Yesterday the president announced that his Secretary of the VA, David Shulkin, was being replaced. I've seen plenty of people lining up against the president to criticize either the dismissal, his replacement, or both. Most Americans, I feel, just want the best for our veterans. I do too. But my experience with the VA was embarrassing. I feel there is not only the need for change, but the need for drastic change. Change that Secretary Shulkin was unable to deliver. I don't think his replacement has the knowledge or skills to run an organization as large as the VA, but I also don't believe that the man at the top is really much more than a spokesperson anyway. So I'm ambivalent about Admiral Jackson. I am willing to give his a fair chance, just like I gave the VA 5 years ago.
Does the VA do a lot of great things for veterans? Yes. Should it be privatized? I have no idea. I like to study and research an issue before I make a decision about what I support, and I have not even scratched the surface when it comes to the VA. All I offer here is my experience as a veteran who tried to give the VA a fair chance.
So what exactly is the VA? It is the Department of Veterans Affairs. They are a federal agency. They have nearly 400,000 employees and operate on a budget of close to $200 billion, about 5% of Uncle Sam's total spend each year. This is separate and distinct from the roughly $600 billion for defense spending, so you can see it's quite the sum. The main purpose of the VA is to operate hospitals and health centers for use by veterans. Most veterans qualify for some form of healthcare through the VA once they exit service, especially nowadays since the "War on Terror" is perpetually going and everyone qualifies for "wartime service." The department does a bunch of other stuff, but providing health care is the main thing.
I left the Army in the summer of 2013 after serving for 4 years. I did not join the National Guard or the Reserves. I did not receive any disability rating, or carry any wounds with me out of the service, either mental or physical. I was actually kind of surprised to find out that I qualified for highly subsidized health care through the VA. As part of my transition, I was guided through the process of registering with the VA. I left the military knowing I could just show up to a VA hospital and be seen, which was somewhat reassuring.
My first job out of the Army offered health insurance. I elected for an HSA plan, because there was an employer contribution each year that actually exceeded the amount of the monthly premiums I would pay. My plan was to bank the money in the HSA for the day when I would not qualify for VA care (I think I qualified for 4 years), and just get all my care through the VA in the meantime. Realizing the importance of the annual well visit, I make an appointment at the local VA hospital about 30 minutes from home for a checkup.
Arriving at the VA, the first thing I noticed was how crowded it was. The parking lot was completely full, and I had to park in an overflow section and walk. The sidewalk was full of vets waiting on rides. The lobby was full of vets waiting to be seen. It was packed. I walked up the the counter and was asked for my VA card. I told them this was my first time, but I was early and I would be happy to sit down to get one. "Sorry," the receptionist said, "but our system is down for ID cards so you'll have to do it next time." Not to worry though! It turns out you don't actually need the card to be seen. Over the next half dozen trips to that VA hospital over as many months, the "Out of Order" sign remained firmly planted on the Plexiglas window for ID card issuance. I never got my card.
The visit with my doctor went pretty well. She asked a lot of questions, mostly centered around mental health and substance abuse, and I don't think I tripped a single red flag. She cut me loose with instructions to get blood drawn, which was right downstairs back in the lobby. I headed down there to find that they are only open during a small window each day. I would need to return later to get my blood drawn.
A day or so later I left early enough to make the window. I waited for a few minutes in the waiting room, and then a cheerful phlebotomist drew about 27 vials of blood. Maybe it was just four. I'm sure it was the appropriate amount. I left.
A week or two later, I get a call. My white blood cell count is low. Come back to do another test. I comply. A week or two after that, no call, and I'm left to wonder if everything is OK. WebMD had me convinced I was HIV positive. Spoiler alert - the private sector has since drawn my blood and confirmed that I do indeed have a white blood cell count that is on the low range of normal. Depending on the guidelines used, it may or may not be abnormal. My current doctor says its probably just the way I am, and is nothing to worry about. The VA never told me that. But I digress.
Well visit in the rear view mirror, I look forward to a year of healthy bliss before I have to brave the hospital parking lot again. But I would not be so lucky. A couple months later, something happens. Now fair warning, this is going to be way too much information. Leave now, or forever be grossed out at what I am about to tell you. Still here? OK then -- I had developed what I believed to be an abscess or a cyst. On my left butt cheek, right by the crack. Now this is actually something that had happened to me before, on my neck. I had an abscess get so infected and so swollen and painful that an Army nurse had lanced and drained it. Besides sticking a Q-tip in your ear, having that abscess drained was the best feeling of my life. So when my ass cheek developed a large red swollen lump that was super painful and tender, I pretty much knew what it was. Once it was clear that this was not going away on it's own, I headed down to the VA.
Now, doctors in general are not the most receptive people for advice on how to do their jobs. VA Doctors are no exception. Despite my best efforts to explain that I had had this exact same experience on my neck and simply wanted the abscess drained, the doctor would not do it. Something about density, infection risk, yadda yadda yadda. So he sent me home with a prescription for antibiotics and instructions on how to do a warm compress and said to come back in 2 weeks if it wasn't gone. I return with the site even more swollen, literally the size of a baseball at this point.
The doctor tells me that yep, it looks like this needs to be drained. I decided to push my luck with the advice giving. "Sir, the last time I had this on my neck, it kept coming back after being drained until I finally had the cyst that it was forming around removed." To my absolute shock and surprise, he agreed! But my joy was short-lived "We could drain it here, but if it turns out to be something that needs to be removed, you'll need that done in our other facility [that was an hour farther away]." I schedule my appointment at that even farther location for their next available date. It was 3 weeks away. Those were an extremely painful three weeks that involved a significant amount of standing.
Finally the day of my surgery arrives. I drive over an hour to an equally crowded and chaotic facility and check in. I am taken to a regular old exam room where a doctor who looks barely older than I am enters with a peer of his in tow. They are surprised to see a patient as young as I am, and inform me that most of the time they work with much older veterans. I'm flattered? Some more small talk and I find out he is in his residency - not even a full doctor. And she is a student. Yay, I'm today's lesson.
I try to advocate for myself and how I'd love to just have the cyst removed and Mr. Dr. Resident tells me that even if it needs to be removed, it can't be done the same day as the area is drained. I'm simultaneously disheartened and enraged at the doctor who misled me at the other facility. So this day would just be a draining, and then I could come back in two more weeks for them to just check to see if there was a cyst to remove. I resign myself to my fate, get hit with two or three local anesthetics, and feel the weird sensation of someone cutting into, tugging, and pressing on an area of your body that just sent its nervous system home for the day. They drain it, stuff it full of gauze, bandage me up, and send me on my way. Now, I don't know if those local anesthetics have an effect on your mental capacities, or if I was just in shock, or if there was something else going on, but in hindsight I was in no shape to drive. Certainly not over an hour back home, this time through rush hour traffic. But I did, and fortunately I didn't hit anybody. That would be the first and last time I would ever go to that facility.
A few days of packing the site and keeping it clean, and it's starting to heal. A few weeks later, and I'm almost back to normal. But then, after the skin heals, the site starts to fill again and get infected. Over Christmas break, at the peak of another swollen episode, I research home remedies for this stuff and discover a product which has an ingredient called Ichthammol which apparently draws this stuff out. I try it and it actually works! The site drains, and I feel 100% better once again.
This cycle of drain, heal, swell, drain continues another time or two and I finally decide enough is enough and I am going to have this taken care of. But instead of going to the VA, I go through my own health insurance. I won't go into the details here, but in a nutshell, I get surgery (under general anesthesia) to remove the source of the problem (which was actually apparently a rogue hair follicle). The doctor sends me for a CAT scan afterwards just to make triple sure it's not something more serious like muscle cancer. The site has since gotten a little irritated from time to time, but I am quick to respond with my home remedies and have kept it out of control and me out of doctors office ever since.
The appointments for the private sector doctors were much closer to my house. The hospital was only 20 minutes away. I was able to get seen much more quickly. Now granted, my total bills were around $13,000 (after insurance "discounts" ((such a scam and a topic for a different day)) I think I was out of pocket about $3000). But the VA wasn't 100% free either - there was a copay for every visit except the well visit. I think I probably sent them $200. But to me, you get what you pay for.
I never went back to the VA after that. I found a local primary care provider, and my 4 years of highly subsidized public healthcare ended last summer. I don't miss it a bit. At the risk of sounding like a pretentious asshole, the VA is simply not intended for people like me. I am a well paid white collar worker with no disabilities who still has all my marbles. The guys crowding the sidewalk at the VA waiting for the volunteer to come back with van to take them back to who knows where? They were older men and women who looked like they had seen much better days. They did not look like the type of people who could turn to private health insurance. The VA is the safety net for them, and I agree that it is vital.
I wish things were better in the VA, I really do. I want the best for my fellow veterans, and I think the VA is far from the best we could offer. As a simple proof, consider this: when someone retires from the military after their 20 years or more of service, they get to enjoy health care coverage at active duty military hospitals. VA hospitals are a breed of their own, and they are not the same places that active duty soldiers or true military retirees go for care. To me, that speaks volumes.
I guess if I want to leave you with anything, it is this... When you think of people who get government assistance for housing, you might think Section 8, and the "projects", right? Not very glamorous... certainly not somewhere you would elect to live if you had other options. To me, the VA is like the heath care version of public housing, but for poor veterans. It is what you turn to when you can't afford anything better. But the moment you can get out of that apartment (or that hospital), you do it, and you don't look back.
I hope my little story adds a tiny bit of depth to your understanding of a very complicated and multi-faceted issue. My experience was in just two locations in a single state five years ago, and I'm sure things are different in other places and other times. There are some disabled vets who get very specialized care which the VA provides better than the private sector ever could. Seek out those stories too. I can only offer my own.
