How Well Does the U.S. Care for Its Veterans? An Expert Weighs In

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By Beth Saulnier

As an undergrad on the Hill, Suzanne Gordon ’67 was an avid antiwar activist who opposed U.S. involvement in Vietnam. Today, she’s a prominent researcher and journalist covering veterans’ affairs, with a focus on healthcare.

Titled Our Veterans: Winners, Losers, Friends, and Enemies on the New Terrain of Veterans Affairs, it explores how serving in the military can impact people, and the issues that many former servicemembers face in rejoining civilian life.

Says the New York Times in a capsule review: “This chilling account explores the physical, economic, and psychological consequences of military service on veteran health and takes a critical look at the many players involved in shaping veteran life in the United States.”

You and your coauthors aren’t veterans; why devote your work to veterans’ affairs?

It's ironic, because I'm an antiwar activist; I’m very concerned about the human cost of the military adventures we get into, but we must care for the people who serve in them. To me, it's an outrage that the politicians who support these wars don't want to pay for their human consequences. Veterans’ benefits should be included in any decision to engage in combat—but many in Congress refuse to give adequate money to take care of the people who sacrifice for us.

And this book was a collaboration with veterans; it couldn’t have been written without the many who shared their experiences with us. We spent years talking with veterans, hanging out with them, going to VA [Department of Veterans Affairs] hospitals with them. So I see our book as reflecting the realities of the veteran experience.

What are the most common misconceptions about veterans’ issues?

There are so many. First of all, I don't think a lot of people understand what a veteran is.

How do you define a veteran, then?

Many people think a veteran is someone who was in combat. But I define it the way we do in the book: anybody who served in the active-duty military. Another common misconception is that all veterans are eligible for benefits. In the VA, access depends on the status of your discharge, whether you have a proven service-connected disability, or whether you have a sufficiently low income.

Also, a lot of people think the only injuries that people in the military have are due to combat. But the military is a series of very dangerous occupations, even if you never leave the continental U.S. People always talk about “combat veterans,” but the problems that veterans have are not just from combat.

People always talk about 'combat veterans,' but the problems that veterans have are not just from combat.

What do you see as the major issues facing veterans?

There is a mental health crisis and a debt crisis, with predatory lenders near bases and even on naval ships. One in four women in the military experience some form of sexual harassment or assault—including rape or even murder.

But fundamentally, one of the biggest issues is that society often blames veterans’ problems on the VA as opposed to the root cause, which is unsafe practices in the military that could be changed.

Obviously, you need a force of arms to defend your country. But you don't need to send people into elective wars. You don't need to make the harms worse, like with burn pits and faulty equipment. And you certainly don't need to expose women—and even some men—to sexual trauma.

In the book, you underscore how much we fund the active military compared with support for the personnel who served in it. Could you talk about that?

The Department of Defense budget rises and rises; politicians fall over themselves to give the Pentagon more money. But when it comes to the VA and the budget for healthcare or benefits, it's like pulling teeth. They may raise the budget, but grudgingly, and it’s never enough.

For example, almost four million veterans have been impacted by various toxic exposures during various wars, including burn pits. Senate Republicans almost killed the bill that would have expanded coverage for many of the military personnel who suffered from burn pits and other toxic exposures.

And again, “It's too much money.” You see this constantly—since the Revolutionary War.

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Speaking of the Revolution: one striking takeaway from your book is how shoddily the U.S. has treated many of its veterans since its founding. How so?

Obviously, if you're in combat, people are going to shoot at you or bomb you; there are certain things you can't prevent. But there are others you can prevent, and the military does not do enough to do that.

You mentioned that benefits depend on how someone is discharged. How does that work?

You can't get access to benefits if you have an “other than honorable” discharge—and since 1980, 600,000 people have received these discharges and don’t get VA benefits, even though they have serious mental or physical problems.

People who have a traumatic brain injury or PTSD and self-medicate by getting drunk and then get into a fight—they’ve received these punishing discharges. Many women who reported sexual assault by a higher-up have received this kind of “bad paper” discharge.

You’ve written extensively about the virtues of the VA healthcare system. Why do you admire it?

Study after study shows that the VA delivers better care than a profit-driven system, by almost every measure—from mental health to cancer care to chronic disease management.

That’s because it's a national system that’s integrated, with electronic medical records and physicians, nurses, and other staff who work in teams. They communicate—they don't just put notes in a record—and talk about complex patients.

And veterans have complex problems. When the average 65-year-old goes to the doctor, they have three to five presenting problems; the average Vietnam vet has nine to 12.

What about the headlines about crumbling VA facilities and months-long waits for an appointment?

The picture of the VA as antiquated, with long wait times and so forth, is the product of a decade or more of propaganda, funded by ultra-conservative foundations and think tanks, and increasingly supported by the hospital industry, because they want to tarnish its image.

And the reason is very simple: money. They want the tens of billions of dollars that we spend on the public sector to go to the private sector.

How has ending the draft changed who becomes a veteran?

Since 1973, we’ve had an all-volunteer military—but many call it an “economic draft,” where poor people are drawn to the benefits. Increasingly, recruitment campaigns place less emphasis on patriotism and more on a good job, healthcare, and a college education.

We increasingly recruit from certain areas of the country—the South, Southwest, and Mountain West. It becomes almost a family business: your granddad and dad were in the military, and now you are. So the consequences of this all-volunteer army is a huge civilian-military divide, where the burdens of service are not equally shared.

Since 1973, we’ve had an all-volunteer military—but many call it an 'economic draft,' where poor people are drawn to the benefits.

Overall, what are some potential solutions to the issues we’ve discussed?

We need people in Congress who support a more judicious foreign policy—one that doesn't see taking up arms as the solution to every problem—and who question the huge expenditures on the military at the expense of everything else, including the care of veterans.

We need to have a real debate about our country's priorities and how we spend our money. The very fact that we use economic incentives for recruitment from poor communities should tell us that we need other ways to help those communities resolve their economic and social problems.

We need to bring veterans, not just traditional veterans’ service organizations, into the debate and try to solve this military-civilian divide—so veterans don't feel excluded, but feel they really are part of the American community they have served so well.

Top image: Illustration by Cornell University

Published August 18, 2022

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Comments

1. 

   Alisa

   23 Aug, 2022

   I have not read the book.
   As a physician, I think there are major concerns with the healthcare that veterans receive (that could be better assessed perhaps by interviewing doctors currently outside of and with insight into the VA system).
   While I agree with some of the criticisms, this should not be a platform for arguing for one political party over another as is apparent from the commentary. Throwing money at an issue doesn’t solve the issue! (And voting down a bill might just mean the money is badly allocated in a proposal!)
   Providing for non-government-controlled services, including healthcare in a competitive private market, would do more to solve the problems and inequalities that veterans face.

   Reply
2. 

   Stone Quillian, Class of 1979

   23 Aug, 2022

   Haven’t read the book yet myself, but as a 31 year USMC veteran who, since retirement, has worked for the Defense Health Agency, I’ll note that adjudicating (eg, figuring out what!??) disability benefits is a vexing issue. As an example, apparently so many veterans has service connected obstructive sleep apnea that the VA has noted that they might need to look at how often they award that. Another vexing issue is how the financial compensation is calculated – it’s a function of one’s retirement pay, not the worth of the individual or economic cost of the disablement.

   Reply
3. 

   Lawrence William Raymond MD, ScM

   24 Aug, 2022

   I plan to read this timely contribution but in the meantime, wish to call attention to the mutually beneficial roles of VA hospitals and medical students and other trainees, especially the “Dean’s Committee” facilities, like the W. Haven VAMC where I once worked. Long live the VA and those whom it serves!

   Reply
4. 

   Kathy Matson

   8 Jan, 2024

   I am dumbfounded by the recklessness of our leaders who neglect accountability for the true costs of war: the human factor. I’m anti-war AND respect the men and women who serve honorably at the risk of personal harm and/or death. Veteran suicide due to lack of services is a travesty. Veterans who have to wait months and years for services is unexcusable. People are not pawns. To all veterans and their families: thank you! Many will respond in humility, from hearts that value freedom for everyone. I wish I could do something more to dignify your service!

   Reply

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