“To care for him who shall have borne the battle and for his widow and orphan.” – Abraham Lincoln,  from his second inaugural address, used as the Veterans Administration motto.

Full Disclosure: I get all of my considerable healthcare needs addressed through  VA healthcare facilities. I have been for several years now since service-connected medical conditions effectively ended my military career in 2004. They control my literal fate in a real and tangible way.

With that in mind, I pretty much know the system inside and out. The good, the bad, and the ugly. Do you know that old saying, “your mileage may vary”? That’s what I tell new VA patients when they ask me what to expect. To the VA’s credit, they have saved many lives. Unfortunately, others have not achieved such positive outcomes.

The soaring lobby of the VA medical center in Orlando
Inside the VA Medical Center in Orlando. If you were picturing an old, dark, dirty hospital, this is not it. I’m not complaining, but there is enough open vertical space in there for two hospitals—photo by the author.

Even before I started using the system for my personal healthcare needs, there’s been talk of scrapping it altogether in favor of giving veterans private medical insurance subsidized by the government. This recent Twitter post from a Florida Congressman reflects the opinion of many and asks questions that need to be asked. Namely, can the system, as it exists now, be saved?

According to RawStory, Florida Representative Matt Gaetz had  a recent question and answer session with FreedomWorks, who describe themselves this way: “FreedomWorks is the nation’s largest grassroots advocacy organization dedicated to the issues of lower taxes, less government, personal liberty and the rule of law.”

This is part of what Gaetz had to say to the libertarian gathering:

“This is my question to the group. Is it savable? Why not abolish the VA, take all of the money that we are otherwise spending and go to an any willing provider system inside of our communities?  And then, if people get bad care, they can vote with their feet and you don’t have a two-tier system of healthcare in this country with our veterans and then with everyone else.”

In theory, it’s not a bad idea. However, there were some in the media who tried to jump all over him with both feet accusing the Congressman of wanting to “defund” the VA. “Defund” has been a trendy word these past couple of years as it has become a pejorative. What I took away from the speech was not the intent to take money away from veterans who need healthcare but to shift it to the free market system. And the VA has been doing exactly that over the past several years in the form of “community care.” More on that in a second.

I think I can speak for all veterans when I say we just want the best care possible, delivered in a timely manner. It doesn’t matter a bit if the person caring for us is a government employee or not. It’s also important that we don’t have to travel too far to be seen. I added that last part because although I live near a major metropolitan area (Orlando, FL), and the nearest VA hospital to me (the one I photographed above) is over 70 miles away. That’s a long trip when you’re not feeling so great.

The main entrance of the Orlando VA Hospital
The main entrance of the VA hospital in Orlando, Florida. Built over seven years at an estimated total cost of $620 million dollars. Photo by the author.

The Current Situation and a Personal Story

The 2023 VA healthcare budget has been increased to over $70 billion for what they call “in-house” care (patients seen in existing VA facilities) and over $28 billion for community care. Community care is offered to a veteran when the VA healthcare system cannot accommodate his or her medical needs in a timely manner. I believe that “a timely manner” is now regarded to be 30 days. That is, if you need to be seen by a healthcare professional and the VA cannot schedule a visit within a month, you can be seen by a private doctor in your community.

Again, it sounds good in theory. In practice, it can be as helpful to you as being thrown from a  flaming train wreck. Let me share a little story, my friends. I have serious service-connected neurological issues. For those of you who might not know, “service-connected” means that the condition was acquired as a result of one’s service with the US military. I won’t get into the exact nature of my injuries because that’s not what is important here.

For whatever reason, my regular VA neurologist could not see me for a scheduled visit. Their next available appointment was 4-5 months away. Because that was so far in the future, I was given the opportunity for community care. The VA would set me up with a private doctor close to my home. That sounds like a good deal, right? Read on. At the time, that sounded like a good option because I was having some more serious than usual issues. “Sure, let’s do community care,” I told the VA scheduler. I was told I’d be contacted by their office to set up an appointment. So I went home and waited, and waited, and waited. Imagine one of those scenes from an old movie where they show the passage of time by pages blowing off a calendar. Two months later, I receive a call with the name of the doctor I was supposed to call. His office was only one town over, so it didn’t seem so bad.

I called that doctor’s office and was told the next available appointment for a new patient was 4 months away. I was pissed but not surprised. At least I was getting a specialist close to home. So I scheduled the appointment and waited, and waited and waited like a kid for Christmas. Two days before the scheduled appointment, his office called and told me we’d have to reschedule because the doctor had a family emergency (I would later learn that a lot of these community care docs have “family emergencies”), but I digress. The next available appointment was in three months. At this point, I started counting on my fingers…I waited three months to see my regular neurologist; appointment canceled. Then two more months of waiting for community care scheduling to call me. That’s five months. Tack on another four for the new patient appointment with the neurologist; that makes nine, and just for fun, the other three put it up to 12 months. A full f’n year when we are supposed to be seen within 30 days. And did I mention I was having some disturbing new symptoms at that time?

Then the magical day arrived. It was like Christmas, and my birthday all rolled into one. My condition had deteriorated a good bit by this point, and to say I was excited to be seen would be an understatement. My wife and I drove one town over (I was to the point where I could not drive myself at that time), and we found ourselves in a shady part of town. You know those crappy strip malls that look half abandoned and only have a liquor store, pawn shop, and cheap insurance place? Yeah, that’s where my doc was. The tiny parking lot was full of potholes.

The waiting room looked like something right out of 1974. Everything was old and either burnt orange or avocado-colored. I didn’t much care, though; I wasn’t there for the waiting room. After about half an hour of waiting, a twenty-something guy in a white lab coat came out into the lobby. The young lady behind the counter introduced him to me as John (not his real name). I thought that was odd, but maybe they were just really casual around here.

Not to blow my own horn, but by that point, I’d worked in medicine for a long time. Both on the government and the civilian side. Plus, Uncle Sam put a fair amount of time and training into teaching me how to read people and deal with them on their level. In five minutes, I realized John did not know his a** from a hole in the ground. He wasn’t asking the right questions; he could not answer mine. This frustrated him, and he was not handling it well. His conclusion was that my issues were all in my head, which is actually partially true because I’ve had a traumatic brain injury, but that’s not what he meant. He attributed my very real and thoroughly tested and diagnosed neurological/nerve damage issues to depression and prescribed anti-depressants…that I was already on. Apparently, he hadn’t looked at my medication list.

John was no doctor, but what the hell was he?

I wrapped up our visit and told him I had to go. On the way out, I caught the attention of the administrative assistant sitting behind the front desk doing a crossword puzzle. Out of his earshot, I asked, “Who is that guy?”. “Oh, that’s John,” she replied as if she had not already told me once. “No,” I said. “What are his credentials?”. “He’s a Nurse Practitioner,” she said. “Bingo!” I thought, that explains it. Not that I have anything against Nurse Practitioners, I don’t. I’m married to one. This one, however, did not know what he was doing.

After I got home, I did a little sleuthing; it turns out he had only been an NP for a couple of months. I was supposed to see a legit board-certified neurologist with an unpronounceable name. What I received was substantially less. To end a long story, I went full circle, called the VA and made an appointment with my original neurologist, and saw him just three months later. For those of you still counting, that’s a full 15 months until I got the care I needed.

More Sleuthing

After doing a bit more digging, I discovered that many doctors did not like to participate in the community care program. It had nothing to do with not liking veterans. As with most things in life, it came down to simple economics; the doctors were paid at the lowest tier by the federal government. I believe the amount may have been equal to Medicare reimbursement, but I’m not 100% sure. Everything in that system is constantly changing and shifting. It’s like a great beast trying to find its way through the night, and along the way, some stuff gets broken.

So, should we keep the VA system or scrap it? That’s the $103 billion dollar question. I’ll be 100% honest with you; I always wondered why ex-servicemembers had their own healthcare system. They were now civilians; why not be treated along with the rest of the civilians? It’s not like we are getting world-class care in the most efficient and effective way possible. Like I tell people, “your mileage may vary.” I’ve had truly excellent care from caring and competent medical teams, and I’ve been to medical providers I would not let work on my dog. It’s a real crapshoot. And I don’t know about you, but I don’t like taking chances with my health. Especially as I get older.

My solution, provide qualified veterans with the equivalent of excellent civilian healthcare. Way, way easier said than done.

But it can be done, and I predict that one day it will.