There's a new Veterans' Administration scandal brewing. A McClatchy investigation suggests that senior VA officials falsified report data and issued misleading public statements about the VA's performance on everything from appointment scheduling to medical outcomes. We need to be sure we're getting accurate information about the VA's performance. But more importantly, the healthcare we provide to our soldiers and veterans should be the best in the world. That's a way to honor them for their service, bolster our national security, and help build a better health system for all of us.
We need a high-level and nonpartisan task force to lead a major initiative that will redesign the entire military health system for the 21st Century. This fask force can address the scandals and doubts of the past. More importantly, it can design the military health system of the future.
The Past: Scandals and Questions
These new revelations about the VA's misleading actions need to be investigated. The McClatchy report raises questions about studies that were partially funded and/or co-authored by the VA's leadership, some of which gave the VA high marks for quality of care. There is no reason to believe that VA studies, such as RAND'S are inaccurate, and McClatchy's reporters seem overly harsh in their condemnation of them. Given the questions that have been raised, however, it would be fair to have an independent committee re-evaluate them. It's to be hoped that this review would exonerate the RAND study and its conclusions.
Independent reports also give the VA high marks. Studies by the Joint Commission and these authors have a great deal of credence, given the impartiality and impeccable reputation of their authors. It should be remembered, however, that this kind of research depends on the accuracy of data submitted by the participating organizations themselves. Since there are now suggestions that the VA falsified other data, a research committee should also re-evaluate the accuracy of the raw data used to draw these conclusions.
This is important for two reasons. First, and most importantly, our veterans deserve the best care we can give them. If we've been misled about the quality of care they're receiving, they may need more from us. Secondly, these excellent results are influencing our national debate on healthcare. Writers like Philip Longman have drawn large conclusions based on those results, citing the VA as the model for national healthcare. That idea has drawn support from progressives like Ezra Klein and Kevin Drum.
While I'm not as enthusiastic a backer of the VA model as these writers are, I can see the role a VA-like system might play in a health reform. Before that happens, however, the cloud of uncertainty created by this latest report needs to be dispelled. Otherwise, the health reform debate may be being skewed by inaccurate data.
My Sentinel Effect piece on the VA lists some more analytical concerns I have about the VA's findings but again, let me be clear: I suspect the VA's quality of care was excellent, especially during the years under study. That was before the system was overwhelmed by returnees from Iraq and Afghanistan which the Administration, an onslaught for which the Administration failed to prepare. But I'm not sure about those findings anymore (and I never believed, per Longman, that it was "the best care anywhere.")
Other non-VA scandals have also plagued the military health system, too. The military's attempts to hide and undertreat soldiers with mental health and physical brain injuries, sometimes even sending these wounded troops back into battle, is shameful. So are the conditions at Walter Reed Hospital.
Each of these scandals needs to be investigated. Our soldiers and the American public deserve answers on why they happened, how they happened, and how to make sure they're not repeated. But that's only the beginning.
The Future: The Best Resources, The Best Ideas, The Best Care
We need to move on from fixing the problems, and learn how to create the best military health system in the world. That's why I'm not just calling for investigations. I'm proposing a top-level nonpartisan task force that will evaluate the entire system and propose innovative, sweeping changes.
The task force should include generals, economists, computer scientists, psychologists, social scientists, and other leaders from a broad range of discipline. Perhaps most importantly, it should include veterans of combat in Iraq and Afghanistan. Its mandate should be to evaluate "military health" in the broadest possible terms - as a social network, as a technological matrix, as an economic system, and most of all as a process that involves real human beings who are putting themselves on the line for their country.
The Task Force should study every aspect of military health from beginning to end. It should begin with the recruitment process - how do we attract people to the military? Do we go for the right people and give them the right expectations? From there it should move to the process of performing induction physicals and assigning new recruits their responsibilities. It should study boot camp and training to determine their impact on future soldier health and behavior.
Innovations in battlefield medicine have saved many lives in the past four years, but what can we do better? What have we learned? Are projects like this "virtual therapy" a great innovation or just a confusing mind game for vets? What can we do better in the fields of trauma care, head injury, and psychological wounds such as PTSD? Will electronic health records across all military systems save lives? And shouldn't we increase research funds for head trauma care, rather than being forced to defend current budget levels?
Even the most far-out DARPA research shouldn't be off limits. Do projects like these attempts to turn our troops into transhumanist supersoldiers make sense? What are their long-term health and national defense implications? (For example: What happens when a "super-soldier" develops terrorist sympathies?)
As for psychiatric treatment, we're now facing the problems that arise when atrocities are committed during a time of war. Rather than stigmatize troops with mental health problems, we need to treat them as we would any other wounded vet. As I've said before, "There's a word for soldiers who return from battle with post-traumatic stress disorder or other psychological problems. That word is - hero." What's the best way to give these heroes the care they need?
From there the Task Force should look at care for the active noncombat military, dependent care (CHAMPUS), and veterans. The Task Force project should conclude by looking at the connectivity among all the elements in the military health system, and how they can be improved.
This project should result in concrete recommendations that give our active and retired military the best health care in the world. This isn't a partisan issue (aside from the current Administration's mismanagement). A healthier military means a stronger defense. As with the NASA program, the R&D for this project will benefit the entire nation by resulting in new innovations in administration, medical technology, and patient care. We'll have more accurate information with which to conduct our national dialog about health reform.
Most importantly, we will have done the right thing by our fighting men and women. We need to do that. They've done the right thing by us.
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