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Wounds of War

By Denny Riley (reviewer)

Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation's Veterans
by Suzanne Gordon
(Cornell University Press, 2018)

Suzanne Gordon's latest book Wounds of War is about the Veterans Healthcare Administration, the healthcare plan under attack by conservative politicians and commentators, the fabulously rich Koch Industries, and Veterans For America, a sham veterans organization financed by Koch. They all malign the VHA (often simply called the VA) on the flimsiest of anecdotal facts. Many of us have been convinced by this attack that the Veterans Health Administration is in worse shape than are the men and women who turn to it for care. Many people, even veterans who qualify for VHA care, put their health in the hands of hope. They hope the HMO or private healthcare plan they're signed up with offers them healthcare professionals who are good. Whether they are good – whether they've had malpractice suits settled against them or had their licenses suspended at some time, can be difficult to discover. For-profit healthcare companies and the medical associations keep their disciplinary procedures as far from the public eye as possible. The assumption is HMOs and private healthcare employ good people. They say so in their advertisements. Certainly better than the Veterans Healthcare Administration, one would think.

Gordon swings our attention to a different view of healthcare in America. The RAND Corporation and the MITRE Corporation "confirmed, in great detail, that the quality of the VHA's frontline care was equal to or superior to that delivered in private sector… wait times for appointments with primary care providers or medical specialists at the VHA were actually shorter than those experienced by patients using private doctors or hospitals."

Those might be sufficient words to convince a person if discussing the matter over dinner or a glass of wine, but the force amassed in the mission to turn the VHA's budget ($200 billion annually) over to the private sector has tremendous clout. So Gordon did the work, and with Wounds of War the facts are known. They are here in black and white.

Full disclosure compels me to say I am a military veteran who receives healthcare at a Veterans Health Administration facility Suzanne Gordon writes about in Wounds of War, and I am satisfied with the care I get, generally pleased. Compared to my friends who are enrolled in private healthcare, I may be the only one pleased with this care.

Gordon hasn't written Wounds of War, however, as a champion of the VHA. She is an award-winning journalist whose eighteen published books are about healthcare, patient safety, nursing, and teamwork, and she goes at this thorough book about the VHA with the mastery she has applied to all of her chosen subjects.

Subtitled How the VA Delivers, Health, Healing, and Hope to the Nation's Veterans, the book covers all of those issues and more. Written in seventeen topical chapters with an introduction, a conclusion, and an epilogue, Wounds of War tells it all. The evolution of many VHA programs is explained, usually in the words of the physicians and clinicians who developed them, with brief biographies of veterans who participated.

Gordon approached the VHA not through interviews either in person or in emails or on the phone. No, she visited a VHA facility and spent days with caregivers, in their offices, in staff meetings, and with patients. She visited the psychiatrist Lanier Summerall at a VHA Medical Center in South Carolina and also at a VHA Medical Center in Vermont. Doctor Summerall has been with the VHA several decades. From a mental health point of view Doctor Summerall describes the integrated healthcare unique in the United States to the VHA.

70% of the United States' medical residents and 40% of all other healthcare professionals receive some or all of their training at a VHA facility.

"We have a breadth of psychological services under one roof that is unequaled even in the most well-resourced private-sector environment," Gordon quotes Summerall. "If a person is homeless, they can get help with a variety of agencies to get housing. If they are having trouble getting a job, we have supportive employment and compensated work therapy. We have residential programs for PTSD and substance abuse and for chronic, hard-to-treat psychiatric illnesses like bipolar or schizophrenia."

Summerville goes on, "Our patients have lifestyle problems, relationship problems, work problems." She says many of the patients cannot possibly coordinate their own care or take responsibility for self-care. "The paramount thing for these people is that everybody here [the VHA facility] knows each other. We are all on the same team in the same place." Continuing, Dr. Summerville says, "We have the only system of integrated mental health and primary care in the country."

As Gordon reveals, the VHA functions very differently from the way it is depicted in most mainstream media coverage. The Veterans Healthcare System has 150 hospitals, 819 clinics, and 300 mental health centers, which employs 250,000 people (a third of whom are veterans themselves) and sees 230,000 patients a day. Among the many VHA innovations and inventions are the implantable cardiac pacemaker, CAT scans, the nicotine patch, the first successful liver transplant, the use of low dose aspirin regimen to prevent heart attacks, and prosthetic technology to help restore the sense of touch for those who have lost an upper limb or use an artificial hand. All of this was done on the Veteran Healthcare Administration research budget where there is no profit incentive, no patents to file, and all discoveries are made available to all Americans.

Then why are problems the VHA may have not simply fixed? Why is there a movement toward privatization rather than getting it operating at the level our veterans deserve? After all aren't these the people we've been told to thank for their service, people often referred to as heroes? Well, first of all there is that $200 billion budget Koch Industries and its allies would like shifted to the private sector. And to a lesser degree the VHA is in a different light than private healthcare. It is a public institution with the mission to fulfill President Lincoln's promise "To care for him who shall have borne the battle, and for his widow, and his orphan" by serving and honoring the men and women who are America's Veterans. As a public institution supported by taxpayers, its books are open. We can look behind the curtain and see how it is run. So those with their eye on the big budget can poke and point with ease.

Private sector healthcare has no equivalent damning light. For instance the Cleveland Clinic, a highly regarded general medical and surgery system with eleven hospitals and eighteen health centers, was fined $650,000 for serious lab violations in 2015, paid $1.6 million to the Justice Department to settle "accusations that it implanted cardiac devices in patients too soon after a heart attack or surgery," in 2016, while the CEO received huge salary increases. The Cleveland Clinic averaged more than $730,000 spent on lobbying between 2014 and 2018. No one clamored for the CEO's dismissal or the closing of any of the Cleveland Clinic facilities.

Of course, money is the issue, it always is. But 70% of the United States' medical residents and 40% of all other healthcare professionals receive some or all of their training at a VHA facility. The VHA is the spine of American healthcare. Gordon clearly and extensively makes that point. And the VHA is looking at a stream of disabled veterans for at least the next fifty years (an estimate based on disarmament happening some time soon.) Who among us will be the one to tell the returning soldier we do not care? Anyone who wants the VHA dismantled does not know the facts. Suzanne Gordon delivers the facts in Wounds of War.

The article first appeared in Peace In Our Times, Spring 2019.

Denny Riley is an Air Force veteran of the Vietnam War and a writer.