VA system as model for healthcare access and delivery?


DETROIT, MI — As a healthcare professional and Senior Care Advocate, it’s a call I get often: “I am a veteran and I want to go through the VA for my medical needs, because they will take care of everything. How do I get started?”

Navigating the VA system is a challenge, without the right help, so I often refer these patients and clients to VA Care Managers and elder law attorneys so veterans (and spouses of veterans) can utilize their well-deserved benefits—and make the most of them. There are often long wait times but because the benefits can be really beneficial, most of our clients and patients are willing to wait for this top-notch care.

There are 22 million veterans in the U.S. today. They are often poor, and the Vietnam-era veterans are getting to an age where they need more health care. The VA has pioneered quality initiatives, delivery system changes and an electronic medical record that is far ahead of the private sector. Veterans’ service organizations praise the VA, even as they complain about waits, precisely because of its high quality.

But any health care program that benefits low-income individuals and families (including the VA, because today the poor are more likely to join the military) is politically vulnerable to budget cuts or calls for privatization, and is likely to suffer from more problems than a health system that benefits everyone—rich and poor, young and old, soldiers and civilians, i.e., the entire population. Otherwise there will be pressure to underfund it.

In our current privatized system, healthy adults (or their employers) pay private insurance companies huge amounts of money for their entire working lives, and not one penny of that helps take care of them when they grow old. How great would it be if instead, a small portion of that money actually went into the same insurance pool that will take care of us when we are old and really need health care and prescription drugs?

In addition, the VA has a special benefit called “Aid and Attendant Care”. If you are a veteran overwhelmed with the high cost of long-term elder care, such as paying for assisted living facilities, home care aids, adult daycare, or skilled nursing, the Veterans Aid and Attendance benefit could be the solution to help offset these rising care costs. A wartime veteran or their surviving spouse with limited income may be eligible to receive a non-service connected pension (this means that the need for care does not have to result from one’s military service). There are three levels of VA Pensions:

1. Basic Pension/Improved Income—for healthy veterans over the age of 65 with low incomes

2. Aid & Attendance—for veterans over the age of 65 that require assistance with their activities of daily living

3. Housebound—–for veterans with a disability rating of 100% that prevents them from leaving their home, but it does not have to be related to their military service.

The Aid & Attendance and Housebound pensions provide additional monthly income over and above the Basic Monthly pension. To be eligible for either, one must also meet the requirements for the Basic Pension.

The VA’s innovative health system and these additional benefits could be an excellent model for Single-payer national health insurance. An improved Medicare for All will offer a single tier of high-quality care to everyone. It would address wait times in an organized way, be transparent and accountable, and allocate medical resources based on need, not ability to pay.

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