The VA as Workers’ Comp: Why Socialized Medicine for Veterans is Worth Defending
Think of America’s forever wars as a funnel between the largest and second largest federal government departments.
Entering at the top of the funnel, via the Department of Defense (DOD), are poor and working-class men and women who enlist in the military, often to escape difficult economic circumstances.
After being sent abroad, hundreds of thousands end up in a world of hurt and further financial distress. Their later need for disability benefits or health care—“workers’ compensation” as it’s called in the civilian world—is met, at the other end of the funnel, by the Department of Veterans Affairs (VA).
Despite the many costly and disastrous foreign interventions planned by the DOD, it has a far bigger fan club on Capitol Hill than the VA. The latter runs a Veterans Health Administration (VHA), serving nine million patients, which is the continual target of bipartisan political attacks, privatization schemes, and underfunding.
When the DOD (or the White House acting on its behalf) asks for a bigger budget, the House and Senate—with few dissenters—vies for which body can allocate more money faster.
On June 12, the House passed a military spending bill that would give the Pentagon another $733 billion. According to the New York Times, moderate Democrats were “reluctant to cut that number” because it was less than the $750 annual budget previously approved by the Republican-controlled Senate.
In the House Democratic caucus, among those carrying the ball for the DOD was Mikie Sherrill, an ex-Navy pilot elected last year. She criticized her liberal colleagues for not believing “in a muscular foreign policy and muscular national defense like I do.” Meanwhile, even the former military officers, like Sherrill, who sit in Congress and lead the charge for the Pentagon, tend to be far less “muscular” in their defense of veterans’ healthcare.
In 2018, Democrats on the Hill helped conservative Republicans and the Trump Administration pass the VA MISSION Act. As currently being implemented, this legislation will siphon billions of dollars away from the VHA’s budget and direct that money toward private doctors and for-profit hospitals often ill-prepared to treat veterans.
As the VHA is starved of needed funding, its staffing levels will further decline and then its nationwide network of public hospitals and clinics will be dismantled. (According to union estimates, there are already 49,000 existing vacancies.)
Rather than expanding veterans’ access to high quality care, Republicans—backed by the Koch Brothers-funded Concerned Veterans for America—and their Democratic Party enablers are laying the groundwork for complete privatization of veterans’ healthcare.
Under the guise of saving taxpayers money and giving veterans more “choice,” these bipartisan opponents of Medicare for All want our best working model of single-payer healthcare to become a poster child for its “failure.”
On the left, M4A advocates like Bernie Sanders and Alexandria Ocasio-Cortez well understand this threat to health care reform for everyone. Sanders has long championed veterans’ health care improvements in Vermont and nationally when he was chair of the Senate Veterans Affairs Committee. Ocasio-Cortez recently joined forces with Veterans for Peace and VHA nurses, who work in her Bronx-Queens district, to hold a town hall meeting against privatization.
VA Care As Workers’ Comp
Rick Weidman, Executive Director for Government and Policy Affairs at the Vietnam Veterans of America, is a leading defender of the VHA who notes, with wry understatement, that “the military is a collection of very dangerous occupations.”
The best-known hazards of military service are encountered in combat, of course. Enlisted men and women assigned to front-line duty in Iraq, Afghanistan, or elsewhere have returned with gun-shot wounds, lost limbs, traumatic brain injuries, PTSD or MST, and respiratory problems from burn-pit exposure.
During non-combat duty, even more military personnel suffer job-related injuries or illnesses similar to those experienced by millions of blue-collar workers in civilian life.
Most American workers who get hurt on the job or develop an occupational disease soon become familiar with the shortcomings of our fifty-state system of workers’ compensation. Benefit levels are too low. Private employers fight their claims. Rehabilitation services are fragmented and managed by private insurers. Workers who get approved treatment for specific work-related conditions may not be able to return to work. At some point, this deprives them of job-based medical coverage for themselves and their families. So even successful workers’ comp claimants can end up in personal bankruptcy due to unpaid bills for other care.
In contrast, veterans who qualify for VHA medical benefits, due to their low income or service related condition, land on an island of socialized medicine within our larger system of private insurance and for-profit health care providers.
After getting a disability rating based on a particular service-related illness or injury, a veteran enters the VHA system and becomes eligible for unrelated treatment, then or later–from hip replacements to cancer surgery and hospice care.
Like residents of the UK covered by the National Health Service, VHA patients get the benefit of an integrated national network of public hospitals and clinics. All VHA doctors, nurses, and therapists are salaried, not paid on a “fee for service” basis. About a third of the VHA’s 300,000 staff members are veterans themselves. This helps create a unique culture of empathy and solidarity between patients and providers that has no counterpart in American medicine.
Healing Shattered Minds
Due to the fact that the DOD is not the most safety-minded employer in the world, many VHA patients have medical conditions attributable to the military’s own failure to provide them with adequate protective equipment or even hazard exposure warnings.
In their new book Shattered Minds: How the Pentagon Fails Our Troops with Faulty Helmets investigative reporters Robert H. Bauman and Dina Rasor describe how most troops deployed to Iraq and Afghanistan were never issued relatively inexpensive helmet pads that would have better shielded them from the impact of Improvised Explosive Devices (IEDs) and the risk of traumatic brain injuries (TBIs)
As Bauman and Rasor report, service members had to order state-of-the-art pads at their own expense or get help modifying their helmets from a non-profit group called Operation Helmet. The authors estimate that supplying troops with properly engineered helmet pads could have prevented between 300,000 and 400,000 TBIs.
A more common, less serious, service related complaint of VHA patients is hearing loss and tinnitus. That’s because almost every branch of the military exposes enlisted men and women to high levels of noise. In the Air Force and Navy, there’s the constant roar of jet engines. In the Navy, there’s the metallic clanking that rebounds through the echo chamber of a submarine or other naval vessels. You don’t have to deploy to the Middle East to be deafened by explosions. Just going through basic training with the U.S. military’s own ordinance can be enough to insure diminished hearing capacity later in life.
Similarly, infantry training leads to musculoskeletal problems because it involves hauling around sixty- to one hundred-pound packs that place an excessive burden on necks, shoulders, knees, backs and ankles.
Veterans also bring signature issues from particular eras. In Vietnam, draftees and enlisted men were exposed to Agent Orange. Other Cold-war era soldiers and sailors found themselves involved in chemical warfare experiments, nuclear weapons testing, and base cleanups with little personal protection. Troops sent to liberate Kuwait came back with symptoms of “Gulf War Syndrome.” Veterans of multiple tours of duty in Iraq and Afghanistan were often exposed to lung damaging and cancer causing toxic burn-pits. Insurgent use of IEDs in those two countries has led the VHA to become a leading center of research on and treatment of traumatic brain injuriessuffered by thousands of troops and professional football players, who now arrange to have their brains sent to the VHA for post-mortem verification of their condition.
Veterans’ Suicide Risk
Combat veterans often suffer from mental health issues, like PTSD. Even men now in their eighties or nineties, who witnessed nightmarish scenes of death and destruction many decades ago in Korea or World War II, seek VHA help for disturbed sleep today. Veterans who suffer from mental and behavioral health problems—whether acquired in or exacerbated by military service— are more prone to substance abuse, particularly opioid use if chronic pain is involved.
They also become a bigger suicide risk. An estimated 20 veterans a day kill themselves, although three-quarters of those have never been to the VHA for treatment. Between 2006 and 2015, the number of veterans receiving specialized mental health care at the VHA rose from 900,000 annually to 1.6 million, a reflection of the ongoing collateral damage from never-ending foreign wars.
VHA caregivers are trained to identify and treat these very specific wounds of war. Every VHA employee receives training in how to better recognize and assist patients who are suicidal. Thousands of VHA mental health providers are taught the latest evidence-based treatments for PTSD. (Outside the VHA, only 30% of private sector providers use such treatments). And primary care providers and specialists alike recognize the kind of diseases produced by toxic exposures, such as Agent Orange related diabetes or burn-pit created respiratory problems.
The VHA ranks with Kaiser Permanente as one of the most heavily unionized health care systems in the country. The American Federation of Government Employees (AFGE), National Nurses United (NNU), the Service Employees International Union and the Machinist-affiliated National Federation of Federal Employees (NFFE) have more than 120,000 members serving veterans. Thanks to this union presence—currently under attack by the White House—veterans’ hospital management pays more attention to the kinds of occupational hazards that are rampant in health care work , particularly in non-union facilities.
For example, the VHA was the first – and may be one of the only U.S. healthcare systems – to install the kind of lift equipment that helps nursing staff avoid debilitating and often career ending back, neck and shoulder injuries.
Due to the troubled and occasionally violent behavior of some patients, the VHA also goes to great lengths to insure a safe workplace for its mental health care providers. (Unfortunately, as documented in a recent Intercept report, the overly aggressive behavior of some Veterans Affairs police officers is not contributing to a safer work environment.)
Less Than Honorable?
VHA eligibility rules are also in need of reform. Congress has allowed the Pentagon to give hundreds of thousands of veterans other than honorable discharges, making them ineligible for VHA care. In some cases, soldiers have been discharged for active duty misconduct related to PTSD or brain injuries – yet they, more than anybody, need later treatment.
Congress has also left the Veterans Benefit Administration (VBA) consistently understaffed and overburdened. VBA is the separate agency that determines whether former military personnel have actually suffered from an occupational illness or injury—and to what degree of disability. After veterans leave the service, they encounter far too many eligibility determination disputes and delays before they can become VHA patients.
But most constructive VA critics know that further outsourcing of veterans’ care is not the answer. That’s why VHA care givers, and their unions and allied veterans organizations, are opposed to privatization and President Trump’s related undermining of federal employee rights.
This is not just a fight to maintain decent medical coverage for eligible veterans or to protect the union contracts of those who serve them. It’s a struggle to defend a national healthcare system far superior to the state-based workers’ comp programs covering millions of workers in the private sector, and which, someday, might be a model for better care for them too.
Suzanne Gordon is an award-winning journalist and author of many books about healthcare, including Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans. A longtime advocate of Medicare for All, Steve Early has aided workplace struggles over health and safety since the mid-1970s–first as a United Mine Workers staff member and then as an organizer and contract negotiator for the Communications Workers of America. They are collaborating on a book about veterans and can be reached at [email protected].