This Veterans Day, in addition to honoring those who serve in uniform, we should spend some time remembering the 300,000 employees of the Veterans Health Administration. The V.H.A. — the nation’s largest public health system — doesn’t just keep veterans healthy; it has developed treatments that help all Americans. And if we don’t defend it, it could be dismantled and auctioned off in whatever remains of the Trump era.
In V.H.A. facilities I have met some of the best doctors, nurses, therapists and medical researchers I’ve encountered in 40 years of reporting on the hospital industry. They deliver high-quality care to more than nine million patients who are, on average, older, sicker and poorer than those served by other systems. Yet, unlike veterans themselves, who are praised by politicians and the press, V.H.A. staff members, and the agency they work for, are routinely denigrated.
President Trump has insisted that “our veterans have been treated horribly” and that the V.H.A. is staffed with “bad apples” who “rob us or cheat us.” Last month, in a speech at a prestigious medical conference in Cleveland, John Boehner, the former House speaker, said the Department of Veterans Affairs, of which the V.H.A. is part, is simply “hopeless.” Its hospitals “provide substandard care to our veterans who deserve the best care,” Mr. Boehner said. “If you’re a real doctor, you’re probably not working at the V.A.”
Studies have shown that private-sector doctors and hospitals are not prepared to deal with veterans’ complex needs. But foes of the V.H.A., backed by wealthy donors like the Koch brothers, want to dismantle its hospital and clinic network and contract out billions of dollars’ worth of veterans’ services to the private sector.
In June, Congress passed the VA Mission Act, which expands veterans’ access to private care and establishes a commission to determine whether to close V.A. facilities. Its members will be appointed by the president, and they could include medical industry representatives who would benefit from privatization. Congress will be unable to vote on the commission’s decisions. The head of the Department of Veterans Affairs, Robert Wilkie, perhaps influenced by a shadowy group of Trump associates nicknamed the Mar-a-Lago Crowd, is said to be developing rules that would significantly increase the number of veterans who get care outside the V.H.A.
At the same time, private-sector care is more expensive, and the president and congressional Republicans refuse to allocate the money to pay for it, so each dollar that goes to it will come out of the V.H.A. budget. This will starve the system of needed resources, leave thousands of doctor and nurse vacancies unfilled, and force hospitals and clinics to shut down.
The Koch brothers may be delighted by the prospect of a crippled system. Patients of the V.A.’s 11,000 physicians and other caregivers have a different view. The V.H.A. isn’t perfect; there have been some bad actors, and veterans often complain about having to wait for appointments. But while veterans’ organizations want better funding and staffing of the V.H.A., they overwhelming support its mission, for reasons outlined in “VA Healthcare: A System Worth Saving,” a report that I co-wrote for the American Legion last year.
Dismantling the V.H.A. would jeopardize the health of its largely poor and working-class patients. It would also undermine the medical research and teaching that benefits all Americans.
V.H.A. researchers have already given us the nicotine patch, the shingles vaccine, and innovative approaches to geriatric and end-of-life care. The administration is conducting a Million Veteran Program to determine how genes affect veterans’ health and ours. Because it treats so many patients with prostate cancer, it received a $50 million grant from the Prostate Cancer Foundation to discover new treatments for that disease.
Insurgents’ use of improvised explosive devices in the Middle East has made the V.H.A. a leading center of research on and treatment of traumatic brain injuries (also suffered by professional football players, who now arrange to have their brains sent to the V.H.A. for post-mortem verification of their condition). The veterans’ system is also a leader in treating amputations and providing state-of-the-art prosthetics.
By 2015, 1.6 million veterans were receiving specialized mental health treatment at the V.H.A., where thousands of mental health providers are taught the latest evidence-based treatments for post-traumatic stress disorder, depression and other conditions.
Seventy percent of all American doctors have received some training at V.A. hospitals. Many are taught about new treatments for the chronic pain from which so many veterans suffer, and how to reduce suicides. Suicide-prevention trainings are mandatory for all V.H.A. hospital employees — from a janitor to the chief medical officer — so they can recognize when someone is at risk.
Many private doctors and hospitals seeking to care for veterans have less experience treating patients with these issues, and they also offer far less coordinated care. At a California V.H.A. residential program for brain-injured Iraq and Afghanistan war veterans, for example, a psychologist and physical therapist work side by side to address their patients’ chronic pain and severe PTSD. This model both provides better care and keeps costs down by avoiding confusion and duplication.
I am not a veteran, nor is anyone in my family. But this year, I’m observing Veterans Day by putting a bumper sticker on my car that says “Save Our VA!” The V.H.A.’s successes are the fruit of 100 years of federal expenditures. Let’s hope that a new Congress and, eventually, a different president, will find that investment worthy of protection before it’s too late.
Suzanne Gordon, a senior policy fellow at the Veterans Healthcare Policy Institute, is the author of “Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans.”
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