Why
the VA Problem Is Not Just the Same Old Government Ineptitude

By

Leonard
Zwelling

     I did some of my internal medicine training
at the Durham, NC VA. I was there when the brand new out-patient clinic opened.
It was a beautiful facility, but the patients were still very difficult. While
there was a smattering of Vietnam vets coming in, the vast majority of my
patients were not combat veterans, but rather men who had served in the
military between Korea and Vietnam. Many had fallen on hard times and had no
other source of medical care. We saw many alcoholics and homeless men. No
matter how much the government invested in prettying up the facilities, the
lives we encountered were often difficult and ugly. That’s internal medicine at an academic medical
center like Duke whether it was the public wards at Duke Hospital or at the VA.
That’s reality. That’s life.

     That was 1973. Forty years later things are
very different.

     Now the Vietnam vets are aging with all of
the attendant difficulties getting old presents to us all. They need help and
deserve it. There is also a new generation of vets from the Gulf War,
Afghanistan and Iraq. They are presenting some unique medical challenges
including PTSD, traumatic brain injury and limb loss that used to be
accompanied by death but is now handled so well on the battlefield that these
severely maimed people make it back home. They make it home to a health care
system that is ill-equipped to serve them. It’s the opposite of what happened
in New York City on 9/11.  

That day the
rescue crews rushed out in accordance with the disaster training they had received
with the idea of caring for survivors that never materialized. On the modern
battlefield, preparations for greater numbers of body bags a la Vietnam were
instead supplanted by remarkable medical miracles that returned living, but
very damaged soldiers home thanks to very advanced medical knowledge and rapid
learning on the battlefield disseminated over the internet. The web saved
people who would have died in previous conflicts.

The VA was just as unready for survivors as the New York
City Fire Department was for incinerated bodies.

     So, now what?

     While General Shinseki appropriately
resigned in the face of withering criticism about his six-year run as VA
Secretary, his leaving improves nothing. Just like the rest of our health care
system, the one serving our veterans is broken.

     There are too many patients needing care.
Now. There are too few doctors receiving too little compensation for working
too many hours. There is no system by which the Defense Department’s military
health records can talk to the medical records of the VA. Mostly, the demand
exceeds the supply with price controls in place. Of course the system is a
mess.

     Money cannot fix everything, but it can
help here. If the country sent these men and women to war, the country ought to
pay for their post-war care. Period. New leadership of the medical care
delivery aspect of the VA system is needed and if that is insufficient, the
government should extend Medicare or Medicaid benefits to war-injured qualified
foreign service veterans to obtain care in the private sector. The military
needs to invest heavily in training new physicians and physician-extenders to
care for the returning veterans. Now. Finally, all certified programs training
medical, PA, nursing and other care-givers should mandate 6 months of service
for all trainees in the VA system.

     What I have outlined is just a start, but
grousing about the ineptitude of the federal government is of no help here. This
is a government created problem associated with a foreign policy strategy
called war. The government MUST clean this up. Now.

     This is not a policy matter about which to
debate. This is a humanitarian crisis and one of responsibility. And if you can’t
get with that, how about this? Just think of the vets as vases at the nearest
Pottery Barn. We broke them. We owe them the best shot at repair.

     Now. 

Leonard Zwelling