Vets in Oregon need a strong VA, not the illusion of choice

In a new column for the Rogue Valley Times, Fernando Gapasin, a Vietnam veteran and VA patient, and VHPI Senior Policy Analyst Suzanne Gordon write about the issues plaguing veterans in rural Oregon:

The Department of Veterans Affairs in Washington, D.C., has taken a lot of heat for its recent job cuts. During the past year, VA Secretary Doug Collins has left 30,000 staff positions vacant and limited new hiring at facilities across the country, including in Oregon. Collins, the Air Force Reserve colonel now running the nation’s largest public health care system, insists that access to medical care will not be affected. According to Collins, the VA is just offering nine million veterans “more healthcare choices.” They can now “get their healthcare when and where it’s most convenient” — via faster referrals to 1.7 million private doctors, hospitals, and clinics.

This costly and unnecessary outsourcing diverts $48 billion a year from the VA’s direct care budget of $134 billion. If the high-quality, specialized services provided by the VA are further defunded and 33 local facilities dismantled, Oregon’s private health care industry is not prepared to meet veterans’ needs. The state’s 144,000 VA patients will have longer wait times for appointments, longer drives to get care where available, and fragmentation of the wrap-around services for vets who qualify for VA coverage based on their low-income, service-related conditions, or recent service in combat zones.

There are multiple reasons for this. First, the VA’s patient population is very different. Former service members have more mental health problems, chronic illnesses and pain, more back, neck and shoulder injuries and higher rates of hypertension and diabetes than non-veterans.

Those in combat returned at higher risk of traumatic brain injury or Post-Traumatic Stress Disorder (PTSD). Nearly a million service members have qualified for VA care recently due to past toxic exposures — from burn-pits in the Middle East or military bases in the U.S. with poisoned soil or water. They join older vets whose health was damaged by Agent Orange exposure in Vietnam or other forms of chemical contamination during the first Gulf War. Veterans also have higher rates of substance abuse and suicide than the general population. The state’s private hospitals, medical practices, and mental health providers are ill equipped to handle an influx of such patients, a third of whom are poor and afflicted with one or more of the conditions above. Thirty-four of Oregon’s 36 counties have a severe shortage of mental health professionals. Twenty-five do not have enough primary care providers. Oregon has not shuttered any rural hospitals since 2005, but some of these facilities have curtailed services. And now, more than a dozen face a heightened risk of closing due to Republican cuts in Medicaid reimbursements.

Fortunately, most VA patients, their care-givers, and veterans groups realize that the VA remains one of our best working models of healthcare delivery that puts patients before profits. Stopping the drive to privatize VA care is a cause worth defending.