Reviewed by Bob Bonner
March 20, 2022
Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans by Suzanne Gordon. (Cornell University Press, 2018, 464 pages.)
Suzanne Gordon has written a blasphemous four-hundred-page book that extols the virtues of a health care system based on need, instead of greed. She demonstrates the superiority of the Veterans Health Administration (VHA) provision of patient care compared to a private, fee-for-service model that suffers from fragmentation, unaccountability, uncontrolled cost, and the absence of care coordination.
Gordon makes her case by citing numerous studies by Rand Corporation and other investigators, and by using personal observation and interviews with veterans, VA staff, representatives of the health care union representing most VA workers (American Federation of Government Employees), people in the VA Central Office, members of Congress, and representatives of Veterans Service Organizations. As a former VA registered nurse and local union official I don’t believe there are many people that know more about the functioning of the VA than the author who has spent five years studying its work.
She begins with a short history of the VA but quickly advances to documenting the metamorphosis of a system once mired in bureaucracy and stagnation but now transformed into a dynamic innovator of care that consistently outperforms its private sector counterpart in both cost and patient outcomes. That kind of performance did not go unnoticed by those making their fortunes off private sector care. They quickly organized an army of sixteen conservative lobbying groups to demand the “immediate privatization’ of VHA. Most of the players had received Koch Brothers’ money and they hired former Florida Congressman, Jeff Miller, an old Tea Partier and enemy of VA care, to peddle their case.
Nobody was more disappointed in VA excellence than President George W. Bush (2001-2009) who went after the agency with a vengeance characterized by locking Priority Eight veterans out of the system, and by implementing co-pays, which his administration knew would drive many veterans away. Bush’s attack extended to having Rep. Christopher Smith, R-NJ, removed as Chairman of the House VA committee because he balked at signing off on the president’s anemic VA appropriation.
Ms. Gordon highlights the integration of teamwork into Primary Care, which has been called the” most significant improvement in primary care in the last decade.” She describes it as “primary care as it should be” entailing comprehensiveness, continuity, and concern for the entire patient rather than a single organ system. She writes glowingly of VHA work with blind rehab aimed at helping veterans to function, use prosthetics, manage chronic pain, cope with spinal cord injuries, eldercare and end of life issues, not to speak of its missions of teaching, research, clinical care, and emergency preparedness. Sections on mental health care and PTSD (Post Traumatic Stress Disorder) describe incredible strides in those fields.
She makes observations on VA care of the homeless which we could/should adopt as a society including the declaration that “housing is health care.” Forty-five percent of all homeless are African American or Hispanic. Homeless are more likely to attempt suicide. She describes how the VHA has attacked the problem of veterans that become entangled in the legal system with alternatives to jail, VA Justice Outreach, establishment of 147 pro bono legal clinics in its facilities, 220 veterans’ treatment courts and a system of “collaborative justice”. Not something we should ignore as a country that accounts for 25% of the world’s incarcerated. The VA has accomplished this and more despite being chronically understaffed and underfunded and caring for a patient population that is older, poorer, and sicker than others.
Suzanne Gordon is an unabashed supporter of VA health care as is this reviewer. I am very thankful for her efforts on behalf of veterans and VHA which have not been limited to this publication. I share her fear of privatization due to the powerful forces we face. They would include the sitting president, insurers, and congress members of both parties who pretend that sending PTSD patients to private settings for their fifteen-minute appointment for emotional breakdown, or military sexual assault victims, TBI patients, or victims of exposure to toxins private sector MDs have not even heard of, would somehow produce a better, less costly patient outcomes.
We both ascribe to the belief that instead of Medicare for All, the battle cry should be VA Care for All. As she has said,” Medicare is just a payer”. If I could add anything to what she has proposed it would be that all the internal VA executive boards and committees include veterans.
Beyond that, I would plead with anybody concerned with satisfying our obligation to “care for those that have borne the battle” the state of health care in America, the privatization of public services, and the resultant corruption of government by powerful financial forces, please read this book. Please get involved in the struggle to save a true public asset.
–Bob Bonner is former president of AFGE Local 2028 in Pittsburgh, PA where he represented US Veterans Administration workers.