Veterans Healthcare in the U.S.

Veterans Healthcare in the U.S. -- Past, Present and Future

PAST

Providing healthcare services and benefits to veterans of American armed forces began as far back as 1636, according to the New York University Internal Medicine Blog written by Dr. Erin E. Ducharme (2008). In fact in 1636 during the regional war between the Plymouth Pilgrims and the Pequot Indians, a law was passed by the Pilgrims that stated: "If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life (Ducharme). In 1776 -- during the Revolutionary War -- the Continental Congress (CC) wanted to encourage enlistments and cut back on desertions, so the CC authorized the payment of "half pay for life" in the event of a loss of limb or "other serious disability" (VA History in Brief).

The bad news was that the CC had no authority to make those payments so the paying of wounded veterans was left to states, which did not always have the revenue to pay soldiers. According to VA History in Brief (2006) only about 3,000 veterans from the Revolutionary War received health-related benefits. A few years later in 1789 -- following the ratification of the U.S. Constitution -- Congress passed the very first "pension" legislation for veterans and in 1808 all the veterans' programs were put under the auspices of the Bureau of Pensions (under the War Department).

In 1811, according to Ducharme, the federal government built the very first "residential and medical facility for veterans" and in 1818 a "Service Pension Law" was enacted by Congress, giving every individual who participated in the Revolutionary War "a fixed pension for life" -- $20 a month for officers and $8 a month for enlisted men (VA History in Brief). This was the first legislation that provided money to veterans that was not connected to injuries suffered during wars. By 1820 the number of pensioners had reached 17,730 and the federal government was shelling out $1.4 million for those pensioners. In 1858 Congress created a new line of payments, authorizing "half-pay" pensions to widows of those killed in wars; the pension also included children "orphaned" because of war casualties until they reach 16 years of age (VA History in Brief).

The Civil War created a lot of new veterans that needed to be helped medically and financially. The VA History in Brief reports that just as the Civil War was breaking out there were about 80,000 veterans, but after the war that number jumped to 1.9 million veterans. Confederate soldiers received no benefits but Union soldiers did. That injustice was resolved in 1958 when Congress pardoned the Confederate service members and "extended benefits to the single remaining survivor" of Rebel troops who had fallen in the war.

Dr. Ducharme explains that President Lincoln in 1865 commissioned the National Asylum for Disabled Volunteer Soldiers and Sailors (which was later renamed "The National Home for Disabled Volunteer Soldiers"). The care provided was residential, hospital and medical care for those disabled during the Civil War. The General Pension Act of 1862 liberalized the benefits for dependent relatives, for widows and children and "for the first time [offered] compensation for diseases like tuberculosis" that attacked troops during active duty (VA History in Brief).

From the end of the Civil War on through the rest of the 19th Century the government began extending benefits to veterans -- and to their widows and dependents -- of the Indian Wars, and the Spanish American War, Ducharme explains. Some 4.7 million Americans fought in World War I and 116,000 of those were killed and 204,000 were injured. VA History in Brief reports that Public Health Service (on contract with the government) operated some hospitals but most injured veterans were cared for in military hospitals; those military hospitals however "were too burdened to keep all patients through recovery." Ducharme reports that between 1931 and 1941 the number of Veterans Administration hospitals nearly doubled, from 64 hospitals to 91 hospitals. The number of beds also doubled, from 33,669 to 61,849.

In 1930 President Hoover signed an executive order establishing the VA, which was responsible for medical services for all war veterans, disability compensation for veterans and several other allowances. After WWII, Ducharme writes, healthcare offered by the VA "began to draw scrutiny from the media with headlines such as: 'Veterans Hospitals Called Backwaters of Medicine' and 'Third Rate Medicine for First Rate Men.'" Another reporter called the VA a "vast dehumanized bureaucracy" and so President Truman appointed General Omar Bradley to take the leadership position of the VA.

Bradley helped transform the VA into a better agency for healthcare by linking services with U.S. medical schools; Bradley brought VA medical services to 66 of the existing 77 U.S. medical schools recruiting 4,000 doctors from those medical schools to provide healthcare services to veterans (Ducharme). In 1943 Congress passed the Disabled Veterans' Rehabilitation Act which offered rehab services for those soldiers seriously disabled in WWII.

The Vietnam conflict resulted in over 55,000 deaths to Americans serving in that effort but moreover, the chemicals that were used by the U.S. In Vietnam caused enormous health problems for returning veterans. Agent Orange, a blend of herbicides that were used in Vietnam from 1961 to 1971, caused many returning veterans to show symptoms of -- or to fully contract -- the following illnesses: B-cell leukemias (hairy cell leukemia); Parkinson's disease; ischemic heart disease and other medical problems (www.publichealth.va.gov).

Millions of gallons of Agent Orange were sprayed on jungle foliage in Vietnam in an effort to prevent the enemy (Viet Cong and North Vietnamese Army) from hiding. The blend of herbicides that made up Agent Orange contained 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) which contained minute traces of 2,3,7,8-tetrachlorodibenzo-p-dioxin (www.publichealth.va.gov). These ingredients were sprayed in all four military zones in Vietnam, a total of 19 million gallons.

The medical problems listed above (related to exposure to Agent Orange) are only the most recent findings by the U.S. Government; earlier, the VA healthcare services had to treat Vietnam veterans for these Agent Orange-related healthcare problems: Acute and Subacute Transient Peripheral Neuropathy; Chloracne; Chronic Lymphocytic Leukemia; Diabetes Mellitus (Type 2); Hodgkin's Disease; Multiple Myeloma; Non-Hodgkin's Lymphoma; Porphyria Cutanea Tarda; Prostate Cancer; Respiratory Cancers; and Soft Tissue Sarcoma (www1.va.gov).

The veterans who were exposed to Agent Orange (who served in Vietnam during the period that Agent Orange was used) do not have to prove that their leukemia or Hodgkin's Disease or other maladies resulted from Agent Orange. The VA has a clause that there can be a "presumption" of relatedness to Agent Orange if a veteran shows up at a VA healthcare facility with any of the above-listed medical problems and diseases.

By introducing a dangers chemical herbicide into Vietnam the U.S. Government -- in its attempt to fight a jungle war using WWII strategies -- created health problems that were widespread among returning veterans. This put a tremendous burden on an already overburdened VA healthcare system. It also shows the lack of foresight that the U.S. military commanders used in strategizing how to win a war in which the enemy dug tunnels in the jungle and could ambush American troops without giving away their position until the seconds before the assault.

PRESENT

In 2010 there are an estimated 153 VA Medical Centers (www.answers.com), 768 VA Community-Based Outpatient Clinics (CBOC), and 232 VA Vet Centers. That totals 1,153 health-related clinics and hospitals. The Veterans Administration (www2.va.gov) states that it has 1603 health-related VA facilities. The VA (www.- -- ) breaks down the total number of living veterans by state and by age. According to VA data, there are (as of September 2009) 289,683 veterans between the ages of 25-29; 736,055 veterans between the ages of 30-34; 865,394 veterans between the ages of 35-39; 1,259,212 between the ages of 40-44; and 1,577,641 veterans between the ages of 45-49.

The data show that there are 1,876,344 veterans between the ages of 50-54 in the U.S.; there are 1,950,273 veterans between the ages 55-59; there are 2,718,431 veterans between the ages of 60-64; and there are 3,232,874 veterans between the ages of 65-70.

All told there are an estimated 23,816,018 veterans living in the United States, the VA reports. Of those, 1,704,429 are between the ages of 85-89 and 939,726 veterans are over 90 years of age (www2.VetPop.va.gov). The numbers of older veterans suggests a serious and substantial demand for healthcare.

The Iraq war has resulted in serious healthcare problems for hundreds of thousands of returning veterans. According to an article originally published in the Los Angeles Times and reprinted in the Boston Globe (Weinstein, 2007), hundreds of thousands of troops that returned from Iraq and Afghanistan have sued the U.S. Department of Veterans Affairs over the "shameful failures" in providing care (mental and physical healthcare) to the veterans. The lawsuit (73 pages) claims the following:

"The VA's outmoded systems for providing medical care and disability benefits [have been overwhelmed by] the huge influx of injured troops returning from Iraq and Afghanistan" (Weinstein). In particular, the attorneys working on this issue claim that the VA is "structurally unsuitable" for dealing with post-traumatic stress disorder (PTSD) which is "a signature problem" veterans of the Iraq and Afghanistan wars are suffering from (Weinstein). Symptoms of PTSD include: "…intense anxiety, persistent nightmares, depression, uncontrollable anger, and difficulties coping with work, family, and social relationships" (Weinstein).

There an estimated 1.6 million men and women who have served the U.S. In those two conflicts, and according to a Pentagon Task Force report an estimated "38% of soldiers and 50% of National Guard members" that returned home from Iraq or Afghanistan "have mental health issues, ranging from post-traumatic stress disorder to brain injuries" (Weinstein). Those numbers, along with the assertion that only 27 of the VA's 1,400 medical facilities have inpatient post-traumatic stress disorder programs, create an enormous gap in needs vs. services, the lawyers for the plaintiffs point out (Weinstein).

The lawsuit does not ask for a monetary reward; it is designed to prevent the VA from "systematically denying what it asserts are valid claims by injured veterans" (Weinstein). Moreover, the lawsuit asserts that the VA has "consistently presented misleading statistics" that have to do with the number of veterans who need mental health services, the length of time it takes to process a claim, and the amount of money the VA needs to meet it's full obligations to veterans.

Meanwhile a report by the Institute of Medicine (IOM) (a branch of the National Research Council, an independent organization that provides advice and research data to the U.S. Government) indicates that soldiers returning from Iraq and Afghanistan "aren't getting enough attention" when it comes to mental health. The IOM urged the Veterans Affairs Department (VAD) to research the problem of "traumatic brain injuries" that are caused when roadside bombs go off near troops (www.CBC.ca.news). The long-term effects of traumatic brain injuries can include seizures, reduced mental capabilities and dementia, according to the IOM report. The report resulted from research conducted by a 16-member IOM panel; on that panel was Dr. George Rutherford, professor of epidemiology and biostatistics at UC San Francisco, who said:

"Job training and job loss due to multiple deployments are other serious issues facing these individuals, as is doctors' ability to diagnose and treat traumatic brain injuries" (CBC).

Also today there is a serious problem with veterans' healthcare in that an estimated 107,000 veterans are homeless -- and many of those are living on the street. The Secretary of Veterans Affairs, Eric K. Shinseki, has restructured the VA's budget for homeless veterans so that 85% of the VA's budget request for next fiscal year (July 1, 2010 -- June 30, 2011) will be spent on medical services (Miles, 2010). This means that health issues like substance abuse, depression, PTSD, traumatic brain injury and other injury-related issues will be addressed more fully.

One fact that is troubling is presented in a research report (Himmelstein, et al., 2007) in the American Journal of Public Health; "…Only a minority of veterans -- those disabled by military service -- are automatically eligible for VA care" (Himmelstein, p. 1). Also, as of 1996, veterans who are "non-poor" (earning more than $30,000 a year) were required to make co-payments at the VA up to $50 a day (Himmelstein, p. 1). Using surveys conducted by the federal government, the authors determined that 1.8 million veterans were not insured and not receiving Veterans Administration care in 2004 (Himmelstein, p. 1).