February 18, 2020
Trump continues to wage war against his own workforce with his fiscal 2021 budget proposal.
The secret is out. The VA ranks among the best in U.S. health care delivery. It's not broken like the Koch Brothers and their mouthpieces in Congress want you to believe. People who have worked with the VA, are mentored by the VA, and receive care from the VA have spoken, and all the lies about how broken the VA is start to collapse.
Last week, veterans, medical school professors, researchers, policy experts, and veterans groups gathered in Washington, D.C. for the "Keeping the Promise: What's Next for the VA" summit to discuss the future of the nation's largest and most important health care system. Panelists talked about how important the VA is to veterans and their communities, but also the entire health care system and to them personally. And they were alarmed by all the loose talk about closing VA hospitals and giving veterans coupons to get their care from profit-hungry health care corporations.
Here are five facts we learned about how the VA heals our nation's heroes, and what needs to be done to strengthen it:
The VA has played a major role in training the country’s doctors, nurses, and other health care providers for decades. Every year, the VA trains, educates, and builds experience for 62,000 doctors, 23,000 nurses, and 33,000 other health care providers. About 70% of U.S. physicians receive some professional training at a VA hospital. Medical school students also prefer to train in a VA hospital due to its advanced clinical training, technologies, and unique patient population.
“Get the dean of any medical school in the country – any nursing school, any social work school, pharmacy school, and they will say we cannot train our health care providers in the country without VA,” said Dr. Lawrence Deyton, senior associate dean for Clinical Public Health and professor of Medicine and Health Policy at the George Washington University School of Medicine and Health Sciences.
Medical students also get exposed to veterans service they may not otherwise have gotten, he said, and they are motivated to return to the VA and take care of veterans.
“I don’t know how many times I get students with me either in my own clinic or when I’m dealing with them in other classes who come back and say ‘Doctor I had no idea that veterans did all that for our country,’” Deyton added.
Did you know that it’s the VA researchers that conducted the first successful liver transplants, invented the implantable cardiac pacemaker, and developed the nicotine patch? Did you know that they pioneered modern electronic medical records, came up with concepts that led to the development of CAT scan, and created artificial limbs that move naturally when stimulated by electrical brain impulses?
VA researchers also discovered leukemia and cancer-causing viruses. They developed drug therapy for moderate hypertension. They discovered a body chemical that helps maintain healthy blood vessels. They developed a method to detect and measure various substances in the blood. The list goes on.
And oh, these medical breakthroughs have earned them Nobel Prizes and other distinguished awards.
And because of the amount of research the VA has been doing, the agency has over the years developed new types of health care providers. Clinical psychology, for example, was born in the VA.
“There are areas where VA has really created new specialties, new types of health care providers,” said Dr. Kenneth Kizer, distinguished professor and director of the Institute for Population Health Improvement at University of California Davis Health System. “This is a potentially huge competitive advantage the VA has that very few other systems have. You have this infrastructure that allows you to look at data, to think of new ways of doing things, to test it in subjective ways.”
Don’t believe the hype about how the VA should be like the private sector – because the truth is, VA hospitals consistently outperform for-profit, private sector hospitals.
Take outpatient care for example, VA hospitals outperform non-VA hospitals in 45 out of 47 comparisons on important criteria such as safety, effectiveness, and timeliness, according to Terri Tanielian, senior social research analyst at RAND Corporation.
VA hospitals are particularly good at providing mental health care – they continue to outperform private-sector hospitals by 30% on every single indicator of good health care. In addition, VA and Defense Department providers are significantly more likely to have cultural competence and inclination to deliver evidence-based therapy for Post-Traumatic Stress Disorder (PTSD) and depression. In contrast, only 13% of private health providers are likely to have cultural competence and use evidence-based approaches for mental health problems.
“So if a veteran needs mental health care, they are much more likely to find a provider who’s got cultural sensitivity to their needs and the inclination to use evidence-based approaches in a VA or DoD setting than they would in the private civilian sector,” Tanielian said.
The VA is better because it has taken specific approaches to try to invest in promotion of evidence-based approaches. It routinely screens patients to identify clinical issues and problems and then refer them to a preferred appropriate follow up. It employs performance measurement approaches to be able to monitor and look for how facilities are doing and identify where improvement is needed. Of course there is room for improvement as there are VA facilities that are not meeting their own high standards. But they are in the minority.
“For most of us that do work in this area perhaps it’s not a surprise that the VA continues to lead with respect to the provision of health care quality,” Tanielian added.
Garry Augustine, executive director of Disabled American Veterans (DAV), has been using the VA for 40 years, and the VA never told him to get certain types of treatment anywhere else because everything he needs is there. That’s because the VA is using a holistic approach to improve overall care quality and patients’ experience.
“The holistic approach is not happening in the private sector. That’s not what they do.” Augustine said.
Besides veterans’ health care, the VA also provides some lesser-known services to veterans and our communities, such as telehealth services, legal services for veterans, and disaster response.
“One of the areas that is so important to our mission at VA that people don’t think a lot about is our responsibility for emergency preparedness,” said VA Under Secretary for Health Dr. David Shulkin. “Within hours after Orlando, we dispatched our mobile med centers immediately on-site. Since the tragic event in Orlando our VA clinicians, our mental health professionals have counseled over 800 family members of people who suffered in that tragedy.”
When Ruth Browne’s 2008 deployment to Iraq was cut short because of her husband’s unexpected death, she came home and sank into depression. She didn’t even know she was sick. So she decided to go back to work at a VA hospital, where she met fellow veterans who helped her get the help she needed.
“I got back to work and I was taking care of the veterans and it was the veterans that came to see me, and it was the veterans that were the providers there that told me and let me know just what I needed and directed me into place,” said Browne, a nurse practitioner at the Gainesville VA hospital in Florida. “Veterans aren’t just there to get their basic care. They network with other veterans. They find out what and where their resources are. And as a provider there, the veterans, when they find out that I’m also a veteran, they loosen up. They tell me everything. They love having another veteran understand what’s going on.”
Veterans indeed choose the VA as their employer of choice. One in three VA employees are veterans.
“Not that private-sector counterparts are not doing their best, but VA employees understand veterans better,” said Tom Berger, executive director at Veterans Health Council of Vietnam Veterans of America.
It’s clear VA hospitals are second to none when it comes to keeping the promise to our nation's veterans. So why are we even having this discussion about whether to shut down VA hospitals?
Well, that’s because powerful special interests like the Koch brothers and private hospital executives see an opportunity to profit off of veterans' health care, and their allies in Congress are too willing to help make that happened. That's how we got what's known as the "strawman proposal" that would shut down VA hospitals.
Recounting his experience recovering from an injury that resulted in partial paralysis, Sherman Gillums, Executive Director of the Paralyzed Veterans of America, challenged elected leaders directly to look at the vital importance of the VA through the eyes of veterans like him, not political advisors and sensationalist writers.
“There are people in your inner circle who are going to tell you that privatizing the VA is the answer. All I ask is that you ask them two questions: the first one is have you received care in a VA medical center in the last 5 years? Or is your opinion informed by a secondhand perspective. The second question will be, who will be responsible for monitoring health care access quality in the private sector when it goes wrong without Title 38 protections to include investigation of waitlists, other access issues, and medical malpractice cases?”
DAV’s Augustine said debating whether we should shutter the VA is a false debate as we know that veterans like the VA and don’t want it to go away.
“We’re not opposed to choice. But don’t give someone a card and say ‘Here, thanks for your service. Good luck.”
“I consider our promise to veterans a sacred promise that cannot and must not be violated,” said AFGE President J. David Cox Sr. Cox served as a nurse at a VA hospital for 20 years and felt serving veterans was a privilege.
“The joy of serving the men and women who served the country; that’s what the VA is all about,” he said.
Visit afge.org to learn more about what AFGE and veterans groups are doing to preserve the VA for veterans and Americans for generations to come.
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