"Can I get a copy of my disability report?" This was from a veteran. My response: no, you can't.
At some point – maybe after the public shaming by folks like Jon Stewart – the government decided to allow veterans who were underserved by the Veterans Administration (VA) to see providers in their local areas. The setup goes something like this:
The VA gives a wad of cash to a private business that sets up a streamlined process to get records to private medical providers. The private medical providers complete a history and physical and render an arbitrary statement of whether or not the health concern could have been caused by or during the veteran's military service. The medical provider writes and submits a report, and two weeks later a check comes in the mail. For psychiatry, the compensation averages $200 an hour. Not too shabby.
But when you look deeper, it's a gross distortion of meaningful, quality health care.
First off, someone in the VA a long time ago thought up the idea of "service connection." It's a fancy way of saying that we're going to parse our military personnel into pieces and only pay for the pieces we had anything to do with." From a purely financial and cold-hearted perspective, it makes sense. Ensuring people are appropriately wounded (I can't even believe I'm writing that) so as to justify us spending money seemingly makes us good stewards of public funds. But service connection implies that separating physical and mental trauma is formulaic and easy and that the veteran can't be trusted to report honest health concerns.
Secondly, veterans go through multiple screenings. I've talked to veterans who have done these screenings, and the trauma of telling and retelling their stories is – I say as a psychiatrist – awful. And to cap it off, medical providers are asked NOT to treat or recommend treatment of any sort.
Then, when you look into the financial realm, it's just as bad. I can guarantee you that while I may have made $200 an hour, the private company with its government contract is making a pretty penny. How much? We'll never know. But I can tell you that between the hourly $200 for the medical provider, multiply that by two or three, and then add the fee the private company takes off the top of the government contract, and you have a VA that doesn't know how to run itself – thereby paying millions to a private company who takes even more money. Happy Veterans Day to you all.
P.S.Y.C.H. means our veterans actually get the care they need, where they want, when they want it, and at a price they can afford. My dad is a Vietnam vet, and since he still lives in my small East Texan hometown, he would rather go to private doctors than VA doctors. Remember, I believe "free" health care actually promotes overuse and abuse. Thus, all people should pay something into the system. For veterans, I recommend an adjustment.
Military P.S.Y.C.H. could house a program wherein part of the military benefit is that the federal government pays 100 percent of a veteran's contribution to the general health fund and 50 percent of any sick visits after their time in the military. (Strangely enough, actively enlisted military folks are treated by the Department of Defense, which has a whole different structure.) This way, the cost of health care would nudge veterans to care for themselves, have financial power to go to whomever they like, and support them for their sacrifice to the country.
I feel sad when I see men and women return from Iraq and Afghanistan and see the devastation in their eyes. If we really cared about our veterans, we'd have a health care system that provided intensive therapy for their psychological trauma. We'd have a system that provided them with case management and helped them get to their appointments. We'd have a system that supported them and helped them transition back into the routine of civilian life. P.S.Y.C.H. can provide all that and more.
So I guess my question is, if you're fine with our current health care paradigm, do you really support our veterans?