On the Sunday before Memorial Day, the principal presiding over my eldest granddaughter’s high school graduation offered a heartfelt tribute to the nation’s veterans. He then asked all vets to stand.
There were 916 graduates. The 10,000-seat arena was nearly filled with family members and well-wishers. In my section of well over a hundred people, just three men stood—two gray-haired grandfathers like myself and one middle-aged. It was the same everywhere you looked.
The crowd mirrored the rapidly changing demographics of the nation’s veterans population. Today’s 19.5 million veterans represent just 7.5% of the adult population, down from 18% in 1980. The 1.3 million-person military is a third of its Vietnam War-era peak, when a draft was needed to fill the ranks and the killed-in-action, wounded and turnover rates were far higher than they are today.
As the Vietnam-era veterans go to their final resting place, the veteran population is expected to drop about 2% a year. The Veterans Affairs Department projects the total number of veterans will fall 40% by 2045.
Yet something entirely unexpected has happened at the VA’s health system in recent years. The number of vets turning to the government-run healthcare system has gone up steadily due to rising demand for its specialized care. Giving them access to private-sector care has not reversed the trend.
Last year, over 6.1 million veterans visited one of the VA’s 172 hospitals and 2,000-plus outpatient facilities for care. That’s up 15% from a decade ago despite a 16% decline in the total number of veterans.
It’s especially surprising because over the past five years, the VA, which employs over 300,000 healthcare workers and traces its roots to the final days of the Civil War, has been rocked by scandal. The 2014 “wait-time” crisis led to a number of resignations, including VA Secretary Eric Shinseki.
Passage the same year of the Veterans Choice Act allowed vets to visit private-sector physicians and hospitals if they had to wait more than 30 days for care or if they lived more than 40 miles from the nearest VA facility. A proposed rule implementing the 2018 Mission Act, which is slated to be finalized this week, will cut that to 20 days or a 30-minute drive.
For Koch brothers-funded groups like Concerned Veterans of America, the scandal provided the perfect excuse for pushing greater privatization of VA services. A large majority of comments on the proposed rule echoed the group’s main talking point: “For too long veterans have been forced to endure substandard care at VA facilities.”
That assertion simply isn’t true. A study published last January in JAMA found that in 2017 wait times at VA facilities had shown marked improvement since 2014 and now are shorter than private-sector wait times. In announcing the proposed rule, VA Secretary Robert Wilkie confirmed the VA “generally delivers higher-quality care than other health providers” and “outperforms non-VA hospitals in most healthcare markets.”
The real threat to the VA isn’t watching its clientele flee to outside providers. Rather, it faces tough challenges in filling nearly 50,000 empty positions. Its budget also faces erosion through greater privatization.
To its credit, the Trump administration proposed a 9.6% increase for the VA health system. But it left it to a divided and dysfunctional Congress to find offsetting cuts. It also proposed getting rid of whistleblower protections in health system union contracts, which are up for renegotiation. Whistleblowers brought the wait-time scandal to light.
Sadly, the long-term problems facing the VA—the need to rationalize facilities, the need to beef up behavioral services to address veteran suicides, and the need to integrate the VA and military medical systems—are barely part of the conversation.
The nation’s vets deserve better than a debate driven by someone else’s political agenda.
