VA Healthcare Access
Commentary from Jim Strickland.
12.21.06


There is a constant buzz about America's Veterans and their health care benefits. I've been reading a lot lately and I hear many good questions being asked; Why should Veterans get health care benefits? Which Veterans should we give the benefits to? Shouldn't Veterans get benefits only for combat or on-duty related injuries? Why is it all we ever read about are budget cuts for Veterans health care? Why doesn't the government do more to reach out to Veterans and bring them into the VA health care system and provide better access to the system? Why are waiting lists for health care so long for Veterans? Are co-pays reasonable for some Veterans?

The answers to those questions vary as much as our political beliefs and are scattered across the board. I'll give you a personal perspective along with a few facts and let you decide for yourself.

At some point in many of our lives, we reach a fork in the road and we are called upon to make a decision. We have an opportunity to join a branch of the military or we can continue on as civilians. In the 1960s, many of us didn't have to make much of a choice; our local draft board made the decision for us as a matter of law. That aside, when we reach this decision point in our lives we're usually young and a bit naive. Some of us choose the civilian life and go into the workforce or on to an advanced school and later seek employment that we hope will satisfy us and bring financial reward. Others will choose to enter the military. Either path is OK, it's a matter of personal choice and that's what this country is all about.

The moment we take our first step toward the military life, all similarity to a civilian occupation ends. No matter the branch of service you choose, no matter the MOS you have, there is no way to fairly compare the life of a soldier, sailor, airman or Marine to any occupation in the civilian world.

For example, if you chose the civilian path at age 19 and you were hired as a sales associate for an electronics retailer, you'd receive a couple weeks of training, a name-tag, a company manual and maybe a little mentoring from a senior associate. You may be assigned to work some weekends and nights or even holidays but overall, it's a good job...you get a 10% discount on your purchases there and your DVD collection is impressive. You aren't working over 40 hours each week since the company won't pay overtime and that gives you plenty of time off. You punch the clock and in a year you have some vacation time accrued and you may be on your way to becoming a shift manager with even more opportunity in the future...it's a fast growing company! You've done well and on your first anniversary with the company you take a nicer apartment and buy a newer car.

The other fellow (or young lady) chose the path leading to the military. He passed a strict physical examination as well as a challenging battery of tests to determine his mental acuity and psychological stability. He was screened for illicit substances and interviewed by any number of serious looking people. Her first day on the job was a long one and later on in the week he recalled seeing a dentist, an optometrist, any number of physicians and medics and his arms were sore from the varied injections deep in muscles up top and withdrawals from veins below. Our new military member had met his team of on-the-job trainers and now knows his Company Commander from a distance and his Drill Sergeant up close and personal. (I don't recall that we were allowed to see the 1st Sergeant at this point. I understood we had to see God first and then the Top.) In the next 3 months or so our new government employee has been trained in everything from advanced first aid to exiting an oil fire on a burning ship. She knows how to swim with an 80 pound pack and combat boots and can take that same wet pack for a 15 mile stroll. He's grateful to be allowed to fall asleep in the mud because after all, it is sleep, isn't it? He knows how long the stench of tear gas will linger in sweaty clothes, how quickly that Drill Sergeant will shove him face first to the ground after he throws a live hand grenade and which side of a Claymore points at the enemy. Above all else, he's learned courtesy, respect, loyalty, initiative, the ultimate importance of The Mission and that his personal pain and suffering does not ever matter.

Our soldier, sailor, airman, Marine will go on to advanced training where as a teenager, he may become responsible for a piece of armament powerful enough to destroy a large city and all the human lives in it. She may fly or maintain an aircraft worth hundreds of millions of dollars. There is no time off. It's understood that at this point we belong to our employer not in any figurative sense but literally. Nights, days, weekends, holidays are just periods of time, nothing more. The only family we have are those like us, those in uniform. Training is constant and an accepted part of our everyday life. Physical drills and exercises are often brutal and there is that expectation that we should always look the part, no matter the conditions.

During our first or second year we have been taken up and transported to other countries into living conditions that range from below zero to intolerably hot. Many of us have seen death. Some have become familiar enough with violent death to become hardened to it and they see the bodies of enemy or fallen comrades without breaking step, ever focused on The Mission. No matter the task or branch of service of the military man or woman, no matter the assignment, we are all exposed to the horror of war in one way or another. Two or three or four years into this life, we are much older than our civilian counterpart. Our young bodies are already becoming painful from the constant demands of long days, sleepless nights, unforgiving schedules, constant travel, loss of family contact and stress...the stress is always there even during the quiet times. We've sustained injuries, some from training, some from combat, some just because the work is hard, harder than most people could imagine.

It's The Mission that demands it you see.

To answer that question about whether Veterans deserve the best health care imaginable: Of course they do. It's preposterous to argue otherwise. There is no other hazardous duty on the planet that subjects so many people to so much physical and mental stress and injury and they must be cared for. Our congress has a duty to provide a reasonable budget in a timely manner to provide high quality health care to Veterans. Is there a limit to spending on Veterans health care? Certainly there is. There is no money tree I'm aware of, health care is expensive and someone has to pick up the tab. Veterans health care must be managed efficiently, not unlike its civilian counterpart.

Should Vets get compensation and health care only for combat related injuries or injuries received during their work related duties or while training? No. Any injury or illness a Veteran sustains while on active duty (not brought upon themselves by misconduct or while AWOL, etc.) must be compensable and continuing medical care must be provided. There is no 24 x 7 job like the military and to try to delineate between "on duty" or "off duty" isn't practical. From the day you take the oath and step forward to the day you have your honorable discharge in hand, you are property of your military branch and subject at any time to be assigned to instant hazardous duty. Compensation must be equitable to that demand.

Is it reasonable to ask that some Veterans make co-pays or otherwise subsidize their care? I think so. If a Veteran has no service connected conditions, has been fortunate in his or her post military life and they can afford to contribute or have another source of health care, yes...let's require them to pay on a sliding scale that is in line with their resources.

Is VHA care as good as I think it is or am I seeing it through my rose tinted glasses? How about access to care and those long waits to receive care? Shouldn't VA do a lot more to bring Veterans into the system? I've had some conversations lately with Veterans who find fault with either their own access to Veterans Health Administration (VHA) care or how limited access affects our unique population. I'm a former civilian health care technologist, executive and health care consultant. I've received health care from civilian providers most of my post-military life and now choose to receive my care from VHA. I'm happy with my care and the availability of services and decided I should look around to see what the reality is.

It's been established long ago that a primary mission of the Veterans Administration, lately the Department of Veterans Affairs, is that of providing health care to Veteran military personnel who were wounded or otherwise injured somehow during their active duty service. The VHA has grown to be the largest health provider organization of its kind in America. In fiscal year 2005 your VHA spent some $31.5 billion for health care at 154 medical centers, 875 ambulatory care and community-based outpatient clinics, 136 nursing homes, 43 residential rehabilitation treatment programs, 206 Veterans Centers and 88 comprehensive home-care programs and treated 5.3 million people. This was a 22 percent increase in the number of patients treated over FY 2001.

The reason for the recent rise in demand for VHA care has come from separate drivers. First, the secret is out; VHA care is as good as it gets. It seems every day you'll see a story about the superiority of the care Veterans receive through VHA. (Before you yell at me about how your VA doctor nearly killed you, let me say I'm speaking of the big picture. I hear the stories of near death experiences caused by this or that and I can only tell you that is no different in a civilian setting. Overall, VHA care is recognized as superior, end of that story.) Then there are the ones of us of the Vietnam era who are becoming seniors with all our aches and pains and we've discovered it's cheaper to go to VA than the doc downtown. Even with co-pays our VA medications are less expensive so economics are driving us to our VA clinic. There is also this new wave of Veterans and some not-quite-yet Veterans who are much more aware of VA health care than most of us were 30 years ago and they're signing up in droves.

Access to care is always a hot topic. There are plenty of articles and columns that criticize VHA regarding access and demanding more outreach to Veterans. I've given this a long, hard look and have come to the conclusion that access is sometimes not as convenient as we would like...we often must drive a couple of hours or catch a DAV van to reach a specialty appointment...but it isn't that bad. I always have to compare to civilian care and much of (civilian) rural America has little or no health care nearby and they're often forced to drive to a nearby "big city" to see a doctor or receive a treatment. I find that wait times are sometimes long but not unreasonable. I waited about 4 months to see an ophthalmologist for my cataracts. I waited about 4 or 5 months to see a rheumatologist. Neither condition was life threatening, both my eye problems and my arthritis had taken 56 years to develop, another couple of months made no difference. In any instance I've needed urgent care I've been seen quickly or immediately approved to use a nearby civilian emergency room.

Lastly, should the VA do more outreach to Veterans? In recent years political games have been played to instruct directors to not market to Veterans or otherwise control the budget but that's mostly showboating in Washington. The VA is mandated to reach out and inform Veterans of services available and I believe that they do an adequate job of just that. I think there are few Veterans around who don't have some understanding of the benefits available to them. The biggest barrier to Veterans receiving VA health care are the Veterans themselves.

We Veterans are a funny lot, diverse in our opinions, our attitudes, our social mores and our way of doing things. Hardly a day goes by that I don't speak to a Veteran who has never accessed the VA system. When asked why, I get the reply that, "It's too much trouble." or "I got my doctor already." or "You gotta do all that paperwork." When I explain that there are monetary benefits or even access to nursing home care and other such things available, many shrug it off and don't want to talk about it. A reader wrote to tell me of her brother, the Vietnam Veteran who had suffered stomach ailments for over a decade. I referred her to a local County Veterans Service Officer to get him some help with accessing the system. Later I wrote to ask how it was going with her brother and she replied, "You can lead a horse to water but you can't make him drink."

There's plenty of outreach and overall there is a lot of good health care for us that we can easily access...if we want to. I volunteer at the local clinic and we will help any Veteran who comes through the door. In my community there are stand downs, churches all have Veterans outreach, public schools are involved in Veterans activities and all the Veterans Service Organizations will assist any Vet who asks for help. If there are Veterans here not getting VA care, it isn't because they don't know about it, they have other issues that keep them from it.

It can be better. Access can be improved, attitudes of caregivers have room to improve, more physicians must be hired and so on. That all gets done when you get involved. Your participation and lending a hand to a brother or sister in arms is what it takes to make an already good thing better!