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Starting from Scratch


By Joan Zweben, Ph.D. VHPI Steering Committee

For nearly 40 years I worked to create a network of healthcare resources that could help residents of Oakland, California who suffered substance abuse and mental health conditions. Treating mental health and ensuring that individuals can break out of the cycle of substance abuse requires one thing: stability.

Stability in care. Stability in funding that care. Creating a stable environment to ensure they get the right care at the right time from the right provider. We worked hard to provide the best care and I’m proud of the care we delivered.

As our organization’s executive director, I was constantly seeking new funding sources to sustain our work. We had multiple contracts and grants, all with different documentation requirements and funding cycles. It was a headache and a scramble. What’s more, when there was a funding gap or leadership turnover in a foundation or government agency to which we applied for help, priorities could change and services could be eliminated.

And we constantly worried about how those administrative changes would impact those to whom we provided care.

But what I was trying to create in our community I had seen implemented inside the Department of Veterans Affairs. Its model of care was exactly what we had been seeking for our patients: stability.

I’ve worked part-time for the VA since the early 1970’s, seeing patients in the VA substance abuse treatment programs in San Francisco. Over the years, I’ve come to appreciate what an excellent model the VA is for all of us, and how it is ideally suited to take care of the needs of our veterans.

Private sector providers simply can’t replicate the clinical stability of the VA. First of all, the VA is a one-stop shop. The convenience of the VA, where everything is in one place, can’t be underestimated.

If you’re a patient, say, with substance abuse problems as well as other chronic or life-threatening conditions, you can usually see all your doctors and nurses and therapists in one central location. That’s not true in the private sector, where you may have to go all over town – or even out of town – to access the variety of services you need.

Second, continuity of care at the VA is far superior to what veterans are likely to find in the private sector. In the private sector, when you switch from one provider to another, electronic record systems are often not compatible; that’s not the case in the Veterans Health Administration, which uses the same electronic record system across the board. By pushing veterans into the private sector, the administration may create a medical records nightmare for them, which could result in substandard care, with potentially life-threatening outcomes.

Third, the VA provides wrap-around services. It addresses not only all the medical needs of the patient, but it also assists with housing, job training, and employment. Providing these extra supports goes a long toward improving the quality of life of our veterans. It also makes it more likely that the veteran will be able to follow treatment recommendations, which is key to good outcomes.

As someone who has treated veterans both inside and outside the VA, I’m very troubled by the efforts to privatize the VA and turn a truly integrated care system into a fragmented one.

I do not represent the VA, but I can tell you the care at the VA is much better than you’ve heard. The problems of private sector care tend to get lost in the discussion of how best to care for our veterans.

It is common for the media to rail against the long lines that some veterans face. But what they fail to mention is the long wait times in the private health care system. The private sector is not required to reveal its wait times, so it is easy to malign the VA, but focused studies indicate the wait times are actually longer in the private sector.

For instance, I’ve got excellent private insurance, but when I recently tried to make a routine appointment with one of my physicians about my chronic, complex medical condition, I was told there was a four-month wait.

We shouldn’t be herding veterans into private sector medical care. The private sector can’t handle the job.

Veterans need and deserve stability in care after their service to our nation. Their health depends on reliable and integrated care. Throwing them into the notoriously unstable, expensive, and fragmented private sector healthcare system is an unsuitable and unsustainable solution.

Although the Department of Veterans Affairs has its issues, it should truly act as the starting point for debate. Pushing veterans into the private sector isn’t an improvement – it’s starting from scratch.

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