Magazine article The American Prospect

Unfriendly Fire: Despite Ideological Attacks and Under-Funding, the Veterans Health Administration Is a Model Public System

Magazine article The American Prospect

Unfriendly Fire: Despite Ideological Attacks and Under-Funding, the Veterans Health Administration Is a Model Public System

Article excerpt

The other day, as part of my current research on patient care at the Veterans Health Administration (VHA), I tagged along with an occupational therapist named Heather Freitag. She works for the VHA's Home Based Primary Care Program (HBPC) in San Francisco, and was making her first visit to a 79 -year-old Korean War veteran suffering from dementia.

The man's wife, only five years younger, was clearly overwhelmed by the burden of caring for him by herself while dealing with her own mounting health problems. For more than an hour, Freitag scrutinized every niche and cranny of their tidy bungalow in the Excelsior district of the city.

The VHA caregiver quickly discovered that her patient's narrow, sagging bed made it too difficult for his wife to turn him. In his frail condition, the two-inch lip around their shower stall had also become an insurmountable obstacle to daily bathing. The veteran's lack of mobility had already resulted in two small bedsores that could--if not properly treated--lead to serious infection and costly hospitalization.

The goal of Freitag's primary-care team is to prevent such problems from occurring. They try to keep patients comfortable and where most would like to remain--in their own home for as long as possible. After returning to her office, Freitag put in an order for a special bariatric hospital bed complete with a state-of-the-art air mattress. She also began designing a plastic chair that would ease the man's difficulty with home shower access.

In caring for this veteran, the HBPC would dispatch to the same San Francisco address a physician, a nurse practitioner, a nutritionist, a geriatric psychologist, and a physical therapist. And, of course, they would be supplemented by home health-care aides (who will be the only providers I can ever expect to see, under similar circumstances, when utilizing my own, privately funded, long-term care insurance sometime in the future). Indeed, for most elderly shutins, home-care workers are the main caregivers who render heroic critical services that help people function in daily life. Such carefully coordinated, high-quality care may be unusual elsewhere, but it is not a rarity at the VHA. In the year I've spent visiting VHA hospitals and clinics all over the country, I've found it to be the norm. While observing primary-care providers and geriatricians, palliative care and hospice specialists, mental-health practitioners, designers of prosthetic devices, medical and nursing researchers, as well as experts in team training and patient safety, I've also interviewed veterans of all ages as well and their family members. Every health-care system has its critics and complainers. But, in 30 years of writing about the interaction between patients and providers, I've never seen better institutional support for the latter caring for the former.

This is all the more remarkable because the VHA's patient population is far older and sicker than the national average. A large fraction of the vets who are cared for by the VHA have disabilities stemming from combat. Yet the VHA delivers care to this challenging population more compassionately and more cost-effectively than other segments of our health system.


In 2007, journalist Phillip Longman wrote a book on the VHA entitled Best Care Anywhere. In it, he demonstrated that our health-care delivery system for veterans (at least those who qualify for VHA services) is far better than Medicare and way better than private insurance--and a better, more-comprehensive model for broader health-care reform than even a single-payer system. But most readers of the daily press would find Longman's picture at odds with the story of the VHA recently depicted in the media.

That's because of one recent overblown scandal combined with the Republican scapegoating of a fine public system that they underfund--and would love to privatize. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed


An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.