In response to reports of long-waiting lists, cover-ups and a toxic culture at the Veterans Administration, President Obama nominated Robert McDonald to head the VA. In his public address yesterday, the president praised Mr. McDonald’s long career in corporate America as CEO of Procter and Gamble. In what should be a red flag not only to progressives but to all of the 99%, House Speaker John Boehner shares the president’s high opinion of McDonald: “Bob McDonald is a good man, a veteran, and a strong leader with decades of experience in the private sector. With those traits, he’s the kind of person who is capable of implementing the kind of dramatic systemic change that is badly needed and long overdue at the VA.” Given that Boehner is on record in favor of privatizing the VA, I can’t help but wonder what sorts of changes McDonald will implement. I also can’t help but wonder why President Obama seems to be falling for the same-old same-old idea that the private sector is better than the public center at just about everything.
McDonald’s nomination is not getting a lot of press. In progressive-leaning news sites it’s been shadowed by the Supreme Court’s Hobby Lobby decision allowing companies the “religious freedom” not to include contraception in insurance plans. But I see these two events as tightly linked — both are part of a growing movement to privilege corporations over people.
The cat’s out of the bag and I assume that McDonald will be a shoe-in to head the VA. But until that is made official we do have a window of opportunity to educate McDonald — who has no experience in health care or social services — about the issues he will face in his new job. To help in that endeavor, I have written an open letter to Robert McDonald. I truly hope he reads it!
Dear Robert McDonald,
There’s been a lot of noise lately about the mess at the VA (the mess you are being tapped to clean up), and I’m sure you’ve heard some big name politicians and pundits — including your friend John Boehner — calling for privatization or at least outsourcing of VA healthcare. You are going to hear from lots of people that government can’t do anything right, that the private sector is more efficient and more cost-effective, and that the best thing you can do for veterans is to give them the same choices about their healthcare that other Americans have.
I’m not going to waste your time telling you that the government actually can do a whole lot right. After all, you were a paratrooper so you know that government airplanes and parachutes generally work. I’m sure you have personal experience with well functioning traffic lights, the interstate highway system, safe drinking water and public libraries. And though you have no experience in the healthcare field, you likely know that in the US — where healthcare is structured around corporate models of private ownership, we spend more on health care and have substantially poorer health outcomes than countries with a national health service.
In order to do a good job for veterans you will need to understand why a market approach doesn’t work for healthcare. At Procter and Gamble your mission as CEO was to sell products to consumers who can make informed choices in the free market. But, as I’m sure you learned being a former military man and all, people don’t choose their injuries or illnesses. That makes it silly at best and cruel at worst to tell people to “choose” the health insurance plan that best “meets their needs.” Actuaries can calculate the odds of certain illnesses for population groups, but we mortal humans can’t foresee our own particular future health. Of course, “choice” is marketable in America and even is touted as a selling point for President Obama’s Affordable Care Act. But happily for you and your fellow service and former servicemen and women colleagues, neither the Department of Defense nor the Veterans Administration has ever bought into that idea.
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Let’s think about that a bit. At Procter and Gamble you could ethically market Charmin’s squeezability over Cottonnelle’s extra-absorbent ripples because you understood that most consumers are capable of evaluating how well their toilet paper does its job. You also understood that in the long run it doesn’t make much of a difference which brand of laundry detergent a consumer uses; Tide may be a bit better or worse than Whisk, but choosing the inferior brand is not going to kill any consumers.
That model doesn’t work in health care. Most people cannot evaluate whether one type of medication, surgical procedure or therapeutic approach works better than another. Nor can most of us assess whether one hospital or healthcare provider has a better track record in dealing with particular health problems or types of individuals. Unlike in the choice of toilet paper or laundry detergent, these differences can be matters of life and death. Let’s take head injuries as an example. Now, someone who doesn’t know much about brains might choose a hospital that looks nice and new and shiny, that has friendly registration clerks, that advertises compassionate patient care. But, trust me, veterans with head injuries would do a lot better at an overcrowded and bedraggled VA hospital where the doctors are specialists in the kinds of injuries suffered in battle and where the cutting-edge research in the world on traumatic brain injuries is being carried out.
At Procter and Gamble you were charged with reducing costs so that you could increase profits for stockholders. And I understand you were good at that! Now, I’m not saying that you shouldn’t streamline VA services so that they will be more efficient. But I am asking you to remember to keep your eye on the only bottom line that really matters in your new job, and that is the health and well-being of our veterans.
I know this job will present many challenges for you, so in closing I’d like to suggest that you bring along with you to the VA one of the mottoes of commerce: The customer is always right. Please, Mr. McDonald, listen to veterans – to men and women, try to understand their concerns, and put their interests above those of politics.
I wish you great success. And please feel free to call on me for advice.
Susan Sered
More on the VA here: The VA Scandal: How About a Reality Check?