Justice for Those Who Serve

Americans observed Independence Day earlier this week, celebrating over two centuries of unprecedented freedom and prosperity with fireworks and barbecues. These 235 years of liberty come at a cost, paid in blood and tears by our soldiers and their families. Regardless of our ideological differences, people of both sides of the political aisle recognize the enormous sacrifice made by our troops.

Our basic sense of justice would seem to require that we honor this sacrifice by providing our soldiers, veterans and their families with special benefits and services. And we do … at least on paper.

Through the Department of Veterans Affairs (commonly known as the VA), current and former military personnel can obtain education and training, employment services, insurance, and low cost loans. Veterans with at least two years of active duty or who were medically discharged due to a service-related injury, may also be entitled to a package of health care services at hospitals and clinics run by the VA. Despite all of these services, however, veterans are more likely to be undereducated, unemployed, uninsured, and homeless. All of these statistics are shocking, but I want to focus on the issue of insurance and access to health care.

Most Americans would probably assume that all veterans can receive medical care through the VA. Despite their service to our country, however, not every veteran is eligible for free medical care. Even if they are, budgetary and resource constraints often limit the type and quality of the care available.

Over the past 15 years, ever since the passage of the Veterans’ Health Care Eligibility Reform Act of 1996, enrollment in VA-supported health care programs has increased nearly three-fold. Even though spending has improved in recent years, primarily in response to the 2007 scandal involving substandard medical care at the Walter Reed Army Medical Center, funding for these VA-supported programs has not kept pace with inflation and enrollment. Worse yet, several politicians have proposed budget-balancing plans that would both freeze health care spending by the VA and reduce disability compensation for over 150,000 wounded and disabled veterans.

Because of these funding limits, treatment is only available for injuries or medical conditions that are directly related to military service. For other illnesses or injuries, care is limited. Veterans are provided treatment for non-service-related conditions only if they fail an economic means test  — meaning they have an income that is less than 80% of average — and only if space at a VA-run clinic or hospital is available.

Waiting lists for appointments at these clinics and hospitals are exceedingly long, even for necessary medical services. Mental health services are a case in point. Despite the dramatic increase in the number of veterans returning from tours-of-duty in Iraq and Afghanistan with post-traumatic stress disorder (PTSD), depression or other combat-related mental illnesses, it can take over four years for a psychologically-wounded soldier to obtain care. Access to substance abuse programs is also difficult to come by, even though combat veterans have exceedingly high rates of alcoholism and illicit drug use.

Rates of suicide among soldiers and veterans have skyrocketed in the last several years.  Active duty soldiers are more likely to take their own lives than to be killed in combat. Similarly, young veterans returning from Iraq and Afghanistan have rates of suicide that are two- to four-times greater than the national average.

All told, over 6,500 veterans kill themselves every year, a fact that the US 9th Circuit Court of Appeals recently attributed to the VA’s “egregious” failure to provide veterans with timely treatment for mental illness and substance abuse problems. In that May 2011 ruling, the court found that the government had violated veterans’ rights to receive mental health care, and ordered sweeping reforms to the VA system. Hopefully those reforms will actually materialize before too many more veterans tragically take their own lives.

Despite their service and sacrifice for our country, nearly 2 million veterans lack access to any sort of medical care. They do not qualify for VA health care benefits, and often can’t obtain or can’t afford private insurance. An additional 15 million veterans obtain care primarily through the VA, or through Medicare or Medicaid. These three programs are underfunded and overburdened, and are currently under attack by budget-minded politicians.

That so many who have served this country lack timely access to basic medical care is appalling. Our veterans deserve better.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on July 7, 2011. It is also available on the WAMC website .]

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About Sean Philpott-Jones

A public health researcher and ethicist by training, Sean holds advanced degrees in microbiology, medical anthropology, and bioethics. He is currently Chair of the Bioethics Department at Clarkson University's Capital Region Campus and Director of the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai, and Director of two Fogarty-funded programs to provide research ethics education in Eastern Europe and in the Caribbean Basin. Until his term expired in August 2012, he served as Chair of the US Environmental Protection Agency’s Human Studies Review Board, an advisory panel that reviews the scientific and ethical aspects of research involving human participants submitted to the EPA for regulatory purposes.
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