WEBVTT 00:00:05.200 --> 00:00:09.060 All across America and around the world, this 00:00:09.060 --> 00:00:15.160 is Veterans Radio. This is Veterans Radio. Good 00:00:15.160 --> 00:00:18.600 day. I'm Jim Fossone. I'm the Officer of the 00:00:18.600 --> 00:00:20.699 Deck today here on Veterans Radio and thanks 00:00:20.699 --> 00:00:23.469 for joining us. We've got some interesting stories 00:00:23.469 --> 00:00:25.649 for you. We always want to remind you you can 00:00:25.649 --> 00:00:28.750 find more about Veterans Radio at its Facebook 00:00:28.750 --> 00:00:32.429 site or at the web, veteransradio .org, where 00:00:32.429 --> 00:00:35.270 we're on the web 24 -7. You can find a lot of 00:00:35.270 --> 00:00:38.310 our podcasts there as well. We post new ones 00:00:38.310 --> 00:00:42.490 every Tuesday, so you can get a new story, a 00:00:42.490 --> 00:00:45.229 new interview, something you didn't know before 00:00:45.229 --> 00:00:49.219 by going to VeteransRadio .org. 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We were recently identified 00:02:20.340 --> 00:02:25.120 as the in the 15th spot, if you will, of the 00:02:25.120 --> 00:02:30.060 top 100 veteran centric podcasts by Feet Spot. 00:02:30.639 --> 00:02:33.020 So really pretty proud of being in the top 15. 00:02:33.659 --> 00:02:38.400 So listen in wherever you're at to veteransradio 00:02:38.400 --> 00:02:42.879 .org and its podcasts. We want to welcome to 00:02:42.879 --> 00:02:46.680 Veterans Radio today, Suzanne Gordon. She wrote 00:02:46.680 --> 00:02:49.659 a report that I saw that triggered my interest 00:02:49.659 --> 00:02:52.680 in this because there's a big policy debate going 00:02:52.680 --> 00:02:57.139 on about VA healthcare and how it should be delivered 00:02:57.139 --> 00:03:01.300 in the future. So Suzanne is an award -winning 00:03:01.300 --> 00:03:05.080 journalist and author. She's spent. I'm going 00:03:05.080 --> 00:03:06.900 to find out more, but I think she spent most 00:03:06.900 --> 00:03:08.879 of her career writing and researching in the 00:03:08.879 --> 00:03:11.199 health care area, all kinds of books and interesting 00:03:11.199 --> 00:03:14.259 things. And for about eight years has been with 00:03:14.259 --> 00:03:17.139 the Veterans Health Care Policy Institute. And 00:03:17.139 --> 00:03:19.639 that's where this report comes out of. Suzanne, 00:03:19.800 --> 00:03:22.400 welcome to Veterans Radio. Thank you so much 00:03:22.400 --> 00:03:25.479 for having me. I'm so excited to be here. Well, 00:03:25.939 --> 00:03:27.939 am I correct that you've spent a lot of your 00:03:27.939 --> 00:03:30.400 professional career kind of writing on health 00:03:30.400 --> 00:03:34.409 care topics? Yes. I like to think of, I mean, 00:03:34.610 --> 00:03:38.650 I spent really my whole life around kind of medicine 00:03:38.650 --> 00:03:41.750 and healthcare. My father was a famous ophthalmologist 00:03:41.750 --> 00:03:46.229 and I'm almost 80 and I kind of just remember 00:03:46.229 --> 00:03:48.710 as a kid running around New York Hospital, Cornell 00:03:48.710 --> 00:03:52.189 Medical School where he was. So I've been in 00:03:52.189 --> 00:03:55.530 touch with, you know, medicine and which medicine, 00:03:55.650 --> 00:03:58.610 which is really not healthcare. So that's something 00:03:58.610 --> 00:04:02.020 we can talk about, but. And then I, you know, 00:04:02.219 --> 00:04:07.259 I've been a journalist since 1971, and I've written 00:04:07.259 --> 00:04:11.960 23 books, and most of my career starting in about 00:04:11.960 --> 00:04:17.060 1984 or five has been about writing about healthcare. 00:04:17.540 --> 00:04:20.540 And I would say I've written, I mean, I've spent 00:04:20.540 --> 00:04:24.220 a lot of time, maybe the last 15 years or more. 00:04:24.939 --> 00:04:28.800 either initially focusing a bit on veterans' 00:04:29.339 --> 00:04:33.120 health care and the VA and then recently basically 00:04:33.120 --> 00:04:37.300 all my time writing about health care and veterans. 00:04:38.339 --> 00:04:45.379 But the thing is that I think my many -year background 00:04:45.379 --> 00:04:50.899 in understanding health care and caregiving has 00:04:50.899 --> 00:04:54.519 really helped me understand the challenges of 00:04:54.519 --> 00:04:57.980 veterans health care, because sadly, the people 00:04:57.980 --> 00:05:00.699 in Congress and even many people in the media 00:05:00.699 --> 00:05:04.740 and in VSOs and so forth don't really understand 00:05:04.740 --> 00:05:07.819 health care, you know, or even medical treatment. 00:05:08.439 --> 00:05:11.860 And yet they proclaim and make all kinds of decisions, 00:05:11.860 --> 00:05:14.980 you know, about systems that they really don't 00:05:14.980 --> 00:05:18.870 know anything about. And tragically, most of 00:05:18.870 --> 00:05:21.810 the people who, you know, the secretaries of 00:05:21.810 --> 00:05:24.529 the VA, and we should talk about that because 00:05:24.529 --> 00:05:26.610 it's sort of interesting, don't know anything 00:05:26.610 --> 00:05:29.569 about healthcare, even though fundamentally all 00:05:29.569 --> 00:05:32.029 they do is run the biggest healthcare and benefits 00:05:32.029 --> 00:05:35.310 systems in the country. Right. This is why I 00:05:35.310 --> 00:05:37.949 wanted to talk about it is because the VA does 00:05:37.949 --> 00:05:41.439 operate, the government does have this biggest 00:05:41.439 --> 00:05:44.699 system in the country. And you mentioned Cornell. 00:05:44.800 --> 00:05:47.480 Let me back up a little bit. You have education 00:05:47.480 --> 00:05:51.379 both from Cornell University, Johns Hopkins University, 00:05:51.379 --> 00:05:54.019 and you've explained kind of why medicine was 00:05:54.019 --> 00:05:56.680 the start, journalism's here, and then health 00:05:56.680 --> 00:05:58.860 care. And there's a difference between medicine 00:05:58.860 --> 00:06:01.779 and health care. Tell folks what your thoughts 00:06:01.779 --> 00:06:05.139 are on that difference. Yes, I'm so glad you 00:06:05.139 --> 00:06:07.990 asked me that. You know, the Veterans Health 00:06:07.990 --> 00:06:09.889 Administration, and I hope people understand, 00:06:09.990 --> 00:06:11.810 you know, the Department of Veterans Affairs, 00:06:12.069 --> 00:06:13.870 which is the second largest agency in the federal 00:06:13.870 --> 00:06:18.290 government, runs under, with its, you know, sub 00:06:18.290 --> 00:06:20.850 -agency, the Veterans Health Administration runs 00:06:20.850 --> 00:06:23.329 the Veterans Health Care System, which is the 00:06:23.329 --> 00:06:27.470 largest health care system. in america the only 00:06:27.470 --> 00:06:30.629 coordinated healthcare system in america that 00:06:30.629 --> 00:06:33.689 delivers coordinated care and i would argue the 00:06:33.689 --> 00:06:37.250 only actual healthcare system in america because 00:06:37.250 --> 00:06:40.310 we really don't have healthcare systems in america 00:06:40.310 --> 00:06:43.649 we have medical treatment systems that that do 00:06:43.649 --> 00:06:48.269 a fairly bad job and even fragmented medical 00:06:48.269 --> 00:06:51.569 treatment. But healthcare is is like way more 00:06:51.569 --> 00:06:54.769 than medicine. It's it's like, so what we call 00:06:54.769 --> 00:06:57.829 social determinates of health. It's like, you 00:06:57.829 --> 00:07:00.430 know what people eat and the air they breathe 00:07:00.430 --> 00:07:04.610 and their socioeconomic status, which is super 00:07:04.610 --> 00:07:07.870 relevant to veterans, what occupations they've 00:07:07.870 --> 00:07:10.629 had, which is super duper, you know, relevant 00:07:10.629 --> 00:07:15.639 to veterans. And In most American think what 00:07:15.639 --> 00:07:18.120 passes for what they call health care it's really 00:07:18.120 --> 00:07:22.540 medical treatment and the VA and I really mean 00:07:22.540 --> 00:07:26.160 this you know the the VA for all its faults. 00:07:26.639 --> 00:07:29.939 and it could certainly be improved as any human 00:07:29.939 --> 00:07:33.220 system can, is really America's only health care 00:07:33.220 --> 00:07:36.939 system. The VA delivers medical treatment, it 00:07:36.939 --> 00:07:39.259 delivers medical care, it delivers mental health 00:07:39.259 --> 00:07:42.339 care, but also deals with veterans' homelessness 00:07:42.339 --> 00:07:48.800 and veterans' employment and veterans' socioeconomic 00:07:48.800 --> 00:07:53.879 status and legal problems. And tragically, And 00:07:53.879 --> 00:07:56.199 then, you know, it has all these other missions, 00:07:56.660 --> 00:07:59.500 like, you know, teaching America, playing a pivotal 00:07:59.500 --> 00:08:02.040 role in teaching Americans healthcare professionals 00:08:02.040 --> 00:08:06.899 in training and being the, you know, second biggest 00:08:06.899 --> 00:08:09.879 research powerhouse in the nation after the National 00:08:09.879 --> 00:08:12.379 Institutes of Health. And then, of course, there's 00:08:12.379 --> 00:08:15.959 also its fourth mission, which is, you know, 00:08:16.019 --> 00:08:19.779 to respond to local, regional, and national emergencies. 00:08:20.930 --> 00:08:26.470 hurricanes, war, tornadoes, wildfires, et cetera. 00:08:26.850 --> 00:08:30.470 It's a really complicated system, and people 00:08:30.470 --> 00:08:35.210 don't get it. They don't get how important it 00:08:35.210 --> 00:08:39.149 is to all Americans, not just veterans. I mean, 00:08:39.190 --> 00:08:42.990 the VA teaches 70 % of American physicians, most 00:08:42.990 --> 00:08:47.809 of American psychologists, huge numbers of American 00:08:47.809 --> 00:08:52.629 nurses. I mean if you have the research it's 00:08:52.629 --> 00:08:54.330 done we've been talking to various people about 00:08:54.330 --> 00:08:59.269 the significant impact VA research does and if 00:08:59.269 --> 00:09:03.230 you cut VA funding and cut that kind of basic 00:09:03.230 --> 00:09:07.110 research the million veteran project which is 00:09:07.110 --> 00:09:10.129 delivering results because you have this huge 00:09:10.129 --> 00:09:15.129 pool of data that researchers can pile through 00:09:15.129 --> 00:09:19.600 and sort of begin to figure some things out But 00:09:19.600 --> 00:09:21.820 you made an interesting comment I want to back 00:09:21.820 --> 00:09:23.740 up to. And we're going to get to the honestly 00:09:23.740 --> 00:09:26.779 veteran radio listeners. I'm going to get Suzanne 00:09:26.779 --> 00:09:30.639 Gordon to talk about her report and the policy 00:09:30.639 --> 00:09:34.179 issues. But you got to set this up a little bit. 00:09:34.500 --> 00:09:38.320 So you mentioned a minute ago how big this is 00:09:38.320 --> 00:09:42.159 and how broad the scope is and that these secretaries 00:09:42.159 --> 00:09:47.659 of the VAs over time have We've had a lot of 00:09:47.659 --> 00:09:50.539 disappointments and a couple of day ones, but 00:09:50.539 --> 00:09:53.340 talk to us about your views. You've looked at, 00:09:53.340 --> 00:09:56.740 boy, who do we have running this thing? And that's 00:09:56.740 --> 00:09:59.710 sort of the message. That's because the presidents 00:09:59.710 --> 00:10:02.950 and Congress really don't get what the VA is. 00:10:03.070 --> 00:10:07.029 It's the largest occupational healthcare system 00:10:07.029 --> 00:10:11.350 in the world. And it's one of the largest, it's 00:10:11.350 --> 00:10:14.409 probably the largest academic healthcare system 00:10:14.409 --> 00:10:19.480 in the country. And so, It has affiliations with, 00:10:19.480 --> 00:10:22.279 you know, runs a nine million dollar teaching 00:10:22.279 --> 00:10:25.899 programs. It has affiliations with 1800 accredited 00:10:25.899 --> 00:10:29.159 health care professional programs. It's an academic 00:10:29.159 --> 00:10:33.240 health system. And, you know, I think the problem 00:10:33.240 --> 00:10:37.879 is that, you know, folks and this is all presidents 00:10:37.879 --> 00:10:40.639 and sort of Congress and so forth. They look 00:10:40.639 --> 00:10:44.720 at the veteran and they say, oh, military. You 00:10:44.720 --> 00:10:48.899 know, oh, who should we get to run something 00:10:48.899 --> 00:10:54.080 military? Let's find a general or let's try, 00:10:54.259 --> 00:10:57.340 you know, an admiral or let's find somebody who 00:10:57.340 --> 00:11:01.600 was a military leader or was in the military. 00:11:02.039 --> 00:11:05.139 But this is really a policy issue, right? This 00:11:05.139 --> 00:11:08.399 is when you talk about veterans health care and 00:11:08.399 --> 00:11:12.159 we hear all about Well, it'll just be grand to 00:11:12.159 --> 00:11:14.539 get all the veterans into community care, and 00:11:14.539 --> 00:11:17.100 they're going to go to care in their local communities. 00:11:17.460 --> 00:11:20.559 And now we're back to sort of a congressional 00:11:20.559 --> 00:11:23.480 thing where I think you would say, these guys 00:11:23.480 --> 00:11:25.039 and gals in Congress don't know what they're 00:11:25.039 --> 00:11:28.659 talking about. So how did you start focusing 00:11:28.659 --> 00:11:32.700 in on what ultimately became, and I haven't read 00:11:32.700 --> 00:11:34.960 this title, I should have, the Veterans Health 00:11:34.960 --> 00:11:38.990 Care Choice, Myth or Reality? a state -by -state 00:11:38.990 --> 00:11:43.389 reality check of the false promise of VA privatization. 00:11:44.629 --> 00:11:51.230 So I started by, you know, in 2014 writing, spending 00:11:51.230 --> 00:11:53.809 five years researching a book called Wounds of 00:11:53.809 --> 00:11:56.049 War where I spent, you know, went all over the 00:11:56.049 --> 00:11:59.649 country. interviewing veterans and hanging out 00:11:59.649 --> 00:12:01.590 with veterans and all kinds of appointments at 00:12:01.590 --> 00:12:05.149 the VA and realizing, you know, writing this 00:12:05.149 --> 00:12:09.970 book about VA healthcare. And I believe the VA, 00:12:10.350 --> 00:12:12.629 the kind of healthcare the VA delivers when it's 00:12:12.629 --> 00:12:16.769 fully funded and staffed and supported by Congress 00:12:16.769 --> 00:12:19.830 and, you know, the administration delivers the 00:12:19.830 --> 00:12:22.950 best healthcare in America. And that's not just 00:12:22.950 --> 00:12:25.929 my view, but it's documented in many studies. 00:12:26.279 --> 00:12:29.480 And so, you know, I mean, one of the things that 00:12:29.480 --> 00:12:33.539 I really understood when I started really delving 00:12:33.539 --> 00:12:36.179 into the VA, and I really didn't understand this 00:12:36.179 --> 00:12:38.580 before. I was kind of like a lot of these folks 00:12:38.580 --> 00:12:42.139 making policy and a lot of the public. I mean, 00:12:42.220 --> 00:12:46.879 I didn't really understand how particular veteran 00:12:46.879 --> 00:12:51.110 patients are. And that's because the VA is really 00:12:51.110 --> 00:12:54.590 like an occupational health system. It deals 00:12:54.590 --> 00:12:58.610 with people who had a job that had a lot of risks 00:12:58.610 --> 00:13:01.649 and they had a lot of injuries and medical conditions 00:13:01.649 --> 00:13:05.850 and mental health conditions and socioeconomic 00:13:05.850 --> 00:13:10.850 consequences of their military service. And they 00:13:10.850 --> 00:13:14.419 are not like You know the private sector patient 00:13:14.419 --> 00:13:18.860 and unless you get that deeply get that you're 00:13:18.860 --> 00:13:22.259 gonna think oh you can just send them across 00:13:22.259 --> 00:13:24.899 the street assuming there's a place to send them 00:13:24.899 --> 00:13:29.320 to across the street and if you know. I mean 00:13:29.320 --> 00:13:33.399 they have super different problems they okay 00:13:33.399 --> 00:13:36.279 they have some of the same problems as regular 00:13:36.279 --> 00:13:39.399 you know a civilian people who never served right 00:13:39.399 --> 00:13:42.120 promise aging problems of this problems that. 00:13:42.860 --> 00:13:45.720 But they also have these very specific military 00:13:45.720 --> 00:13:48.259 related problems and they actually can't get 00:13:48.259 --> 00:13:51.799 into care at the vha if they don't have those 00:13:51.799 --> 00:13:57.659 problems and or low income right so. That. tells 00:13:57.659 --> 00:14:02.100 you the minute you recognize that there are these 00:14:02.100 --> 00:14:05.879 different problems, then you say, oh, well, do 00:14:05.879 --> 00:14:09.240 the people caring for them know about those problems, 00:14:09.580 --> 00:14:12.679 recognize those problems, know how to treat those 00:14:12.679 --> 00:14:16.539 problems effectively? And of course, at the VHA, 00:14:16.960 --> 00:14:20.059 they do. Maybe they could approve, et cetera, 00:14:20.379 --> 00:14:23.120 because like 100 % of their patients are veterans. 00:14:23.559 --> 00:14:26.700 Right? Every single person that walks into your 00:14:26.700 --> 00:14:30.259 office is going to be a veteran. And they're 00:14:30.259 --> 00:14:34.059 going to have medical challenges, health care 00:14:34.059 --> 00:14:36.820 challenges unique to that job, as you mentioned. 00:14:38.000 --> 00:14:43.299 Yeah. And I want to you have some material in 00:14:43.299 --> 00:14:45.700 here on national statistics. And one of the things 00:14:45.700 --> 00:14:49.419 I kind of was a little taken aback by until I 00:14:49.419 --> 00:14:51.000 thought about it. So that makes some sense to 00:14:51.000 --> 00:14:55.659 me. The veteran patient population is older, 00:14:56.419 --> 00:15:01.960 poorer, and sicker than non -VA patients. Talk 00:15:01.960 --> 00:15:03.720 a little bit about that and how that impacts 00:15:03.720 --> 00:15:06.200 things. Well, I'm going to tell you the stats, 00:15:06.360 --> 00:15:08.580 and then I'm going to give you a really wonderful 00:15:08.580 --> 00:15:14.259 example of this. So basically, they are poor. 00:15:14.759 --> 00:15:23.169 I mean, I did an analysis of all 50 states. and 00:15:23.169 --> 00:15:25.750 whether, you know, there's enough private sector 00:15:25.750 --> 00:15:30.230 providers to handle an influx of 9 million nationally 00:15:30.230 --> 00:15:35.289 or, you know, 1 .5 million here or 40 ,000 there. 00:15:36.629 --> 00:15:41.210 And I looked at every single state, right, the 00:15:41.210 --> 00:15:44.190 data on, you know, who makes up the veteran population. 00:15:44.230 --> 00:15:50.179 It was really fascinating about 25 % of veterans 00:15:50.179 --> 00:15:54.840 in any state earn, have an annual personal income 00:15:54.840 --> 00:15:59.399 of 25 ,000 or less, and probably another 20 -ish, 00:16:00.080 --> 00:16:03.960 give or take, have an annual income of 50 ,000 00:16:03.960 --> 00:16:10.919 or less. And so it's probably 20, you know, 2020 00:16:10.919 --> 00:16:18.620 or whatever, compared to 12 % of the regular 00:16:18.620 --> 00:16:23.039 population. So they're poor, right? And between 00:16:23.039 --> 00:16:27.179 2 % and 6 % of veterans in any state, give or 00:16:27.179 --> 00:16:32.320 take, have a personal annual income of over $200 00:16:32.320 --> 00:16:35.580 ,000 compared to 12 % of the American population. 00:16:35.899 --> 00:16:38.700 So they're, you know, poor. When you're poor, 00:16:39.220 --> 00:16:42.419 you're sicker by definition, right? But then 00:16:42.419 --> 00:16:46.100 they have all these health care problems that 00:16:46.100 --> 00:16:49.200 come from military service, and those problems, 00:16:49.200 --> 00:16:51.720 you know, don't have, I mean, you don't have 00:16:51.720 --> 00:16:54.379 to be deployed, you don't have to leave the continental 00:16:54.379 --> 00:16:58.299 United States to have those problems. So I'm 00:16:58.299 --> 00:17:00.220 going to give you two examples. I mean, you know, 00:17:00.340 --> 00:17:02.820 Camp Lejeune, where they were poisoned, you know, 00:17:02.980 --> 00:17:08.480 water. All kinds of you know muscular skeletal 00:17:08.480 --> 00:17:11.240 injuries because of extreme exercise with carrying 00:17:11.240 --> 00:17:13.779 70 pound backs on you know that's going to packs 00:17:13.779 --> 00:17:15.900 on your back that's going to do a number on your 00:17:15.900 --> 00:17:18.640 knees on your shoulders on your ankles you know 00:17:18.640 --> 00:17:23.839 etc on your hips. Chronic pain higher risk of 00:17:23.839 --> 00:17:28.559 suicide military sexual trauma PTSD I but I want 00:17:28.559 --> 00:17:31.220 to give you an example that I think really highlights 00:17:31.220 --> 00:17:35.880 so the point of this is that they need. You know, 00:17:36.079 --> 00:17:42.279 psychologists and oncologists and pulmonologists 00:17:42.279 --> 00:17:46.319 and primary care doctors, et cetera, who know 00:17:46.319 --> 00:17:50.180 where they served in the military and what the 00:17:50.180 --> 00:17:53.099 particular risks of that are. Because otherwise, 00:17:53.299 --> 00:17:55.559 they won't know how to treat these people. So 00:17:55.559 --> 00:17:57.460 I'm going to give you this great example. I mean, 00:17:57.460 --> 00:18:01.940 it's kind of horrible. So Kyle and Hunter just 00:18:01.940 --> 00:18:06.009 told me about this. Kyle is the CEO, the new 00:18:06.009 --> 00:18:11.029 CEO of IAVA, and she was a pilot in Iraq and 00:18:11.029 --> 00:18:15.150 Afghanistan. And it turns out that pilots and 00:18:15.150 --> 00:18:18.690 aircrew have very specific occupational injuries 00:18:18.690 --> 00:18:22.130 and risks. And one of them is for certain kinds 00:18:22.130 --> 00:18:26.069 of cancer, prostate and this thing called ocular 00:18:26.069 --> 00:18:29.789 melanoma. Have you ever heard of ocular melanoma? 00:18:29.789 --> 00:18:34.180 Okay. Well, neither have a lot of... I mean some 00:18:34.180 --> 00:18:37.200 providers of have heard of it but they certainly 00:18:37.200 --> 00:18:40.799 don't know it's a risk for you know pilot so 00:18:40.799 --> 00:18:44.819 many you know in the v a that a pilot. That somebody 00:18:44.819 --> 00:18:47.819 was in an air crew or pilot they get screen for 00:18:47.819 --> 00:18:52.400 ocular melanoma which is like a super rare melanoma 00:18:52.400 --> 00:18:54.859 we all know melanoma you know your skin you look 00:18:54.859 --> 00:18:57.690 for that weird mall blah blah blah. Well, it 00:18:57.690 --> 00:19:00.529 turns out that ocular melanoma, which represents 00:19:00.529 --> 00:19:07.950 5 % of melanomas, is super rare. And it also 00:19:07.950 --> 00:19:13.230 has no symptoms as it grows in your eye. And 00:19:13.230 --> 00:19:17.009 it's kind of invisible. It's like, boy, in there, 00:19:17.029 --> 00:19:20.890 right? You have to do special exam. Well, if 00:19:20.890 --> 00:19:24.369 you don't catch it, Early so so it makes it very 00:19:24.369 --> 00:19:26.750 scary right you don't catch it early you can 00:19:26.750 --> 00:19:28.890 lose your vision i mean you can lose vision you 00:19:28.890 --> 00:19:33.430 can go blind. And you can die because it could 00:19:33.430 --> 00:19:36.829 spread and it has a five year survival rate of 00:19:36.829 --> 00:19:39.950 fifteen percent so this is like very lethal very 00:19:39.950 --> 00:19:43.910 rare and very lethal. Well she if she had been 00:19:43.910 --> 00:19:48.609 in the private sector she they caught it she 00:19:48.609 --> 00:19:51.230 would have had this melanoma growing in her. 00:19:51.740 --> 00:19:56.559 God knows what would happen to her. A private 00:19:56.559 --> 00:20:00.200 practice primary physician would never ask, never 00:20:00.200 --> 00:20:02.980 look, never understood. No, and you're not going 00:20:02.980 --> 00:20:06.880 to get the kind of dilation eye exam. You know, 00:20:06.880 --> 00:20:09.380 I'm not exactly sure what they do, but they do 00:20:09.380 --> 00:20:12.940 special exams, you know, on a young person. But 00:20:12.940 --> 00:20:15.339 at the VA, it's like, oh, you're a pilot. Hi, 00:20:15.500 --> 00:20:18.240 come here. We're going to, you know. And so here's 00:20:18.240 --> 00:20:21.569 the thing. I don't think that the folks in Congress, 00:20:21.710 --> 00:20:23.490 I mean, I think there are people in Congress, 00:20:24.089 --> 00:20:27.450 sadly, who do not care, but I think there's others 00:20:27.450 --> 00:20:31.730 who just do not know. And so we are playing by 00:20:31.730 --> 00:20:35.490 sending these many of these vets out to the private 00:20:35.490 --> 00:20:38.829 sector, we are playing Russian roulette with 00:20:38.829 --> 00:20:43.849 their lives. I think I'm alarmist because people 00:20:43.849 --> 00:20:49.259 should be alarmed. And so the thing is, If you 00:20:49.259 --> 00:20:51.940 send people out to the private sector, the way 00:20:51.940 --> 00:20:54.619 we're doing in the numbers we're doing, then 00:20:54.619 --> 00:20:58.720 you have to require that private sector providers, 00:20:59.400 --> 00:21:01.180 if there are enough of them and we haven't even 00:21:01.180 --> 00:21:05.380 gotten that to that issue, have the same extensive 00:21:05.380 --> 00:21:10.240 trainings in all these things that VA providers 00:21:10.240 --> 00:21:14.539 have. And the problem is that there aren't enough 00:21:14.539 --> 00:21:19.019 veterans in America. You know, veterans represent 00:21:19.019 --> 00:21:23.079 the people who are eligible for the VA, 9 million 00:21:23.079 --> 00:21:28.839 vets who are enrolled represent not 3 % of the 00:21:28.839 --> 00:21:32.839 American adult patient population. There will 00:21:32.839 --> 00:21:37.319 never be enough vets in any one person's practice 00:21:37.319 --> 00:21:42.180 to make it financially or even intellectually 00:21:42.180 --> 00:21:47.119 and professionally. um uh give the incentive 00:21:47.119 --> 00:21:50.380 for you as a doctor or a mental health professional 00:21:50.380 --> 00:21:53.920 whatever you spend the hours and hours and hours 00:21:53.920 --> 00:21:57.799 and hours needed to know how to care for jim 00:21:57.799 --> 00:22:02.180 or joe or whoever or gene so suzanne let me because 00:22:02.180 --> 00:22:03.900 you just mentioned we haven't gotten there yet 00:22:03.900 --> 00:22:08.980 and you're right let's Talk about what your report, 00:22:09.160 --> 00:22:10.980 because you went, and this is the part that's 00:22:10.980 --> 00:22:13.259 really interesting, is you went state by state, 00:22:13.259 --> 00:22:17.059 analyzed, does that state have enough capacity 00:22:17.059 --> 00:22:22.359 to actually absorb its veteran population, whether 00:22:22.359 --> 00:22:24.180 they could absorb it good or bad, right? We're 00:22:24.180 --> 00:22:25.660 now kind of talking about, well, they won't have 00:22:25.660 --> 00:22:28.240 the experience to absorb it well. But talk a 00:22:28.240 --> 00:22:31.500 little bit about your conclusions on it after 00:22:31.500 --> 00:22:34.859 looking at 50 states, one by one, not as a broad 00:22:34.859 --> 00:22:41.470 scale. Could you even do this? No, it's not possible. 00:22:41.609 --> 00:22:44.690 I mean, that's the problem. So even if you had 00:22:44.690 --> 00:22:47.230 a bazillion or, you know, like, I don't know 00:22:47.230 --> 00:22:51.809 how many help, you know, 785 ,000 doctors who 00:22:51.809 --> 00:22:55.329 are well versed in veterans health care, and, 00:22:55.369 --> 00:22:59.089 you know, you know, 2 .2 million nurses and I 00:22:59.089 --> 00:23:02.279 don't know how many psychologists. um even if 00:23:02.279 --> 00:23:06.420 they you know we we don't have the right distribution 00:23:06.420 --> 00:23:10.740 and enough to take care of veterans so essentially 00:23:10.740 --> 00:23:14.480 you want to send these veterans into a health 00:23:14.480 --> 00:23:18.759 care system in the united states which cannot 00:23:18.759 --> 00:23:23.799 deliver in many places the basic minimum care 00:23:23.799 --> 00:23:31.980 to its citizens in those states I mean, the global 00:23:31.980 --> 00:23:36.660 picture, if you just want to talk globally, 89 00:23:36.660 --> 00:23:42.400 % of American counties have severe shortages 00:23:42.400 --> 00:23:48.559 of primary care providers, right? And 79 million 00:23:48.559 --> 00:23:52.059 Americans, right? That's like 30 % of the adult 00:23:52.059 --> 00:23:56.720 population live in shortages of. where there 00:23:56.720 --> 00:23:59.720 is shortages of primary care providers and other 00:23:59.720 --> 00:24:04.200 physicians. In mental health, and we have to 00:24:04.200 --> 00:24:07.500 remember that, you know, over 41 % of veterans 00:24:07.500 --> 00:24:11.559 have a serious mental health condition. We have 00:24:11.559 --> 00:24:14.339 a major shortage of mental health providers. 00:24:14.839 --> 00:24:18.799 And as the former, you know, head of Tom and 00:24:18.799 --> 00:24:22.619 so the former head of the National Institutes 00:24:22.619 --> 00:24:26.900 of Mental Health, He he when he left he said 00:24:26.900 --> 00:24:29.940 you know we have like a mental health crisis 00:24:29.940 --> 00:24:32.359 in america that is so severe that it's almost 00:24:32.359 --> 00:24:35.779 like a social justice issue and he reminded us 00:24:35.779 --> 00:24:38.519 that of the seventy eight thousand you know kind 00:24:38.519 --> 00:24:41.259 of mental seven hundred eighty thousand professionals 00:24:41.259 --> 00:24:45.599 in america very few of them are actually trying 00:24:45.599 --> 00:24:48.259 to deal with what are called serious metal. mental 00:24:48.259 --> 00:24:52.039 illness smi right and veterans have a lot of 00:24:52.039 --> 00:24:53.940 serious they don't just have like you know oh 00:24:53.940 --> 00:24:57.819 i'm worried about you know this or that or oh 00:24:57.819 --> 00:25:01.420 my gosh i'm a little anxious they have like schizophrenia 00:25:01.420 --> 00:25:05.420 and you know depressed major depressive disorder 00:25:05.420 --> 00:25:10.279 and ptsd and combat related ptsd and mental military 00:25:10.279 --> 00:25:14.400 sexual trauma I have a friend who went to a private 00:25:14.400 --> 00:25:16.480 sector mental health provider because there was 00:25:16.480 --> 00:25:19.640 a wait at the VA and the private sector provider 00:25:19.640 --> 00:25:23.299 said, so what are you here for? And she said, 00:25:23.400 --> 00:25:26.140 well, this and that and MST. And the provider 00:25:26.140 --> 00:25:34.059 said, what's MST? I mean, it's logical. Rather 00:25:34.059 --> 00:25:40.400 than build up this need for services and VHA, 00:25:41.019 --> 00:25:43.980 in the last half a dozen years, the approach 00:25:43.980 --> 00:25:47.400 has sort of been, well, if we can't get to you 00:25:47.400 --> 00:25:49.680 in time, just go out to the private community 00:25:49.680 --> 00:25:54.200 thinking that solves it. Well, your point is 00:25:54.200 --> 00:25:57.220 it doesn't solve it first because there isn't 00:25:57.220 --> 00:26:00.059 capacity to do it. There isn't training to do 00:26:00.059 --> 00:26:03.359 it. I want to read one sentence out of your conclusion, 00:26:03.400 --> 00:26:06.480 which is our survey of the current American healthcare 00:26:06.480 --> 00:26:10.289 landscape. confirms that shifting more patients 00:26:10.289 --> 00:26:14.390 into the private sector is an unwise policy decision 00:26:14.390 --> 00:26:17.150 that will not fulfill the nation's promise to 00:26:17.150 --> 00:26:20.849 provide timely, high -quality care to the 9 million 00:26:20.849 --> 00:26:27.349 VA patients. This is a policy issue. Talk to 00:26:27.349 --> 00:26:30.609 us about what the audience for this report from 00:26:30.609 --> 00:26:33.049 the Veterans Health Care Policy Institute, who's 00:26:33.049 --> 00:26:40.119 the audience? I'm always when I when I write 00:26:40.119 --> 00:26:42.380 books or, you know, I always am asked, Oh, what's 00:26:42.380 --> 00:26:44.799 your niche audience? And my I refuse to do that. 00:26:44.799 --> 00:26:47.140 It's like, you know, I want everybody to read 00:26:47.140 --> 00:26:50.579 this. So my audience is folks like you. My audience 00:26:50.579 --> 00:26:53.619 is people in Congress. My audience is veteran 00:26:53.619 --> 00:26:56.460 service organizations. I want to get this, you 00:26:56.460 --> 00:26:59.539 know, out to veterans, because like if you buy 00:26:59.539 --> 00:27:04.829 the idea that you're getting more choices. Think 00:27:04.829 --> 00:27:07.269 again cuz like there aren't a lot of choices 00:27:07.269 --> 00:27:10.309 out there maybe particularly if you're a rural 00:27:10.309 --> 00:27:13.730 veteran twenty five percent of veterans and basically 00:27:13.730 --> 00:27:17.549 what's gonna happen is you're gonna be defunding 00:27:17.549 --> 00:27:21.430 the VA which they're doing eventually the american 00:27:21.430 --> 00:27:23.970 taxpayer is gonna say well wait a minute nobody's 00:27:23.970 --> 00:27:26.589 using it why should we pay for it and then you're 00:27:26.589 --> 00:27:29.809 not gonna have the a is a choice and here's another 00:27:29.809 --> 00:27:33.329 thing jam that and you can relate to this. Another 00:27:33.329 --> 00:27:36.190 thing that really worries me super super worries 00:27:36.190 --> 00:27:41.289 me in my long now long connection to vets. One 00:27:41.289 --> 00:27:45.490 of the things I see is that many veterans when 00:27:45.490 --> 00:27:48.029 they leave the service they do not immediately 00:27:48.029 --> 00:27:50.529 go to the VA this is particularly true for mental 00:27:50.529 --> 00:27:54.490 health conditions and and pain and stuff like 00:27:54.490 --> 00:27:58.079 that right. and then you know 30 years later 00:27:58.079 --> 00:28:01.339 20 years later their wife says oh my god enough 00:28:01.339 --> 00:28:04.180 with this or you've got to go or their buddy 00:28:04.180 --> 00:28:07.799 or they retire and they came nothing to do and 00:28:07.799 --> 00:28:10.559 it all comes back to them and then they go to 00:28:10.559 --> 00:28:15.460 the VA well the that means that the VA has to 00:28:15.460 --> 00:28:20.259 be there not just for for them folks now but 00:28:20.259 --> 00:28:23.799 for when they finally get it in their heads Holy 00:28:23.799 --> 00:28:27.539 moly, I need help. So we need a VA not just, 00:28:27.559 --> 00:28:31.880 you know, now but in 30 years. Be there 30 years 00:28:31.880 --> 00:28:35.119 or 20 years or yes. Yeah, I mean, these, yeah, 00:28:35.279 --> 00:28:38.500 I have sat in on so many peer support groups 00:28:38.500 --> 00:28:42.779 for Vietnam vets. It's heart wrenching stories 00:28:42.779 --> 00:28:48.230 of people who for decades Literally decades lived 00:28:48.230 --> 00:28:52.630 with anxiety and panic attacks and nightmares 00:28:52.630 --> 00:28:55.809 and blah, blah, blah. And they finally three 00:28:55.809 --> 00:28:58.930 months ago, three years ago, went to the VA and 00:28:58.930 --> 00:29:01.970 they're getting help. But so, you know, we have 00:29:01.970 --> 00:29:04.950 to think not just like right now, we have to 00:29:04.950 --> 00:29:09.549 think longitudinally. People resist getting health 00:29:09.549 --> 00:29:13.990 care. They resist getting help. I want a wide 00:29:13.990 --> 00:29:16.829 audience to look at this. That's my view on the 00:29:16.829 --> 00:29:19.470 audience. And don't get scared off because it's 00:29:19.470 --> 00:29:22.869 too thick. You need the first 10 pages. That's 00:29:22.869 --> 00:29:25.869 where it's all at. Because then it's backed up 00:29:25.869 --> 00:29:29.269 by 50 more pages, state by state, what's going 00:29:29.269 --> 00:29:32.250 on. So you can read the 10 pages, kind of go, 00:29:32.309 --> 00:29:34.349 wow, I didn't think about some of these things. 00:29:34.670 --> 00:29:38.549 Let me go look at where I live and go to that 00:29:38.549 --> 00:29:43.140 state and say, oh. There is this shortage and 00:29:43.140 --> 00:29:46.319 that shortage of doctors or nurses or healthcare 00:29:46.319 --> 00:29:50.519 in my area. Because I do think there's been a 00:29:50.519 --> 00:29:52.980 push to sell to veterans and veteran service 00:29:52.980 --> 00:29:56.119 organizations that this community choice is the 00:29:56.119 --> 00:29:59.099 way to go. It may be a portion, it certainly 00:29:59.099 --> 00:30:02.660 can't be all. And I'm getting in trouble if I 00:30:02.660 --> 00:30:04.799 don't, we didn't talk about it. Should have done 00:30:04.799 --> 00:30:06.200 it at the beginning. I'm getting in trouble if 00:30:06.200 --> 00:30:10.079 I don't talk about or have you talk about. What 00:30:10.079 --> 00:30:12.940 is the Veterans Health Care Policy Institute? 00:30:13.240 --> 00:30:16.119 Sure, Matt, thank you for asking. So we're a 00:30:16.119 --> 00:30:21.160 group of veterans, journalists, researchers, 00:30:22.319 --> 00:30:26.460 people who work for the VA, and we formed what 00:30:26.460 --> 00:30:29.859 is really the kind of only think tank. We think 00:30:29.859 --> 00:30:33.539 a lot in research and write about veterans' health 00:30:33.539 --> 00:30:38.319 care issues. and we fight against the privatization 00:30:38.319 --> 00:30:42.440 of the VA, we don't believe, we believe, and 00:30:42.440 --> 00:30:45.559 this has always been true, that there is a role 00:30:45.559 --> 00:30:47.779 for private sector care. It used to be called 00:30:47.779 --> 00:30:50.559 fee -based care if the VA can't really do it, 00:30:50.559 --> 00:30:53.759 if they can't get to you in a reasonable amount 00:30:53.759 --> 00:30:57.299 of time, or if they just don't have the service. 00:30:57.539 --> 00:31:00.059 They don't have labor and delivery. I mean, it 00:31:00.059 --> 00:31:02.960 doesn't make sense, and so they pay for you to 00:31:02.960 --> 00:31:05.970 get it. you know, in the private sector. But, 00:31:05.970 --> 00:31:10.450 so we, but we are, you know, proudly for public 00:31:10.450 --> 00:31:14.589 programs, and we want the VA, the Veterans Health 00:31:14.589 --> 00:31:17.549 Healthcare, the Veterans Health System to be 00:31:17.549 --> 00:31:20.710 expanded, to be improved, to work well. And we 00:31:20.710 --> 00:31:24.309 also want to remind people of, you know, the 00:31:24.309 --> 00:31:27.410 fact that it, while it primarily serves veterans, 00:31:27.690 --> 00:31:31.509 it serves all Americans, you know, and people 00:31:31.509 --> 00:31:34.230 sort of, I think a lot of people look at, oh, 00:31:34.230 --> 00:31:36.490 VA healthcare, that's just for them. Why should 00:31:36.490 --> 00:31:40.269 I pay attention? I was one of those people before 00:31:40.269 --> 00:31:43.650 I started doing work and research on the VA. 00:31:43.829 --> 00:31:46.170 I thought, well, oh, so they have this great 00:31:46.170 --> 00:31:48.450 innovation in care. What difference does it make? 00:31:48.549 --> 00:31:50.650 It's not going to impact me. I had absolutely 00:31:50.650 --> 00:31:54.890 no idea about VA research. I didn't know that 00:31:54.890 --> 00:31:57.769 my first shingles vaccine was thanks to the VA, 00:31:57.769 --> 00:32:01.750 you know. whoever you're getting healthcare treatment 00:32:01.750 --> 00:32:05.890 from probably did some training in their medical 00:32:05.890 --> 00:32:09.170 school and residency and fellowships at a VA 00:32:09.170 --> 00:32:11.869 hospital because they trained some folks. If 00:32:11.869 --> 00:32:16.069 you're interested listeners in the Veterans Healthcare 00:32:16.069 --> 00:32:20.069 Policy Institute you can find it at veteranspolicy 00:32:20.069 --> 00:32:23.269 .org. That's where you can go and there's a lot 00:32:23.269 --> 00:32:27.500 of good information there and you can Also track 00:32:27.500 --> 00:32:31.140 what Suzanne Gordon's doing and titles of all 00:32:31.140 --> 00:32:34.640 our books and things, which is too long to read 00:32:34.640 --> 00:32:40.200 out loud at suzannecgordon .com. Did I get that 00:32:40.200 --> 00:32:44.000 right? Yeah. Okay. Just realized there's a C 00:32:44.000 --> 00:32:46.299 in the middle of that and I didn't have it down 00:32:46.299 --> 00:32:52.250 earlier. As I say, you've spent the last decade 00:32:52.250 --> 00:32:55.829 or more working in this veterans healthcare space. 00:32:57.490 --> 00:32:59.769 Almost always when you're doing that kind of 00:32:59.769 --> 00:33:02.630 research and writing, you get that glimmer of, 00:33:02.730 --> 00:33:04.910 oh, this is the next thing I got to chase down. 00:33:05.369 --> 00:33:07.490 So is there the next thing you feel you have 00:33:07.490 --> 00:33:11.579 to chase down? Well, yeah, I mean, I think I, 00:33:11.579 --> 00:33:14.319 I really want to write some stuff to help people 00:33:14.319 --> 00:33:18.240 understand that the VA is an occupational health 00:33:18.240 --> 00:33:21.660 system. And, you know, that means you have to 00:33:21.660 --> 00:33:25.200 know about the occupations that these your patients, 00:33:25.200 --> 00:33:29.299 you know, had not just, you know, I mean, after 00:33:29.299 --> 00:33:31.440 they left the military, but while they were in 00:33:31.440 --> 00:33:35.119 the military, and America doesn't do occupational 00:33:35.119 --> 00:33:38.710 medicine. Well, you know, And it doesn't do health 00:33:38.710 --> 00:33:41.849 care well. So I want to write about that. I'm 00:33:41.849 --> 00:33:47.269 writing now a paper on the impact of VA, the 00:33:47.269 --> 00:33:49.990 current VA policies and cuts on women veterans, 00:33:50.130 --> 00:33:53.750 which is significant and goes way beyond abortion 00:33:53.750 --> 00:33:56.150 services. The media has focused on that, but 00:33:56.150 --> 00:33:58.950 it's so much bigger than that. I don't know. 00:33:59.569 --> 00:34:03.069 I mean, I think we have this. I mean, fundamentally, 00:34:03.230 --> 00:34:06.890 I'm not a veteran and I want the kind of care 00:34:06.890 --> 00:34:10.570 I think all Americans deserve, the kind of care 00:34:10.570 --> 00:34:15.630 that the VA gives when it's at its best and when 00:34:15.630 --> 00:34:18.449 it is supported by the public. And, you know, 00:34:18.449 --> 00:34:21.550 and I think it's really sad that so many veterans 00:34:21.550 --> 00:34:26.389 don't really sort of appreciate this. And I guess 00:34:26.389 --> 00:34:29.329 the other thing that I really want to say to 00:34:29.329 --> 00:34:32.409 your audience, I suppose, is, I mean, what I 00:34:32.409 --> 00:34:37.179 feel is so tragic and sad is I have a lot of, 00:34:37.300 --> 00:34:39.380 I know a lot of folks who work for the VA, I 00:34:39.380 --> 00:34:41.400 mean they're psychologists, they're chronic care 00:34:41.400 --> 00:34:45.860 docs, they're, they're everything. And it's really 00:34:45.860 --> 00:34:50.079 sad to me to see how they're being attacked by, 00:34:50.079 --> 00:34:53.940 you know, Congress, by the administration. These 00:34:53.940 --> 00:34:56.480 are people who could have worked somewhere else 00:34:56.480 --> 00:34:59.099 and made a whole lot more money. They're super 00:34:59.099 --> 00:35:02.659 smart, they know a lot, and they have devoted 00:35:02.659 --> 00:35:05.920 their lives. you know, really, because they're 00:35:05.920 --> 00:35:10.480 mission driven. And it makes me very sad to see 00:35:10.480 --> 00:35:16.300 VSOs and other groups not supporting them. Because, 00:35:16.699 --> 00:35:21.019 I mean, You know, I know folks who are in tears. 00:35:21.199 --> 00:35:23.760 I mean, they are be receiving and veterans should 00:35:23.760 --> 00:35:27.440 be outraged that, you know, the Trump administration 00:35:27.440 --> 00:35:31.099 is sending messages to their VA doctor and nurse 00:35:31.099 --> 00:35:35.260 telling them literally, you know, you are not 00:35:35.260 --> 00:35:38.559 contributing to American prosperity and you should 00:35:38.559 --> 00:35:42.300 do more productive. And this is a quote work 00:35:42.300 --> 00:35:45.599 elsewhere. So what is administration is saying 00:35:45.599 --> 00:35:49.460 taking care of veterans? isn't productive work. 00:35:49.699 --> 00:35:53.579 If I were a vet, I mean, I'm outraged on behalf 00:35:53.579 --> 00:35:56.360 of vets. If I were a vet, I would be flipping 00:35:56.360 --> 00:36:00.780 out. I think we should flip out in appropriate 00:36:00.780 --> 00:36:04.579 ways and just be going to these congresspeople 00:36:04.579 --> 00:36:08.239 and saying, what are you saying here? Is that 00:36:08.239 --> 00:36:11.239 what you believe about the service I gave my 00:36:11.239 --> 00:36:14.679 country? Well, I want to encourage people to 00:36:14.679 --> 00:36:17.380 find the Veterans Health Care Policy Institute 00:36:17.630 --> 00:36:21.329 paper titled Veterans Healthcare Choice, Myth 00:36:21.329 --> 00:36:24.510 or Reality, a state by state reality check for 00:36:24.510 --> 00:36:29.190 the false promise of VA privatization. Suzanne 00:36:29.190 --> 00:36:32.289 Gordon, thank you for talking to us about this. 00:36:32.670 --> 00:36:35.570 It was very interesting reading and obviously 00:36:35.570 --> 00:36:37.670 a lot of work into it and that's why I encourage 00:36:37.670 --> 00:36:41.550 people go look at your particular state. It's 00:36:41.550 --> 00:36:43.929 going to reframe your thinking on this issue. 00:36:44.489 --> 00:36:46.710 Suzanne, thank you for talking to Veterans Radio. 00:36:46.969 --> 00:37:09.050 Thank you for having me Jim. You can follow Veterans 00:37:09.050 --> 00:37:12.150 Radio on Facebook and listen to its podcasts 00:37:12.150 --> 00:37:16.590 and internet radio shows by visiting us at veteransradio 00:37:16.590 --> 00:37:20.690 .org. That's veteransradio .org. We would again 00:37:20.690 --> 00:37:23.869 want to thank our national sponsors, the National 00:37:23.869 --> 00:37:27.809 Veterans Business Development Council, nvbdc 00:37:27.809 --> 00:37:32.889 .org. 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