“To care for him who shall have borne the battle and for his widow and his orphan.” (Abraham Lincoln, Second Inaugural Address, 1865)
Since 1946, the Veterans Health Administration has had a hand in the education of Americas physicians. According to Veterans Administration (VA) statistics, 36,747 medical residents, 20,516 medical students, 239 fellows, and 1,267 dental residents and dental students received some or all of their clinical training in one of Americas VA medical centers in the year 2010.
Our veterans have served bravely to protect our freedoms; they have served – sometimes unknowingly – to better the health care of all Americans by helping to train our nations doctors. This post, a diversion from our typical scientific endeavors, represents a tribute to our veterans. The prescription outlined below calls on the VHA to fully embrace the spirit of those words spoken by Abraham Lincoln during his Second Inaugural address.
Currently, the VA provides eligibility for a select group of veterans. Highest priority veterans are military retirees, recipients of the Purple Heart, and those with service-connected injuries and medical conditions.
Many veterans remain ineligible for benefits or face expensive co-payments to receive services. In this era of decades-long wars fought by volunteer soldiers, we should re-examine the values we place on the care provided to our service members. While in the active military, service members are entitled to health care at military medical centers around the world or through TRICARE, an insurance plan that allows members to receive care in the private sector. However, once outside of the military, veterans may not have guaranteed access to the Veterans Affairs medical centers despite having conditions affecting their to physical and mental health. A 2007 study showed that 1.8 million veterans were uninsured. The percentage of working age veterans that were uninsured at that time was over 12 percent. Expanding the figure to include members of veterans households found that 5.6 million remained uninsured.
The authors of that 2007 study (founders of the group, Physicians for a National Health Program) supported opening up VA Medical Centers to all veterans to eliminate this problem. At Policy Prescriptions, where we believe that our nation ought to adopt a universal health care system focused on continuity, affordability, and access to quality care, expanding access to VA medical centers to all veterans seems a moral imperative.
Veterans health care is subject to annual budget appropriations and therefore is not considered an entitlement. Therefore, the VA may arbitrarily restrict access to care to veterans of lower priority in favor of other veterans. In fact, this has happened in the past. In 2003 a freeze was placed on enrolling Priority 8 (non-service connected, non-poor) veterans. Relaxation of this freeze, by lifting the income threshold, began in 2009.
The President and Congress should make the policy choice to eliminate the enrollment restrictions on current veterans once and for all. What seems simple would be to make veterans health care contingent on only two things: serving out a minimum military service commitment and successfully obtaining an honorable or general discharge (i.e. a discharge other than dishonorable).
It should not matter if a soldier sustained an injury during conflict or if upon return to civilian life that veteran earns an income higher than his or her colleagues. What should matter is that he or she volunteered to protect American freedoms. On becoming a veteran, he or she should be entitled to nothing less than access to adequate health care.
How much would it cost to insure all the remaining uninsured veterans? A simple calculation of all the uninsured veterans multiplied by the average cost of a health insurance plan in todays marketplace would give a price tag near $9 billion.
Are the American people no better than the owners of the National Football League? Nine billion dollars just happens to be the same figure that has had owners and football players mired in a lock out for over 2 months. Certainly our veterans mean more to us than $9 billion does to a bunch of millionaires and billionaires.
Therefore, we urge the Congress to pass laws that entitle all our veterans access to health care through the nationwide network of VA medical centers.
Cedric Dark, MD, MPH