I’ve long been bewildered by the extensive negative news coverage of the Department of Veterans Affairs, where I formerly worked and continue to get all my medical care. My confusion does not stem from a misplaced belief that there are never problems at VA medical centers: human error is virtually unavoidable, and in a system that serves over six million patients a year, it seems inevitable that some of them will have negative experiences. Nor is it because I don’t believe in the value of journalists and members of Congress holding VA accountable: I fully recognize the benefit of oversight for continual improvement. Rather, my puzzlement stems from the vast gap between the relentlessly downbeat media stories and the data showing VA consistently out-performs other sectors of care in quality, safety, effectiveness, timeliness, and other measures – despite serving an older, sicker, and poorer population – at lower cost.
Those interested in an in-depth exploration of America’s largest integrated health care system would be well-served to read Suzanne Gordon’s paean to the Veterans Health Administration, Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans (Cornell University Press, 2018). Gordon brings the deeply valuable perspective of someone who has many years of experience reporting on the broader healthcare landscape to this project. Unlike short pieces by journalists who must cover multiple beats in a competitive media landscape, she has the background and depth to move beyond superficial coverage using VA’s self-reported data to compare individual VA facilities to one another, and instead takes on the far more complicated task of assessing VA in comparison to other care systems on a wide range of topics, from primary care to suicide prevention to geriatrics. Crucially, Gordon also identifies ways in which VA improves health care for all Americans, such as by training 70% of medical residents and conducting tremendous amounts of research – which has resulted in advances including the nicotine patch, implantable cardiac pacemaker, and best care practices implemented nationwide.
Gordon explains how VA has been at the forefront of implementing best practices ranging from integrating mental health care into primary care, interdisciplinary pain management, providing training and supervision on challenging treatment modalities like prolonged exposure (PE) therapy, and more. She explores in depth the unmatched rehabilitation support VA provides to enhance functioning among veterans with spinal cord injuries, impaired vision, and amputations. And Gordon highlights the non-medical services that VA provides to connect veterans experiencing homelessness or legal problems with vital resources. Interwoven in the data she gleaned from her documentary research are the voices of both VA health care providers and veterans receiving care at VA who she interviewed at sites across the country, which keeps the text engaging and accessible for lay readers. Additionally, she intersperses the topical chapters with short, in-depth profiles of people whose passion for serving veterans is inspiring: a VA volunteer, a neurologist learning cognitive behavior therapy, an occupational therapist exploring how bikes or nature can improve outcomes, and Memphis police officers developing a new crisis intervention model with local universities and VA.
There has been a significant push in recent years to dramatically increase the amount of care veterans receive in the private sector – pressure that has increased under the current administration. Gordon examines whether this is realistic, ultimately concluding it is not. She cites a survey of 15 metro regions that found an average wait time to get a first appointment with a physician was up to 24 days – compared to five days to see a VA primary care doctor. The situation is worse in rural areas and mental health care: the private sector does not have the capacity to absorb millions more patients. Gordon also addresses little-known components of the VA system that privatization is unlikely to replicate, such as its system for managing disruptive behavior (unlike in the private sector, where providers “can and routinely do ‘fire’ patients who are uncivil, threatening, or physically violent,” VA is required to provide the full range of medical services to eligible veterans). And she brings into sharp focus the reason we know so much about the very real challenges admittedly VA wrestles with: the required transparency that comes with being part of the public sector, “accountable to Congress and the public for administrative errors, personnel failures, or clinical mistakes, in a way that the health care industry in general is not.”
By the concluding chapter, readers are likely to be convinced that VA is “a system worth saving.” We are currently at risk of slowly decimating the VA, a uniquely strong system that provides top-notch care to a population that carries a heavy health burden. Veterans deserve a system that can provide high-quality, comprehensive, integrated care for their war injuries, which VA delivers. Gordon’s excellent volume demonstrates why we must not only fight to keep it strong, but should even use VA as a model for completely revamping America’s profoundly broken health care system. Rather than buying into anti-government, pro-privatization rhetoric, all those who want our servicemembers to be able to access top-notch care once they leave the military would be well-served by reading Wounds of War and pushing back – hard – on the insidious attacks on VA, an incredibly successful government agency that makes a profound difference in the lives of millions of Americans.
About the author:
Suzanne Gordon is an award-winning journalist and author. She has written for The New York Times, The Los Angeles Times, The Washington Post, The Atlantic, The Nation, The Washington Monthly, The American Prospect, The Globe and Mail, The Toronto Star, JAMA, The Annals of Internal Medicine, The BMJ, and others. She is the co-editor of the Culture and Politics of Health Care Work series at Cornell University Press.
Suzanne is the author or co-author of 11 books including Life Support: Three Nurses on the Front Lines, Beyond the Checklist: What Else Healthcare Can Learn from Aviation Teamwork and Safety. Her latest book is The Battle for Veterans’ Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care. She is an Assistant Adjunct Professor at the UCSF School of Nursing and an Affiliated scholar with the University of Toronto Faculty of Medicine’s Wilson Centre. With Lisa Hayes, she has written a play about patient safety and teamwork entitled Bedside Manners. Suzanne is the Senior Policy Fellow at the Veterans’ Health Care Policy Institute.
About the Reviewer:
Kayla Williams is currently a Senior Fellow and Director of the Military, Veterans, and Society Program at the Center for a New American Security. She is the author of the books Love My Rifle More Than You, a memoir of her time in the Army, and Plenty of Time When We Get Home, about her family’s journey to recovery after her husband’s combat injury.