The Mirror We Refuse to Look In

Graphic courtesy Arc Digital

I make a concerted effort to let most of the social media back-and-forth over Rep. Alexandria Ocasio-Cortez go by without worrying to much. The digital comings and goings of the freshman rep of NY-14 just do not interest me much, and the reactions to them even less so. The coverage of all things AOC is disproportionate to her or her critics’ actual impact on day-to-day life, and understanding I only have so much bandwidth, it is an easy call to not engage. That determination comes from when I first joined Twitter, and I took a good hard look in the mirror at myself and set down some rules I try to follow, to keep such teapot tempests from spilling over into real life. Such rules were tested this week as social media got all atwitter over a video clip of the Congresswoman stating, as part of a larger point, that the VA provided the highest quality of care and punctuated it by leading the crowd she was addressing to respond “If it ain’t broke, don’t fix it.” She followed that up a few days later with comments including “Because there is a myth that all VAs everywhere are broken…If we can starve them of budgets and make sure they can’t do their job, then we can say the whole system should be thrown away. I’m not going to back down from protecting the VA.”

Now normally this is where one would segue into an op-ed on the subject at hand, using the quotes to pivot into a larger point, throw in some anecdotes, some data points, quote some other people, and make sure there is some rhetorical device threaded through the narrative to give the piece a nice arc before driving home the point at the end. A nice finished product with a start, a conclusion, a few catchy quotes, and the wider world sees a completed thought, as professional-looking as amateurs can make it. But what is needed here, and needed at the VA, is some humility and truth that there is no such thing as a nice, neat finished project when it comes to the story of Veterans Affairs.

So here, with all the humility I can muster, is the truth of how you came to read this, an honest account, not just a well-presented polished piece purporting to impart great insight and easy answers.

Fighting down my initial reaction to such a comment comes first. I remember that Alexandria Ocasio-Cortez is a person, a sitting congresswoman - youngest ever, in fact - and has lived a very different life from mine with very different experiences. She really believes what she said, and probably doesn’t know better, and hopefully wasn’t overtly trying to offend veterans who are not happy with the VA system. So deep breaths, skip the outrage, don’t make it personal, move along to the substance and avoid just hot-taking what was said. Having done that, the truth is easy enough: The VA is capable of providing excellent health care. That isn’t the issue. Is it providing excellent health care uniformly? Certainly not, not even close.

So how do I address the legion of reasons why that is? How do I do that, or at least attempt to do that?

What is not working is ripping through five thousand words across ten different drafts that I discarded at various points of frustration and anger trying to convey my point. How to write an arc into a story like the VA, a confluence of dozens of different issues both product of the giant machine of state and the intensely personal matters of life and death that are contained within? The mental strain starts getting the best of me, so I call a halt to think of some way to switch off my brain and reset.

So I go take a bath. I hate baths. I’m a shower guy, and years of living with daughters taught me the faster the better since hot water is never available when it’s my turn. But with certain issues I have, old school self-care fills in where the VA and ineffective and not-a-good-idea heavy pain meds can’t, so Epsom salt baths it is. Off goes the shirt, and then as I have a thousand times before I see myself in the mirror.

Mirrors suck. I hate them even more than baths. They are blunt, uncompromising things. But sometimes blunt and uncompromising is called for, especially when wrestling with a problem you are trying to solve, and problem solving starts with assessing yourself. Mirrors are good for that. I see plenty about the VA in my mirror. The modified mid-line laparotomy scar that goes from sternum to lower abdomen with the 30-odd staple scars running along both sides. The various laparoscopic scars, some of which have been used more than once, the chest tube scars on the sides, the J-tube scar that is more like a big splotch, the triangle hole that serves as a belly button but is version 3.0 of that, surgically constructed at the end of the fourth major surgery in as many months. The heart surgery scar above that from the pericardiectomy when they couldn’t keep the blood and fluid out of my heart lining after the second emergency surgery. You can’t see the scar tissue in my throat from the ventilator after the heart surgery when they couldn’t get me back up from anesthesia without me seizing, so they just left me down for five days before finally succeeding. Nor can I see the seventy pounds that used to be there when I was still at fighting weight that is no longer, and never again will be, on my frame.

So how do I write those memories into a piece about the VA?

I sit back against the tub, space heater blowing hot air across me, unable to get all that into a coherent thought. I fire off a tweet about emotions of the topic I’m writing getting the better of me. I know the issues of the VA. I know those surgeries saved my life. I know the back story as well. I know that my surgeon, best in the world at what he does, traveled across the street to the Durham VA one day a week from Duke, and I was fortunate enough to get him. I remember him telling me ten minutes into my first appointment what he suspected, how he thought years of misdiagnosis and a surgery I had while on active duty he feared was done incorrectly years before needed to be repaired. I remember the words “The VA cannot handle this, we have to get you to where we can treat you,” and the ten months it took to make that happen through a byzantine system of referrals, approvals, and bureaucratic nightmares. How once it was finally finished the approval people laughed and joked about how quickly it was done and how lucky I was. I remember that after the first surgery it was far worse than feared, and I remember most of the next four plus months in the hospital as they worked to fix it, minus the ventilator and surgeries of course. The anesthesia means not remembering, and the medical records and pictures of restraints make it clear that is for the best. The recovery and therapy of learning how to move, walk, and do just about everything again is still vivid. I remember, come time to go home, having fought for ten months to get approval in the first place, it took five more days of administrative nonsense to get home health care approved to release me. The irony of fighting them to get in the hospital only for them to fight to keep you in it is something some screenwriter should mine someday.

So how do I add that piece into the story, that the horribly flawed, worse run, and finally replaced VA Choice program, which while a policy debate to many, is the only reason you are reading this since otherwise I would be dead right now?

On the bathroom floor, a message comes from someone who saw my frustration tweet, a writer I respect but had never spoken to before. I vent. “There is an astounding grace and humility in saying ‘I’m in the middle of this and even I can’t figure it out’,” comes the reply.

Good advice, and it has the benefit of being true. I’m in the middle of the VA debate, and I have no idea what the answers are. In fact, I’m convinced there isn’t an easy, simple one. There isn’t even a good way to quantify the problems.

Maybe use a bunch of stats and numbers to show that despite more than doubling the budget for the VA over the last ten years, the system is deluged in patients, crippled in staff shortages they cannot fill, and hamstrung by a bureaucracy that grows as fast as the issues.

Maybe point out that just this month three veterans committed suicide on the grounds of VA facilities, making it at least 22 in the last 18 months to do so. Maybe also point out that those 22 are just a fraction of the estimated 6000 a year, and that the suicide rate among VA patients is higher than that of veterans who are cared for elsewhere.

Maybe point out that the quality of care received doesn’t matter a bit if the veteran cannot navigate the benefits and claims system in an expedient manner in the first place, or can’t get an appointment in a timely fashion, or needs a referral to a specialty that isn’t available or only available far away.

Maybe point out that the plight of veterans is really popular to use when a politician says something wrong, or a football player kneels, or some other political issue of the day needs draped in the flag to make its point more emotionally investing, but the rest of the time America as a whole seems pretty content to do nothing substantial about it. If that seems cold, so sorry, but evidence demands a verdict and if things haven’t improved over different congresses and different presidents and different eras the problem does not lie solely at the feet of politicians of either party but with all of us. Otherwise we would make them do something about it.

The truth is the government can no more fix the VA than I can fix it from my bathroom floor.

Veterans Affairs is the government, and it is us too. The two are inseparable, and that is the problem. The VA is where all the fantastic ideology and political, economic, healthcare, and social theories go to die, a living example of their limits. Are you a proponent of socialized, government-run, or single-payer healthcare? VA has the good and bad of that. Think government should keep its promises regarding benefits? VA has the good and bad of that. Have strong thoughts of the role of government in healthcare? VA has the good and bad of that. Which is why anyone using the VA as the example for their ideology is going to have to, at best, cherry pick their examples. So most don’t, refusing to look at the mirror the VA is reflecting back at us as a country. Those theories have good and bad points, and their limits are in full view within the VA system. The most powerful forces in government are a combination of mild neglect and inertia inherent to the behemoth of a huge federal government, of things continuing to grow and self-propagate with little outside force to change. Thus you have very bad things entrenched into an institution that has a noble purpose and good intentions, the latter good parts being the excuse to not change the former problems. This leaves little to no real recourse to correct it.

Debate over Veterans Choice, and the larger one of how much if any privatization the VA may use to try to address some issues, is chasing symptoms but will do little to cure the problem. Choice, or whatever outside referral program is tried, is still going to be administered by the VA. It will be a political football for all time, as the VA itself is, subject to the whims of congress critters who will speechify how voting for X number of dollars proves they care. It will still be a cabinet position appointed by whomever is president, overseeing the second largest department of government.

You did know that, right? That the second largest part of our federal government, after its first cousin the Department of Defense, is Veterans Affairs. It’s growing by the minute, nearly as big as the next two largest departments put together. It takes that much of Washington to care for 18 million people the way the VA does it. And it’s a shambles most of the time. But it is a necessary shambles, for good or ill, since it was promised to the people who rely on it. Until the day it is replaced with something better, and I’m skeptical of that, the VA is it for the 18 million veterans our country has and the 9 million that stream through the doors of VA healthcare each year.

Blaming the “them,” the government and politicians, for the mess at the VA is the base alloy of VA dysfunction. Reagan’s oft-quoted line about government being the problem has merit, but it’s half the story. Having a representative democracy means we have the government we chose. And allowing something to continue without change is the same as choosing. It’s easier to blame the dysfunction than look in the mirror of what our chosen government is doing and realize our own hand in it.

How the VA is administered affects far more than just veterans. If we want to have a national conversation on healthcare for the 320+ million of us - and specifically government’s role in that - we should take a long, hard, honest look at how that same government is currently struggling with only the 9 million who use VA healthcare system each year. Most of those veterans are dependent on the VA for more than just healthcare and a benefits check, and how our government treats those dependents is a fair judgement of how it will treat the rest of us.

There are no easy answers to the future of Veterans Affairs. There are plenty of problems still beneath shining exteriors of the multitude of brand new facilities VA is building across the country. Throwing more and more tax payer money at it isn’t the answer, nor is abandoning the leviathan to its fate. Whatever the answers are, it will start with a humbling and honest look at what the VA is, and isn’t, what it was meant to be and what we have allowed it to become. Then, and only then, can we figure out the right path to what it should be, and make it about actually caring for those who have borne the battle, and not just a partisan battle over who can appear to care more.