Too Expensive and Not Sustainable?

BY PETE PETERSON, GOVERNMENT AFFAIRS CHAIR, AND STAFF

There is a whole bevy of artificial turf “grass-root organizations” pushing hard to dismantle the VA health care system (VHA) and privatize medical care to veterans even though they know that to deliver the same core medical case management and coordination of quality services now offered by VHA would start at a level of at least $140 billion a year in the private sector.

Congress would be appalled at the increased cost of private sector care over care provided by the VA. Much of this expensive care treats individual health issues unlike the VA, which cares for the whole veteran. Besides, the private sector is overwhelmed and can’t handle an infusion of veterans. It would be fiscally irresponsible to put veterans into the general market.

Additionally, there would be no overall case management, and the problem of having an integrated medical record is still not solved. The same cries about VA compensation and pension being unsustainable are based on the assumption that the country can’t afford it because the U.S. is somehow broke.

Well, the United States is far from broke. In fact, the U.S. continues to be the richest country in the world, and the richest country ever in the history of the world.

Many veterans and their families may want to ask how, if the U.S. is broke, why are we moving toward the greatest tax reduction ever for the richest people who need it the least?

Having just put sixteen years of the most costly war in U.S. history on a credit card, why is Congress demanding that veterans pay cash for needed services by cannibalizing existing veterans programs?

That does not mean VVA believes that we can never sunset a veterans program if it is truly not needed, or if it is not fulfilling its purpose in an effective or efficient manner.

Far from it. VVA has been the most insistent voice in Washington for the last forty years demanding meaningful accountability from the VA as an institution and meaningful accountability from VA executives who in the past were rarely, if ever, held accountable for misfeasance or just simply doing a disgracefully bad job.

The Secretary and his team now have the tools to hold the VA management accountable, if the Secretary and his team will only use those tools.

What is a “veteran”?

Title 38 of the Code of Federal Regulations defines a veteran as “a person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable.”
This definition suffices for the purposes of VA health benefits and services. At least it’s supposed to.

In November, in accordance with a law passed by Congress in July 2015, the VA commenced offering new ID cards for veterans who do not interact with the VA. But these cards are not available to every veteran. Why? Because VA officials made the irresponsible decision to issue the new IDs only to veterans with an honorable discharge, even though individuals with so-called bad paper do, in fact, meet the legal definition of “veteran.”

The new ID cards will provide proof positive of military service. Veterans who are registered with the VA for health care and other benefits already have a valid VA ID and do not need a second one.

Because the legislation authorizing the cards was an unfunded mandate, and because the VA did not want to saddle veterans with having to pay out of pocket for the card, they initiated a public-private partnership with Office Depot. This office supply store will print the cards in return for an acknowledgment on the back of the card.

To get a new ID card, the veteran—the honorably discharged veteran—must request one on the VA’s website and must present a copy of his or her DD-214 “or other official document from the official military personnel file of the veteran that describes the service of the veteran.” The law does not specify excluding veterans with an other-than-honorable discharge.

The VA has yet to offer any insight into the reasoning behind its decision. This is another slap in the face of hundreds of thousands of veterans who left the military with bad-paper administrative discharges. Many, if not most, of these men and women had years of honorable service before running afoul of some rule or regulation, or getting caught smoking a joint, or having some conflict with an officer or senior NCO.

What is not taken into account is the reality that such a veteran may have been suffering from undiagnosed and untreated mental health issues such as PTSD or TBI, anxiety, or major depression.

Minor insubordination or drug use renders these men and women ineligible for a host of VA benefits and health care.

Kris Goldsmith, who founded High Ground Veterans Advocacy, expressed the dilemma faced by OTH veterans: “I find it incredibly frustrating, and deeply hurtful that the VA would deny hundreds of thousands of veterans like me our very identity, after all that we know today about the nexus of PTSD and bad paper.”

There are two types of individuals who claim usually clandestine military service: legitimate veterans who enhance their resumes in part because their assignments while in uniform were not very exciting and did not make for heroic stories; and those who either never served a day in uniform or whose service was terminated because of poor performance or the inability to embrace military service.

They too often manage to fool others, such as community leaders hungry for a hero to lead a parade or address a throng of citizens on Veterans Day, and members of the media who violate the norms of good journalism by not checking out the bona fides of some poseur, imposter, or wannabe.

One of the most recent frauds in the roster of ignominy is one John Garofalo. He was identified by Fox News as a “Purple Heart recipient who taught himself the art of glass-carving.”

Fox featured a story about this highly decorated Navy SEAL, veteran of Vietnam, recipient of two Purple Hearts. The hook to this story: Garofalo had hand-carved a presidential seal that he wanted to present to the president.

Fox, it seems, had been snookered. Turns out that Garofalo’s claims were untrue.

“The fact is that he did not serve in Vietnam,” Fox said in a statement. “He was never a U.S. Navy SEAL. Even though he showed us medals, Garofalo was not awarded two Purple Hearts or any of the other nearly two dozen commendations he claimed to have received, except for the National Defense Service Medal.”

The Navy Times detected something fishy in Garofalo’s claims. They did some real research and some real reporting. They revealed that Garofalo has been falsely portraying himself as a SEAL and Vietnam veteran for years. While he did serve in the Navy at a base in Virginia and in Rota, Spain, between 1963 and 1967, his sole decoration was the National Defense Service Medal.

He is only the latest of thousands who make false claims of valiant service performed, of medals and commendations awarded, including the nation’s highest award for valor, the Medal of Honor. One legitimate Medal of Honor recipient exposed more than five hundred liars, men (and a few women) who claimed to have been awarded the MOH.

Some impostors like Garofalo live their lie for years, feted in their communities for their heroic service. Some manage to hoodwink the VA to receive disability compensation amounting to thousands of dollars before—and if—they get caught.

Among the telltale signs of a poseur, fraud, or wannabe are a discrepancy in age, e.g., a 50-year-old in 2017 who claims to have served in Vietnam, an individual who claims that his clandestine service was so secret there is no record of his exploits in his military files, someone who dresses up in a uniform with ribbons festooned over his left breast that are out of order; one whose DD-214 contains inconsistencies, or who refuses to show others his real DD-214.

As a result of congressional action, the Department of Defense publishes an online list of recipients of the Medal of Honor, the Distinguished Service Cross, and the Silver Star. Organizations of Army Rangers and Navy SEALS also publish lists of legit members of their confraternity—along with “walls of shame” of those who have been caught in a lie.

Although attempts to repeal and replace the Affordable Care Act have been put on hold for now, consider how such a repeal would affect health care use among VA patients.

In 2013, prior to the major coverage expansions under the ACA, nearly one in ten nonelderly veterans was uninsured, lacking access to both VA coverage and non-VA health insurance.

Uninsurance among nonelderly veterans fell by an adjusted 36 percent after implementation of the ACA, from 9.1 percent in 2013 to 5.8 percent in 2015.

By increasing non-VA health insurance coverage for VA patients, the ACA likely led to a decrease in demand for VA care.

The demise of the ACA, should this occur, would likely increase the number of uninsured nonelderly veterans and further increase demand for VA health care.