A Matter of Priorities

         I remember in Animal House, a classic movie, (show your college age kids as a training film - just kidding) when the lads screwed up and were placed on "double secret probation." Of course the secret was that no one knew what the rules are. I'm finding the same wall of silence/secrecy in my current quest for data  prior to writing a planned essay.

        The essay will undoubtedly anger some readers, who only consider planar data and can't or won't think dimensionally. The topic is the Veteran's Administration, and the still present carping about wait times, etc. I find myself a bit torn here, simply because I had an uncle by marriage and a brother, both of whom served less than four years in the military, both of whom were discharged with absolutely no service connected disability but both of whom passed away while under the VA's care. There is no question that either one received anything less than the best possible care. In the uncle's case, it was hospice care, and  in my brother's case it was several cancer  surgeries, chemo and radiation therapy. My contention, however, is that neither should have been a VA patient.

       Right up front, I say this because I believe they both should have been recipients of Universal National health care, but that's a subject for another time, and one which actually, I have rehashed several previous times on FaceBook and in my blog. Not all countries maintain a distinct veterans’ health care system. In England, for example, veterans obtain care through the National Health Service (NHS) like everyone else. They have priority when there is a waiting-list for services, and there are some programs within the NHS to address veterans’ special needs, but there is no separate system.

       My concern with the VA is based on a simple proposition: That we should provide, in fact that we owe, every service person who was injured while in the service of the nation, care related to  physical or emotional issues connected to that service for as long as they live. Meanwhile, The Department of Veterans Affairs' Office of Inspector General on July 27, 2016  confirmed that more than one-third of the people thought to be seeking eligibility for VA benefits are deceased, and said many of them have been dead for more than four years! First, we must look at what is, before discussing what should be.

       World War I ended in late 1918 , and after the cheering died down, several things became apparent in the USA. The Wilson administration had no clue and no plans for how to cope with returning service personnel returning to the civilian workforce. Even as the war continued , in 1917, there were violent race riots in St. Louis  and other northern industrial cities,  as blacks who had willingly migrated North to fill wartime jobs were pushed out when white workers struck. The result was worthy of the KKK at its worst. Post war, major problems at the end of the war included labor strikes, more race riots, and a lag in the economy due to farmers' debts. The Red Summer of 1919 saw an increase in violence in over two dozen cities, as returning veterans (both white and African-American) competed for jobs. In the 1920s, anti-Communist sentiment rocked the United States, as some activists pointed to this economic misery as capitalism's legacy.

       While World War II was still being fought, the Department of Labor estimated that, after the war, 15 million men and women who had been serving in the armed services would be unemployed.  Roosevelt and VP Harry Truman were both well aware of history and understood ,as well that there would be about 3 1/2 times as many returning veterans after armistice was signed with Germany and Japan, than after WWI.  To reduce the possibility of postwar depression brought on by widespread unemployment, the National Resources Planning Board, a White House agency, in June 1943 recommended a series of programs for education and training. This  became the Serviceman’s Readjustment Act and sailed through Congress. The bill unanimously passed both chambers of Congress in the spring of 1944. President Franklin D. Roosevelt signed it into law on June 22, 1944, just days after the D-day invasion of Normandy.

        Most simply called it "the GI Bill of Rights,” as it offered Federal aid to help veterans adjust to civilian life in the areas of hospitalization, purchase of homes and businesses, and especially, education. This act provided tuition, subsistence, books and supplies, equipment, and counseling services for veterans to continue their education in school or college. It also kept those in college out of the work force! Over the following 7 years, approximately 8 million veterans received educational benefits. Under the act, approximately 2,300,000 attended colleges and universities, 3,500,000 received school training, and 3,400,000 received on-the-job training. The number of degrees awarded by U.S. colleges and universities more than doubled between 1940 and 1950, and the percentage of Americans with bachelor degrees, or advanced degrees, rose from 4.6 percent in 1945 to 25 percent a half-century later.   

        Of course, as many will have realized by now, this is unrelated to the VA. I only point it out for the casual reader who may never have considered the difference. The point to be made here is that the GI Bill was a "temporary" (although some features still exist) fix to a temporary problem .

       The Veteran's administrations and predecessor entities is an ongoing program of support. How ongoing, you ask? Post Revolution and war of 1812, some states voted pensions for vets of those conflicts. My own great grandmother was the last surviving widow to draw a War of 1812 pension when she died in, believe it or not, at the age of 104 in the early 1930s! In 1890, Congress enacted a new law that paid a pension to any Union veteran of the Civil War who served for at least ninety days, was honorably discharged, and suffered from a disability, even if not war-related. In 1904, (Republican) President Theodore Roosevelt, himself a veteran of the Spanish-American War, ruled that old age itself was a disability(!), thereby increasing the number of eligible veterans for pension payments.

       At its peak, the Civil War pension system consumed approximately forty-five percent of all federal revenue and was the largest department of the federal government (other than the armed services). One reason for this was the political power held by Union veterans’ groups like the Grand Army of the Republic (GAR), which had been founded in Illinois in 1866.After the Civil War, a succession of Republican presidents continued awarding not only (Union) Veterans, but widows of veterans, and even adult children of veterans  a series of increasing pensions, in what everyone knew was a massive vote getting scheme.

        The first national effort to provide medical care for disabled veterans in the United States was the Naval Home, established in Philadelphia in 1812. This was followed by two facilities in Washington, D.C. -- the Soldiers’ Home in 1853 and St. Elizabeth’s Hospital in 1855. Post WWI in 1921 Congress created the Veterans’ Bureau to consolidate veterans programs managed by three agencies — the Bureau of War Risk Insurance, Public Health Service and the Federal Board of Vocational Education.

        President Hoover, in his 1929 State of the Union message, proposed consolidating agencies administering veterans benefits. The following year Congress created the Veterans Administration by uniting three bureaus — the  Veterans’ Bureau, the Bureau of Pensions and the National Homes for Disabled Volunteer Soldiers. The new agency was responsible for medical services for war veterans; disability compensation and allowances for World War I veterans, Army and Navy pensions; and other minor issues.  From 1931 to 1941, the number of VA hospitals  increased  from 64 to 91, and the number of beds  from 33,669 to 61,849.

        Now that we have the data, here's my "take" on it. We (Congress) have continually expanded a program which was originally intended to take care of persons who served in the military, most of them draftees during some expansion phases. The original mission, primarily the care of veterans with service connected medical issues and/or disabilities, has grown to include people who should, in my opinion, not be the government's responsibility  after separation from the military. Again, before you get angry, these  are not people, with disabilities or medical conditions which in any form are related to their military service!

       The first group, and one which should seem obvious, is those persons who served several years and for whatever reason decided to leave the military. If these persons have no service connected disability or on- going medical problem, there is, in my opinion , no reason that we should be responsible for them for the next 50 or so years. The idea that we are all responsible for a two year member who leaves the service healthy and then, after smoking for forty years, develops lung cancer is beyond my comprehension. That was precisely the case with my uncle.  A working life after service of 45 years ought to leave an individual with healthcare safeguards. Of course, at present this group still includes some draftees who were forced to serve. I would recommend that since we are now in an all volunteer era, those who enlist as a career choice should have no more or no less than any other employee of any other organization, that being, if injured and separated with a disability  -  full health care under at the VA for life. If separated without disability - a year at most of  health insurance  coverage, unless, of course that  VA re-evaluation determined that the former member's current medical issue is, in fact, service related, not simply a poor lifestyle choice.          

        The second group, of which I am a member, is the relatively large group of military retirees (with no service related health issues at time of separation) who have Medicare and Tricare (a superb Medicare supplement) who also, by law, pay Medicare part B, and yet, for whatever reason, go to VA facilities for routine medical care, even though their coverage would allow them to go at no cost to any doctor they choose in the community. This is especially troublesome in  areas with high concentrations of retirees, such as Florida and Arizona. (Here comes the hard to find stuff, and, in my opinion, the real reason the VA is jammed with "customers.")   Florida had over 7% of the veteran population in 2013. What troubles me is that the number of VA Health Care System enrollees who are actually disabled (as defined by the VA, which is very liberal with 10% disability ratings) is far fewer than half of the total Florida veterans enrolled and receiving services. Let's rephrase that: Some, if not most,  of those clogging the VA Health Care System , especially military retirees, have other healthcare options as a result of their service which, if used, would free up more needed beds, appointments, consults, etc. Of these, as of 2010 in a nationwide VA survey of all veterans,  40% using the  VA clients had Medicare, 39% had in force employer or other insurance, 7% had Tricare or other, and  just 9%  of those seen by the VA were indigent or had no insurance !

       If even one service related disabled vet ( physical, emotional, whatever) can't get help, it's a national disgrace. The system has bloated to proportions which were never intended. In a final fact barrage, consider this. It is now possible for a retired disabled veteran to get Social security disability, full retirement pay and full disability pay all at the same time!   

        While most Americans aren’t able to collect Social Security disability payments if their income is at least $13,000 a year,  Social Security rules don’t treat military retirement or VA disability payments as regular income, which means veterans can collect tens of thousands of dollars from the Pentagon and VA and still get money from Social Security.  With the Social Security Disability Insurance trust fund predicted to run out of money in two years, this fact raises serious  questions about whether disability benefits are getting to those whose livelihoods depend on them. The VA says it “generally agrees” with a recent GAO  report’s conclusions, while . Social Security officials had no comment.  Social Security’s disability trust fund is expected to run out of money in 2016, and  cracking down on double dippers could help extend the program’s life somewhat.

About 3 percent of military retirees collect all three benefits right now, GAO investigators said. Most of them have a VA disability rating of 50 percent or higher, though just 17 percent of the disabilities are combat-related.  Of the $3.5 billion spent in 2013 on the triple dippers, $1.4 billion came from the VA, $1.2 billion came from the Pentagon, and $937.4 million came from Social Security.

        As for the individual veterans, the GAO identified 101 who earn more than $150,000 a year in triple-dip benefits. Another 2,200 veterans earn between $100,000 and $150,000. Investigators pulled seven cases at different benefit levels for further study, and in all but the lowest two, the veterans were making more as retired disabled than their salaries would have been if they’d still been in the service! Remember, this is cash in hand, medical care is esentially free for these persons!

       A 54-year-old who retired in 1997 after 20 years in the military, who had lung disease, vascular disease and lost use of his feet (non-service related and non-compliant diabetic), collected $122,887 in benefits (plus free medical) in 2013 — nearly three times the $43,808 someone of his pay grade would have made in the military. Meanwhile, a 59-year-old who retired in 2004 after 26 years, who lost his feet (diabetes again), is blind in one eye and has renal problems, collected $152,719 in 2013 — more than twice the $72,824 salary of someone at his final military pay grade. Most of his benefits — $85,958 — came from VA disability, while $46,396 was military retirement, and $20,365 was from Social Security.

        Both these men as retirees, whether their disability was service related or not,  have better health insurance than most of us will ever have. It seems to me that something is wrong when the way to make more money is to get sick.

        I reiterate, this isn't about disabled vets whose disability is in any remotely connected fashion, service related. It is primarily, simply my assertion, based on what data is available, that there are a significant number of persons using VA medical facilities who should not be, for reasons I enumerated in the essay.

        If you disagree, please comment, but please be objective. For those who don't know me, as a reminder, I am a 26 year veteran  retiree who uses Medicare and Tricare, even though we have a VA clinic where I live. I do so because I believe the VA was designed for persons who need it, not those who consider it as just a convenience. And finally, and a partial reason for writing this,  I do know people who do use the VA yet have two retirements (one civil service, the other military retirement)  and  have Medicare and Tricare, yet go to the VA taking up staff and Physician's time and resources.