Every veteran who has survived catastrophic injury, such as blindness, amputation, spinal cord injury, and severe head trauma, will likely have a lifetime bond with the Department of Veterans Affairs (VA), like it or not. In addition to the specialized care expertise that VA has honed over the years, which is rivaled by very few, if any, providers in the private sector, VA is the only place these veterans can also receive timely access to home modifications, adaptive drivers training, home-based care, peer mentoring, caregiver assistance, and VA claims education and assistance.
Hopefully, this was the most important take away from the listening session that President Donald Trump held with healthcare industry experts at the White House on Monday, February 8th, to discuss the actions necessary to improve healthcare access and quality for veterans. The only way the President would get that message is in the words and experience of Tiffany Smiley, former nurse, now caregiver and advocate for her husband, Scotty, who was injured in 2005 while deployed as an Army platoon leader in Iraq, after a suicide car bomb took his eyesight. Mrs. Smiley was invited to participate in the listening session as the voice of the caregiver and, vicariously, veterans as well — and the best hope for changing a VA system that often appears too broken to save from itself.
While I am sure everyone in the room had listened to her story and expressed compassion for her and her husband's plight, the danger when discussing ways to fix VA has always been the sheer magnitude of a problem that impacts nearly nine million veterans enrolled in the VA healthcare system. When waitlists, understaffing, crumbling infrastructure and breaches of the public trust seem so prevalent throughout the system; it can prove difficult to focus on the relatively few veterans who are most vulnerable or feel the greatest impact: the veterans who rely on VA's specialized services. The difficulty lies in the fact that those specialized services do not exist in a vacuum; they are supported by the primary and tertiary components of the VA healthcare system that are, in turn, supported by the needs of the general veteran population being pushed to the private sector through Choice Care. If general VA healthcare diminishes, so too might specialized care as an unintended consequence.
Whether Mrs. Smiley had the right answer in the room that day remains to be seen. There's no doubt, however, that she raised the right questions to the panel of experts around the table and the President just by her mere presence. How can the private sector fill the void created by failing VA facilities? How do we ensure veterans are protected when seeking care in the private sector? Is the best solution to shift more VA primary care to the community along with a proportional increase in resources, such as nursing staff, shifted to VA specialized care services that serve veterans with unique needs? How do we avoid the pitfalls of fragmented care, particularly for veterans with severe disabilities or mental health care needs?
The only hope for veterans and veteran advocates who want to "make VA great again" is that the experts around President Trump will have the right answers because they will be forced to deal with the right questions, starting with those presented by the experiences of Tiffany and Scotty Smiley that are shared by so many.
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