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Veterans Day, A Solemn Reminder

By J. John Charyk

Today is Veteran's Day. I never served in the military, but I abhor injustice and so today is an appropriate time to bring to attention unscrupulous actions being taken by the current administration that will have a profound negative impact on our veterans.

Let me set the stage by turning back the clock to the Vietnam War era, a defining period in history for members of my generation. At that time a mandatory military draft existed for men 18-25. The order in which men would be called into the service was determined by lottery, ostensibly a fair system, right? WRONG! In practice, families with wealth and influence could manipulate the system of deferments and loopholes to orchestrate the release of their sons from the obligation to serve. (example-Donald Trump's 1968 deferment for bone spurs). John Fogarty of Creedence Clearwater Revival addressed the inequity of the draft system in his 1969 protest song "Fortunate Son". Lyrics of successive choruses are:

    It ain't me, it ain't me
    I ain't no senator's son,…
    I ain't no millionaire's son…
    I ain't no fortunate one...

The human cost of war is typically summarized in a simple tally of dead and injured on the battlefield. But of course, that's just the tip of the iceberg. A 2021 study found that 30,177 veterans of post-9/11 conflicts had died by suicide, which is four times as many as were killed in the conflicts themselves. In the two decades following the Vietnam War the suicide rate among veterans was as high as 22/day, most by firearm. More recently, it is "only" 13 suicides/day.

So, with that reminder of the unjust treatment and horrific difficulties many veterans have faced throughout their lives, let's look at the shameful way the Trump administration is furthering its own agenda by deconstructing veterans' health care policy.

The Veterans Health Administration (VHA) evolved from its origins after the Civil War to become the nation's largest integrated healthcare network, encompassing 144 VA medical centers and 1,232 outpatient sites serving 9 million veterans every year.

About 10 years ago, a program called the Veterans Community Care Program (VCCP) was established to allow veterans to obtain care from selected providers outside the VA system if certain criteria were met. Initially this was seen as constructive policy, and indeed for many vets, especially those in some rural areas, this program serves as a vital safety net. But as this outsourcing of vets from the VA system to a for-profit private system has been scaled up, VA resources and personnel have been cut, and significant problems have become evident. For one, the VCCP lacks critical features that were pioneered at the VA, including integrated care coordination and comprehensive screenings. Very few VCCP providers have been trained in the many special health needs of vets such as rehab from amputations, traumatic brain injury, PTSD, and toxic exposures (e.g. burn pits, agent orange). An example of this disparity is the finding that only 2 percent of VCCP mental health providers have completed even one of the eight veteran-specific trainings required for all VA mental health providers. A recent survey of Iraq and Afghanistan Veterans using the VCCP found that only 31 percent felt their community providers understood their medical needs.

The current secretary of the Department of Veterans Affairs, Doug Collins, has been aggressive in his intention to steer veterans and their health care dollars away from VA medical facilities and into private hands. In the first 6 months of the new administration, the VA recorded a net loss of thousands of health care positions. The losses include 688 physicians, 1,882 registered nurses, 365 licensed practical nurses, 316 nurse assistants, 511 social workers, and 201 psychologists. These moves destabilize the VA system and undermine its long-term sustainability.

We've seen this trend by the current administration of outsourcing the work of government agencies into the private sector in many domains that serve the public, all done in the name of government efficiency. Examples are FEMA, FAA, NOAA, and the Dept. of Education. And now the ideology of small government is being applied to dismantle our veteran's health care system. Decades of research have established that the VA produces health care outcomes equal or superior to the private sector across virtually all categories of medical conditions. Pushing veterans into the fee-for-service profit-driven medical model will have many negative consequences. For example, many health insurance companies that contract with the government set up pre-approval processes and case reviews, which can drag on and ultimately result in denial or delay of care, Currently, when care is delivered within the VA system, administrative approvals for most tests, referrals, and procedures ordered by a VA physician are not required. If health care for veterans is privatized, access will become more difficult, care will become fragmented, more expensive, and quality will decline.

Our veterans deserve more than a smile and a "Thank you for your service". In fact, a survey in 2023 found that nearly 70% of younger service members and veterans feel uncomfortable and awkward when people tell them, "Thank you for your service". Many expressed a wish that Americans go beyond small talk to connect with them on a more meaningful level. Perhaps asking a vet about their needs, experience, and preferences regarding government provided health care would be a way to start that conversation and then follow that up by passing on what you hear from them to your elected federal officials.

J. John Charyk received his MD degree from Georgetown University, did his postgraduate residency training at University of Colorado, and practiced full-time in Spokane, WA from 1983-2009. He subsequently spent 6 years as a clinical instructor, most recently for the University of Washington School of Medicine.