Sunday, May 22, 2016

Another Government Agency in Distress

From: The American Legion Magazine, June 2106

More than medicine
By Joseph J. Frank

Until the land mine went off, it was a pretty routine assignment. I was directing a truck loaded with sandbags to a bridge site at Tam Ky, in what was then South Vietnam. The road from base camp to the river had been swept for mines, but the truck swerved left, off the main path. There was an explosion, but I didn’t hear it. The next thing I remember is lying flat on the ground, sensing my legs were still in the air. A medic was immediately upon me, pushing painkillers through my skin, to go along with numbing shock. Strange thoughts entered my mind. Someone was giving me last rites. Was I dead? No, I did not think I was dead. Then I heard the beat of Huey blades in the tropical air. 

I will never forget the date. It was Jan. 14, 1968, 48 years ago – the height of the Vietnam War. I had begun that day as a strapping young soldier in the Army’s 39th Engineer Battalion (Combat). It was the last morning I would rise and feel my feet hit the ground beneath me. 

I came back to the United States paralyzed from the chest down, a T4-5 paraplegic. The hardest part of a spinal injury, for many of us, is psychologically accepting the reality that no matter how hard we try, we’re never going to get up and walk again. The human brain is not easily convinced of this and continues, almost involuntarily, to attempt to solve a problem for which there are not yet any medical answers. 

For me, this new and different life began at the Hines VA Spinal Cord Center in Chicago. There, I had doctors and counselors who understood not only my condition but my context. Healthy soldier one day and paralyzed veteran the next, I had suddenly returned to the United States to begin the yearlong rehabilitation from an injury in a war that most Americans misunderstood or hated. Some would look at me and see an illustration of political viewpoints I did not necessarily share with them. 

In a ward with 32 other paralyzed veterans I learned to get dressed in the morning, take care of myself, operate my wheelchair, keep my upper-body muscles strong and drive a vehicle without the use of lower limbs. I also learned what it means to have health-care services specific to my status as a veteran, delivered in the company of others who have served in uniform. As a young veteran in need, I realized that VA care is a cherished benefit reserved only for those of us who pledged our lives to defend our nation. It’s something we get in return for what we have given.

As the VA privatization movement rattles through Washington heading into the fall elections, I think back to that year I spent at Hines. After I got used to my wheelchair, I started helping other paralyzed veterans in the ward as some had done for me when I arrived. I made several discoveries that first year of major adjustment, and those discoveries have guided my career as a champion for veterans and people with disabilities alike. 

I discovered, for instance, that veterans need caregivers who understand the post-military journey, whether we are looking for relief from post-traumatic stress disorder, trying to figure out a new prosthesis, hunting for a job, filing a claim, buying a house or getting checked for hepatitis C. As an American Legion member, and later as a counselor and service officer in the St. Louis VA system, I also discovered why it’s important to be both a constructive critic and a tireless advocate of VA health care. We address the system honestly and demand improvements when needed because VA health care belongs to us, the veterans who use it. Too often today, I find that the biggest supporters of VA privatization are not VA patients at all. Many are not even veterans.

Too often, veterans’ criticism of VA has been misinterpreted as condemnation. And our calls for change and reform within the system have been erroneously translated into a perceived demand for its transfer to the private sector. The American Legion has supported the 2014 Choice Act and its provisions only as a temporary measure for veterans whose VA facilities are unreasonably distant or overbooked. The Legion opposes permanent use of non-VA providers, as well as expansion of vouchered care to the private sector, for a number of relevant economic reasons, including lower average cost per patient – but there’s much more to it than that.
More importantly, VA consistently outperforms other providers in terms of patient satisfaction and quality. That was certainly the case for me in VA’s spinal cord program, which is superior. A VA health-care provider is far more likely to know where to turn for answers on claims applications, disability ratings adjustments, or college and career help. VA health care is more than medicine. It’s a network of people – providers and patients alike – who care about veterans in ways non-VA medical practitioners can’t be expected to understand, let alone provide. Why would we ever want to take this benefit – a health-care system that understands the context of our lives as veterans and can help us in multiple ways – and hand it off to private providers whose quality probably ranks lower and cannot fully understand our needs and the services available to meet them? Outsourcing is only preferable when veterans have no other choice, such as those who live in rural areas distant from VA facilities.

I was honored to serve on the presidential committee of people with disabilities that brought into existence the Americans with Disabilities Act (ADA), which improved the lives of millions and continues to do so. Not only did the ADA open doors and make upper floors accessible to people who use wheelchairs, it changed perceptions. I remember vividly that, in 1968, children were often frightened by wheelchairs. Today my grandkids want to ride on mine. My work on the ADA, and its success, proved that revolutionary positive changes can be accomplished even when dealing with the federal government, and greater understanding can be achieved on a bigger scale about people outside the average U.S. demographic, like those of us who use wheelchairs and military veterans.

The year I was elected national commander of The American Legion, Congress passed the Veterans Health Care Eligibility Reform Act of 1996, which opened up VA to all who honorably served our nation. Priority groups were established to ensure that those with the greatest needs and service-connected conditions would move to the front of the line should demand exceed capacity. As demand grew and capacity did not, today’s access problem understandably arose. The movement to expand privatization because we haven’t solved the access-demand problem seems to suggest that veterans don’t deserve the quality care we fought to achieve in our VA system. Now that quality is great, we will need to go someplace else. That’s pretty hard to accept, regardless of your service-connected disability rating.

A couple of years ago, I went back to the Hines VA center, where this journey began. This time, I was on a completely different mission, conducting an American Legion System Worth Saving site visit. The chief of the center met our group there, and he brought with him a yellowed file from 1968. It was mine. In it was a written chronicle from my arrival as a frightened, young and newly discharged soldier whose future was irreversibly changed, through my wheelchair training, weightlifting, psychological counseling and driving lessons. I was carried into that VA facility and I drove away from it, back to my family in Missouri where I would start a new life. I have been independent, happy and productive ever since, with the benefit of great family support. I knew then, from my experience at Hines, that what lay ahead for me wasn’t always going to be easy, but there are ways to solve almost any problem.  

Joseph J. Frank served as national commander of The American Legion from 1996 to 1997. He also worked as a benefits officer for Paralyzed Veterans of America and as a peer counselor in the Robert Woolsey Spinal Cord Center, attached to the St. Louis VA Health Care System. He often speaks at schools and veterans events about his career in advocacy.

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