Monday, March 26, 2007
Want to thank veterans? Fix the VA
Steve Huff
Recent columns
From the RoundTable blog
If Walter Reed Hospital is the tip of the iceberg, what is at the bottom?
In other words, if our most injured warriors-on-terror languish in squalor and bureaucratic morass at the military's flagship hospital, what is happening to veterans of other wars: World War II, Korea, Vietnam, the first Gulf War? What about those who served in peacetime?
I'll tell you; I doctor them every day.
They are solid individuals who, for the most part, have gotten on with life. Some are decorated heroes, others served unceremoniously between wars. They tell stories of survival, victory, injury, illness -- and of the VA health system.
I repeated some of their stories before the last presidential election ("The VA isn't doing right by veterans," Oct. 5, 2004). They contradicted the boastful rhetoric of the Bush administration and the VA. The goal was to let people know that the VA was not truly providing "exceptional" service to its veterans.
Although veterans responded graciously in person, they confided that they could not risk complaining in public. They had heard too many stories about veterans who had lost their VA privileges for such outbursts.
I found out what they meant when officials threatened to revoke my VA privileges, pushed to have me fired from my civilian job and asked me to turn over my veterans to another doctor. A special file was opened, I'm told, for the purpose of collecting dirt on me.
Salem VA employees, including then-director Stephen Lemons, wrote letters to the editor that, in my opinion, simply denied that there were problems.
So much effort was expended to distract, discredit and deny, it's hard to imagine anything good coming out of it.
For whatever reason, though, some things have improved. I don't hear quite as many complaints as I used to. Veterans get referrals without as much hassle, and seem generally satisfied with their hospital stays. Lines of communication have opened. The other day we received an e-mail asking what we thought of a policy before it went into effect.
For veterans without other health-care options, the VA provides a valuable service.
But let's not fool ourselves. Veterans continue to wait weeks or months for evaluations that would take hours or days in the real world. Expensive medications are nearly impossible to prescribe, even when the alternative choices are inferior. Co-pays continue to rise. The dermatology department has vanished. Vets are forbidden from proper colon cancer screening with colonoscopy. Rigid VA policies and procedures threaten to grind our office to a halt.
What floats this dysfunctional iceberg?
Our military is receiving health care on the cheap. The wars in Afghanistan and Iraq have lasted years longer and have created far more injury and illness than ever imagined. At the same time, taxes have been cut, and the federal deficit has ballooned.
In June 2005, VA Secretary Jim Nicholson stunned Congress with a bailout request for more than $1 billion. Without it, 80,000 vets would have been left out in the cold. What more of a dope slap did the administration need?
Next problem: Military medical systems seem more military than medical. Collaboration is discouraged. Complaining is scorned. Policies are handed down imperiously. I haven't seen much regard for the civilian standard of care. The buck stops when it hits the ground.
Bureaucratic morass? The stories are legion: Veterans suffocate under mounds of redundant paperwork; appeals for benefits languish indefinitely; doctors do the combined work of secretaries, transcriptionists and billers while they could be seeing other patients.
Do not believe that all these bogeys simply slipped under the administration's radar. That level of ignorance would require that the White House, Congress and Department of Defense accidentally jammed their fingers in their ears, squeezed their eyes shut, and sang "LALALAALALA" for half a decade.
Thankfully, former Secretary of Defense Donald Rumsfeld and his notions of a "leaner" military are gone. Since the Walter Reed exposé, several other high-level officials have taken hits.
I'm afraid, though, that the whole iceberg is contaminated. It's time to melt it down and start over -- on solid ground.
Rebuilding the military health system is a decades-long project that will require billions and billions of dollars, and -- brace yourselves -- maybe even a tax increase.
Tens of thousands of aging veterans will die before they can reap the benefits they were promised. Six hundred thousand have graduated Iraq and Afghanistan to become new veterans. A couple hundred thousand future veterans hope to come home soon.
Can you think of a better way to thank them?
Huff, who lives in Patrick County and practices family medicine, is a Roanoke Times columnist.
