The Hoops We Jump Through: Obstacles to Veterans and Civilians’ Right to Heal

The Hoops We Jump Through: Obstacles to Veterans and Civilians’ Right to Heal

Veterans protest the deployment of traumatized soldiers. (Source: underthehoodcafe.org)
Veterans protest the deployment of traumatized soldiers. (Source: underthehoodcafe.org)

In financial terms, the Veterans Administration (VA) and commercial insurance companies are totally different. One, a government funded institution, cares for all recently returned and disabled veterans. The other, a market-based approach, offers only the services patients can afford. Nevertheless, patients in both systems are angry. They aren’t getting the services they need. I spoke with veterans and civilians about their experiences in these bureaucracies and discovered strikingly similar barriers to health care. These unnecessary obstructions have inflamed members of both groups into taking action.

On March 23, 2010, President Obama signed the Affordable Care Act into law. The ACA promised to reform our healthcare system, extending coverage to 33 million uninsured Americans. It also requires most individuals to purchase insurance from commercial companies starting in 2014. But frustrated civilians are calling for another solution. Last December in Maryland, three human rights organizations launched the Healthcare is a Human Right campaign. Echoing a successful struggle in Vermont, United Workers, Health Care Now, and Physicians for a National Health Program demand a taxpayer-funded universal health care system to cover everyone in the state.

On October 7, 2010, Iraq Veterans Against the War launched Operation Recovery, a campaign to stop the deployment of traumatized troops. Service members and veterans demanded the right to heal from posttraumatic stress disorder (PTSD), military sexual trauma (MST), and traumatic brain injury (TBI). Two years later, Operation Recovery continues to grow due to successful outreach drives at Fort Hood and Joint Base Lewis-McChord. Under the campaign’s auspices, local chapters have begun addressing the deficits in the Veterans’ Administration healthcare system.

The near simultaneous development of the two campaigns is not surprising. Both reflect the American people’s outrage at being continuously ignored. They imply that healthcare is a basic human need—one that we are as capable of meeting as any other industrialized nation. And both of the campaigns blame the government for failing to meet it.

Graham Clumpner feels lucky—he received a TBI diagnosis two years after his discharge from the Army, three and a half years after the car wreck that damaged his brain. The diagnosis was critical. The VA funds veterans’ treatment for five years after discharge. After that, services cost money, unless the vet can prove a military-related injury and get a disability rating to determine the government’s financial responsibility. This means they need documentation of the injury and their health prior to serving. Unfortunately, the military does not perform MRIs on new recruits. The VA would be unable to see a change in brain function without the careful notes of combat medics who recorded Graham’s accident and loss of consciousness. His eyesight and hearing are another story. The government lost the results of their routine tests on his eyes and ears before service. Rather than give him the benefit of the doubt, they deny his problems have any military connection.

“I’m still fighting with them,” says Graham. “It’s been five years now, and I’m still not covered for my eyes or my ears.”

For other vets, psychological conditions, like posttraumatic stress and military sexual trauma, are difficult to diagnose. PTSD shares symptoms with other ailments, and MST sufferers must prove they were sexually assaulted in the military. When institutions employ such restrictive and inflexible policies, they hinder patients’ access to care.

Commercial insurance companies also maintain strict rules, sometimes with deadly consequences. Rebecca, an administrative worker at a doctor’s office, encountered this tragic situation when her mother was diagnosed with leukemia years ago. A cutting-edge cancer treatment program at Johns Hopkins accepted her, but her provider wouldn’t cover the out-of-state service. An intelligent and determined woman, she managed to force a change after a few weeks of pushing and even writing to legislators. The treatment didn’t work; her mother eventually passed.

Still, Rebecca says, “that’s a few weeks earlier that she could have been treated with a really aggressive cancer. Things like this are specifically designed to wait people out to let them die, so that they don’t pay for it.”

Sergio España, who also lost his mother to leukemia, remembers that his parents chose not to try an experimental treatment over concerns about insurance coverage. Like Rebecca, he wonders how her chances might have changed if his family’s options hadn’t been limited by costs.

Even when institutions approve coverage, baffling structures and protocols can overwhelm all but the most intrepid clients. The VA employs case officers to assist veterans navigating its departments, but each officer may have up to 40 clients at a time, and not everyone gets an officer. Patients often have trouble locating services, and staff have trouble responding.

Former Army sergeant Jacob George recalls his first attempt to access VA mental health assistance. After three tours in Afghanistan, he went to the mental health clinic looking for someone to talk to about his experience. One week later, he sat down with a man he discovered was a pharmacist, who asked several questions and then started writing prescriptions. When Jacob clarified that he wanted therapy, not drugs, the pharmacist replied that he would need another appointment; they typically offer medication first.

Jacob now understands the language he needs to use to get appropriate services, but only after a great deal of self-education about his conditions and the system itself. While he emphatically encourages everyone to take ownership of their own health, he also points out that we can’t expect returning soldiers to have that capacity. “If you have severe posttraumatic stress,” as does nearly everyone who has been in war, “you’re very reactionary. It’s extremely hard to focus, and to think about things in the long-term, then that system is a complete nightmare.”

Civilians seeking help also find themselves in terrifying confusion. Many managed-care policies require referrals—notes from primary care physicians recommending certain treatments. Patients may need appointments with their regular doctors before every visit with a specialist, even for routine maintenance or urgent care. Waiting to get insurance approval for tests, treatments, or durable medical equipment can delay services that medical professionals are otherwise ready to provide.

Rebecca has to stagger her doctors’ visits because her co-pays, $20 for her primary care doctor and $30 for specialists, drive up the cost of care. On top of this, insurance companies sometimes commit paperwork errors—such as losing a doctor’s name or address—that can result in denials. Rebecca is glad her professional knowledge enables her to advocate for herself. Even with her help, many of her patients have difficulty comprehending their insurance plans.

Despite complaints about the VA system, Jake and Graham offered glowing praise for most of the healthcare staff, who frequently go above and beyond their job duties with limited resources and support. Johanna Buwalda, a therapist who serves veterans, says nurses and doctors eagerly cooperate with her, though she is unaffiliated with the VA. She once saw a nurse tech stay hours past her shift to comfort an anxious patient. Because the staff at Chicago’s Jesse Brown Medical Center receive no training on trauma, their nurses’ union asked Johanna to offer voluntary training during staff lunch hours. The same union attempted to hold meetings with patients on how to improve care, but the directors forbade the group to meet at the hospital, fearing that the conversation would reflect badly on them.

Organized people, however, can change the system’s problems. Last year, IVAW and the National Nurses’ Union partnered to demand improvements, and together convinced Jesse Brown’s administration to hire thirteen new nurses.

While civilian groups seek to replace their healthcare system with a new one, veteran organizers focus on improving the VA, not dismantling it.

“It’s a functioning free healthcare model,” says Jacob. “I think that should be available and accessible to everyone in this country. I think we should all have federally funded, free health care.” Anyone who’s lived without health insurance probably agrees.

The changes the two campaigns are fighting for can’t come soon enough. A record 349 military service members committed suicide last year, their mental health needs unmet. Thousands of Americans die each year without proper health coverage. Surely, the men and women who have served our country deserve the highest quality treatment. But we shouldn’t stop there. The United States has world-class health institutions and no excuse not to provide each person in it with world-class care. Our society’s failure to care for our troops is emblematic of our decision to prioritize war and profit over human need. When we demand a different set of values, we will find the resources to cover everyone.