially less than other physicians, making it hard to fill vacancies.

Occasionally, Congress votes to increase the VA budget, allowing the department to offer raises or one-time bonuses that attract new physicians. But then, subsequent budget cuts and government-wide salary freezes drive VA doctors to the private sector. Physician and nurse shortages, due entirely to inadequate budgets, are the main reason why veterans have long waits for appointments and procedures.

2. Access

Second, the VA has no control over the number or location of veterans who gain the right to medical care through their military service. The number of veterans was shrinking prior to 9/11. The wars in Afghanistan and Iraq made 4 million additional veterans eligible for VA medical services. Dramatic advances in saving the lives of wounded soldiers mean there are more severely disabled veterans needing complex care. Growing understanding of the psychological effects of combat has led to a dramatic increase in the number of veterans who apply for and can benefit from psychological treatment.

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In addition, veterans, like other Americans, are more likely to live in the South and West than earlier generations. Thus, VA hospitals and clinics, mostly built in the post-war era, are not where the veterans live. It should be no surprise that some of the longest waits for care and the center of the scandal around VA officials falsifying data on the wait time for care was in Arizona, an area with many veterans and not enough VA facilities.

3. Privatization

Finally, many conservatives and for-profit health providers in search of new customers want to convert the VA into a conduit for government money to buy private insurance or care for veterans. Private care is more expensive and generally of lower quality care than what the VA now provides. Thus, increasing the use of private facilities will disrupt the continuity of care that is the basis for much of the VA’s lower costs and better outcomes. Funds diverted to pay for private care will rob the VA of resources needed to hire more doctors and nurses or to build facilities where they are needed.

President Trump said he fired former VA Secretary David Shulkin, the man Jackson had been nominated to replace, to facilitate further privatization. Veterans’ organizations and members of Congress from both parties oppose privatizing because of the deleterious budgetary and health effects they say it would have.

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The ConversationIt remains to be seen what role the new VA head will play in this conflict. The outcome will determine whether the VA’s problems worsen as the VA takes on the faults of America’s private health care system, or if the VA is given the resources to demonstrate the advantages of government provided medical care.

Richard Lachmann, Professor of Sociology, University at Albany, State University of New York

This article was originally published on The Conversation. Read the original article.


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Damning CNN timeline shows how Trump ‘thinks white people matter more than nonwhite people’

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CNN's Brianna Keilar on Monday delivered a damning verdict on President Donald Trump's racist attacks on Democratic lawmakers -- and she backed it up with a timeline of the president's bigoted words and actions.

During a segment about Trump’s weekend tweets, in which he told Reps. Ilhan Omar (D-MN), Alexandria Ocasio-Cortez (D-NY), Ayanna Pressley (D-MA) and Rashida Tlaib (D-MI) to “go back” to their countries despite the fact that all four are American citizens, Keilar argued that the president's racism is part of a pattern of bigotry that's followed him throughout his life.

"This fits a pattern to the president who has long made it clear that he thinks white people matter more than nonwhite people, even if they're American," she said. "30 years ago he called for the death penalty for the Central Park Five, five minority youths who were falsely accused of rape. Trump [is] still refusing to believe their innocence 16 years after they were exonerated."

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MSNBC host says Trump just openly embraced racists: ‘This actually feels different to me’

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On Monday, President Donald Trump went on an unhinged rant against Congresswoman Ilhan Omar (D-MN), Alexandria Ocasio-Cortez (D-NY) and House Speaker Nancy Pelosi (D-CA).

In an often rambling question session with reporters, Trump repeatedly told the two Congresswomen to leave America (both are U.S. citizens) if they're so critical of the U.S. and Israel.

MSNBC host Ali Velshi observed that Trump had truly crossed the line and directly appealed to the sentiments of white nationalists.

Watch:

MSNBC's @AliVelshi: This time "actually feels different to me. This feels like the president really owning the idea that he's saying things that are attractive to white nationalists and racists." pic.twitter.com/vtK1T3GHuU

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World hunger on the rise with more than 820 million at risk, UN report says

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More than 821 million people suffered from hunger, food insecurity and malnutrition worldwide last year, the United Nations reported Monday -- the third year in a row that the number has risen.

After decades of decline, food insecurity began to increase in 2015 and reversing the trend is one of the 2030 targets of the UN's Sustainable Development Goals.

But getting to a world where no one is suffering from hunger by then remains an "immense challenge," the report said.

"The State of Food Security and Nutrition in the World" was produced by the UN Food and Agriculture Organization (FAO) and other UN agencies including the World Health Organization.

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