Near the end of the Civil War, during his second inaugural address President Abraham Lincoln spoke the words that would become the motto of the Veterans’ Administration:
“[L]et us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow, and his orphan…”
If VA healthcare is judged at the level of services provided by the individual physicians, nurses and staff who work day to day with veterans’ at one of the Nations’ VA district facilities, then in most cases the care could be considered compassionate and commendable. It is not a coincidence that this is also the image that advocates of the Veteran’s healthcare system rush to portray when yet another veteran’s healthcare scandal brings them under the threat of public scrutiny. In fact, a University of Michigan Consumer Survey reported the following:
* VA outscored the private sector by 11% in inpatient care.
* VA outscored them in outpatient care by 11%.
* 91% of VA patients are happy with overall customer service at VA.
* VA scored 94% in “veterans loyalty” category.
The unfortunate truth for both veterans and those who actually provide their care is a much more dismal reality. It is becoming readily apparent in the recent rash of veterans’ healthcare scandals that funding, staff and facilities are hopelessly inadequate to meet the increasing numbers of wounded and disabled emerging from our latest national folly in the Middle East. Faced with an aging Vietnam-era veteran population as well increasing numbers of veterans returning from Iraq and Afghanistan, veterans’ healthcare has become a shell game of fiscal micromanagement, moving inadequate funding from one crisis to another as they arise. The question becomes less that of providing the absolute highest level of care and consideration for veteran “beneficiaries” and more that of an attempt to cloud public awareness regarding veteran healthcare inadequacies.
Walter Reed Army hospital has brought public focus on numerous controversies surrounding veterans’ healthcare. A great deal of dialogue has been generated demanding quick solutions to problems, which have plagued the beneficiaries of this care, the veterans, for decades. The bottom line, like most else in a profit based culture is money. When the dialogue gets serious regarding veterans’ care, the human element takes a secondary position to the management of inadequate and unavailable funding. The VA is the largest integrated healthcare system in the nation with 155 hospitals, 900 outpatient clinics and 135 nursing homes. Currently it treats 2.5 to 5 million veterans’ at a cost which translates to 20% less than private healthcare providers.
What is the solution?
In the current debate two primary “solutions” are generally offered regarding inadequacies in veterans’ health care:
1) One form or another of “privatized” veteran care wherein current facilities remain “as is” but veterans are given a “health care insurance card” that would entitle them to free care at any provider of their choice with “no strings, no if, no ands, or buts,” as suggested by Sen. Larry Craig R-Idaho.
2) A $5 billion proposal suggested by the Democrats to “beef up” the existing healthcare system using these funds to create specialized treatment centers, upgrade current facilities, hire and train new personnel, and streamlining evaluation and tracking procedures.
While either option could provide temporary relief from what ails the system neither is a solution within itself and neither addresses the underlying issue of a nation which will readily allocate $878 billion to defense spending and the creation of new veterans yet only allow $84 billion toward caring for those veterans which defense spending has created. This is nearly 10-1/2 times more in Billions of $ spent. That financial issues are much closer to the heart of those concerned than providing veterans’ care is highlighted by a recent Defense Department report which expresses concern that military healthcare alone might consume nearly 12% of the defense budget by 2015. Susan Hosek, senior economist at the Rand Corporation recently stated, “So the concern is that over time they (DoD) are going to have to shift their resources from military personnel or equipment to pay for healthcare costs.” To avert this possibility the Navy and Air Force will slash their forces by 15,000 in 2006 and save $138 million per year. Conversely, the Bush administration has asked for an increase in Marine and Army personnel of 92,000 over five years which will easily eliminate any savings seen by the Navy and Air Force cutbacks. And so it goes, three card Monty at both the taxpayers and veterans’ expense.
These data are a wonderful thing to look at in a world of economists, lobbyists, and politicians, but how does it translate into the everyday world of the veteran? In the survey referenced earlier, responses were gathered from a representative sample of the 2.5 to 5 million veterans currently seeking care or benefits within the VA system. In fact, the current number of veterans of all wars is 24.6 million. Of these 9.5 million are 65 years of age or older. 8.2 million or 30% of all veterans’ are Vietnam era veterans. If, in fact, a quality of care is delivered which even resembles that indicated by the Michigan survey, why are a mere 10% of veterans availing themselves of this care?
Under the auspices of Lincoln’s promise, each veteran was guaranteed care by a “grateful Nation” should he/she become injured in its service. For some veterans, experiences within the VA system are no worse than those of any civilian who must deal with an increasingly complex and dehumanized American healthcare system. Unlike civilians however, most veterans do not have the option to access alternative healthcare providers if their “HMO” proves unsatisfactory. Also, and again unlike civilian populations, the healthcare required by veterans’ is often far more complex than common aliments found within a non-veteran population. The traumatic wounds, multiple disabilities, exposure to toxic chemicals/substances and stressors which affect the everyday life of the veteran are rarely encountered outside combat environments which have created them.
Although the VA administration would adamantly deny it, initial attempts to seek care from the veteran’s viewpoint generally begin in an adversarial environment where overworked, understaffed and under-funded facilities seek to limit the ever increasing numbers of possible beneficiaries at the primary level of entry into the system. Thus, veterans battle with the VA administration over basic eligibility, and progress through the long waits in crowded waiting rooms that more closely resemble a Russian gulag than a contemporary healthcare facility. Many of the veterans not seen within the VA system are combat traumatized veterans of past and current eras who find they would rather self-medicate through drug and alcohol addictions or suffer silently, than engage the convolutions of this bureaucratic system. Although I reside in New Mexico, the following are examples of what a veteran might encounter with no alternative than that of entering the VA system, anywhere in America;
1) VA Claims: In New Mexico, 28% of 4700 new claims are still pending after 6 months. As of March 3 of 2007, there was a national backlog of 401,000 un-adjudicated claims for compensation. Of these, 115,000 have waited 6 months or more. Many older claimants “will die while waiting for adjudication of claims,” stated Randy Reese, National Service Director for Disabled American Veterans. In 2000, 579,000 disability claims were filed. By 2006, the number had increased to 806,000. While the backlog of claims continues to grow, lack of funding has resulted in hiring freezes at the Veterans’ Benefits Administration making settlement of claims increasingly inaccessible.
2) Eligibility: Initial denial of benefits implying veterans’ claims are based on “preexisting” conditions requiring extensive proof to be provided by claimant showing “service” connection.
3) Waiting lists: Once eligible, veterans encounter waiting lists of 2 months (initial consultations) to 2 years (routine checkups) for appointments.
4) Inconsistency in primary care physicians: Many VA facilities are located near research hospitals and University medical facilities so the VA can avail themselves of medical students in residence. Reciprocally, veteran populations offer training for students and research data. Once residency is complete, however, many of these new doctors leave to take jobs in the more lucrative world of private healthcare.
5) Aging facilities: Most VA institutions are 50 years old or more and limited funding allows only cosmetic upgrades, not the complete renovations, which would be required to bring them up to par with private healthcare facilities.
6) Access to Care: Dependent upon nature of care required, VA District 18 veterans (Albuquerque, New Mexico) will travel from as far as Montana or Amarillo Texas for some types of healthcare. In many cases identical care could be provided on a Fee Management basis locally without the need for extensive cross state commutes. However, in cases where fee management care is authorized, many private facilities refuse care to veteran patients due to prior history of non-payment on part of the VA.
7) Travel pay/ per diem: Veteran beneficiaries receive reimbursement of $.11 per mile contrasted with State or Federal employee rates of $.445 per mile. Rates and availability of food and lodging are not set federally but by district medical care provider (i.e. District office management.) In a recent Senate hearing, requests for an increase in these rates was met with the VA argument that fair compensation would result in an additional cost to the VA of $1 billion which must in turn be deducted from veterans’’ healthcare funds.
8) Disability Compensation: Most service-connected disabilities occur near the beginning of an individual’s earning cycle. In those cases where the disabilities are severe enough to indicate a rating of 100% service connection, many of the individual’s involved have not yet been members of the workforce long enough to accrue job skills which might aid in supplementing their monthly compensation. Even so, in some cases these supplemental earnings will be factored into proportionally reducing disability compensation payments. The Compensation Program was created to “provide monthly payments and ancillary benefits to veterans, in accordance with rates specified by law, in recognition of the average potential loss of earning capacity caused by a disability, disease, or death incurred or aggravated during active military service.” As a result, dependent upon severity and nature of disability the 100% disabled veteran (using Vietnam era veterans’ as an example), can expect to receive between $25,000 and $30,000 per year which translates into $6,000-30,000 less than the $36,000 to $57,657 (U.S. census) mid quintile earnings of their peers. All costs and expenses accrued by the veteran in accessing healthcare at a VA facility beyond those discussed above also become the direct responsibility of the veteran. These “hidden” expenses amount to a very literal reduction in a veterans’ income to subsidize access to healthcare, which it is the government’s responsibility to provide.
9) Disputes: Disputes regarding compensation, benefits, or disability are addressed within the internalized system of the VA. Members of various VSOs (Veterans Service Organizations (VFW, DAV, Order of the Purple Heart, etc.)) are selected by the veteran to represent them in claims or appeals against the VA. Claims can take as long as several months to several years to be resolved, moving through a hierarchical procedure which if not followed can result in denial of appeal or necessity of reinitiating the process from square one. Veteran claims can often require a literal “act of Congress “ to bring about final resolution.
10) Dehumanization: War is the most inhumane and vile of our human undertakings. The survival of combat veterans requires they participate in behaviors, which are the antithesis of our very human nature. This experience can create trauma so severe as to make most veterans feel as though they somehow exist outside the sphere of “normal” humanity. This lies at the core of PTSD (post-traumatic stress disorder) and the affinity many veterans feel for a hospital environment comprised of others who share their experience. The items defined above serve not to bring resolution to these feelings but rather exacerbate this sense of dehumanization, counter to the objective inherent in the motto of the VA healthcare system.
Care for the veterans is important. But what about the citizens of Iraq? It has now been estimated that there are over one million excess mortalities since March 2003. Given that the aggression -- which according to the Nuremberg Tribunal, is the “supreme international crime” -- of Iraq was predicated on a lie, how does this speak to Iraqi veterans? What is the responsibility of the servicemen and women?
Knowing these things, what can be done to improve, forestall or prevent them from becoming obligatory elements of our veterans futures? Not being an economist, nor politician, nor member of VA management, I can only speak as a 100% disabled combat veteran, a “position” I have held for close to 40 years. I am a “beneficiary” of the VA system and have a few modifications, which I believe would make the slogan “Support the Troops” less 2-dimensional than a car magnet. Some of these may seem a little extreme but they are based on a sincere presumption that veterans’ care is actually a priority of someone other than the veterans’ themselves or their immediate families.
The topic, which repeatedly rises to the surface faster than cream and more often than any other when speaking of veterans’ needs and services is MONEY. That which is not available to veterans is justified by the phrase “We just don’t have the funds.” So where does this funding come from?
The estimated Defense budget for 2008 approaches $878 billion, a figure which will increase as we factor in the growing costs of our invasion of Iraq and Afghanistan. Of this amount $84 billion, or roughly 10%, is the combined mandatory and discretionary budget amount allocated for veterans. Year by year, this figure too, will increase proportional to the numbers of veterans’ created by our military misadventures around the world. Perhaps it is time to build the true cost of waging war into the budget that makes it all possible.
The current veteran population represents 12% of the total U.S population. In other words, while 88% of all Americans live in the land of Big Macs, Humvees and American Idol, veterans take all the hits outside our borders, living and suffering the reality of securing resources, changing governments, and providing “national security.” Perhaps it is time we consider giving them a little larger slice of the apple pie our defense budget represents. Mandatory allocation of thirty to fifty percent of the defense budget might be an interesting place to start. Although money can do nothing to relieve the experience of war, it can insure that those who have actually participated in war need not endure a layering of additional post combat suffering as well.
* Funding at this level could be used to provide sufficient staff to not only handle, but also expedite claims. In fact, salaries might be offered for staff at levels high enough to actually encourage full time, long-term employment.
* Veterans’’ claims could be entertained from an initial “benefit of a doubt” level, meeting the immediate needs of those who have served, with enough staff to sort out the details later.
* Facilities could be improved and brought to levels comparable to private sector healthcare.
* Specialized treatment centers could be created regionally to treat and study trauma and injuries unique to combat.
* Waiting lists for access to care could be reduced to levels where doctors might actually be seen within 15 minutes of scheduled appointments.
* Where travel to healthcare facilities was necessary, rates comparable to those paid employees of other State and Federal agencies might be offered to veterans as well, making it unnecessary to involuntarily reduce the amount of spendable income available to them.
* For those veterans electing to seek care in the private sector, medical cards could be issued insuring providers of payment at primary rather than discounted rates, thereby guaranteeing veterans only the highest level of care.
* Compensation could be paid at levels, which actually represent the median “lost earning capacity” of veterans.
* Treating veterans’ as human beings, honoring and respecting their sacrifice, and actually providing them that which was promised at the time of their enlistment would not only reduce the number of claims against the VA but might also assist in helping veterans’ regain the humanity which was taken from them.
* Finally legislation might be introduced requiring the input and decision level participation of actual combat veterans at all levels of veterans’ care and benefits. Decisions would thereby be made with true regard for veterans’ needs and not as the result of a juggling act of limited funds worthy of a circus clown.
One can already hear the voices of Pentagon staff, the contractors, lobbyists and their political, bi-partisan lapdogs raising a cry of protest. How can we keep America safe on half our budget? How can we bring freedom and democracy to the oppressed? To them, veterans must raise their voices and respond: how can you who know little or nothing of war, wage it at our expense? How can you who will never know the meaning of a lifetime spent suffering war’s consequences continue to fund your folly by adding to the burden of our suffering? We were once your warriors. We served honorably, placing ourselves freely in harms way that you might remain safe and distant. How can you the citizens whose lives and lifestyles have been secured by our sacrifice, remain silent while we are homeless, uncared for or traumatized? Can you actually believe that waving a tiny flag or placing a decal on your vehicle relieves you of your indebtedness?
We are your troops, and you as has always been the case, have abandoned us. We have sacrificed our humanity that you might not need do so as well. To each of you who are not of our brotherhood, we as veterans must learn to respond: Without honor and respect for what we have given there will be no future service. If you cannot afford to both wage war and care for your warriors, then you must change the nature of how you view war. Pay the price for what we have given or take up the fight yourselves!
Tim Origer is a 100% disabled combat veteran of America’s War in Vietnam and currently works as an activist for peace and veterans’ issues in New Mexico. He can be contacted at: firstname.lastname@example.org. Read an interview with Tim Origer conducted by Dissident Voice Co-Editor Kim Petersen.