Veterans Counting on Trump to Get Their Health Care Right

Long wait times, poor accountability, worker shortages — why the Shulkin nomination is key

by Jo Kline Cebuhar | Updated 13 Jan 2017 at 10:41 AM

Deadly delays in service. The falsification of records. The harassment of whistleblowers.

The mismanagement and corruption within the Veterans Health Administration in 2014 was a top-of-the-hour, front-page story. A few administrative heads rolled, even a few really big ones. Then — crickets.

Little has changed for veterans over the past two-plus years.

The wait for first-time applicants into the VA averages 389 days. There has been scant agency accountability; veterans' care remains a "high risk" issue, according to a new report by the Government Accountability Office (GAO) — and whistleblowers are still being targeted. President-Elect Donald Trump has promised a thorough housecleaning of the VA and is committed to giving our veterans the care they deserve.

With those goals in mind, here are a few observations for the just-nominated secretary of veterans affairs, David Shulkin, the current under secretary of health for the U.S. Department of Veterans Affairs:

It's partly about the numbers.
In 2014, Congress created the Choice Program, a band-aid that shifts qualifying veterans to non-VA providers as an alternative to delays and limited access. Policymakers may now be tempted to further reduce VA programs, knowing the overall number of veterans has been shrinking since 2001. That's true — but during that 15-year period, the number of health system enrollees increased by 78 percent, and over 1 million members of the military are expected to separate from service in the next few years.

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Veterans have an increased risk for dementia. Agent Orange exposure and Parkinson's disease are now connected, and baby boomer veterans have a Hepatitis C infection rate five times that of other veterans.

What will they find if they do venture outside the VA for medical care? First, they'll be among the 10,000 baby boomers who turn 65 every single day and are already competing for services. And it's not just the consumer side that's undergoing dramatic changes. Boomers are providers as well as patients. The worker shortages now plaguing the entire health care industry will continue — in a big way.

In four years, we'll need 27,000 more physical therapists than we now have and by 2030 we'll have unfilled jobs for over 900,000 nurses and 90,000 doctors. Potential delays and limited access are not exclusive to veterans and should be prompting a nationwide evaluation of impending needs throughout the health care system.

Veterans have unique health care needs.
Providing care for our veterans is about more than just accessibility. We don't know enough about the impact of multiple deployments or the passage of time on veterans' service-related physical and mental health issues. We do know, however, that veterans have an increased risk for dementia due to post-traumatic stress disorder and traumatic brain injury, that Agent Orange exposure and Parkinson's disease are connected, and that boomer veterans have a Hepatitis C infection rate five times that of other veterans. As this population ages, the demands for treatment and care that accompany chronic diseases will escalate. Are we ready for that?

The Veterans Health Administration is presently serving only 42 percent of America's veterans. For the other 58 percent, less than a third of the non-VA providers they use fully understand how to refer a veteran to the appropriate VA specialist. Are community providers prepared to recognize and treat the unique physical and mental health conditions of those who seek care outside the VA system — by choice or otherwise?

The U.S. has a duty to honor its commitment to veterans.
Finally, the paramount reason to give veterans our very best is not a function of demographics or funding. It is America's duty to honor its commitment to veterans, which dates back to 1775, even before we were a free and independent nation.

Over the past 240 years, 1.1 million Americans have made the ultimate sacrifice and another 1.4 million have been wounded while protecting our freedoms. Our veterans deserve no less than the heartfelt thanks of a grateful nation and the respect and dignity of competent, comprehensive, and compassionate health care. Simply put — continuing to fail our veterans is no longer an acceptable option.

There is much work to be done, should you be confirmed, Dr. Shulkin. Thank you for accepting the challenge and may God be with you.

Attorney Jo Kline Cebuhar is the author of books on medical decision-making and the meaning of legacy, including "The Practical Guide to Health Care Advance Directives."

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