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No Health Care System is Perfect: But I'll Take VA Health Care

By Jack Mallory

I'm a Vietnam vet. I've gotten my health care through Vet Centers and VA Medical Centers for the last ten years, when I retired, left for-profit care, and became a VA patient. I've also got nearly 2,500 hours in as a volunteer at one medical center where I staff the information desk and transport wheelchair patients to their appointments.

I've seen VA health care from these perspectives. As an academic, I've also looked into the quality of VA health care quality through readily available secondary sources like Phil Longman's Best Care Anywhere and Suzanne Gordon's Wounds of War.

Discussions among vets about VA health care often devolve into individual stories, frequently complaints, about specific cases and/or claims that "The VA doesn't give a shit," or "The VA's just waiting until we're all dead." This, of course, feeds the privatization frenzy. I've tried to provide them with alternative info in the form of the statistics that show VA health care to be as good or better than "civilian" care in many areas—see the books referenced above. But numbers don't seem convincing to non-academics, so when The Veteran asked me to contribute my experiences with VA care, I decided to stick with my personal story.

As an "uncompensated employee" at the VA Medical Center, I have the chance to observe interactions between patients and staff (about a third of whom are vets) and shoot the shit with patients myself. I get a feel for the culture of VA health care. Watching those interactions, I see almost entirely respect, care, and professionalism. Vets tell me they like, or love, their VA health care because they feel respected, cared for, and treated professionally.

The first time I walked into my Med Center, I saw an employee dealing with a WWII vet in a wheelchair with obviously sincere concern, compassion, and affection—far beyond the practical requirements of the situation. I had the feeling that if I lived to 90+, I might expect the same kind of care. (To provide complete transparency, that employee has been my significant other since shortly after that event, 6 1/2 years ago!)

And the culture of VA care is something that could never be replicated in a for-profit setting. Vets, of all ages and eras, understand each other, know how to speak to and support each other. Vet humor, likely unacceptable outside the VA, is a huge part of that culture. I had a great bullshit session with a patient awaiting a fitting for a glass eye a few weeks ago: We brainstormed ideas about designs—an American flag? Eagle, Globe and Anchor? (a Marine, obviously)? Trump's face, just for shock value? Maybe a mirror, so others would see their own faces in it? Not a likely conversation elsewhere else. Plus the usual when were you in, who were you with, were you ever at Fire Base _____? A patient brought me an 11th Armored Cav hat just as a thanks-for-volunteering gift last week! The VA provides a level of cultural comfort we'll never find at our local doc-in-the-box clinic/hospital.

I've had the good luck to be pretty physically healthy. Most of my VA care has involved treatment for PTS and associated issues. I've had four therapists: Two great, one good, one useless. The useless one was a Vietnam vet, whose expertise and therapeutic focus was on getting his patients up to 100% disability. Currency, not care.

The two great ones were women who had never been in the military. The first, whose name I'll mention because she died a few years ago, was Carol Ahern. I know several vets at the Hooksett, NH, Vet Center who will tell you that Carol kept them alive, others that say she saved their marriages, through their work with her. When I was part of her PTS group, some of the vets had been working with Carol for 10 years or more. I've been working with the other woman for three years; I'll leave her name out because I haven't asked if I could share this. I decided that the best way to describe the quality of care I receive from her is by sharing a letter that I wrote:

"Dear ____,

I've been asked to write you a kind of "attagirl!" letter for your retreat/training whatever it is. I'm honored to do that.

Vets are an untrusting lot, or at least that's true of many Vietnam vets I know. We don't much trust society in general, the government, the VA, and clinicians in particular. It is, I think, a symptom of both PTS and moral injury. For a therapist to win a veteran's trust is not an easy accomplishment.

You've done it. You've earned my trust, and from what I've seen in the PTS and Moral Injury groups you have won the trust of all of us. Veterans whose service spans several wars and several decades seem to have concluded that you can be trusted, that you have our best interests in heart and mind. How have you convinced us? What has worked?

I see it as the result of four processes. You listen. You understand. You care. And you respect us enough to learn from us.

Like a good teacher, you spend more time listening than talking. You ask questions, you prompt, you bring the answers out of us rather than telling us the answers. We often don't know what's going on inside: our conversations with you help us make that clear to us.

You are clearly knowledgeable enough, from both training and years of working with vets, to understand what we tell you—I suspected that when you and I first talked about Jonathan Shay's work. If you were familiar with Jonathan's work, you were not only knowledgeable but even likely to be a decent human being! You understand the military culture and the tactical situations which have created our experiences. When you don't understand, you ask for clarification, but it's rare to see you surprised. This creates a feeling of safety in group and individual sessions—we're not about to shock you, to trigger some kind of condemnation.

And while you are a clinician (what an awful word!), you aren't clinical. You care about us, as veterans generally and as individuals. That care is evident in every interaction: the handshake, the smile, and the eye contact at the beginning and end of every session. We're often looking for any hint of insincerity to justify our mistrust. Your sincerity is obvious. And, in a society in which real caring for veterans seems rare, and among some vets who themselves don't believe the government/VA really cares, it's incredibly important for vets to see that someone does.

As an educator, I know that the fact that you learn from us as much as we learn from you is enormously important. It shows that you are open to new ideas, new understanding. You are growing in what you do—the next time I, or any other vet, walks through your door we get an even better counselor. A session with you is an opportunity for us to understand ourselves better, and an opportunity for you to understand vets better. It also shows that you respect us as sources of that new understanding. We aren't just "patients," or "clients," but people who interact with you as fellow human beings: a conversation rather than "therapy." Again, as a lifetime teacher, I can look back on my time in the classroom and value the immigrant students who taught me so much about their lives and their importance as young, new Americans. I think I can sense the same thing going on in your mind vis-a-vis veterans. I loved those students; forgive me if I think you love us as veterans.

Can there be anything more important than re-instilling trust in those who no longer trust the people or institutions they live amidst? I can't imagine that there is. You do that, ____, and I thank you for it."

____ does this work because she cares about us as veterans, not because the VA pays her bigger bucks than she'd make in private care. And I'd far rather be treated by someone who cared for me, who did it because she believed it was worth doing than someone who did it for the bucks.

I'm not claiming that ____ is an average VA employee, clearly. But I hope that by passing this letter on it will convey the appreciation this vet—like many vets a pretty suspicious, mistrustful, skeptical individual—feels for the effort, the expertise, and the understanding that she, and VA health care generally, represents. Keep our health care in the VA, improve it within the VA, and keep it out of the for-profit system!