In early November, PBS aired a program it’s billing as a ‘documentary.’ But unless there is some critical post-production editing, VA: The Human Cost of War is anything but an honest portrayal of the nation’s most successful and largest coordinated health care system.
While the film has big ambitions, promising to explain how the VA “came into existence, how and why it has changed over time, how it has come to be broken in critical ways in recent generations and how it may be reformed going forward” it conveniently cuts from scene to scene, absorbing some facts while discarding others to fit its predetermined narrative. And although it promises to be comprehensive, it fails to cover even a sliver of the VA’s real story in its less-than-an-hour runtime.
The film will be released at a particularly perilous period for America’s veterans. Congress is currently deliberating whether to further shave away Veterans Health Administration resources and critical care programs in order to outsource services to the for-profit healthcare industry.
A veteran and Fighting for Veterans Healthcare board member was invited to an advance screening in Los Angeles and reports that the film left her head spinning. How had the production team gotten it so wrong?
Here are five big ways the film misses the mark upon the first viewing. The film:
1. Employs a simple narrative to explain the incredibly complex wait list scandal
VA: The Human Cost of War only examines the wait list crisis through the lens of salacious media reporting. What was the cause of so many veterans waiting for care? According to the film, we’ll never really know.
It never mentions crucial elements to the whole story. It never:
- Highlights the chronically high number of VA caregiver vacancies which left fewer doctors with more patients.
- Mentions the unrealistically high standards VA set for itself that pushed medical centers.
- Questions why Congress did not provide the VA with the resources it needed (and requested) as American troops were deployed in the War on Terror.
- Explains the role of politically-motivated organizations like the Koch Brother Network-funded Concerned Veterans for America (CVA) that pounced on the scandal in an explicit effort to defeat Democratic lawmakers at the polls.
The unprecedented politicization of America’s veterans is rarely mentioned in mainstream media that reference CVA. But don’t be fooled – one longtime military reporter said “In my 37 years covering veterans’ issues, I have never seen veteran issues used more cynically or politicized more thoroughly than during the past several years”
That’s not all that filmmakers failed to put in their docu-drama.
2. Ignores the Reality Behind Veterans’ Suicide
The film latches on to a well-known and tragic statistic: on average, 20 veterans die every day due to suicide.
It never mentions that the VA’s approach to preventing suicides is more comprehensive than is commonly found in the community, that the VA’s innovative clinical use of suicide predictive analytics has no community counterpart, or that veterans who receive care from the VA are far less likely to commit suicide than veterans on the outside. According to data from 2014, rates for those outside the VA continue to skyrocket.
The film also ignores that nearly every Veterans Health Administration employee is trained to recognize potential warning signs. No matter where you get care in the VA, whether it’s your physical therapist or primary care physician, at-risk veterans rarely go unnoticed or untreated.
And, more cynically, the film focuses on one tragic story of a veteran to propel the action forward.
3. Misrepresents Who Decide Which Veterans are Eligible for VA Care
The Department of Veterans Affairs is tasked with reviewing and approving or denying health care claims and service for veterans. They’re instructed to rule on the side of veterans as often as possible, but they don’t make the rules.
VA eligibility is largely determined by two bodies: the Department of Defense and the United States Congress.
When a veteran leaves the military, their discharge status determines who is eligible for veteran benefits. Veterans who have received a ‘less than honorable’ discharge are often excluded from getting the help they need. That’s true even if their discharge was because of behavior directly related to the trauma experienced on the battlefield.
Congress could remedy the situation if it wanted, but would be forced to allocate funding to care for many more veterans than are currently served. Lately, Congress has tried to correct past inaction, but you could say it’s a work in progress.
4. It Doesn’t Show the VA’s Unique Care Model
To make matters worse, the film’s casual explanation of the VA’s three distinct services does a disservice to the coordinated care model that’s unique in American healthcare. Their attempt at an apples-to-oranges comparison leaves the viewer distraught and plays to our culture’s obsession with supposed bureaucratic dysfunction.
Most Americans are forced to compete for health care – whether we recognize it or not. We compete for appointments, are forced to choose between different drugs because of cost, and have to choose between our preferred doctor and that which insurance says we can visit. And, this process often takes days, weeks, and more often than not, months. And most of us fill out the same form, over and over.
At the VA, the coordinated care model ensures that veterans have access to a team of doctors that actively engage each other on individual cases. If the VA’s primary care physician determines the veteran needs to see a cardiologist, that veteran will often be able to simply walk down the hallway for their next appointment.
One of the major problems of the current VA Choice program is that care is incredibly difficult to coordinate once the private sector gets a hold of a veteran.
5. There’s No Comparison with Non-VA Care
If the film wanted to make an apples-to-apples comparison, it should have looked beyond the VA. There is not a single instance in the film where the VA is seriously measured against the private sector.
Here’s what they missed:
- Wait times at the VA are better or as good as those in the private sector.
- Health care at the VA is better or as good as that in the private sector.
- The VA is able to negotiate lower prescription drug prices than the private sector, leading to more savings for the patient.
- One in five patients at the VA sees a physician on the same day they make an appointment.
- For patients with cardiac conditions, the mortality rate at the VA is lower than it is in the private sector.
- Because of its integrated care model, diabetic patients at the VA are care for and coached to care for themselves. They respond significantly better than diabetic patients than those on private insurance and on Medicare, who are left to navigate the complications of diabetes on their own.
- Medical errors in American hospitals are the third leading cause of death behind cancer and heart disease.
This list may be expanded upon a repeat viewing of VA: The Human Cost of War. But one thing is for certain – to date, the mainstream media has rarely captured the full scope of veteran’s health care system. When watching, you may want to keep a copy of this book and this magazine article, next to your remote.