In early 1970, I was on reconnaissance in I Corps in Viet Nam as a 1st Lieutenant Team Leader with the 101st Airborne Division Pathfinder Team. No, we did not bite off the heads of ducks to impress the indigenous, but we were in “the bush” and were considered in harm’s way.
On a rather ordinary insertion to inspect potential landing zones, I was moving my team from one area to another when we encountered heavy booby trapping. I stepped on one myself without it exploding. But as I moved up from my usual third spot to my slack man to get us off the trail, he stepped on a rocket propelled grenade booby trap that killed him instantly, and knocked me badly about. Only slightly wounded but with profound hearing loss, I literally picked up the pieces, got us extracted, made my way to the Da Nang 95th Medevac, and was evac’d stateside. I was extremely embarrassed to receive a Purple Heart given my slight impairments.
My initial foray with VA healthcare was positive. I was assigned to a Long Island, NY Naval Dispensary. The name and exact location are long lost to me. Unlike John Kerry, I never kept a diary. But my surgeon must have been fabulous, because he reconstructed my perforated ear drum using jaw muscle, and it “works” to this day. No, I cannot hear well, and yes, I have wicked huge tinnitus, but I’m used to that.
I was left with another year of service as a company commander of a military intelligence unit. Who would have thought? And that was, from a maturing standpoint, important in my adult development. I had a Finnish 1st Sergeant who became a life-long friend and bitter cribbage enemy. But I digress.
When I DEROSED (a wonderful term meaning left the military), I was assigned a service related hearing impariment of 0%. Besides the land mine explosion, I’d led over 40 air combat assaults sitting right next to a door gunner using only cigarette filters for ear protection. I received a 10% disability for other conditions.
I left the military and resigned my commission, given my suspicion that given my Pathfinder training (“First In, Last Out”), I might be in demand in the future (which actually proved true). When I returned to civilian life, I was astounded at how few of my contemporaries served in the military much less in Viet Nam, and even lesser in actual combat. What an ass am I.
But it was far from all bad. I applied for law school. Given my (albeit Ivy League) undergraduate performance, that was a stretch, having majored in partying and baseball. But with huge optimism and very good LSAT scores, I applied to and was accepted to Boston University School of Law.
After a cleansing cross country camping trip with my wife of now 47 years, I arrived in Boston quite intimidated. I’d never studied in my life. Then, I asked the Dean of Admissions about spare scholarship money. He looked at my folder and indelicately asked, “How in hell did you get admitted here? You probably have the lowest undergrad cum in our entire class.” Not a good start. He quickly added that it was because I was a wounded Viet Nam vet, and then suggested I get the hell out of his office.
I graduated 2d in a class of almost 300 very aggressive students. Surprised me too.
But then there was my brother in law Mike Kelly. Marine at 17. He served two tours in RVN, and I first met him in I Corps some 7 months after I had married his equally red headed sister. He was the poster boy for too young, too uneducated, too badly used. After he left the Marines, he experienced the full panoply of veteran scourges, the most devastating of which was post traumatic stress syndrome.
During law school, Mike lived with us, and I accompanied him to the Boston VA Hospital far too many times. The conditions there were appalling, and his treatment was indescribably worthless.
I vowed never to use the VA system. My 10% disability got me (in the 70’s) about $25/month, good for beer money but only if you drank sparingly. Over many years and many tribulations, Mike eventually was declared 100% disabled.
I completely ignored the VA. I did well professionally and believed that others more deserving and needy than I needed the resources. However, in 1996 I was diagnosed with prostate cancer, and with a little research, figured out that in I Corps right next to the completely defoliated DMZ, I had served in a high Agent Orange use area.
With my employer-based coverage, I had the matter taken care of at Johns Hopkins, and my recovery has been first rate. Yet, my wife started getting on me about, “What if it’s passed on genetically?” “Shouldn’t the VA have some responsibility here?” I dragged my feet truthfully. I didn’t want anything to do with the VA.
Funny how some things work. I retired in 2012 to Cape Cod where I’d played baseball in the late 60’s and met my wife in the legendary Land Ho Bar in Orleans. I started to attempt home repairs, and discovered that if I could prove I was a service-related disabled Vet, I could get a 10% discount at Home Depot, something that Home Depot does everything in its power to hide. When I asked how I might get this deal, I was told I needed a Department of Veterans Affairs ID card.
So, for the first time in decades, I walked into a VA office in Hyannis which was empty but for a youngish lad who welcomed me way too respectfully. After I explained why I was there, he looked at me like I was insane. “Sir, with all due respect, you are an idiot.” You have untold benefits, dah dah. I nodded and replied that all I really wanted was the cahd. That’s Massachusetts-ese for card. He told me that to get one, I needed so sign up for a VA physical exam. So I did.
Long story short, my physical exam was taken by a nurse practitioner who gave me the very best, most thorough, exam I’d ever received. Like an hour. I promptly fired my MD PCP who was at best surly, and now use her exclusively for my primary care.
She also walked me through the host of things I’d ignored for years, and with her guidance, got upgraded to a 40% disability. That’s about $700/month, more than beer money. I now get all my meds through the VA MyHealtheVet.com website (which is hugely efficient and inexpensive).
They are all over me. I get calls about mental health counseling (always valuable), support hose stockings for wounded legs, dietary counseling, and finally, I’ve ordered my hearing aids through the VA. VA hearing aids are first class stuff. I have hearing aids that work via Blue Tooth for phone calls, iTunes workout music, and my TV at night so I don’t disturb my wife while I watch the Patriots or Arnold. They almost tell me when to go to the bathroom.
I can email my PCP NP at the VA with questions and get a response within 24 hours. This is magic!
I realize that as a Purple Heart vet, I’m at the top of their food chain. But lord, I never had any idea. I’m quite healthy thank goodness, and visit my Hyannis outpatient facility perhaps 4 times a year. They are unfailingly polite and on time. The facility is spotless clean and is peopled with clearly accomplished and motivated professionals who tell me they love working there. The few times I had to visit the mother ship in Providence, RI, I also was treated wonderfully.
When a pinched nerve in the cervical spine area took me to Providence for an MRI two years ago, the neurologist who reviewed the findings with me was a youngish man who left private practice for the VA and loved working there serving veterans. His enthusiasm was obvious and not jargon. And he spent 45 minutes with me!!
This appears to be at odds with the current reporting on VA care, and of course, I have no idea what the conditions are in the more heavily populated areas. But I can say this. Today, I’m proud to report that I receive most of my healthcare via the VA. I’ve convinced contemporaries to get care at the VA, and they report similar experiences.
I’m fortunate to be financially able to keep my Parts A and B Medicare coverage, and gap filler through Blue Cross Massachusetts, just in case. But if I can, I will choose the VA every time.
The VA is so much different than it was when I was a resident working at one in the 80s. It gets abused a lot for political purposes. That said, I think your point about conditions varying is true. Some Vas experience serious seasonal swings. It is hard to staff for that.
Having gone into the VA system well after your experience as the CEO of a major insurer, I’m thinking you’re uniquely positioned to do a comparison. You probably went away from your appointments thinking “Wow. I wish I’d known about this five years ago?”
With that in mind, if you could jump in your time travel machine and head back in time, is there anything you would do differently as a CEO at a private insurer?
Anything you think the VA might benefit from borrowing from the private sector?
I get these are big, political questions.
I assume a productivity metric like revenue generation is irrelevant for a VA doctor and I wonder to what extent, if any, the number of patients seen each day factors into his or her performance evaluation or compensation. I suspect not very much.
Something that we did at Blue Cross RI was, for those who would agree to it, assign them a nurse case manager to help them navigate both the delivery and financial aspects of care. Their cases had to be complex, of course. While 30% of those approached agreed to do it, 95% of those who had done it would recommend it to a friend or relative. A trust issue of course. The assumption was that we would try to deny them care. What we really tried to do is assist them and even permit exceptions for care that might otherwise not be covered if it made sense in their unique circumstances. IF the VA had the resources, which it should, that would be great.
The other thing is communications. The commos from the VA are government-speak and very difficult to decipher, even for me. Clear, concise, direct messaging to veterans who are chronically ill on what to do, how and when to do it, would help.
The last thing is home care. I don’t know if the VA does it, but it could dramatically reduce costs and improve outcomes by reaching veterans who have difficulty traveling, thereby avoiding ER or inpatient visits.
In terms of what I would have done differently as CEO, the list is too long. Second guessing oneself is unavoidable. I’ll think about it.
I never knew about the 10% discount at Home Depot. I’ll ask for it next time I go. I have a 30% disability rating for my CAD. While I served in RVN for a year (1968-1969 in Chu Lai), I was never in the “bush” and wasn’t exposed to Agent Orange as far as I know. However, under rules passed by Congress, CAD is on the list of conditions that qualify people for disability benefits if they served in Viet Nam for as little as one day! I received a 30% disability rating which currently pays me $455.75 per month yet I can function perfectly fine except for athletic pursuits which I was never very good at anyway. I never use the VA system because it’s not especially convenient from where I live and other vets need it more.