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Public sector workers face many privatization threats. But one of the biggest jobs-

management fights over outsourcing are now raging, nationwide, at the largest public health system in the United States.


Operated by the Department of Veterans Affairs (VA), the Veterans Health Administration (VHA) serves 9 million veterans at 1,300 hospitals and clinics across the country. His patients include ex-soldiers who are low-income, have service-related medical conditions, or have recently returned from combat zones.

More than 300,000 VA staff members are represented by the American Federation of Government Employees (AFGE), National Nurses United (NNU), the Machinist-affiliated National Federal of Federal Employees, or the Service Employees International Union (SEIU). This makes their employer one of the most heavily unionized healthcare systems in the country.

As we document in a new book, these federal workers provide specialized care that is far better coordinated and more affordable than care in the private healthcare sector. The VA conducts medical research that benefits all Americans and also plays an important teaching hospital role in training thousands of new doctors, nurses, and other health care professionals.

All VA assistants are salaried, rather than being paid a service fee. VA medical centers don’t spend billions of dollars on advertising, marketing, or executive compensation like for-profit hospital chains do. And veterinarians who qualify for VA care don’t face the mountains of paperwork and financially burdensome out-of-pocket payments required by most private insurers and even Medicare.

The threat of privatization

Five years ago, conservative Republicans and corporate Democrats in Congress took the hammer to this model healthcare system when they passed the VA MISSION Act of 2018. As implemented by Donald Trump and, sadly, Joe Biden as well, this legislation siphoned off billions of dollars to agencies direct the care budget and channel that money to private doctors and for-profit hospitals, often less prepared to treat veterans.

The VA has been partially converted to a Medicare-style bill payer presented by outside providers. The powerful private interests that earned this new $33 billion a year federal revenue stream want to preserve and expand it. They include some of the same for-profit companies trying to undermine traditional Medicare coverage by switching nearly half of all seniors to Medicare Advantage plans.


The negative impact of costly and unnecessary outsourcing of veterans care was recently documented by the Veterans Healthcare Policy Institute, based on a nationwide survey of AFGE members. In a report titled Disadvantaging the VA, Oregon veterans like Keegan Miller and Henri Henrickson describe their positive experiences with the VA as patients. And local union activists like AFGE Local 2157 Vice President David Bump are calling for a reversal of multiple Trump-era policies and practices that make serving veterans more difficult.

Approximately one-third of the VA workforce is made up of former service members, which fosters a unique culture of togetherness between patients and providers that exists nowhere else in U.S. healthcare. VA union members, their patients and families, and veterans organizations rallied last spring to defeat an ill-advised White House plan to downsize many VA facilities, particularly in already underserved rural areas.

Despite that major political victory, piecemeal privatization of veterans’ health care continues, making organizing the ongoing community work for Save Our VA more important than ever, in Oregon and other states.

Steve Early and Suzanne Gordon are co-authors of a new book called Our Veterans: Winners, Losers, Friends and Enemies on the New Terrain of Veterans Affairs from Duke University Press. Early is a longtime union reporter, and Gordon is co-founder of the Bay Area-based Veterans Healthcare Policy Institute. They can be reached at Lsupport@aol.com

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