An Inside Look at Veterans’ Health Care Now Under Attack

As a Vietnam veteran who served in the Marines between 1968 and 1972, I am all too familiar with wounds of war.  Like so many people who served in Vietnam, on both sides, I live with PTSD, health issues from Agent Orange exposure, the skeletal wear and tear from lugging heavy packs in the jungle for 18 months, and hearing loss. I’m much luckier than many I served with, unluckier than some.

I know how hard it was to get Congress and the Veterans Administration to recognize these—and other—service related conditions.  Thanks to the organizing efforts of veterans’ themselves over many decades, eligibility for VA medical coverage has been expanded to nine million people and the care they receive has steadily improved.

Unfortunately, those gains are now at risk, due to a Trump Administration push to out-source more VA services to private hospitals and doctors and, if possible, privatize our entire national system of veterans’ hospitals and clinics. The anti-VA agenda of the White House, a Republican-controlled Congress, and rich donors like the Koch Brothers has benefited from much negative coverage of the VA in right wing media outlets and even mainstream publications like the New York Times.

At our most recent national convention in August, Veterans for Peace (VFP) resolved to step up the grassroots fight against privatization by helping to rally more veterans, VA care givers, and other affected union members against this threat. One important and timely new tool in this effort is Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans, a book by longtime healthcare journalist, Suzanne Gordon.

Wounds of War

In her past books and reporting, Gordon has written extensively about problems arising from our for-profit, private insurance-based medical system. She is a single payer advocate and favors public health care delivery (as opposed to payer) systems like the National Health Service in Britain, which the VA’s medical system (known as the Veterans Health Administration) resembles in many ways.

During her five years of research and interviews with hundreds of veterans and VA staff, Gordon learned much about the illnesses and injuries that can be acquired or exacerbated by military service. Those problems, she reminds us, do not only afflict combat veterans.

Some of the veterans we meet in her book have never left the United States but are suffering with chronic pain and PTSD. Even non-deployed veterans may have been exposed to toxic chemicals, concussion producing explosives, and brutal training regimens—or even just brutal superiors.

Anyone familiar with the specific problems of the veteran population would not be surprised to discover that we can be a cranky bunch, suspicious of government, and ready to pounce when we feel slighted. We are also, as she shows, deeply vulnerable.  We recognize and appreciate the help that is proffered once we get past our anger and suspicions.

Inside Look at the VA

To show us how the VA provides this help, Gordon follows veterans as they go to primary care appointments, take counsel with mental health practitioners, attend classes to deal with chronic pain, learn how to cook healthy meals, recover from traumatic brain or spinal cord injuries, convalesce from strokes, cope with vision loss at the VA’s numerous Blind Rehabilitation Centers, and numerous other programs that comprise the VA’s comprehensive healthcare system.

The VA also has many programs to help alleviate and eliminate homelessness among veterans, and supports justice programs for veterans with legal problems.  As a long-time board member of the San Francisco based Swords to Plowshares Veterans Rights Organization, I am particularly glad that Gordon took the time to investigate how the VA engages in public-private partnerships with groups like Swords.  Unlike predatory public-private partnerships—where private companies profit by raiding the public till—these partnerships with local non-profits (run for, and often by, veterans) actually pursue a common good.   Gordon documents their successful efforts to reduce veteran homelessness and keep veterans out of jail.

Two of the chapters I found most interesting were those on veteran suicide and end of life care.

We have all read the headlines about the VA’s failure to stem the epidemic of veteran suicide. The media and Congress routinely blame the VA for problems that should be placed squarely on the shoulders of the Pentagon, Congress, various Administrations, war profiteers, and that segment of the public that supports America’s wars.

The VA is making a heroic effort to stem the flow of death – currently far higher than the butcher’s bill for our six on-going wars.  The VHA has many thousands of social workers, therapists, psychologists, psychiatrists, and other staff specially trained to find and help disturbed veterans who are in danger of hurting themselves or others.  Of the estimated average of 20 veterans who successfully kill themselves every day (more than 7,300 per year) only 6 of them have had contact with the VHA in the last two years.  The VA has many programs to periodically reach out to veteran clients as well to veterans who have never come to the VA.  But if a veteran is isolated or does not respond to overtures, the VA cannot help.

In her chapter on suicide prevention, Gordon takes us to Canandaigua, in upstate New York, where she visits the national Veterans Crisis Line (VCL).  VCL staff, we learn, responds to calls not only from veterans, but active duty service members and any person contemplating suicide who, by mistake, hits 1—the number reserved for veterans—when they dial a suicide crisis line. I was humbled by the psychological burden on the hotline staff who talk down suicidal veterans who are locked and loaded and who are threatening to do in themselves and sometimes family members.

In another very moving chapter, Gordon visits VA hospital wards and nursing homes where we meet veterans who are confronting their last days of life.  Gordon describes the kind of palliative and hospice care the VHA provides.  This makes the VHA a model for a broader healthcare system that often tries to prolong life no matter what the harm to the patient.

Throughout this book we see how the most comprehensive healthcare system in the US works—not always perfectly, certainly—but damned well.  It’s honestly a surprise how well it works given the hostility it faces from politicians and corporate interests who want it reduced to a TRICARE-style insurance payer.

What’s At Stake for Veterans

Gordon shows what veterans would lose if the VHA were to be privatized by contrasting its outcomes with those in private hospital chains, which prioritize profits and minimize transparency and accountability.  By stark contrast, the VA is accountable by law to Congress and the public, which is why we are always reading about its problems.

Gordon argues that we veterans must fight to reverse the VA MISSION Act of 2018, concocted by the Koch brothers funded Concerned Veterans for America, served up by a supine Congress and gleefully signed by
President Trump. The major veterans’ service organizations (my own beloved American Legion, as well as more than 30 others) have been conned (or worse) by its very few good points and supported its passage.  It is largely a bad law that will inevitably degrade the comprehensive care that the VHA provides 9 million veterans while it siphons off money to a private non-system that will charge much more while delivering far less.  Ensuring that the VA is able to fight off slow strangulation leading to privatization is our major task over the next year as the regulations for the VA MISSION Act are devised and implemented.

It is clear that veterans and non-veterans alike should heed the call in Gordon’s book and join to fight against privatization of the nation’s only truly integrated healthcare system.

Paul Cox is a civil engineer and chair of the American Legion War Memorial Commission in San Francisco, a board member of Swords to Plowshares Veterans Rights Organization, and a founder of the SF Chapter 69 of Veterans for Peace.  He also helped found the Veterans Healthcare Policy Institute.  He can be reached at: