Eric Shinseki and the Crisis at the Department of Veterans Affairs: Is it a Scandal? Or a Prototype? And Is Cancer Treatment Next…to Get the Treatment?
Chicago, IL -- Are the problems of the Department of Veterans Affairs an unfortunate scandal? Or are they a matter of deliberate Obama administration policy? The latest news from Washington, including Friday’s resignation of Veterans Secretary Eric Shinseki, is reverberating loudly here in Chicago, where the American Society of Clinical Oncology (ASCO) is having its 50th annual meeting.
Here at the mammoth McCormick Place convention complex, tens of thousands of cancer doctors, scientists, patients, and others have gathered to update themselves on a disease that could ultimately afflict half of all Americans--indeed, billions of people around the world. So yes, we should all care what happens with ASCO, because it’s a matter of our lives.
Increasingly, ASCO is moving left politically, allying itself with Obama policy. So it was notable that one of the key speakers on the first day of the convention was Dr. Ezekiel Emanuel. Working in the White House for the first three years of the Obama administration, Emanuel was one of the architects of the 2010 Affordable Care Act, aka, Obamacare. Today, Emanuel is professor at the University of Pennsylvania, a fellow at Obama’s favorite think-tank, the Center for American Progress, and a contributing writer for The New York Times. In other words, he meets all the criteria for being a VIP--a Very Important Progressive. And interestingly, he is a rockstar here at ASCO; he dominated an opening-day panel at the Grand Ballroom. (And yes, he is the brother of Chicago Mayor Rahm Emanuel, as he and others couldn’t resist pointing out.)
If the VA controversy is “only” a scandal, then ASCO can simply tut-tut the scandal and continue to align itself with the Obama policy vision. But if the VA flap proves to be a problem of policy, then ASCO has more of a problem, because the larger cancer community wants to defeat cancer--not lose the battle as cheaply as possible.
Thus we can see: The VA question--one-time scandal vs. continuing overall policy--is not just a matter of semantics; it is, as Joe Biden might say, a BFD.
If the VA’s problems are just an unfortunate, even tragic, one-time scandal, then presumably the problem can be addressed with a little bit of cleaning up. That is, just get rid of a few rotten apples. Or, okay, maybe get rid of many rotten apples, each of a rather large size. Indeed, now that 60 percent of the VA’s 216 major facilities have been implicated, that would seem to suggest that a good chunk of the VA’s 320,000 employees are implicated.
That’s bad enough. But from an Obama point of view, that’s still a manageable problem--even if the VA situation shows, as Peggy Noonan and other pundits have argued, that Obama is a bad manager, or not a manager at all.
Yet still, no matter how bad the VA’s problems might prove to be, nobody will think that the President himself was traveling to, say, Phoenix, determined to destroy wait-list records.
However, if Americans do come to believe that Obama’s policy vision guided the VA in its choices, that’s a much different matter. After all, we know that the Obama vision has reshaped the overall healthcare policy of the federal government--and so why should the VA be an exception? And if the Obama policy vision is proven to be flawed, even downright wrong-headed, then the problems of the VA can be connected directly to Obama himself. That is, they go right to the President sitting at his desk in the Oval Office.
That’s a potential problem for President, but it’s also a big problem for American veterans--and for all of us. How so? Because if the problems of the VA are of a policy nature, then these problems won’t get better until the policy changes. That is, policy continuity will override mere name-changes. And so far, there’s no sign that the larger policy is going to change. Personnel, yes; policy, no.
And why is that? Here’s why: because the guiding policy of the Department of Veterans Affairs is the same policy as the Department of Health and Human Services--indeed, the entirety of the Obama administration’s healthcare agenda.
Maybe that’s why the President showed such obvious reluctance to part ways with Shinseki; as the he said on Friday, “I want to reiterate, he is a very good man.” And Obama continued: “I don’t just mean that he’s an accomplished man. I don’t just mean that he’s been an outstanding soldier. He’s a good person, who’s done exemplary work on our behalf.” In other words, even as he was accepting Shinseki’s resignation, Obama sounded as if he would hire him all over again.
Some have suggested that Obama’s affection for Shinseki traces back to their common suspicion of the Iraq War. And in fact, Shinseki became a hero of the anti-war left, which propelled Obama to the Democratic presidential nomination in 2008.
Yet we should understand that it’s not just Shinseki whom Obama likes, but the idea of the VA healthcare system itself. After all, the VA is what the left really wants--that is, a single-payer system. And Obama has endorsed such a system many times in the past.
For those who think that a wise and benevolent federal government could and should oversee a big unified healthcare system for all, then the VA counts as positive way-station on the path to single-payer utopia. Indeed, as Ben Shapiro of TruthRevolt.org has chronicled, the VA system has received steady accolades from some of the biggest names in the liberal MainStream Media, including Paul Krugman, Nicholas Kristof, and Ezra Klein. Such positive vibes are not easily undone, either in the MSM or in the White House.
To be sure, a few venturesome souls in the MSM have dared to zing Obama for his devotion to Shinseki. For example, MSNBC’s Chris Matthews said on the air that the President was “not alert.”
Yet for most part, the MSM have lined up behind the idea that the problem of the VA was just sort of bad luck. The headline of The New York Times editorial on Saturday sums it up: “Mr. Shinseki Takes the Fall.”
And as a Times news story put it, the VA is “burdened with a decades-old legacy of overwhelmed facilities and management failures.” So you see, in the MSM telling, Shinseki is a victim, nothing more, and besides, the VA’s problems go way back.
And yet as the Times admits, the VA’s situation has changed in just the past few years, as Baby Boomers have flooded the system, bringing with them difficult diseases, including cancer:
Most of the veterans now seeking treatment at department facilities are aging Vietnam-era service members, many with chronic illnesses like diabetes that require long-term care or with cancer and cardiovascular disease that require complicated and expensive treatment.
Ah yes, cancer, as in oncology, as in ASCO.
One might assume that the oncologists at ASCO would be rightly concerned about the cancers afflicting the veterans’ population, as well as all Americans. And without a doubt, the average cancer doctor is a committed cancer fighter.
Yet ASCO, as an organization, is increasingly political, moving increasingly toward the ideological left. In his opening speech on Saturday, ASCO President Clifford Hudis actually cited Lyndon B. Johnson’s 1964 “Great Society” campaign as an inspiration for ASCO’s efforts. Hudis approvingly quoted LBJ’s line about his “War on Poverty” efforts: “We can afford to win it. We cannot afford to lose it.” Such incantatory talk is the language of politics, of course, not the language of science.
Yet in such a politicized context, Obama priorities have a way of becoming ASCO priorities. And that’s an ominous development for cancer patients.
To put it plainly, the Obama administration sees the familiar healthcare system as an opportunity for cost-savings, not scientific breakthroughs.
As we all know, in 2008, the President campaigned not only on health insurance for all, but also on “bending the cost curve” of healthcare, saving each family a third off its healthcare bills. And in the minds of Ezekiel Emanuel and all the others tasked with implementing Obama’s pledge, there was only one way to redeem that promise: Americans would have to consume less. That is, get by--or not--on less medical treatment.
And here’s where ASCO started to come in; one flashpoint issue has been cancer screening. Back in November 2009, the US Preventive Services Task Force, an executive branch agency, suggested fewer breast cancer screenings for women. The result was an uproar, as critics accused the Obama administration of seeking the rationing of care and treatment. And so Health and Human Services Secretary Kathleen Sebelius, eager to make straight the way for Obamacare legislation, quickly backtracked on the guidelines.
Yet even so, in the years since Obamacare has been enacted, the Preventive Services Task Force continues to issue new guidelines, on everything from anemia to sexually transmitted diseases to cancer--all kinds of cancer. In fact, the Task Force continues to be guided by the same mindset: Americans should consume less healthcare, in order to save money for the overall system.
So now we can see how the problems of the VA might be more than just a scandal; the problems might represent conscious government policy. Yes, an outside report on the VA might identify “chronic delays in care,” but from a coldly utilitarian cost-saving point of view, such delays could be seen as a desirable feature, not an accidental bug. Did the VA miscalculate? Even break the law? Perhaps. But whether these actions were illegal or not, VA staffers seem to have been eager to play on the Obama team; they wanted to get with the administration policy program.
If the President wants to cut costs, the thinking seems to have been, then. by golly, each of us here at the VA will do our part. (And if that gets each of us performance bonuses for phony-ing up the numbers, well, all the better!)
As Robert Goldberg, vice president of the New York City-based Center for Medicine in the Public Interest (CMPI) observed to me here in Chicago, “The VA has been ‘redlining’ cancer patients, and other patients, too.” That is, shunting vets aside, isolating them, cutting them off from the best possible treatment. Goldberg explained that one of the key ideas in such rationing has been “pathways”--that is, one-size-fits-all tracks for treatment derived by bureaucrats in Washington, not by cancer specialists actually treating a particular vet.
Meanwhile, of course, the rest of us can step back and recall the cynical Washington wisdom: The real scandal in DC isn’t what’s illegal; the real scandal is what’slegal. In other words, it doesn’t take scandalous behavior to kill off vets; it just takes bureaucrats following a death-panel protocol.
And so where does ASCO fit in? Which side is ASCO on? Is it on the government’s side, or on the patient’s side? Speaking here in Chicago, Ezekiel Emanuel, the Obama alum, made his position clear. As a Reuters headline reads, “Cancer doctors urged to consider value when treating patients.”
To which Goldberg responded, “Value is code for ‘rationing.’” Goldberg pointed to an ASCO document published in January, “Value in Cancer Care,” as yet another indicator that at least some ASCO politicos are more eager to line up with Team Obama than with their own patients. That is, they are willing--make that, determined--to see a politicized notion of “value” trump the Hippocratic Oath.
Indeed, the front page of Friday’s ASCO Daily News, a thick newspaper created just for the convention and distributed free to conventioneers, prominently featured two pro-rationing articles. One article declared, “Not only is it our duty to present and report on the latest clinical advances, but we must examine the ‘value’ these therapies provide to society as a whole.” In other words, a cancer doctor should be looking over his or her shoulder while treating the patient, always asking, in effect, Am I doing the right thing according to the cost-cutting precepts of Obamacare?
And the other article, headlined “The Complexity of Value: Weighing Perspectives of Various Stakeholders,” went on to tout Emanuel’s giving weight to these new stakeholding players. The idea of “stakeholders,” we might note, is yet more code for politicized intervention in the cancer treatment process.
In fact, I saw plenty of nodding ASCO heads when Emanuel told the audience in the Grand Ballroom, “We are not doing everything we can to lower costs.” These ASCO-ers, at least, were happy to do their part to fulfill the Obama vision.
Is cost an important issue? Sure it is. But across the country, there are plenty of individuals, and institutions, that concern themselves with costs. Yet in the face of such institutional pressure to cut costs, one might hope that cancer doctors, at least, would line up firmly with their own patients, zealously fighting to keep them alive. That’s the checks-and-balances system in action. Cancer patients need their doctor to give them the best care possible, not to play mediator, or politician--or Obama apple-polisher.
Moreover, in treating illness, drugs seem to be part of the cost-solution, not the cost-problem. After all, taking a pill is cheaper than sitting in a hospital. Prescription drugs account for less than one-tenth of the national health expenditure, and 86 percent of these prescriptions, by the way, are low-cost generics. Indeed, theCongressional Budget Office recently concluded that, for seniors, drugs pay for themselves in terms of lower treatment costs within the system.
And of course, people working, and producing, provide the best economic elixir of all. As John Castellani, president of the pharmaceutical trade association, noted recently, “In 1964, only 34 percent of cancer patients were surviving five or more years beyond diagnosis. Today, 66 percent are.” That near-doubling of positive health outcomes, thanks to cancer treatment, adds up to trillions in value to the economy; a CMPI-affiliated group, MyLifeIsWorthIt.org estimates that just since 1990, 51.2 million life-years have been added thanks to cancer treatment, for a total gain to the GDP of $4.9 trillion.
Yet dogma is dogma, and belief is belief. And so dogmatic ASCO-ers, true-believing in the liberal vision of one big egalitarian system--in which people get a card that says “health insurance,” but not much more--are increasingly pushing their group toward a new era of skimpy cancer treatment.
To be sure, not everyone in the cancer world is on board with the rationing idea--oops, make that the “value” idea. Notably, cancer patients, and their families, are far from being on board. Nor would not be the first time, we might note, that the interest of providers and consumers are not aligned; we have seen the same thing in the case of public schools, where unionized teachers are often on one side of a fight, and parents are often on the other side.
In fact, some activists have even noticed that the Obama administration is fully capable of spending more money on special-interest health matters, playing to niche constituencies that it deems to be special and worthy.
On Friday, @LungCancerFaces, in attendance at ASCO, tweeted out, “Medicare now pays for sex change but not for preventative CT for #lungcancer What's wrong with this picture? #LCSM.” (CT, we might note, stands for “computerized tomography,” and #LCSM is “Lung Cancer Social Media.”)
Yes, you read that right. The Obama administration doesn’t want to pay for lung cancer screenings, but it does want to pay for sex-change operations.
Welcome to Obama’s America: less money for cancer treatment, more money for sex changes. In the light of such choices, we can see that maybe the problems of the VA, as with the problems of HHS, aren’t a matter of scandal, or even incompetence. Instead, they are a choice, a matter of priorities. The Obama administration has wanted to spend less as a matter of policy--except, of course, for special new priorities, such as full funding for sex-change operations.
And so it would seem that Veterans Secretary Shinseki and HHS Secretary Sebelius were simply carrying out those chosen priorities. If they made mistakes, well, they made mistakes--but Obama carried both of these Cabinet appointees for as long as he could. (Sebelius, we might recall, lasted in her post for more than six months after the disastrous rollout of healthcare.gov. As with Shinseki, the President seemed in no hurry to cut her loose, either.)
So now, it would seem, the picture is coming clear. Obama wants to spend less, and he wants to ration. And he found loyal subordinates, such as Shinseki and Sebelius, who would carry out those policies, even as he found loyal advocates, such as Emanuel, who would spread the word to groups such as ASCO.
In other words, this shortchanging of traditional medical consumers--that is, patients who are ill and in need of comprehensive care--looks less like an unwanted scandal, and more like a deliberate policy.
So now we know: If we need a sex-change operation, we have a friend in Washington. But if we have cancer, or are at risk for cancer, well, that’s a different story.
So now we’ll have to see whether ASCO will stand up for cancer patients. So far, from what we’ve seen in Chicago, the signs are far from encouraging.