Major Malfunctions: An Overview of U.S. Veterans Healthcare
Within the American pantheon of values, respect for those who serve in the military is paramount. Many from across the political spectrum have paid tribute to the deeds of veterans. For instance, incoming Congresswoman Alexandria Ocasio-Cortez tweeted how she was “so very, very honored to organize shoulder-to-shoulder with … veterans” in support of Common Defense, a grassroots progressive veterans’ group which endorsed her. The recent passing as well as the funeral proceedings of President George H.W. Bush show the high level of appreciation that the American public has for its veterans; Bush Sr. was a veteran of the U.S. Navy during World War II.
Despite America’s praise of veterans, another talking point that many Americans of different backgrounds and beliefs seem to agree on is the abysmal state of government-provided veterans’ healthcare that is provided by the Department of Veterans Affairs. The VA is widely seen as being wholly unfit to provide proper healthcare to those who are so highly respected in American society and has in fact contributed to nationwide crises, such as the opioid crisis. This inevitably leads us to the question: what are the VHA’s main problems, and how can one set about in alleviating them?
Contrary to what many might believe, veterans are often highly satisfied with the care they receive through the VHA. This has been shown in studies, such as one published in JAMA Internal Medicine in which it compared VA with non-VA hospitals. On average, VA hospitals were ranked superior in mortality and readmission metrics as well as performing equal to or better than non-VA hospitals in Agency for Healthcare Research and Quality Patient Safety Indicators (PSI). Conversely, VA hospitals scored worse in terms of patient experience, and patients of VA hospitals were less likely to recommend them to a friendthen the patients of non-VA hospitals.
Although not immediately explicit in its analysis, the study does highlight many of the problems surrounding the VHA. One glaring issue is that many veterans are forced to endure shockingly long wait times to receive care, which was brought to a head in an infamous 2014 scandal in which the VA hospital in Phoenix was discovered covering up wait times. Furthermore, in 2017 the Washington Post found that in this same hospital 1,100 patients had waited more than 30 days for appointments, the average wait time for a psychotherapist was 75 days (critical for a population prone to mental health disorders), and, in one case, a veteran had died due to not receiving a VA-scheduled cardiology exam. In another instance, Richard Simpson, a Marine veteran who had participated in Cold War-era U.S. atomic bomb tests and later developed numerous cancerous lesions, reported that a VA doctor was able to determine the nature of his disability in only seven minutes; however, this swift test came only after 65 years in which Simpson fought with no avail to get any help from the VA. “If I’ve been that way for 65 years,” Simpson lamented, “why did it take them that long to figure it out, and why should I not get back-paid until 1953 when it happened?” This story is not an outlier either. Many in my home state of New Jersey have been forced to undertake long drives in order to satisfy basic needs, such as hearing aids.
Veterans at the Phoenix VA hospital in 2010. The Phoenix hospital was discovered in 2014 to have falsified wait times for patients; in 2017 the hospital still had major administrative and scheduling problems
According to healthcare journalist Suzanne Gordon, many others have been locked out of veterans benefits completely due to the complicated conditions for eligibility. For example, more than 125,000 veterans are ineligible due to receiving “other than honorable” discharges, which could result from drunkenness on duty, engaging in fights, or before 2011, being openly homosexual. Veterans in this situation can apply for discharge upgrades, but these, according to Gordon, are rare. Even if a veteran has been honorably discharged, if they served after 1980, they are required to show evidence of a “service-connected disability” in order to be eligible for the VHA’s full Medical Benefits Package.[i]
For this reason, many veterans use other means of private or public health insurance. In 2016, the U.S. Census Bureau, found that the majority of veterans of working age are enrolled in employer-sponsored health insurance. Only about one-third of American military veterans of working age were enrolled in the VA’s healthcare system; of these, three-quarters were simultaneously enrolled in other health insurance plans.
It is for this reason that many have advocated for either partial or complete privatization of the VA, as well as giving veterans more choices in using private health care. The 2014 Veterans Choice Act allowed veterans facing wait times of a month or longer, or who lived more than 40 miles from the nearest VHA facility, to seek private sector health care. One of the sponsors of this bill, Senator John McCain, who recently passed away, lobbied in 2015 and 2016 for a bill to make the Veterans Choice Act, which had been originally conceived as a stop-gap measure in the midst of the 2014 Phoenix scandal, permanent. Other groups have advocated for the privatization of the VHA’s services. One of these organization, a veterans service organization, or VSO, called the Concerned Veterans for America, which has been controversial for being backed by the billionaire Koch Brothers, pushes a conservative agenda even outside of veterans affairs, and has drawn close to President Trump and his policy goals. Several CVA officials, previously including senior CVA advisor Darin Selnick, hold positions in the Trump White House.
Senator Marco Rubio (R-FL) at a 2015 town hall sponsored by Concerned Veterans for America in Exeter, New Hampshire. CVA has been accused of being a Koch Brothers front group, and aggressively campaigns for privatization of much of the VHA’s services, something that major VSO’s oppose. (This picture is the property of Michael Vadon)
While some argue that privatization would allow veterans to access superior private sector healthcare, many feel this will decrease the care afforded to them. Suzanne Gordon, for example, praises the VHA for its integrated health care services. She notes that not only can a veteran’s medical records be shared with VA hospitals across the country, but thanks to the VA’s integrated health care services, in a single clinic a veteran could “[see] his or her primary-care practitioner … [as well as talk to] a nutritionist about a diet, a pharmacist about how to correctly administer insulin, or a mental health professional.”[ii] Critics of privatization fear that making veterans more dependent on private health care will consequently fragment their healthcare, forcing them to coordinate different medical services themselves. Gordon also points out the valuable research the VA does with regards to veterans health, which in many cases goes on to general usage. According to David Shulkin, the VA Undersecretary for Health from 2015 to 2017, in 2015 VHA researchers published 9,480 scientific papers.[iii] Suzanne Gordon also points out that, unlike civilian private practitioners, VA health care professionals are more aware of issues specific to veterans; this includes ailments which veterans are more at risk from, including PTSD, prostate cancer due to Agent Orange (a Vietnam War chemical weapon) exposure, or problems specific to military service, such as mental health issues due to the experience with violence and killing.[iv] For these reasons, many VSOs, including the American Legion, Veterans of Foreign Wars, and Disabled American Veterans, oppose increased privatization.
In general, it seems that American military veterans are satisfied with the quality of VA healthcare services but are frustrated by a cacophony of administrative and logistical failures, which in some cases have devastating consequences. As many Americans now push for universal health care, the status of the VHA will be determined both by the struggle between pro-privatization and anti-privatization groups, as well as how the VHA is able to fit the evolving healthcare landscape.
[i]Gordon, S. (2017). The Battle for Veterans’ Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care. Ithaca: Cornell Publishing.