Veterans deserve our gratitude for all they do to keep us safe. Our appreciation should extend far beyond Veterans Day — as in, year-round. And most importantly, it should include better, more comprehensive healthcare.
Veterans have unique health needs. From those with mental health issues to elderly and disabled veterans, their healthcare coverage should address those needs. Sadly, this isn’t always the case.
Unique Health Needs of Veterans
Issues affecting veterans cannot always be seen. There are often psychological and psychosocial elements that aren’t easily diagnosed or treated. And then there are the mental health issues, which include the following:
- Anxiety disorders
- Bipolar conditions
- Sexual trauma
- Substance abuse
- Suicide prevention
There are also issues of chemical exposure, including the accumulation of lead, and infectious diseases, depending on where and when they served. These are issues that can only be detected by blood tests — blood tests that the VA considers, “ancillary services,” that may or may not be covered, depending on the conclusions of their primary care providers.
According to the Veterans Administration, “certain health concerns may be more likely to affect Veterans who served in a specific time and place.” To that end, they have a special page on their website where veterans or their family members can see if any time-and-place considerations are applicable to them.
One of the problems facing veterans is the issue of non-specific conditions like fatigue, general pain and soreness, and problems affecting memory and concentration. And that’s compounded by a complex system of care where knowing what’s covered and what isn’t is sometimes challenging.
Another common problem affecting veterans is hearing loss and impairment. They’re routinely exposed to loud noises, such as gunfire, large weaponry, loud engines, and heavy machinery, all of which can easily contribute to hearing problems.
How the VHA Is Different From Typical Healthcare
According to a RAND study conducted on April 15, 2018, veterans receive the same or better care at VA hospitals as patients do at non-VA hospitals. VA Acting Secretary, Robert Wilkie, in response to the findings said, “We are constantly striving to improve our care at VA, but this should encourage Veterans and the public that VA care is in many instances as good as or better than the private sector.”
The study focused on three (out of six) “Domains of Quality Care” as defined by the National Academy of Medicine:
- Patient-centered care
Not taken into account in the study were the other three Domains of Quality Care: timely, efficient, and equitable, meaning care that doesn’t vary based on gender, ethnicity, geography, and social status.
These omissions are curious at best. But what may be even curiouser are that the VA hospitals were only measured against three non-VA hospitals, the selection of which, especially if not chosen impartially, could have greatly affected the study’s results.
Furthermore, there is no explanation in the study itself for these omissions or the selection criteria for the non-VA hospitals.
A Unique Perspective
David J. Shulkin, M.D. spent 25 years in the private sector as a healthcare manager. In 2017, he became the ninth person to hold the title of U.S. Secretary of Veterans Affairs. After comparing and contrasting the VA model of care with the private sector, he has “come to realize that many of the essential services provided by the VA cannot be found in or even replicated in the private sector.”
He added that the VA has greatly evolved through the generations and is the only healthcare organization that offers all the necessary services that veterans need under one roof. He also outlined the three core strengths of the VA that differentiate it from private healthcare:
- An emphasis on conditions and disorders that most affect veterans
- A veteran-centric team approach to care
- An integrative approach combining physical, mental, social, and economic health
What really sets the VA apart from the private sector, according to Shulkin, are the physicians. Unlike private hospitals and clinics, the VA doctors are experts at dealing with difficult issues that most affect veterans: substance abuse, suicide prevention, PTSD, and other similar issues.
From Humble Beginnings
On March 3, 1865, one month before the end of the Civil War, President Lincoln established the first federal veterans facility, the National Asylum for Disabled Volunteer Soldiers. It was the first of its kind anywhere in the world.
In 1930, the federal government combined the newest version of that first organization—the Bureau of Pensioners and National Home for Disabled Veteran Soldiers with the Veterans Bureau to form the present-day Veterans Administration. Since then, the VA has grown from 54 hospitals to (as of 2015):
- 150 hospitals
- 800 community outpatient clinics
- 126 nursing care units
- 35 domiciliaries
More Changes Are Necessary
And while progress has no doubt been made during those 150+ years, there is still much work to do, according to practicing surgeon and Senior Fellow at the Center for Health Policy Studies, John O’Shea.
According to a leaked document published in the Huffington Post in July of 2015, nearly one-third of veterans died while awaiting care. That one-third represents around 238,000 veterans.
The document outlines some glaring issues involving both policy and practice at the VA. This includes exceptionally-long wait times and secret wait lists. You may recall that of the three Domains of Quality Care that the RAND corporation chose to ignore in its study. One was timeliness of care. The other was equitable care, as in no prejudice. In other words, no secret wait lists.
In O’Shea’s own words, “The VA health care delivery system is in need of comprehensive reform to ensure that America’s veterans receive quality, timely, and affordable health care.” Care that he says has fallen short, in part due to access and accountability issues.
In the short-term, O’Shea recommends the four following measures:
- Settle issues regarding access
- Resolve management failures and physician shortages that contribute to those issues of access and accountability
- Make decisions based on need and circumstances rather than arbitrary judgments from administrators
- Streamline the entire VA healthcare system
O’Shea’s long-term recommendations, in many ways, echo those listed above:
- Veteran care should be more need-focused and not based on political or institutional concerns
- Put more resources toward helping those injured in the line-of-duty
- Outsource care if needed, rather than make veterans endure lengthy wait times
- Be more fiscally responsible
- Be more accountable
The original VA motto includes these words, as spoken by President Lincoln during his second inaugural address: “To care for him who shall have borne the battle and for his widow, and his orphan.”
While the VA has experienced much growth and gone through many positive changes over the years, there is still much work to be done. The veterans deserve, at the very least, quality healthcare during their years of service and beyond. During your next Veterans Day barbecue or celebration, take a few minutes to reflect on all they have given up, and continue to give up, to ensure the rest of us remain safe.
Editor’s note: This article hits a special place in my heart and I simply must say this. As the former wife of a former Congressman (that’s a lot of formers), I know that they receive the best health care/health insurance available and the fees are affordable. I recommend that all U.S. Representatives and all U.S. Senators receive the same care as our Veterans for at least one year. They should be given pseudonyms so no one gives them special treatment. Even better, they should all be given some time on the “front lines” wherever we’re fighting and then come home and see if the Veteran’s care meets their needs. Unfortunately, those who make our laws would never vote for such a bill. I’m just sayin’… Irene