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Slow & Deadly Slide: VA Down The Tubes

By Bill Davis

—Bill Davis
VVAW National Office

"In mid-1985 the Paralyzed Veterans of America (PVA), a national vets service organization, contracted with the American Health Planning Association to undertake a study of the impact of selected policy changes on veterans' healthcare. Although there had been almost continuous expansion in both vets benefits and eligibility for VA services for nearly half a century, the last decade has seen VA medical care budget remain essentially level in real dollar terms. In the mid-eighties, vets are facing the prospects of cut backs in funding allocations for VA medical care system and changes in eligibility standards for VA care."

-From the Preface of Veterans' Healthcare: Actions & Interaction Final Report

For those veterans who have been under the care of the VA hospital system and those people who have acted as watchdogs to monitor VA practices through the years, the results of the PVA study will not be shocking; the results will only add to the feeling of impending doom. The VA healthcare system is on the verge of major policy and treatment changes that could spell the end of healthcare for millions of veterans—of all eras.

The slow and deadly slide of VA healthcare beginning in the 1960's continues on the road to oblivion in the 1980's. In the late '60's and early '70's, returning Vietnam veterans saw an acute shortage of the programs we needed most; we realized that things were not improving within the VA system as one President after another from the Nixon Administration on placed rubber stamp caretakers in position to survey the steady decline.

Vets needed help but came to understand that inevitably we would have to help ourselves. VVAW initiated, with the help of professionals, a nationwide rap-group network, a national discharge-upgrading project, a national veterans in prison project, GI and veterans counseling centers. Vets, at the same time, recognized the responsibility of the VA to pick up the check.

The bitter fighting for recognition of post traumatic stress as a veterans disability, improved benefits in other fields, and the lingering hell of Agent Orange herbicide poising was the order of the day.

In hospital demonstrations, violent confrontations, tear gas, mace and beatings were all too common in the early and mid '70's. Sympathetic VA workers were slowly weeded out or pushed into obscurity. But, the work by many paid off. Programs were created and means of communication came into existence. Now began the battles to consolidate our gains and simply to find the way through the VA maze to use what we had won. Along the way our understanding of older vets and their specific healthcare problems grew. Now, the futures of the VA, the implications of the PVA Study and the designs of the Reagan Administration place us side by side—the veterans population: under attack.

The study, released in January of 1987 was a meticulous, in-depth look at four VA medical districts—2 north and 2 south—ranging from District 2 (Upstate NY), District 17 (Illinois and portions of Indiana), District 12 (Florida) and District 24 (West Texas, New Mexico, and Arizona). These areas; chosen for their high density of veteran populations, are also areas of high Vietnam-era veterans populations.

All four districts reflected the same problems in the categories reviewed. The study focuses at one point on a major category frequently passed over or ignored—the needs of individual vets. The finding in the final report states, "Many studies directed at the future of vets healthcare have been conducted by many different groups. Such studies have almost universally dealt with costs and focused on the aggregate of all vets, when the real issues are need and the individual vet."

The National Academy of Science (1977) recommended that veterans requiring healthcare be phased into the existing community hospitals over time. This theory which came to be known as "mainstreaming" was supported at various times by vets' spokesmen looking for a way to insure quality healthcare for vets. But that bubble has burst. In only a term and a half the Reagan Administration has successfully dragged down the national level of healthcare so drastically through budget cuts in health, education, welfare, that the VA cannot look elsewhere—not even at the university medical centers which have often been connected with VA hospitals; these too have been slashed to the bone.

In 1984 the Congressional Budget Office studied planning for future medical care needs for veterans. They concluded that, to cope with increasing demands for VA services, the solution was to decrease length of stay in VA facilities. Three years later, after the VA tried this approach, the real world intruded; there has been an increase in the numbers needing to be treated. And this should be no surprise considering cuts in medicare and medicaid by the Reagan Administration.

Undisturbed by such trifles, Ronnie and his boys quickly moved to restrict VA usage further. Through Public Law 99-272, passed in 1986, the VA now has three categories (A, B, and C) on which to determine which veterans are to be served based on conflict, age, type of disability and, most importantly, income. Nearly 14 million vets in categories B & C (who are earning $20-$25 thousand, with or without dependents) are far too wealthy to need help by the VA standards. The 30 million vets in category A fall into 7 other groups which may someday determine if they live or die. The future is bleak for vets of any new conflicts. No one thought to include them at all: will they have top retrace the steps of Vietnam vets or even the Bonus Marchers of the 1930's to regain their benefits?

With cutbacks the order of the day, all districts in the study show similar distress. Plans to close some VA Medical Centers, large or small, leave a vacuum of service and the total loss of specialized treatment—a mental facility closing with no room for those particular patients at other local or regional medical facilities.

The VA Answer of "downsizing"— limiting available space and time of stay— is a failure in the face of increasing numbers being treated. Real numbers show that the same amount of resources are required for smaller numbers of sicker people. This is the proverbial "road to hell" without any good intentions.

All the studies to date failed to grasp one of the key elements of the PVA study—aging. The veteran population is aging more rapidly than the general population, primarily because there are clusters of veterans of the same age. In the districts studied younger vets are migrating from occupational necessity, thus pushing up the average age. The basic formula is simple: increased age equals increased demand for VA services. It's not easy to grasp the fact that Vietnam vets entering their 40's are, as a group, the "young vets." At this pace the VA will be a museum piece to be dusted off and viewed with nostalgia at the time when we need it most.

Chicago, within District 17, was the most dramatic of the four areas studied. The crisis is not in the future there: it has arrived. In Chicago there is a higher usage of the VA services by indigent, non-service connected vets than in any of the other districts studied. With healthcare for the public at large in crisis in Chicago and surrounding Cook County, reductions proposed by the Office of Management and Budget to force vets into "mainstreaming" are unrealistic—community healthcare facilities, to which vets would be shifted, are too sick themselves. The Reagan Administration's so-called "safety net" does not exist. It never did except in the minds of those in the White House.

Who gets the short end? As usual, the poor and minorities. In Chicago 36% of the VA medical center discharges were Black vets, a rate 2.7 times that for the VA system as a whole.

Bed space in nursing homes in the Chicago area, long a source of controversy, is seen in a new light. Bad as it has been in the past with filthy, rat-infested homes, corrupt officials and inspectors, with VA denials of wrong-doing as their "certified homes" make headlines fit for supermarket tabloids, things are getting worse. Vets of all eras, removed form their peer groups, the process of "dumping" vets at private sector nursing homes where unscrupulous managers rip off VA checks (along with social security, pension and whatever other checks might be coming in)— all of these things add up to a remarkable deal for vets! Now, even these wonderful havens of comfort, resting spots for those who served their country, are no longer available.

As vets have watched the slow decline of benefits for decades, it is difficult to accept that things can get worse, but a lot of veterans have found their health getting worse and the future is damn grim.

Veterans owe the Paralyzed Veterans of America and their research group a deep debt of gratitude for this body of work. Whether this report becomes a death knell for veterans' healthcare or a rallying point that is long overdue remains to be seen. The answer, though rhetorical, is simple. Veterans of all eras must unite to fight for decent benefits for ALL veterans; what is being done to vets of World War II today will be done to Vietnam vets tomorrow— if there's still a VA to do anything!

(More information on the PVA study is available from the: Paralyzed Veterans of America, 801 Eighteenth St NW, Washington, DV 20006)