Controversy over NFL players purportedly kneeling in protest of police brutality during the National Anthem has spurred much debate on what exactly “respecting the flag” means. At issue is whether kneeling constitutes disrespect for the military or conversely, as some argue, demonstrates support for the democratic ideal of peaceful protest that is embodied by the flag itself. At least that appears to be the issue at first blush.
The Anthem Plays
However, the problem runs deeper than protest and what happens during the opening ceremony before a football game. For those of us who have attended football games with great sensitivity to the moment the National Anthem plays, stark is the fact that many attendees who have nothing to do with kneeling, instead talk, laugh, order beer, use their smartphones, and even stay seated while it plays. This suggests a far greater apathy that may offer an explanation for why fewer and fewer eligible, qualified young people join the military than in past times. These people escape the harsh glare of criticism reserved for the helmeted millionaires on the field yet arguably bear far greater consequences in terms of future national defense.
The kneeling argument, however, eclipses the latter concern because of its provocative, non sequitur underpinnings. When Francis Scott Key penned the National Anthem as the American flag flew over an embattled Fort McHenry in 1819, his references to hirelings, slaves, and freemen were contemporaneous to that time and, yes, serve as reminders of the tortured logic behind how freedom was defined back then. But it would be like associating the #MeToo movement with Key’s work and refusing to stand for the National Anthem until women stop being victimized by predatory sexual practices. Or kneeling until child abuse is virtually nonexistent. All noble pursuits having nothing to do with the lyrics in a song written almost 200 years ago or professional football players who claim the vicarious suffering of social oppression.
A Bigger Problem
While I wholly disagree with the notion of kneeling in protest during the National Anthem, there should be no mistaking the problem is bigger than kneeling or ignoring tradition while preparing to watch a game. The symptoms of the problem manifest in the form of prolonged family separations, multiple deployments, and transition stresses that the 1% who serve today have endured as the military falls short of recruiting goals, thus constantly flirting with the idea of lowering recruiting standards to make up for the loss — all while society bickers over what happens 10 minutes before kickoff.
The reality is respect for the flag and National Anthem transcends race, social standing, and gender today. The faces of the 1% are becoming increasingly diverse, as reflected in VA and military hospital rehabilitation wards, polytrauma units, and cemeteries. They didn’t fight, suffer loss, and die so that American citizens could be forcibly compelled to stand or hold off on their hotdog orders until the National Anthem finishes. They fought and died in order to keep patriotism alive. Real, selfless, consistent, genuine, sometimes painful patriotism, which is what Francis Scott Key imperfectly yet poignantly embodied in words that day.
Another lesser-known person also embodied patriotism at great personal sacrifice. William Harvey Carney was awarded the Medal of Honor for a heroic flag rescue. Carney, formerly enslaved before he escaped to the North and enlisted in the 54th Massachusetts Colored Infantry Regiment, became the first African American soldier to be given the nation’s highest honor. He earned it by taking the regiment’s flag from its fatally wounded bearer and continued advancing during his regiment’s assault on Fort Wagner in 1863.
Despite suffering wounds during the advance, he eventually returned to Union lines, proclaiming that his duty was to keep the flag from touching the ground during the battle. He was certainly not a highly paid athlete, and few reasonable people would blame him for denouncing the flag and what it stood for where his family, social standing, and opportunities were concerned in those times. Yet, he chose to stand for what it truly symbolized: his inner patriotism. That is how real patriotism is defined and the reason that standing up and for the flag matters.
The “John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018,” or VA Mission Act of 2018, was signed into law by President Donald Trump on June 6. This is a critical inflection point in veterans’ healthcare. The new law, once implemented by the Department of Veterans Affairs (VA), will give military veterans in need of healthcare greater autonomy in the pursuit it. Among other features, it will also provide support and benefits to the caregivers of severely disabled veterans who served before 9/11, thus extending to them the same long overdue benefits that their Post-9/11 counterparts receive.
The passage of the new law was roundly celebrated by those who attended the event, an eclectic mix of legislators, veteran advocates, VA leaders, and political insiders who were also celebrating a sort of truce. A temporary end to political infighting and hostilities that, ironically, fell on the 74th anniversary of D-Day, the day the U.S. invaded Normandy. Through all the smiles and handshakes in the Rose Garden as the ink dried on the new law, those who knew better were aware that the real battle lay ahead in the implementation, where well laid plans face their true test.
The flash point has been, and will continue to be, the meaning and extent of “choice.” Where the Veterans Access, Choice, and Accountability Act of 2014 gave eligible veterans several limited options in how they could access healthcare either in the VA or the private sector with VA authorization, the newly ratified VA Mission Act will further empower them by removing the pre-authorization requirement and allowing for access to “walk in” care. Some fear that allowing veterans this “unfettered” choice will open the door to a purposeful and preconceived divestment effort that runs along ideological fault lines and will erode VA’s capacity to provide care as veterans increasingly opt for non-VA care. Others counter argue that the VA is too big and inefficient to succeed, and those who have served should be able to choose a provider wherever and whenever they need healthcare, which is the underpinning of the new law.
However, the new law does more than stoke the “choice” question and open benefits to caregivers. This ambitious legislation will also set new standards in how providers are paid, provide continuing medical education for non-VA medical professionals, improve opioid prescribing practices, and sanction a VA asset and infrastructure review that will force legislators to contemplate the closure of costly, underused facilities in their districts. Perhaps the most compelling provision is the authority the VA Secretary will be given to launch pilot programs through a newly established VA Center for Innovation for Care and Payment. New ideas and innovations will need to be taken from the abstract and actualized in a government agency that past critics have considered a cemetery where great ideas are put to final rest. Only time will tell whether the change imperative provoked by an impatient public, a Congress in want of a significant legislative victory relative to veterans, and a president who is determined to make improving veterans’ healthcare one of his crowning achievements, has indeed set the groundwork for badly needed innovation to thrive.
Whether the VA Mission Act will be a panacea for all that ails the VA remains to be seen. Regulations that will put the law in effect still need to be written. Those who will lead the effort still need to fill current vacancies. The career bureaucrats and 370,000+ VA employees who will be charged with carrying out those new regulations in their day-to-day work need to believe a new day has, in fact, arrived. More importantly, the veterans who will place their lives in the hands of medical providers and healthcare networks under the VA Mission Act need to see real evidence that the nation they defended truly and meaningfully thanks them for their service.
In metaphorical terms, the post of VA Secretary is the piece of rope that lies between two powerful opposing forces — one pulling for sending significantly more care for veterans outside of the Department of Veterans Affairs (VA), the other for keeping the VA healthcare system relatively intact – with neither side intending to relent. It’s not just the fact that Dr. Ronny Jackson, President Trump’s nominee to replace Dr. David Shulkin, will become the sixth leader of the VA in four years. It’s also the fact that the job has proven to be a career quagmire for leaders who had otherwise enjoyed success in other sectors, from the battlefield to the boardroom.
Despite Dr. Jackson’s insistence that he doesn’t intend to privatize the VA, the “privatization paradox” will be a major test for the incoming secretary. Since the 2014 Phoenix scandal, the VA has devolved into a demoralized institution characterized by accountability witch hunts (perhaps deservedly), long vacancies in critical leadership positions, and a constant barrage of negative media that had routinely eclipsed any positive press at every turn.
Even when leaders such as Dr. Shulkin had managed to snatch achievement from failure’s death grip, it was as if any success the agency enjoyed only served to accelerate the efforts of those who counted on its failure to justify further fragmenting it among non-VA and private sector healthcare providers. The idea of expanding options for veterans who need healthcare is not the problem, on its face. It’s whether one believes “cowboy capitalism” can indeed deliver better healthcare, as Dr. David Gratzer and others have argued. Or the counter notion that it’s the government’s job to provide care for those “who have borne the battle,” not profit-seeking corporations.
This is the inheritance of a physician who’s leaving his relatively anonymous post as the White House physician since 2006, and he had better manage his expectations. So too must President Donald Trump. His pick for VA Secretary may have seen his last best day for quite some time, assuming he’s confirmed by Congress, as he prepares to follow in the footsteps of a battle-tested U.S. Army General, the savvy CEO of a multinational corporation, and an accomplished healthcare executive whose tenures as secretary had fallen short of expectation, largely for reasons out of their control.
In their wake still lies a healthcare system that’s suffering an identity crisis as career bureaucrats, veterans, veteran advocates, and ideologues vie for its fate. Even as Dr. Shulkin claimed tremendous progress on his watch, which President Trump has acknowledged, there’s no doubt that the VA needed to continue to improve. But there are different flavors of bad, and America will soon find out whether this is as bad as it gets for the VA — or whether the latest changes will lead the situation to something far less palatable.
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“Is the VA too big to succeed?” asked the father of a veteran named John, whose labyrinthine journey through the VA over the last 7 years began with a veritable bang. A remotely detonated explosive device, one that had turned his son, a decorated Army infantryman who would run toward the sound of danger to save the lives of his comrades, into something far different just a few years later. He’d become a troubled soul whose drug-seeking and erratic behavior amounted to a prison sentence for his entire family, and their love for him became his inescapable chains.
Among a love for guns, a fear of emergency rooms, a mistrust of authority, avoidance of guardianship, and delusions that could be triggered by anything—from fireworks to the sight of someone wearing a black burka in an airport—John carried within him a combustible mix of torments that would be foreseeable consequences in a tightly coordinated system of care. The system that the VA needs to be in order to fulfill its commitment to America’s veterans.
“This is what it’s like to live with a traumatic brain injury,” his father said. “A time bomb waiting to go off that has some in the VA seemingly ducking for cover instead of trying to defuse it.”
The statement is harsh because the reality is harsh. For those veterans who manage to survive shrapnel or a sniper’s bullet cutting through their brains, a new fight begins from the moment they wake up and realize they’ve survived. In many people’s view, these soldiers were lucky to see their families again. Lucky to have a chance at some semblance of recovery. Lucky to return to a grateful society that lionizes its wounded warriors. Lucky to have access to the only healthcare system with the military cultural competency to deliver the best care possible.
Unfortunately, it’s a system comprised of nearly 300,000 employees who provide healthcare to veterans at 1,243 facilities, including 170 VA Medical Centers and 1,063 outpatient sites of care of varying complexity, all under a combination of decentralized authority and obfuscated accountability. It’s a system that might indeed be too big to succeed, at least in the case of the “outliers” like John. The only way veterans like him stop being outliers is when their names get added to the fateful 22-a-day list.
For them, “lucky” is a relative term. When one considers that the families of soldiers with traumatic brain injuries are largely forced to face it alone, as well as the reality that the veterans will never actually recover, it becomes clear those families are confined for a lifetime by their loved ones’ conditions. Those veterans are lucky only until the consequences of their condition touch society through the legal system or at society’s margins, where behavioral problems are wrongly perceived as misconduct rather than a result of neurological dysfunction.
They’re lucky until VA providers begin to overprescribe opioids and/or fail to coordinate care among the multiple providers treating them. These veterans are lucky until those same doctors reach limits imposed by policy and budgets, and in the case of John’s father, stop returning calls because they have no more answers.
John’s father calls his son an outlier because he’d witnessed the more-easily treatable brain injury patients face far fewer barriers to access and receive better, more coordinated treatment at the VA. Those veterans were the statistical low-hanging fruit who were touted by the VA as proof that the mental healthcare system was working. But it is the outliers, those who beat the odds and now present the greatest treatment challenges, who will determine whether the VA is too big to succeed.
People Before Policy
Outlier or not, any veteran who served this country and suffered a traumatic brain injury at the hands of the enemy should not be misunderstood or deemed too difficult to treat as a whole person. For when their care is uncoordinated and fragmented, the enemy wins twice: first when the bomb went off and did its damage on the battlefield; then again when the affected veteran later hurts himself or others. John’s father, who has fought to get his son the comprehensive care he’d needed for seven years since his return from Afghanistan, is again at an impasse and now reduced to cynicism: “Maybe the VA will finally be there for my son when we have to bury him.”
Is the VA too big to succeed? The present and future enemies of the United States of America and her democracy presumably hope so. However, it is up to VA leadership, Congress, and the President to put that hope to rest by putting people before policy in how mental healthcare is delivered. It is also their job to ensure that outliers like John don’t pay an enduring, unnecessarily painful price as a “thank you” for their service.
(Editor’s note: During the 2016 Presidential Campaign, President Trump promised to make American Veterans a priority of his administration. A new law regarding VA has been put in place and this article serves to examine it.)
The day before the U.S. would lose two more American lives during combat operations in Iraq, President Donald Trump signed an emergency spending bill, the VA Choice and Quality Employment Act, that authorizes more than $2 billion for the Veterans Choice Program. At present, almost one-third of VA appointments are referred to the private sector, up from fewer than 20 % in 2014. The VA’s annual budget of about $180 billion will provide $2.1 billion in funding for veterans’ health care in the community at government expense.
While the new law will draw attention largely because of the urgency in which it replenished the VA’s healthcare budget — a budget that has been depleting faster than expected since 2014 — the new law also addresses other critical priorities aimed to improve the VA:
A bilateral exchange program for employees in VA and the private sector to cross-train providers in both health care domains
The development of training and annual performance standards for employees and preparing them for future leadership roles within the Department
The establishment of promotion tracks designed to retain employees with special expertise
Provisions to attract transitioning service members and recently graduated college students into employment opportunities with the VA
Training on recruitment and retention best practices for human resources professionals
These and several other initiatives will be funded for six months through offsets such as reduced pensions for some Medicaid-eligible veterans and the collection of fees for housing loans. The law also provides an additional $1.8 billion for core VA health programs, which includes leases for 28 new VA medical facilities.
Critics of the Veterans Choice Program, which had included this author in the past, insist that expanding care in the community is merely a slow walk to privatization. Others argue that offsetting the cost of expanded community care by reducing other veterans’ benefits is unconscionable and will lead the VA to a slippery slope where even more benefits will be cut. But these arguments ignore the more immediate problem created by understaffing in VA and the accountability vacuum, particularly among VA’s senior middle management tiers, that has eclipsed all the great work VA has been doing.
Critics also disregard VA Secretary David Shulkin’s focus on investing in “foundational services” that are part of VA’s national commitment to provide: spinal cord injury treatment and rehabilitation, blinded rehabilitation, inpatient mental health, prosthetics, and care coordination, some of which will be funded through budget apportionments at each facility at the direction of the Secretary.
As those debates continue, however, the bigger problem is what will happen when the Administration and Congress can no longer move the goal posts where funding VA health care is concerned. The six-month funding plan that was underwritten by the new law bought Congress more time to debate broader issues over VA funding and its future. But bad news doesn’t improve with age, and the challenges may actually worsen if an incremental approach to investing in veterans’ healthcare doesn’t pay off soon.
On a positive note, at least in my view, the status quo is dying a slow but certain death in VA. The newly signed law could be what keeps VA from dying with it. While it will do nothing for the two brave souls our country lost in Iraq on Sunday, it will give the health and wellness of the nine million veterans enrolled in the VA health care system a fighting chance.
There is an elderly veteran somewhere in the country with a crackling cough who needs an x-ray to rule out pneumonia. There is a female veteran who needs diagnostic testing to ensure her blurry vision and lower leg numbness is not an early manifestation of multiple sclerosis. More alarmingly, there is a combat veteran contemplating suicide who would be perhaps best served by VA mental health services but will be referred to care in the community because the waitlist is too long. None of these veterans care about ideology or to be the political pawns of pro- or anti-privatization proponents. They simply want to seek treatment for what ails them in a fair, predictable, and trustworthy system.
In recent testimony on the future of veteran healthcare before the Senate Veterans Affairs Committee, VA Secretary David Shulkin may have provided more questions than answers for these veterans.
Shulkin offered the first glimpse of his plan to redesign the current Veterans Choice Program, called the Veterans’ Coordinated Access Rewarding Experience, or CARE, Program. Under the new initiative, veterans would no longer access community providers based on a set of arbitrary, administrative rules, which mandated authorization for community care for veterans who live more than 40 miles away from a VA medical facility or if the wait time for care is 30 days or longer. It also includes a number of pilot proposals that will test new ways to generate revenue and manage the healthcare system. They also leave many believing those pilot proposals are precursors to privatizing a healthcare system that veterans will end up paying for out of pocket.
Will veterans be hurt or helped by the new plan? The answer doesn’t lend itself well to the oversimplified, headline-expedient explanations the public has become accustomed to. For one, many service-disabled, retired veterans enrolled in VA opt to pay through the Department of Defense’s payer-only insurance, Tricare, to access care in the community. Other veterans use Medicare. Still others use private insurance that also bears costs.
Additionally, many factors influence the decision on how Joe or Jane Veteran choose to access care. Distance. Wait time. State of health. Urgency of need for care. Complexity of care needed. Prior experience with VA. Then consider that any number of these factors could influence the choice of 9 million veterans who are eligible for VA care, and one can see how truly complicated the problem is when taken out of the abstract.
Previous arguments for privatization have not exactly helped the situation or the dialogue in media and on Capitol Hill. It did not take a genius to figure out that some of the proposals outlined in the VA Secretary’s plan mirrored the VA Commission on Care’s 2016 “strawman” document, which was widely criticized as a feeler to test reaction to proposals to privatize VA. Trying to sell veterans, Congress, and the public on the idea that a longstanding government agency should abrogate its sacred obligation to care for veterans to the private sector in the name of small government — and the cowboy capitalism that has increasingly characterized the healthcare industry — was not exactly a sound strategy, at least not in the short term.
But the opposite extreme is just as unpalatable, if the country and Congress are serious about giving veterans timely access to the best healthcare possible that our country can afford. The private and community sectors, notwithstanding their limitations and lack of sensitivity to veteran-specific issues, already incur the burden of providing care to many who have worn the uniform. Even with the new measures that will implemented by the passage of the accountability and whistleblower protection law if passed, it will take some time to purge VA of unethical and underperforming employees and transform the culture. It will also take time to adjust staff levels and establish metrics that will allow veterans to measure the quality of VA care against community care.
Should veterans have to pay out of pocket when they seek care for a service-related condition? Probably not. But those military retirees who use Tricare opt to do so. Should VA recoup payment from insurers, like Tricare, Medicare, and Medicaid for treating veterans who are covered by those entities? Current law does not allow it. But failing to do so obscures the true cost of providing care for veterans, which arguably explains why VA budgets have fallen woefully short for decades. And finally, can VA afford to maintain parallel VA and non-VA healthcare frameworks in the long run? The answer is likely no. And it is on this question that the future of VA, as we now know it, presently hinges.
Outsourced federal and state functions such as prisons, law enforcement, firefighting, trash collection, waste water treatment, railroads, airports, energy companies, postal services — even warfighting through the use of private contractors — presents a litany of lessons and cautionary tales on both sides of the debate. But advancing slippery slope arguments in support of the status quo or mere incremental improvements to the system will not make life better for veterans who have suffered enough and await major changes in VA.
Somewhere in between lies uncharted territory, where expanded care into the community and the private sector makes sense and, if resources are redistributed more efficiently, increased investment in the foundational VA services that non-VA providers cannot deliver makes sense as well. But allowing a fear of privatization to quash innovation, suppress the exploration of untested practices, and impede breaking with convention will be a disservice to those who defended our country and now await meaningful change to a system that just about all involved say is badly needed.
Albert Einstein said of risk and the status quo, “A ship is always safe at the shore—but that is not what it is built for.” In the case of VA healthcare, whatever the best option ultimately happens to be, it is the one that positions our government to best fulfill its obligation to our nation’s veterans without scandal, disappointment, or political ideology. It is also likely to be the one approach that has not yet been tried.
No service member leaves the military typically hoping that their livelihood will hinge entirely on the integrity of a public servant’s work ethic. Or that the quality measures of VA healthcare will depend on whether the medical facility is under pressure to report favorable numbers. But that’s exactly what’s been happening for years at VA medical facilities across the country.
Even after the Phoenix scandal of 2014, and the exposure of Tomah VA’s “Candyman,” drug-stealing hospital employees, and a VA provider caught watching porn while with a patient made headlines, we still find ourselves ensnared in a circular, fruitless conversation on the need for greater accountability in VA. Hopefully, that will change as the U.S. House of Representatives soon decides whether the VA Accountability and Whistleblower Protection Act of 2017, following the Senate’s passage of its own accountability bill, is the answer.
The VA Accountability and Whistleblower Protection Act of 2017 will grant VA Secretary David Shulkin the authority to quickly fire unethical and negligent VA employees while protecting whistleblowers who assume the risks associated with speaking truth to power about wrongdoing. The challenge Shulkin faces is bigger than his authority, however, should the bill pass.
The VA’s entrenched and self-serving culture will inevitably come at odds with his enhanced authority — an immovable object against an irresistible force — except, in this case, one side will have to give. The question is how do stakeholders ensure that accountability has a fighting chance against a ubiquitous, powerful enemy with a near-perfect record of victories. The answer is to turn that enemy against itself.
“[C]ulture precedes politics, “said American businessman Foster Friess, “and I think the attempts to try and legislate people’s behavior isn’t going to be productive until the culture decides what they want to achieve.” Lying at the core of VA’s cultural identity are the true power brokers in the agency, the middle-senior managers, who wield the most authority with the least accountability, at least in the eyes of the public.
These are the high paid VA executives with highfalutin titles who work at the Veteran Integrated Service Network (VISN) offices and VA Central Office and rarely, if ever, have to interact with veterans. Their comfortable distance from a myriad of problems in VA, many of which are within their domain of control and authority to confront and resolve, is the problem. Also, they are rarely implicated when VA scandals are uncovered (Remind me of who was the VISN Director for the Phoenix VA in 2014?) even though their poor decisions or dereliction of duty can often be directly linked to problems at the facility level.
Worse yet, too many have spotty work histories of their own as former VA facility directors who were “punished” by receiving a promotion and transfer to a VISN office. Some spend more time positioning themselves for contracts and consultant positions in their post-VA life than visiting the VA hospitals under their auspices. Under the present VA healthcare framework, these same individuals are paid to manage the budgets, oversee the staff, and enforce the policies at every single VA medical facility in the country, which drives their collective influence in VA.
Realistically, it will be up to them, not the Secretary, to decide whether the agency is ready for a new era of heightened accountability, free of the moral hazard and recidivist behaviors that many come to expect of VA. It will be up to the VA Secretary, however, to decide whether these VISN “oligarchies,” as many view them, should continue to wield that kind of power along with the anonymity that has shielded most of them from accountability.
On balance, numerous senior managers are shielded because of the good works of many VA employees and the capabilities the agency performs very well. No other large healthcare system rivals VA’s competence to deliver specialized services at a national level, such as spinal cord injury and disease and polytrauma care or synthesizes access to healthcare, benefits, support, and peer mentorship better than VA. But what VA needs most right now is the one “ability” it presently lacks and can no longer be taken for granted — accountability.
Whether that means better protecting whistleblowers, shortening the reprimand process, or recouping ill-gotten bonuses and relocation expenses, achieving a state of being answerable to the public, the Congress, and most importantly, veterans will be dictated by the worst behavior the VA Secretary is willing to tolerate. This starts with examining the role and influence of the senior middle managers, who have the most at stake once the showdown between accountability and culture begins.
The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of earlier wars were treated and appreciated by our nation. — George Washington
President George Washington’s proclamation that a nation will be judged by how it treats its defenders—meaning its veterans – seems not only prescient but apropos in our current day and age. The judges who matter most are the young people who will be tomorrow’s defenders, and their judgment will inform their decisions to raise their right hands, take the oath and fight for their country. Or choose not to serve.
Nine percent of the American population made the decision to fight for their country after Pearl Harbor, the first historic attack on the homeland in modern history that pulled the U.S. into World War II. Compare that to less than one percent of the population that served after the second historic attack on the homeland on September 11, 2001. The gulf between then and now, regarding the collective willingness to serve, begs a few questions: Have we simply become a less patriotic nation? Or are we just more cynical, given how military service is depicted and perhaps devalued today?
Some reports suggest that along with a cook, mail carrier, corrections officer, and taxi driver, any enlisted military occupation is considered among the worst jobs in America. The speculated reasons are stress, work environment, emotional factors, income level, and career prospects. Assuming this is true—or even just perceived to be true by young people—it’s no wonder the allure of military service has diminished. The numbers tell the story as evidenced by the ninety-nine percent of America who didn’t serve after 9/11 and ninety-three percent of which have never served in the military in any era. The fact is, most U.S. citizens have decided not to serve in uniform.
And, why should they? They are inundated with perpetual bad news about life in and after the military. Veteran suicide, veteran unemployment, veteran homelessness, delayed access to VA healthcare, delayed receipt of VA benefits, military sexual trauma, scandal in the military, the long-term effects of Agent Orange, burn pits, Anthrax vaccinations, Camp Lejeune water contamination and rampant post-traumatic stress are among the persistent headline-grabbing issues. All this has made it hard to see an upside to joining the military for the kid who was born on or soon after September 11, 2001, and will be old enough to join the military next year.
Here’s what that young person will likely not know, however. While our government faces many problems in how it administers benefits and healthcare to veterans, many veterans, because of their military service, enjoy financial security, have good educations, possess strong work ethics, and receive excellent healthcare. Veterans are also generally well-regarded by their local communities and receive many city and county benefits, such as property tax exemptions, college tuition assistance and even dedicated parking spaces in some areas for Purple Heart recipients. Veterans also regularly benefit from random acts of kindness by strangers in the form of upgrades to first class on flights, anonymously paid dinner tabs, and a simple “thank you for your service” by citizens who don’t care what you look like, what your politics are or the number of military decorations you’ve earned. All that matters is their service.
Veteran status is one of the few stations in American society where race, religion, and gender are eclipsed by merit and character of service. Most importantly, to become a veteran, one must pass tests of will, character, selflessness, and dedication unlike any other occupation, and is rewarded with a lifelong badge of honor that is coveted by many, yet earned by few. It is the one place in society where the term “hero” is least likely to be an exaggerated characterization, whether one served as a cook or a general in harm’s way.
For the record, I don’t believe we are a less patriotic society. Nor are we smarter simply because fewer Americans choose to avoid the perceived pitfalls of military service. Americans are content to love our troops because most citizens don’t have to be those troops. That’s fine, I suppose, as long as we are willing to reward those who choose to run toward the sound of danger—repeatedly, in many cases—so others never have to. It is that reward, in the form of benefits, good quality of life, social standing and respect that will ensure future generations of Americans will value military service enough to endure its rigors.
To that end, America must build on that value with each new generation by treating veterans well. It’s not just the right thing to do; it is the best recruitment strategy for the future of our nation’s military.
Every veteran who has survived catastrophic injury, such as blindness, amputation, spinal cord injury, and severe head trauma, will likely have a lifetime bond with the Department of Veterans Affairs (VA), like it or not. In addition to the specialized care expertise that VA has honed over the years, which is rivaled by very few, if any, providers in the private sector, VA is the only place these veterans can also receive timely access to home modifications, adaptive drivers training, home-based care, peer mentoring, caregiver assistance, and VA claims education and assistance.
Hopefully, this was the most important take away from the listening session that President Donald Trump held with healthcare industry experts at the White House on Monday, February 8th, to discuss the actions necessary to improve healthcare access and quality for veterans. The only way the President would get that message is in the words and experience of Tiffany Smiley, former nurse, now caregiver and advocate for her husband, Scotty, who was injured in 2005 while deployed as an Army platoon leader in Iraq, after a suicide car bomb took his eyesight. Mrs. Smiley was invited to participate in the listening session as the voice of the caregiver and, vicariously, veterans as well — and the best hope for changing a VA system that often appears too broken to save from itself.
While I am sure everyone in the room had listened to her story and expressed compassion for her and her husband’s plight, the danger when discussing ways to fix VA has always been the sheer magnitude of a problem that impacts nearly nine million veterans enrolled in the VA healthcare system. When waitlists, understaffing, crumbling infrastructure and breaches of the public trust seem so prevalent throughout the system; it can prove difficult to focus on the relatively few veterans who are most vulnerable or feel the greatest impact: the veterans who rely on VA’s specialized services. The difficulty lies in the fact that those specialized services do not exist in a vacuum; they are supported by the primary and tertiary components of the VA healthcare system that are, in turn, supported by the needs of the general veteran population being pushed to the private sector through Choice Care. If general VA healthcare diminishes, so too might specialized care as an unintended consequence.
Whether Mrs. Smiley had the right answer in the room that day remains to be seen. There’s no doubt, however, that she raised the right questions to the panel of experts around the table and the President just by her mere presence. How can the private sector fill the void created by failing VA facilities? How do we ensure veterans are protected when seeking care in the private sector? Is the best solution to shift more VA primary care to the community along with a proportional increase in resources, such as nursing staff, shifted to VA specialized care services that serve veterans with unique needs? How do we avoid the pitfalls of fragmented care, particularly for veterans with severe disabilities or mental health care needs?
The only hope for veterans and veteran advocates who want to “make VA great again” is that the experts around President Trump will have the right answers because they will be forced to deal with the right questions, starting with those presented by the experiences of Tiffany and Scotty Smiley that are shared by so many.