In the years after my military service in Iraq, I have walked the few blocks from my apartment to the Manhattan Veterans Affairs Medical Center hundreds of times to see my healthcare providers. The hospital, built in the wake of World War II for returning veterans, has provided me with excellent care for everything from emergency room visits and primary care, to specialist visits in dermatology and otolaryngology.
As I shelter-in-place in the American epicenter of the world’s worst pandemic in 100 years, I am, however, worried the VA will be unable to fulfill its missions to care for future generations of veterans or serve civilian sector patients in a national emergency.
The VA is lurching toward privitization, and quality of care is diminishing as a result.
That’s because Congress has steadily weakened the Veterans Health Administration, the nation’s largest healthcare system. First came the passage of the VA Access, Choice and Accountability Act of 2014, then the VA MISSION Act of 2018. Both the Choice and MISSION Acts were supposed to offer veterans more “choice” by liberating us from the clutches of a big government bureaucracy. If I encountered a wait at the Manhattan VA, I would be sent to a private-sector doctor. The process was supposed to be both hassle-free and free of charge and I was supposed to get high-quality care in the private sector. VA Secretary Robert Wilkie assured veterans that the VA wouldn’t be privatized and I’d still be able to get the same quality of care I’d received for the past twelve years.
That’s not quite how it worked out. Until about two years ago, when I would visit the VA, I rarely had to wait more than 15 minutes for appointments in any department. Doctors, nurses and other staff were attentive and earnest. Most importantly, they understood my specific military-related health problems and the way military culture has shaped my life. Private sector doctors, as one RAND Corporation study of New York State providers documented, don’t really understand military culture or veterans’ specific healthcare problems. If an Iraq veteran like myself complains of respiratory problems, they don’t think of burn pits, they think of run of the mill asthma. If a female veteran is having nightmares, they may not ask about Military Sexual Trauma (MST), they may prescribe Ambien.
In all my years of getting VA care, I’ve paid a very minimal co-pay. When I used my Choice card a couple of years ago, I ended up having to pay $1500 out of pocket for a service the VA could have provided at no charge.
The MISSION Act has only made things worse. Because so much money and energy has been devoted to sending veterans to the private sector, there has been little left to fill the 50,000 vacancies at the Veterans Health Administration. When I recently visited a gastrointestinal specialist, I experienced the results of this staffing shortage. The waiting room was so full that patients were sitting on the floor and spilling out into the hallways. Some were waiting up to 5 hours for their appointments. The doctors and nurses were clearly overwhelmed and had to turn patients away to return at a later date. Now, the VA in Manhattan is being asked to admit civilian patients because private hospitals are even more overwhelmed.
When I worked in the Army’s geospatial intelligence service, we mobilized a vast array of geographic data to provide detailed and accurate mapping products of Iraq to ensure the safety of my fellow servicemen and women during combat, rescue and humanitarian missions. It doesn’t require a background in military geo-urbanistics to see the cliff we are hurtling towards. The nation’s private healthcare system, which has always had trouble coordinating patient care and collaborating rather than competing, is at the point of collapse and Manhattan’s major medical centers are dependent on help from the VA, not the other way around. In one of the great ironies of this pandemic, civilian patients are finding the VA, not the private sector, is in some cases, their only choice for emergency or hospital care.
In New York City, they say things are slowly getting better. Many problems will, however, persist even after we have a vaccine and/or effective treatments for COVID-19. Nor will COVID-19 be the last threat we encounter. The VA will once again be called upon for help. Will it be able to respond? How will the VA be able to care for the thousands, perhaps millions of veterans who have lost their jobs and their health insurance due to this pandemic and who find that the VA is their only reliable healthcare provider?
This should lead Congress to challenge the wisdom of efforts to privatize the VA rather than strengthen and improve it. It is incumbent on President Trump and Secretary of Veterans Affairs Robert Wilkie to do everything in their power to save American lives — veteran and civilian alike — by making sure the VA is fully funded and staffed. Revitalizing the VA through a repeal of much of the MISSION Act and other deleterious legislation should be a top priority for lawmakers moving forward. We need to use all the resources at our disposal to prepare for the next epidemic and the VA is a central element of that response.
Essam Attia is a veteran of the US Army who served in the Iraq War. He is a visual artist who lives in Manhattan and is active in the Veterans for Peace, Save Our VA campaign and Common Defense.