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Enlisting in the cause heralded by the Partnership for Veterans Health Care Budget Reform, the American Federation of Government Employees (AFGE) launched a nationwide radio campaign urging Congress to provide full, mandatory funding for veterans health care. In the ad, AFGE urged the presumptive Republican nominee for President, Sen. John McCain, to support this effort.

“As the nation’s highest profile veteran and a ranking member of the Senate Armed Services Committee, Sen. McCain now is in a position to do something that will have long-range impact on the health care of his fellow veterans,” AFGE President John Gage said. “AFGE strongly feels that recent proposals by Sen. McCain are misguided.”

Sen. McCain’s proposals are simple: Give veterans vouchers to receive care at private, for-profit healthcare facilities. That move, according to AFGE, which represents thousands of VA employees, would be tantamount to dismantling the Veterans Health Administration. If implemented, it could very well mean the beginning of the end of the Department of Veterans Affairs.

Many veterans living far from VA Medical Centers or community-based outpatient clinics do have a legitimate beef in accessing care. Yet right now, one out of every ten healthcare dollars spent by the VA goes outside the system in what is known as fee-basis care. This is understandable. What is not understandable is the logic behind Sen. McCain’s voucher plan.

“That would be the end of the VA,” AFGE member Phil Glover says in the ad. It would mean “the end of the promise and the start of a huge boondoggle for big corporations.”

“While it has been argued that the VA has not been responsive to the growing needs of the burgeoning veterans’ population, many of the shortfalls can be directly attributed to a lack of funding,” said J. David Cox, AFGE national secretary-treasurer, a former VA nurse. “Vouchers could cripple the system by diverting much-needed funds away from veterans’ health care.”

We couldn’t agree more with Cox. VVA and the other VSOs have expended much time and energy to help transform the VA healthcare system into perhaps the finest integrated managed care system in the world. While we understand the frustrations of some veterans who live far from VA facilities, a wholesale system of vouchers will not benefit them. Rather, it will result in less care for a lot more money.

The lessons of Iraq, where privatizing services such as transportation and providing food and fresh water has led to waste, corruption, inefficiencies, and egregious costs, ought to be a red light to any who would seek to reform the VA through privatization.
Sen. McCain needs to meet with, and listen to, the VSOs. His promise of vouchers could derail his campaign among veterans and their families.

The VA continues to refuse to complete the re-survey of the original participants in the National Vietnam Veterans Readjustment Study, which was done more than twenty years ago, even though it is mandated by law. If this was done, we would have a good picture of the chronicity of PTSD and of the psychosocial long-term effects of service in Vietnam, and we would have a robust mortality and morbidity study of Vietnam veterans.

With the second study of the same participants, and a review of the death certificates of those who are dead, we would have an immensely valuable longitudinal study that would allow policymakers to plan properly for the health care that will be needed for Vietnam veterans in the future, and it will also be invaluable in planning for the proper shape of health care for those fighting today.

The VA refuses to do the study and thumbs its nose at the law. It is the view of VVA that public officials do not get to pick the laws they obey. It is our view that these officials are violating the public officers’ oath they took when they act in a lawless manner like this.

For the VA to maintain that the methodology used in the original NVVRS is “controversial” because one hired hand at the American Enterprise Institute says it is, can only be compared to saying that the fact of the Holocaust carried out by the Nazis is “controversial” because a few right-wing nuts say it is.

Further, we cannot abide the increasing secrecy of deliberative processes at VA, particularly by the secret, closed-door meetings of the Advisory Committee on PTSD and the mostly secret deliberations of the Advisory Committee on Serious Mental Illness, coupled with memos that say “Shhhhhh!” in regard to letting real numbers on veteran suicides become public, even to Congress.

This includes the now infamous memo from a program chief, directing clinicians at the PTSD program at Temple (Texas) VA Medical Center not to take the time or effort to properly diagnose PTSD, but to instead give it a made-up term that is not even a diagnosis.

All of the above, plus the VA’s continued refusal to treat the veterans community as a serious partner in the process of addressing serious problems with the systems for delivering healthcare and for adjudicating claims for service connection, bespeaks of a patronizing behavior that would be unacceptable in any case, but is certainly unacceptable in light of the increasing failures of the VA.

It is time for the VA leadership to take patients and veterans’ advocate leadership seriously. It is time for the VA to uphold all of the laws of the United States, and way past time for the VA to start holding its officials, managers, and supervisors accountable.

In a most welcome surprise, some two dozen GOP senators broke rank to vote for Virginia Democratic Sen. Jim Webb’s S. 22, the GI Bill for the 21st Century, solidifying an overwhelming 75-22 margin of victory for the bill in the upper chamber. By the time you read this, the GI Bill should be the law of the land, despite the President’s vow to veto it.

President Bush, who is always praising our brave young women and men in uniform, is not being true to them in opposing this legislation. S. 22 is the right thing to do for those who have been promised an education. It will allow veterans to attend college and no longer be forced to go to work rather than go to school. It is a bill that Vietnam veterans should have had, but never did.

A wrong will be righted when S. 22 becomes the law of the land.

“The hardest thing for me to do,” one of our colleagues said, “is to give up smoking. That’s harder than losing weight, and harder than beginning an exercise regimen.”

Because smoking is heavily involved in the top four causes of death in this country, and because helping veterans to kick the habit can improve their health, the VA, thanks to the initiative of Dr. Bopper Deyton, has funded the work of the Committee on Smoking Cessation in Military and Veteran Populations, under the auspices of the Institute of Medicine.

At its meeting on June 2, the committee heard testimony about why active-duty troops and veterans smoke and what the military services and the VA are doing to encourage people to quit. Keith Haddock of the University of Missouri discussed the “social pull” of smoke breaks. Smoking, he said, “is one of the only reasons a member of the military can take a break or leave a duty area.”

Haddock and the other presenters discussed the lure of smoking as well as methods that are effective in encouraging smoking cessation. Unfortunately, there is no overriding policy on smoking in the military; there are, in fact, 218 different policies concerning tobacco use.

Col. G. Wayne Talcott, who discussed Air Force policies and procedures for tobacco use control, opined that a “top-down buy-in” is needed to meet the challenge of how to promote “a tobacco-free lifestyle and culture” in the military.

On the VA side of the ledger, Dr. Tim Carmody, who runs multi-level smoking cessation programs at the VA Medical Center in San Francisco, promoted the creation of a Center of Excellence for Tobacco Use Cessation. W. Clint McSherry, his colleague at the VAMC at Perry Point, Maryland, noted ongoing budgetary constraints in funding programs for tobacco control. He also decried the attitudes of too many VA employees who smoke.

But it was VVA’s Tom Berger whose impassioned plea to the committee really resonated. If you want to know why active-duty troops and veterans smoke, he said, talk to them. Go over to Walter Reed Army Medical Center and Bethesda Naval Hospital and meet with the newly wounded and those who have been recuperating for a year or more. Spend some time with them, if you want to be enlightened.




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