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So listen in wherever you're at to veteransradio
.org and its podcasts. We want to welcome to
Veterans Radio today, Suzanne Gordon. She wrote
a report that I saw that triggered my interest
in this because there's a big policy debate going
on about VA healthcare and how it should be delivered
in the future. So Suzanne is an award -winning
journalist and author. She's spent. I'm going
to find out more, but I think she spent most
of her career writing and researching in the
health care area, all kinds of books and interesting
things. And for about eight years has been with
the Veterans Health Care Policy Institute. And
that's where this report comes out of. Suzanne,
welcome to Veterans Radio. Thank you so much
for having me. I'm so excited to be here. Well,
am I correct that you've spent a lot of your
professional career kind of writing on health
care topics? Yes. I like to think of, I mean,
I spent really my whole life around kind of medicine
and healthcare. My father was a famous ophthalmologist
and I'm almost 80 and I kind of just remember
as a kid running around New York Hospital, Cornell
Medical School where he was. So I've been in
touch with, you know, medicine and which medicine,
which is really not healthcare. So that's something
we can talk about, but. And then I, you know,
I've been a journalist since 1971, and I've written
23 books, and most of my career starting in about
1984 or five has been about writing about healthcare.
And I would say I've written, I mean, I've spent
a lot of time, maybe the last 15 years or more.
either initially focusing a bit on veterans'
health care and the VA and then recently basically
all my time writing about health care and veterans.
But the thing is that I think my many -year background
in understanding health care and caregiving has
really helped me understand the challenges of
veterans health care, because sadly, the people
in Congress and even many people in the media
and in VSOs and so forth don't really understand
health care, you know, or even medical treatment.
And yet they proclaim and make all kinds of decisions,
you know, about systems that they really don't
know anything about. And tragically, most of
the people who, you know, the secretaries of
the VA, and we should talk about that because
it's sort of interesting, don't know anything
about healthcare, even though fundamentally all
they do is run the biggest healthcare and benefits
systems in the country. Right. This is why I
wanted to talk about it is because the VA does
operate, the government does have this biggest
system in the country. And you mentioned Cornell.
Let me back up a little bit. You have education
both from Cornell University, Johns Hopkins University,
and you've explained kind of why medicine was
the start, journalism's here, and then health
care. And there's a difference between medicine
and health care. Tell folks what your thoughts
are on that difference. Yes, I'm so glad you
asked me that. You know, the Veterans Health
Administration, and I hope people understand,
you know, the Department of Veterans Affairs,
which is the second largest agency in the federal
government, runs under, with its, you know, sub
-agency, the Veterans Health Administration runs
the Veterans Health Care System, which is the
largest health care system. in america the only
coordinated healthcare system in america that
delivers coordinated care and i would argue the
only actual healthcare system in america because
we really don't have healthcare systems in america
we have medical treatment systems that that do
a fairly bad job and even fragmented medical
treatment. But healthcare is is like way more
than medicine. It's it's like, so what we call
social determinates of health. It's like, you
know what people eat and the air they breathe
and their socioeconomic status, which is super
relevant to veterans, what occupations they've
had, which is super duper, you know, relevant
to veterans. And In most American think what
passes for what they call health care it's really
medical treatment and the VA and I really mean
this you know the the VA for all its faults.
and it could certainly be improved as any human
system can, is really America's only health care
system. The VA delivers medical treatment, it
delivers medical care, it delivers mental health
care, but also deals with veterans' homelessness
and veterans' employment and veterans' socioeconomic
status and legal problems. And tragically, And
then, you know, it has all these other missions,
like, you know, teaching America, playing a pivotal
role in teaching Americans healthcare professionals
in training and being the, you know, second biggest
research powerhouse in the nation after the National
Institutes of Health. And then, of course, there's
also its fourth mission, which is, you know,
to respond to local, regional, and national emergencies.
hurricanes, war, tornadoes, wildfires, et cetera.
It's a really complicated system, and people
don't get it. They don't get how important it
is to all Americans, not just veterans. I mean,
the VA teaches 70 % of American physicians, most
of American psychologists, huge numbers of American
nurses. I mean if you have the research it's
done we've been talking to various people about
the significant impact VA research does and if
you cut VA funding and cut that kind of basic
research the million veteran project which is
delivering results because you have this huge
pool of data that researchers can pile through
and sort of begin to figure some things out But
you made an interesting comment I want to back
up to. And we're going to get to the honestly
veteran radio listeners. I'm going to get Suzanne
Gordon to talk about her report and the policy
issues. But you got to set this up a little bit.
So you mentioned a minute ago how big this is
and how broad the scope is and that these secretaries
of the VAs over time have We've had a lot of
disappointments and a couple of day ones, but
talk to us about your views. You've looked at,
boy, who do we have running this thing? And that's
sort of the message. That's because the presidents
and Congress really don't get what the VA is.
It's the largest occupational healthcare system
in the world. And it's one of the largest, it's
probably the largest academic healthcare system
in the country. And so, It has affiliations with,
you know, runs a nine million dollar teaching
programs. It has affiliations with 1800 accredited
health care professional programs. It's an academic
health system. And, you know, I think the problem
is that, you know, folks and this is all presidents
and sort of Congress and so forth. They look
at the veteran and they say, oh, military. You
know, oh, who should we get to run something
military? Let's find a general or let's try,
you know, an admiral or let's find somebody who
was a military leader or was in the military.
But this is really a policy issue, right? This
is when you talk about veterans health care and
we hear all about Well, it'll just be grand to
get all the veterans into community care, and
they're going to go to care in their local communities.
And now we're back to sort of a congressional
thing where I think you would say, these guys
and gals in Congress don't know what they're
talking about. So how did you start focusing
in on what ultimately became, and I haven't read
this title, I should have, the Veterans Health
Care Choice, Myth or Reality? a state -by -state
reality check of the false promise of VA privatization.
So I started by, you know, in 2014 writing, spending
five years researching a book called Wounds of
War where I spent, you know, went all over the
country. interviewing veterans and hanging out
with veterans and all kinds of appointments at
the VA and realizing, you know, writing this
book about VA healthcare. And I believe the VA,
the kind of healthcare the VA delivers when it's
fully funded and staffed and supported by Congress
and, you know, the administration delivers the
best healthcare in America. And that's not just
my view, but it's documented in many studies.
And so, you know, I mean, one of the things that
I really understood when I started really delving
into the VA, and I really didn't understand this
before. I was kind of like a lot of these folks
making policy and a lot of the public. I mean,
I didn't really understand how particular veteran
patients are. And that's because the VA is really
like an occupational health system. It deals
with people who had a job that had a lot of risks
and they had a lot of injuries and medical conditions
and mental health conditions and socioeconomic
consequences of their military service. And they
are not like You know the private sector patient
and unless you get that deeply get that you're
gonna think oh you can just send them across
the street assuming there's a place to send them
to across the street and if you know. I mean
they have super different problems they okay
they have some of the same problems as regular
you know a civilian people who never served right
promise aging problems of this problems that.
But they also have these very specific military
related problems and they actually can't get
into care at the vha if they don't have those
problems and or low income right so. That. tells
you the minute you recognize that there are these
different problems, then you say, oh, well, do
the people caring for them know about those problems,
recognize those problems, know how to treat those
problems effectively? And of course, at the VHA,
they do. Maybe they could approve, et cetera,
because like 100 % of their patients are veterans.
Right? Every single person that walks into your
office is going to be a veteran. And they're
going to have medical challenges, health care
challenges unique to that job, as you mentioned.
Yeah. And I want to you have some material in
here on national statistics. And one of the things
I kind of was a little taken aback by until I
thought about it. So that makes some sense to
me. The veteran patient population is older,
poorer, and sicker than non -VA patients. Talk
a little bit about that and how that impacts
things. Well, I'm going to tell you the stats,
and then I'm going to give you a really wonderful
example of this. So basically, they are poor.
I mean, I did an analysis of all 50 states. and
whether, you know, there's enough private sector
providers to handle an influx of 9 million nationally
or, you know, 1 .5 million here or 40 ,000 there.
And I looked at every single state, right, the
data on, you know, who makes up the veteran population.
It was really fascinating about 25 % of veterans
in any state earn, have an annual personal income
of 25 ,000 or less, and probably another 20 -ish,
give or take, have an annual income of 50 ,000
or less. And so it's probably 20, you know, 2020
or whatever, compared to 12 % of the regular
population. So they're poor, right? And between
2 % and 6 % of veterans in any state, give or
take, have a personal annual income of over $200
,000 compared to 12 % of the American population.
So they're, you know, poor. When you're poor,
you're sicker by definition, right? But then
they have all these health care problems that
come from military service, and those problems,
you know, don't have, I mean, you don't have
to be deployed, you don't have to leave the continental
United States to have those problems. So I'm
going to give you two examples. I mean, you know,
Camp Lejeune, where they were poisoned, you know,
water. All kinds of you know muscular skeletal
injuries because of extreme exercise with carrying
70 pound backs on you know that's going to packs
on your back that's going to do a number on your
knees on your shoulders on your ankles you know
etc on your hips. Chronic pain higher risk of
suicide military sexual trauma PTSD I but I want
to give you an example that I think really highlights
so the point of this is that they need. You know,
psychologists and oncologists and pulmonologists
and primary care doctors, et cetera, who know
where they served in the military and what the
particular risks of that are. Because otherwise,
they won't know how to treat these people. So
I'm going to give you this great example. I mean,
it's kind of horrible. So Kyle and Hunter just
told me about this. Kyle is the CEO, the new
CEO of IAVA, and she was a pilot in Iraq and
Afghanistan. And it turns out that pilots and
aircrew have very specific occupational injuries
and risks. And one of them is for certain kinds
of cancer, prostate and this thing called ocular
melanoma. Have you ever heard of ocular melanoma?
Okay. Well, neither have a lot of... I mean some
providers of have heard of it but they certainly
don't know it's a risk for you know pilot so
many you know in the v a that a pilot. That somebody
was in an air crew or pilot they get screen for
ocular melanoma which is like a super rare melanoma
we all know melanoma you know your skin you look
for that weird mall blah blah blah. Well, it
turns out that ocular melanoma, which represents
5 % of melanomas, is super rare. And it also
has no symptoms as it grows in your eye. And
it's kind of invisible. It's like, boy, in there,
right? You have to do special exam. Well, if
you don't catch it, Early so so it makes it very
scary right you don't catch it early you can
lose your vision i mean you can lose vision you
can go blind. And you can die because it could
spread and it has a five year survival rate of
fifteen percent so this is like very lethal very
rare and very lethal. Well she if she had been
in the private sector she they caught it she
would have had this melanoma growing in her.
God knows what would happen to her. A private
practice primary physician would never ask, never
look, never understood. No, and you're not going
to get the kind of dilation eye exam. You know,
I'm not exactly sure what they do, but they do
special exams, you know, on a young person. But
at the VA, it's like, oh, you're a pilot. Hi,
come here. We're going to, you know. And so here's
the thing. I don't think that the folks in Congress,
I mean, I think there are people in Congress,
sadly, who do not care, but I think there's others
who just do not know. And so we are playing by
sending these many of these vets out to the private
sector, we are playing Russian roulette with
their lives. I think I'm alarmist because people
should be alarmed. And so the thing is, If you
send people out to the private sector, the way
we're doing in the numbers we're doing, then
you have to require that private sector providers,
if there are enough of them and we haven't even
gotten that to that issue, have the same extensive
trainings in all these things that VA providers
have. And the problem is that there aren't enough
veterans in America. You know, veterans represent
the people who are eligible for the VA, 9 million
vets who are enrolled represent not 3 % of the
American adult patient population. There will
never be enough vets in any one person's practice
to make it financially or even intellectually
and professionally. um uh give the incentive
for you as a doctor or a mental health professional
whatever you spend the hours and hours and hours
and hours needed to know how to care for jim
or joe or whoever or gene so suzanne let me because
you just mentioned we haven't gotten there yet
and you're right let's Talk about what your report,
because you went, and this is the part that's
really interesting, is you went state by state,
analyzed, does that state have enough capacity
to actually absorb its veteran population, whether
they could absorb it good or bad, right? We're
now kind of talking about, well, they won't have
the experience to absorb it well. But talk a
little bit about your conclusions on it after
looking at 50 states, one by one, not as a broad
scale. Could you even do this? No, it's not possible.
I mean, that's the problem. So even if you had
a bazillion or, you know, like, I don't know
how many help, you know, 785 ,000 doctors who
are well versed in veterans health care, and,
you know, you know, 2 .2 million nurses and I
don't know how many psychologists. um even if
they you know we we don't have the right distribution
and enough to take care of veterans so essentially
you want to send these veterans into a health
care system in the united states which cannot
deliver in many places the basic minimum care
to its citizens in those states I mean, the global
picture, if you just want to talk globally, 89
% of American counties have severe shortages
of primary care providers, right? And 79 million
Americans, right? That's like 30 % of the adult
population live in shortages of. where there
is shortages of primary care providers and other
physicians. In mental health, and we have to
remember that, you know, over 41 % of veterans
have a serious mental health condition. We have
a major shortage of mental health providers.
And as the former, you know, head of Tom and
so the former head of the National Institutes
of Mental Health, He he when he left he said
you know we have like a mental health crisis
in america that is so severe that it's almost
like a social justice issue and he reminded us
that of the seventy eight thousand you know kind
of mental seven hundred eighty thousand professionals
in america very few of them are actually trying
to deal with what are called serious metal. mental
illness smi right and veterans have a lot of
serious they don't just have like you know oh
i'm worried about you know this or that or oh
my gosh i'm a little anxious they have like schizophrenia
and you know depressed major depressive disorder
and ptsd and combat related ptsd and mental military
sexual trauma I have a friend who went to a private
sector mental health provider because there was
a wait at the VA and the private sector provider
said, so what are you here for? And she said,
well, this and that and MST. And the provider
said, what's MST? I mean, it's logical. Rather
than build up this need for services and VHA,
in the last half a dozen years, the approach
has sort of been, well, if we can't get to you
in time, just go out to the private community
thinking that solves it. Well, your point is
it doesn't solve it first because there isn't
capacity to do it. There isn't training to do
it. I want to read one sentence out of your conclusion,
which is our survey of the current American healthcare
landscape. confirms that shifting more patients
into the private sector is an unwise policy decision
that will not fulfill the nation's promise to
provide timely, high -quality care to the 9 million
VA patients. This is a policy issue. Talk to
us about what the audience for this report from
the Veterans Health Care Policy Institute, who's
the audience? I'm always when I when I write
books or, you know, I always am asked, Oh, what's
your niche audience? And my I refuse to do that.
It's like, you know, I want everybody to read
this. So my audience is folks like you. My audience
is people in Congress. My audience is veteran
service organizations. I want to get this, you
know, out to veterans, because like if you buy
the idea that you're getting more choices. Think
again cuz like there aren't a lot of choices
out there maybe particularly if you're a rural
veteran twenty five percent of veterans and basically
what's gonna happen is you're gonna be defunding
the VA which they're doing eventually the american
taxpayer is gonna say well wait a minute nobody's
using it why should we pay for it and then you're
not gonna have the a is a choice and here's another
thing jam that and you can relate to this. Another
thing that really worries me super super worries
me in my long now long connection to vets. One
of the things I see is that many veterans when
they leave the service they do not immediately
go to the VA this is particularly true for mental
health conditions and and pain and stuff like
that right. and then you know 30 years later
20 years later their wife says oh my god enough
with this or you've got to go or their buddy
or they retire and they came nothing to do and
it all comes back to them and then they go to
the VA well the that means that the VA has to
be there not just for for them folks now but
for when they finally get it in their heads Holy
moly, I need help. So we need a VA not just,
you know, now but in 30 years. Be there 30 years
or 20 years or yes. Yeah, I mean, these, yeah,
I have sat in on so many peer support groups
for Vietnam vets. It's heart wrenching stories
of people who for decades Literally decades lived
with anxiety and panic attacks and nightmares
and blah, blah, blah. And they finally three
months ago, three years ago, went to the VA and
they're getting help. But so, you know, we have
to think not just like right now, we have to
think longitudinally. People resist getting health
care. They resist getting help. I want a wide
audience to look at this. That's my view on the
audience. And don't get scared off because it's
too thick. You need the first 10 pages. That's
where it's all at. Because then it's backed up
by 50 more pages, state by state, what's going
on. So you can read the 10 pages, kind of go,
wow, I didn't think about some of these things.
Let me go look at where I live and go to that
state and say, oh. There is this shortage and
that shortage of doctors or nurses or healthcare
in my area. Because I do think there's been a
push to sell to veterans and veteran service
organizations that this community choice is the
way to go. It may be a portion, it certainly
can't be all. And I'm getting in trouble if I
don't, we didn't talk about it. Should have done
it at the beginning. I'm getting in trouble if
I don't talk about or have you talk about. What
is the Veterans Health Care Policy Institute?
Sure, Matt, thank you for asking. So we're a
group of veterans, journalists, researchers,
people who work for the VA, and we formed what
is really the kind of only think tank. We think
a lot in research and write about veterans' health
care issues. and we fight against the privatization
of the VA, we don't believe, we believe, and
this has always been true, that there is a role
for private sector care. It used to be called
fee -based care if the VA can't really do it,
if they can't get to you in a reasonable amount
of time, or if they just don't have the service.
They don't have labor and delivery. I mean, it
doesn't make sense, and so they pay for you to
get it. you know, in the private sector. But,
so we, but we are, you know, proudly for public
programs, and we want the VA, the Veterans Health
Healthcare, the Veterans Health System to be
expanded, to be improved, to work well. And we
also want to remind people of, you know, the
fact that it, while it primarily serves veterans,
it serves all Americans, you know, and people
sort of, I think a lot of people look at, oh,
VA healthcare, that's just for them. Why should
I pay attention? I was one of those people before
I started doing work and research on the VA.
I thought, well, oh, so they have this great
innovation in care. What difference does it make?
It's not going to impact me. I had absolutely
no idea about VA research. I didn't know that
my first shingles vaccine was thanks to the VA,
you know. whoever you're getting healthcare treatment
from probably did some training in their medical
school and residency and fellowships at a VA
hospital because they trained some folks. If
you're interested listeners in the Veterans Healthcare
Policy Institute you can find it at veteranspolicy
.org. That's where you can go and there's a lot
of good information there and you can Also track
what Suzanne Gordon's doing and titles of all
our books and things, which is too long to read
out loud at suzannecgordon .com. Did I get that
right? Yeah. Okay. Just realized there's a C
in the middle of that and I didn't have it down
earlier. As I say, you've spent the last decade
or more working in this veterans healthcare space.
Almost always when you're doing that kind of
research and writing, you get that glimmer of,
oh, this is the next thing I got to chase down.
So is there the next thing you feel you have
to chase down? Well, yeah, I mean, I think I,
I really want to write some stuff to help people
understand that the VA is an occupational health
system. And, you know, that means you have to
know about the occupations that these your patients,
you know, had not just, you know, I mean, after
they left the military, but while they were in
the military, and America doesn't do occupational
medicine. Well, you know, And it doesn't do health
care well. So I want to write about that. I'm
writing now a paper on the impact of VA, the
current VA policies and cuts on women veterans,
which is significant and goes way beyond abortion
services. The media has focused on that, but
it's so much bigger than that. I don't know.
I mean, I think we have this. I mean, fundamentally,
I'm not a veteran and I want the kind of care
I think all Americans deserve, the kind of care
that the VA gives when it's at its best and when
it is supported by the public. And, you know,
and I think it's really sad that so many veterans
don't really sort of appreciate this. And I guess
the other thing that I really want to say to
your audience, I suppose, is, I mean, what I
feel is so tragic and sad is I have a lot of,
I know a lot of folks who work for the VA, I
mean they're psychologists, they're chronic care
docs, they're, they're everything. And it's really
sad to me to see how they're being attacked by,
you know, Congress, by the administration. These
are people who could have worked somewhere else
and made a whole lot more money. They're super
smart, they know a lot, and they have devoted
their lives. you know, really, because they're
mission driven. And it makes me very sad to see
VSOs and other groups not supporting them. Because,
I mean, You know, I know folks who are in tears.
I mean, they are be receiving and veterans should
be outraged that, you know, the Trump administration
is sending messages to their VA doctor and nurse
telling them literally, you know, you are not
contributing to American prosperity and you should
do more productive. And this is a quote work
elsewhere. So what is administration is saying
taking care of veterans? isn't productive work.
If I were a vet, I mean, I'm outraged on behalf
of vets. If I were a vet, I would be flipping
out. I think we should flip out in appropriate
ways and just be going to these congresspeople
and saying, what are you saying here? Is that
what you believe about the service I gave my
country? Well, I want to encourage people to
find the Veterans Health Care Policy Institute
paper titled Veterans Healthcare Choice, Myth
or Reality, a state by state reality check for
the false promise of VA privatization. Suzanne
Gordon, thank you for talking to us about this.
It was very interesting reading and obviously
a lot of work into it and that's why I encourage
people go look at your particular state. It's
going to reframe your thinking on this issue.
Suzanne, thank you for talking to Veterans Radio.
Thank you for having me Jim. You can follow Veterans
Radio on Facebook and listen to its podcasts
and internet radio shows by visiting us at veteransradio
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