Rachel Maddow: The reason they [Republicans] are able to propose something that radical [privatizing the Department of Veterans Affairs] is because the problems at the VA seem so intractable. If I had been running Republican campaign against President Obama last year, I would have run it entirely on the VA — a bureaucracy, a bloated big government program that can’t be fixed, and let’s do right by our veterans. Do you have any new ideas for trying to fix it? You can’t find a person in politics who doesn’t say we shouldn’t do right by our veterans. But for some reason, this can’t get fixed fast enough.

Hillary Clinton: Yes, and I don’t understand that. You know, I don’t understand why we have such a problem, because there have been a number of surveys of veterans. And overall, veterans who do get treated are satisfied with their treatment. … Now, nobody would believe that from the coverage that you see, and the constant berating of the VA that comes from the Republicans, in part in pursuit of this ideological agenda that they have. 

Maddow: But in part because there has been real scandal.

Clinton: There has been. But it’s not been as widespread as it has been made out to be.  

– Exchange on MSNBC’s “The Rachel Maddow Show,” Oct. 23, 2015

Several readers asked us to fact-check this claim, which drew sharp backlash from veterans groups and both Republican and Democratic lawmakers.

Clinton is referring to the VA scandal that unfolded in 2014 after whistleblowers alleged that dozens of veterans died at the Phoenix VA while waiting for medical care. The VA Office of Inspector General later acknowledged that wait lists may have contributed to the veterans’ deaths. Patient and appointment record falsification and manipulations were then found to be a systemic, years-long problem.

In response to the scandal, Congress passed a bipartisan $16.3 billion bill to overhaul the VA, setting aside $10 billion to allow veterans to seek private medical care in certain circumstances. Some advocates called on Congress to expand this program to give veterans more options to get care from private doctors. A bipartisan task force commissioned by the conservative veterans group Concerned Veterans for America proposed drastic changes to the VA, including converting the Veterans Health Administration into an independent, government chartered nonprofit corporation.

Clinton was criticized immediately for downplaying the VA scandal, by saying it was not “as widespread as it has been made out to be.” But her campaign later clarified that Clinton does believe there is a systemic problem of delays in veterans’ access to health care and processing their disability claims. The campaign told The Fact Checker that she was “speaking with reference to Republicans who have sought to use the wait times scandal to suggest the VA is so incompetent as to be beyond fixing, such that the only fix is privatization.”

Nonetheless, it’s worth exploring her claim that a “number of surveys” show veterans “are satisfied with their treatment.” What do the surveys show us?

The Facts

The Clinton campaign pointed to three surveys where the majority of veterans showed general satisfaction with the VA’s health care.

A 2013 study commissioned by the VA used the American Customer Satisfaction Index to gauge veterans’ satisfaction. The health system’s inpatient care, based on veterans who had recently been discharged from a VHA acute medical center, rated 84 on a 0 to 100 scale — four points higher than the industry average. Outpatient care scored 82, within one point of industry average.

A VA-funded Rand Corporation study of veterans receiving mental health services from the Veterans Health Administration found 74 percent of patients reported being helped by the treatment they received, and 42 percent were “highly satisfied” with their VHA mental health care. But since the survey’s results are several years old (they were completed in 2008 and 2009), the results may be used as a baseline to judge future satisfaction with the VA’s services, according to the Rand Corporation.

The third report from the campaign was a September 2015 Veterans of Foreign Wars survey of veteran attitudes and expectations of health care in the aftermath of the VA scandal. Using this study puts one on more solid ground when talking about veterans’ experiences with the VA within the context of the wait time scandal.

Among the 1,847 veterans surveyed, 52 percent who said they were eligible for VA health care said they prefer the VA. But the VFW also found that veterans’ preference for care changes based on the type of insurance they have. The VFW conducted the survey by sending out a Web survey link to its members and passing out physical surveys at a national conference. The purpose is to get a pulse of the veteran community, rather than conduct a scientific survey, a spokesman said.

These three examples show the range of surveys of various veteran populations and their experience with the VA medical care. So, the veracity Clinton’s statement really depends on the surveys used. The ones that she used were favorable toward the VA — plus, two out of three of them were funded by the VA. And the two VA studies of veteran satisfaction are of patients who actually received care. The crux of the VA scandal is with problems over access to care — over scheduling and manipulation of wait time data.

A campaign spokesman said that Clinton did not intend to “put too much weight on these surveys other than noting their existence.” So we decided to look at other surveys exist, that are conducted by independent sources using methodologies that meet The Washington Post’s standards. These surveys show a spotty picture of veteran attitudes toward VA medical care.

A July 2014 Gallup survey of 1,268 veterans in the broader veteran population found 55 percent of veterans said it is somewhat difficult or very difficult to access care. “The common perception of most veterans about the difficulty of accessing VA care, many of whom have personally used the VA system, confirms that the department is failing to meet the medical needs of many of those it is designed to serve. At the same time, that is not the belief or experience of all veterans, with three in 10 saying it is easy to get access to medical care through the VA,” according to the Gallup report.

The Gallup survey is the most relevant to the VA scandal, as it relates specifically to access to care at the VA.

The 2011 Pew Research Center survey of veterans showed the best results for the VA. They found 52 percent rated the VA as excellent or good, and 38 percent rated it as only fair or poor, in meeting the needs of veterans. These results were similar among pre-9/11 and post-9/11 veterans.

Meanwhile, the December 2013 Washington Post-Kaiser Family Foundation survey of post-9/11 veterans found more negative views of the VA using the same question as Pew did: 58 percent rated the VA as only fair or poor in meeting veterans’ needs, and 38 percent rated the VA as excellent or good. Among veterans who reported using VA health care when they were interviewed, 42 rated the VA positively and 57 percent rated it negatively.

Clinton campaign spokesman Brian Fallon said in a statement: “At this point, Republicans are trying to exploit the scandal to try to score partisan points and push an ideological agenda to privatize the VA. Hillary Clinton has said repeatedly that the systemic problem of excessive wait times at the VA is an outrage, but she refuses to believe the VA is beyond fixing. Republicans are trying to suggest the only solution to the VA’s problems is to privatize it, but Hillary Clinton will not apologize for insisting on doing the hard work to reform the VA, rather than ending it altogether.”

A side note: Sen. Bernie Sanders used a similar talking point in a recent interview with Maddow. He said: “When I was chairman [of Senate veterans affairs committee], I had all of the major veterans organizations in front of me. American Legion, all of them. And I said, ‘Tell me, when veterans get into the VA, do you think the quality of care is good?’ And they said, ‘It’s good to excellent. And that’s how most veterans feel.’” But the difference with his statement is that he does not cite numerous surveys, and attributes the feedback to veterans groups he spoke with.

(Huge thanks to Scott Clement, who heads The Post’s polling unit, for vetting and analyzing the polls cited in this article.)

The Pinocchio Test

Clinton makes a sweeping claim that a “number of studies” show that veterans who received medical care at the VA were satisfied with the treatment. She references these surveys to say that the VA’s problems are not to the extent that Republicans make them seem. It’s important to note that both Republicans and Democrats have heavily criticized the VA for mismanagement and lack of accountability.

Post-care satisfaction surveys do not necessarily reflect the population of veterans at the center of the VA scandal, which dealt particularly with patients’ access to care. A large portion of veterans who received medical care may have had positive experiences, but this overlooks the hundreds of thousands of patients who experienced delays in care, or the dozens who died while waiting for care, as the inspector general found.

While she says numerous surveys show veterans’ satisfaction, the examples her claim is based on are either funded by the VA or a non-scientific survey of veteran attitudes. Independent, scientific surveys show veteran attitudes toward medical care at the VA are mixed. And the Gallup poll that most directly relates to the issues unearthed by the scandal found that 55 percent of veterans found it somewhat difficult or very difficult to access VA care.

It’s misleading to make a sweeping generalization about veterans attitudes on this topic and attribute it to “numerous surveys.”

Two Pinocchios

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