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The federal contracting system has long been plagued by monopolists, union busters and rampant profiteers. From pentagon to the Department of Agriculture, bad behavior by private companies is routinely and paradoxically rewarded with public funds and little oversight by government institutions. Sometimes these corrupt dynamics literally cost lives.
The Department of Veterans Affairs (VA) has been under attack for a long time costly and ineffective recruitment network to which you have built (often, very inappropriately) attend to the health needs of veterans. This dysfunction has been both caused and made worse by privatization schemes which transfer billions to private corporations, at the expense of basic access to care for veterans.
These ineffective privatization schemes extend to everything from the VAs computer network to your provision of mental health treatment. Each additional iteration of privatization undermines veterans’ basic access to quality care, enables the obscene profiteering of taxpayer dollars by private companies, encourages the formation of abusive monopolies, and endangers both workers and patients .
Perhaps nowhere is this dynamic on display more brutally than in the VA’s relationship with its dialysis contractors.
Pointless death and moral damages
There are more than 40,000 veterans enrolled in the Veterans Health Administration (VHA) who suffer from kidney failure, seconds the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Renal failure is largely treated by dialysis, and approx 81 percent of veterans who received dialysis treatment through the VHA do so through so-called community providers, which is now largely accomplished through two separate programs; the National Dialysis Services Contract (NDSC) program and the Community Care Network (CCN).
NDSC is significantly more expensive for dialysis services, in part because its rates are not capped by Medicare rates, as CCN is. This is obscene, given that providers have been found to charge NDSC patients significantly higher rates compared to Medicare patients, despite providing no justification for such a significant price differential.
Of course, while it (appropriately) attempts to correct price discrepancies between government programs, the CCN itself has proven to be a wildly inappropriate system, who depend on private care providers who usually do not fulfill their care commitments. Still, it is the preferred (and significantly less expensive) system for dialysis care within the VHA and, except limited circumstancesveterans are supposed to be referred first to providers insured under the CCN umbrella.
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But a 2023 VA Inspector General report found that from October 2020 to September 2022, nearly 95 percent of treated veterans were receiving dialysis services from NDSCs and no CCN. This translates into 20,800 people being referred to NDSC services and a paltry 1,200 referred to CCN.
Of those 20,800, the vast majority of patients ultimately received treatment from just two providers. The two, known in the report as Contractors B and E, treated 42 percent and 45 percent of patients respectively, meaning just two NDSC contractors treated a large amount. 87 percent of NDSC patients and 82 percent of VHA dialysis patients overall. Although the specific names of these contractors are not listed in the report itself, the identities are fairly obvious: the two largest VHA contract recipients for dialysis are Fresenius i DaVitawhich have so far received a total of $1 billion and $559 million, respectively, through the NDSC since 2019.
That functional duopoly (which exists within i outside of the VHA) has created a reality a Which one dialysis has gone from a miraculous life-saving medical innovation of the 1960s to a legal quagmire filled with pointless deaths and moral damages. this includes clinics over-administering dialysis with fatal effects, providing disproportionately poor health outcomes for ethnic and racial minorities, retaliation against patients who raise too many concerns, and more.
This system has left contracted companies almost completely unaware of the damage suffered by patients in their facilities. From the lack of adequate supervision for dialysis references specifically, in the VAs lack of supervision For their contractors in general, these basic administrative failures cost vets their health and even their lives every day.
Abundance of union and labor abuse
The lack of a basic standard of care, or adequate federal oversight to enforce it, has also been exacerbated by these duopolists’ abuse of their employees, further undermining the quality of patient care while doing serious harm to caregivers.
Fresenius and DaVita have chosen for years to put their profits before patients and staff by not adequately staffing their facilities. Lack of staff, com recognized by these same corporations, it can lead to unexpected clinic closures, can harm long-term patient outcomes and can contribute to an absolutely brutal work environment for staff members.
Dialysis, which consists of a machine that purifies the blood and performs the functions of the kidneys, is a delicate and complicated medical process, which requires specific and careful attention in order to correctly dose the medicines used in the process, properly maintain the machines and ensure that patients are receiving properly scheduled visits. Changes in these details, or a simple failure to maintain them, can routinely be devastating to patients’ health.
Even so, dialysis caregivers Fresenius and DaVita are being asked to serve the needs of up to ten patients at a time due to severe staff shortages. They often work multiple 12-hour shifts a week, are poorly compensated, and are threatened and intimidated by their bosses when they try to stand up for themselves or their patients. Not to mention, Fresenius and DaVita have long tried to prevent health care workers from improving clinic conditions for themselves and their patients through intensely repressive union-busting activities. This has included the use of union avoidance consultants, often holding captive audience meetings and distributing anti-union pamphlets, and aggressive managerial harassment and intimidation of union advocates in the workplace. It has also included allegations that Fresenius is engaging in retaliatory firings, retaliatory discipline, threats to suppress legally protected activities, and bad faith bargaining, which are very serious (and illegal) acts that are currently investigated by the National Labor Relations Board (NLRB).
Meanwhile, instead of addressing these crises, Fresenius and DaVita have spent years engaging in extensive share buybacks and lavish executive payouts. From 2018 to 2022, DaVita spent more than $7 billion on share buybacks and Fresenius spent $1 billion in buybacks from 2017 to 2020. This financial windfall for executives has increased enormously generous ransom funds that Fresenius accepted in 2020 (to be fair, DaVita declined the money), years of obscene benefits, and billions in federal contract funding. It makes these companies’ disregard for their staff or patients all the more inexcusable, and makes the federal governments’ criminality in holding them accountable all the more egregious.
Supervision is easy and necessary
As we said One time and anotherthe federal government does not must and indeed I should not favoring abusive companies through its recruitment system. Public dollars should fuel the public good, not arbitrarily line the pockets of companies and their executives who break state and federal laws to harm their patients and staff.
What is perhaps most disappointing about this structure is that the VA’s own systems are now it is supposed to be structured around the diversion of funds from these duopolies in the first place. However, there is a total lack of desire or willingness to meet these basic standards. At the very least, the VA along with all government offices can and should fight to ensure compliance with their procurement policies, especially those that exist primarily to defend their patients and staff from abusers and monopolists.
If nothing else, the government should ensure that public money is well spent and that the public is protected against abusive contractors, by closing the revolving door between contractors and government agencies, preventing government awards from being used for stock buybacks and union busting, and enforcing strict corporate eligibility standards to participate in procurement bids when sued by other parts of the government for violations of federal law.
As VA’s contracts with NDSC administrators come to a formal end this September, the department has another opportunity to finally address this part of its broken procurement infrastructure. However, the department has made few concrete plans on how to move forward and move away from it. They must, for the sake of veterans, caregivers and taxpayers alike.
#bows #dialysis #duopoly
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