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Veterans' Health Care: A Solemn Promise

By Dr. Maggie Kozel
. 2 Comment(s)

We have promised as a nation to honor our enormous debt to disabled veterans by providing them with the best health services that modern medicine has to offer.  We need to keep that promise, and we need to pay the tab as readily as we funded the wars that caused them harm. A move towards reduction or privatization of veterans’ health benefits, as is currently being proposed by deficit hawks like Senator Tom Coburn and Representative Michele Bachmann, seems an odd way for us to try and meet those responsibilities.

I learned firsthand about universal health coverage - similar to what disabled veterans now receive - in that great bastion of socially-progressive thinking known as the U.S. Navy.  I spent eight years as a U.S. Navy medical officer, including shipboard and overseas duty.  Health care priorities were set by – I swear I’m not making this up – healthcare professionals, based on clinical evidence, rather than what insurance company executives decided in strategy meetings. Drug formularies were driven by pharmacists working with physicians, not by marketing executives and expensive pharmaceutical ads. There was no incentive to create medical conditions so that we could implement expensive tests and treatments. No money ever changed hands; just show your ID and you were in. Most of all, there was a pervasive sense of mission and purpose.  Before any of us dismiss universal, single-payer health care on the basis that it is socialism – or, even worse, European - it is worth taking a closer look at what our own military and veteran systems have managed to accomplish.  And before we take the VA health system away from veterans, we should look at the facts.

The reality is that the VA healthcare system is one of the best health care systems in our country, based on well-documented measures of physician quality, clinical outcomes and patient satisfaction. Prudence would seem to dictate that we should be studying the VA’s health care system to see how we can achieve their high level of care and low level of hassle, rather than devising ways to dismantle what works and insert veteran care into a civilian system that by almost all measures performs less well.

One particular danger of dismantling the VA system is in the area of mental health. Our civilian third-party-payer system has been particularly inadequate for the diagnosis and treatment of psychological and emotional disorders in general. In contrast, the VA, bolstered by funding increases from the Obama administration, has been rising to the challenge of treating and supporting the growing number of our veterans who carry the invisible yet debilitating wounds of war in their hearts and minds.  To release them into our civilian system, where psychiatrists get reimbursed for little more than monthly  “med checks,” and where talk therapy is a luxury that few can afford, would be unconscionable.  What is particularly frightening is that we may not know the true extent of veteran traumatic head injury for another decade, but it is safe to say the price tag will be huge. That painful truth does not diminish our obligation.  We sent them to war.  We must care for them. 

Our nation needs to seriously consider what we want in a civilian health care system and how we are going to pay for that. We can learn a great deal about universal health coverage, both the benefits and the pitfalls, from the VA.  In the meantime, let us all pledge to continue providing veterans with the best system currently available – that provided by the VA - until we come up with something even better for all of us. 

This blog post is a modified version of one that appeared in Huffington Post earlier this year.  It is submitted today in honor of Veterans’ Day.

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  1. joel weddington

    Great blog, and it makes sense to take pause and appreciate that the VA is the only completely Federally owned and operated medical system in the U.S. It is - to put it right out there - socialized medicine, like that of the U.K. And it works! We always try to hold Medicare up as a kind of gold standard when the VA is probably much more so.
  2. Arlene Conley

    It's now Dec 15, 2011.

    The forces to dismantle the VA are alive and well. The process is moving along handily in South Dakota. Under the guise of "how do we serve a dwindling veteran population in rural areas?" the blueprint is being drawn to privatize veterans' medical care. The day of "here is your voucher, now you're on your own" will surely follow. Though admittedly I have read angry veterans raging against incidences of substandard care, I have listened to far greater numbers of heartfelt expressions of appreciation for outstanding care at VA facilities. The VA medical records system is the standard bearer for the world. Patient maimings and death due to treatment errors is far lower in the VA system than in the private sector. The VA is far more dedicated to wellness than the private sector. It follows enrolled patients all their lives (if they choose to enroll early), regardless where their professions and lives take them. It calls patients in for checkups, pays for transportation. It's all far more cost effective than the "crisis" medicine practiced in the private sector. The veteran population in the U.S. is, across the board, a sicker population with higher incidence rates in diabetes, heart disease, cancer and PTSD...yet veterans incur less per capita expense than the population at large because of wellness tracking and dramatically reduced errors which brings us full circle back to the point of superior medical records keeping. Let's KEEP the VA! Let's expand it. Invite the public in. We sure as h--l, ought not be trying to kill it. Follow the story in Hot Springs, Ft. Meade, and Rapid City, South Dakota. If this is the beginning of the future of the VA in America, we will have squandered one of America's greatest social resources. And failed in one of its most cherished social contracts, the one we've made with those who defend the front line.

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