Veteran healthcare has become a very large concern for the American public and politicians alike. Both mental health and physical health are important topics to discuss. The most recent wars in Iraq and Afghanistan have resulted in "over 46 000 soldiers wounded in action, some with serious and debilitating conditions, such as chronic pain, traumatic brain injury, and high risk for cardiovascular disease" (Eisen et. al). These physical injuries often go untreated for far too long due to the many failures of the VA. When it comes to mental health the numbers for veterans returning home from overseas are just as astounding, "13.9% screened positive for probable posttraumatic stress disorder, 39% for probable alcohol abuse, and 3% for probable drug abuse" (Eisen et. al). These numbers are far higher than those of the general population. Unfortunately only about half of those veterans seek out treatment, however the more startling statistic is that a bit less than 50% of those who seek out treatment actually receive the care they need ("Veterans and Military").  All of these numbers amount to one thing; the VA is not doing its job very well. The VA needs to be completely overhauled. The government needs to provide more money to the system for aging veterans, improve communications, develop a more organized wait system, hold the proper people accountable, and give veterans the option of privatized healthcare. 

In 2014 the VA faced their largest scandal in history. Reports of extremely long wait times and unanswered phone calls at VA hospitals flooded the news. Stories of veterans passing away from illnesses that would have been treatable had they received timely care were on the front page of newspapers. Veterans were being forced to wait for months before seeing a doctor even though VA procedure states "New patients are supposed to see a doctor within 14 days after their paperwork is accepted" (Maraniss, Samuels).  Once this scandal broke the VA had their inspector general investigate the reports. He found that "out of about 800,000 records stalled in the agency's system for managing health care enrollment, there were more than 307,000 records that belonged to veterans who had died months or years in the past" (Devine). While a good portion of these veterans passed away while awaiting care, this discovery exposed yet another error in the VA system. There is no follow up, so when a veteran does pass away their record is often left in the VA system just adding to the backlog (Devine). The inspector general concluded that VA employees then forged paperwork to hide the fact that so many records were stalling in the system (Maraniss, Samuels).  The long wait times were the most widely covered issues but they were far from the only issue the scandal uncovered. Improperly managed gastroenterology programs, outbreaks of Legionnaires' disease, and even illegal drug deals were also part of the allegations. These problems plagued hospitals across the country, most famously Phoenix, as well as Miami, Columbia SC, Pittsburgh, and Fort Collins CO (Maraniss, Samuels). In total "manipulation and falsification of wait-time data at more than 40 facilities indicate a serious systemic problem" (Kitzer, Jha). People all over the country were outraged. Politicians on both sides of the aisle called for change, and veterans outreach groups called for those accountable to be fired immediately. Unfortunately change has taken far too long to happen, and not many people have been held responsible for such a poorly run administration. 

The VA is a federally funded administration, meaning that each year Congress establishes a budget for it based on the current demand. Since 1940, when the budget was first formally established, the average increase each year has been 3.8% (Scott). The largest jumps in money allotment tend to come at the end of wartime, most notably World War II and the Vietnam War. During the years shortly after the invasion of Iraq and Afghanistan the budget increased steadily, which makes sense considering the number of soldiers overseas, as well as aging Vietnam veterans (Scott). However the budget seems to have plateaued after 2011, increasing by only about 1000 dollars each year. Scott argues that this is because the Iraqi conflict had ended so there was not a need for a large increase. What she fails to realize is that just because the war had technically ended does not mean the need to treatment ended. Many of those injured need long-term care, as well as veterans who have returned with PTSD. The budget needs to consider that "PTSD diagnoses among deployed troops grew by 400% from 2004 to 2012" (Sifferlin). For thousands of veterans PTSD is an extremely pressing issue, one that is not fixed with on trip to the doctor. These veterans need potentially years of therapy and treatment, something that should be allotted for in the budget. 

Part of the reason the need for a budget increase does not feel so pressing is because there are large portions of veterans not enrolling in VA healthcare. The main reason the say they did not enroll is because they were not aware of their benefits ("Veterans Surveys and Statistics").  This problem of confusion when it comes to benefits is widespread not just healthcare. Only 60% of veterans say they understand their benefits as a whole including healthcare, life insurance, disability compensation, and education ("Veterans Surveys and Statistics").  The things veterans are most confused about in addition to being unaware of their benefits are how to apply, and being unaware of the program as a whole. The VA should be working to make veterans more aware of their benefits and make the application easier.

The most famous face of the VA scandal is Barry Coates. Coates was an Army veteran who "was having excruciating pain and rectal bleeding in 2011" (Bronstein, Black, Griffin). He went to several VA hospitals and was consistently misdiagnosed. He was finally put on a list for a colonoscopy, which he received several months later. It was discovered Coates had a large cancerous tumor. In January "Coates' family said he died from the cancer that had been left untreated by the VA for so long" (Bronstein et al.). The death of 46-year-old Barry Coates is a tragedy that could have been avoided. If the VA had an efficient system to organize their wait list Coates' tumor would have been discovered much earlier and treatment would have been more effective. Coates spent the last two years of his life fighting for reforms to the VA (Bronstein et al.). While he is the most well known veteran to pass away due to incompetence at the VA he is certainly not the only one. Lives could have been saved if the VA had a strong system for managing the records of all of their patients. Developing this system is one of the key elements that need to be addressed by the government as they try and fix the VA.  

Another large element that needs to be addressed in order to fix the VA is the accountability issue. Despite the stalling of applications and the forging of paperwork the Department of Veterans Affairs stated it fired fourteen people. To only hold fourteen people responsible for such large issues outrage enough however, "new internal documents show that the real number of people removed from their jobs is much smaller still: at most, three" (Philipps). Three people nationwide have been held accountable and properly punished for the numerous issues in the VA. This number is ridiculously low and is one that Congress is trying to address in order to prevent a scandal like this from happening. The legislation, called the VA Accountability Act "would sharply cut the time allowed for employees to appeal terminations to less than 30 days. The existing rules do not allow employees facing termination to collect pay while they appeal to the Merit Systems Protection Board for federal employees  --  a process that can last up to two year" (Philipps). It is extremely important that this passes, or the VA will continue to employee the same people who caused the issue in the first place. 

By allowing the VA to continue to employee the same people there have not been many solutions to the problems uncovered two years ago. The majority veterans phone calls are still going unanswered, in fact an ABC news investigation discovered through "Recently obtained VA documents show that in 2014, 55 percent of calls never got through to a representative. And, so far in 2015, that number is even higher, at 59 percent" (Gilger, Martin). This proves that nothing has changed, in fact the argument can be made that when it comes to unanswered phone calls things have actually gotten worse. However, no one should be surprised that this is the case. By not firing the source of the problem the problem will continue to repeat itself. What is even more appalling is the only people to get fired from answering calls at the VA call center are those who do not follow the VA policy that states employees are not allowed to spend more than ten minutes on the phone per caller (Gilger, Martin). This is unfair to the thousands of veterans and their families who are making calls to ask questions and get clarification on the benefits they are entitled to. 

The unanswered phone calls extend beyond just the benefits hotline. Dennis Magnasco, an Army veteran from Massachusetts showed the difficult process veterans have to go through in order to make an ordinary doctors appointment. Magnasco filmed himself while he called the VA to make an appointment. He is sent through a series of automated voiceovers repeatedly (Bendery). Magnasco's boss, Seth Moulton is a Representative who is also an Iraq War veteran. He was extremely disappointed in this VA system so he shared the video on his Facebook page. The video went viral, and as a result the phone system at that Massachusetts hospital was fixed. However for Magnasco and Moulton this was not enough. They wanted all the hospitals fixed not just theirs, which is why Moulton proposed a piece of legislation called the Faster Care for Veterans Act (Bendery). He has received support from both sides of the aisle for the legislation that proposes the "VA to run an 18-month pilot program that lets veterans in certain networks use an app on their phone to schedule or cancel VA appointments themselves" (Bendery). Apps like this already exist, people can make all types on appointments with just a few clicks on their phone, so it should be easy enough to instill this system for the VA. A simple change like this will allow veterans faster access to healthcare and will take the responsibility out of the hands of people who clearly could not handle it. 

When the scandal broke in 2014 the people who were punished were the people who exposed the problems. Instead of firing the people who hid the applications or left the phones unanswered the VA took it out on people like "Chris Kirkpatrick, a psychologist at the Tomah Veterans Affairs Medical Center, was reprimanded by his supervisor in April 2009 for raising questions about the medications being prescribed for veterans" (Perez). It turned out however that Kirkpatrick was right; the VA hospital he worked at was significantly over prescribing drugs. Kirkpatrick however did not get to see this revelation come to light; he was fired three months later and committed suicide (Perez). The Senate held hearings to investigate the treatment of whistleblowers like Kirkpatrick. After the hearings Sen. Ron Johnson, R-Wis., the leader of the hearings was quoted saying "The VA has a cultural problem with regards to whistleblower retaliation" (Perez). 

While there is no perfect solution to fixing the VA, experts have proposed the idea of giving veterans more of a choice in their healthcare. Mercedes Schlapp writes a very compelling article, arguing that "government run health care for our veterans is a failed experiment, and it is time to overhaul the U.S. Department of Veterans Affairs" (Schlapp). The VA scandal of 2014 proved that once again, the government has failed at managing veteran's healthcare. Schlapp provides a potential solution to the VA. She argues that veterans should be given the option to have privatized healthcare.  It is unfair to force the veterans to use a healthcare system that has "become a breeding ground for cover-ups and mismanagement resulting in lack of quality care for our veterans where thousands of them are being treated as second class citizens" (Schlapp). A national veterans advocacy group argues for a very similar solution. They also believe that veterans should be given a choice to opt for private healthcare and they want "a conversion of the Veterans Health Administration into a non-profit corporation rather than a government agency" (Wagner). This group advocates that the VA has become far to politicized and because of that they have forgotten who they truly work for, the veterans. By giving veterans the chance to use private healthcare the VA will become much less overwhelmed so that those that chose to stick with the VA will be given the care they deserve.

Several professionals have argued that the despite all of its problems VA healthcare is extremely high quality. These professionals argue, "Some other health systems also provide excellent patient care, and every place has it weaknesses, but the VA generally stands out on quality, said Elizabeth McGlynn, associate director of Rand Health" (Gerencher). People like McGlynn believe that the VA is able to provide better healthcare because the doctors and nurses are paid on a set salary instead of being paid based on the services they provide (Gerencher). While this could eliminate the doctors sending away for expensive unneeded tests it also can have the opposite affect. When these doctors are being paid a set amount no matter the treatment they prescribe they can very easily lose incentive to look deeper into illnesses. Serious illness could be dismissed as a common cold or a virus when in reality it is much more serious. The VA Phoenix Medical center in fact "has mortality rates for common conditions that are among the highest within the VA and higher than those in many private hospitals. Its rates of catheter-related bloodstream infections are nearly three times the national average" (Kitzer, Jha). The VA has faced scandals for years including in 2009 when "two VA centers in Florida and Tennessee contacted thousands of veterans to alert them that they may have been exposed to contaminated colonoscopy equipment that could put them at risk for hepatitis or HIV" (Gerencher). Gerencher dismisses this scandal by saying that "despite such sporadic problems, many experts credit the VA with staging a remarkable turnaround" (Gerencher). Aside from the obvious fact that exposing thousands of people to HIV is an enormous problem the VA has not experienced the massive change the author believes it has. The VA has faced numerous scandals since this one in 2009, including the massive one that came out in 2014. The thousands of people impacted by the extremely long wait times, including those who passed away while waiting for care would argue that the VA is not the highest level of healthcare, because they never got the chance to experience it.

These problems will not be fixed overnight. There is no easy answer but there is plenty the public can do to help. Laws like the ones proposed to strengthen the wait list system and to allow veterans to make their appointments with an app need to be passed. These efforts tend to be bipartisan so whichever political party someone affiliates with there are most likely politicians who plan on passing these laws. Pay attention during election season to hear the different plans for solution. For the more driven person, write a letter or call your local senator. Ask them what they are doing to fix this problem. 

