Editorial Column: Care and Clarity at the VA

The Pioneer Press

April 23, 2008 – War affects different people in different ways. We know more about that because of advances in various sciences, technology and computing power. There’s still a lot left to learn. But this is certain: The price of war isn’t limited to the cost of bullets.

That’s why it’s so important to have a strong, efficient, accountable federal agency to disburse care to those among us whom our nation sent off to fight. For the first time in its modern incarnation, the Department of Veterans Affairs is led by a general who is also a doctor, James B. Peake.

Peake, a surgeon, is a decorated veteran of the war in Vietnam and formerly was Army surgeon general. He became secretary of veterans affairs late last year, in the wake of the Washington Post’s investigation of bureaucratic nightmares and scandalous conditions affecting injured war veterans.

Secretary Peake was in the Twin Cities last week to cut the ribbon on the Paralyzed Veterans of America Vocational Rehabilitation Center here, and he stopped by for a discussion with the Pioneer Press editorial board.

Earlier that day, the Rand Corp. had released a new study concluding that “fundamental gaps remain in our understanding of the mental health and cognitive needs of U.S. service members returning from Afghanistan and Iraq, the costs of mental health and cognitive conditions, and the care systems available to deliver treatment.”

The Rand study focused on post-traumatic stress disorder, major depression and traumatic brain injury. It examined their prevalence among returning soldiers, the care system available to them, the societal costs of these conditions and the cost of delivering high-quality care to all who need it.
The consequences of PTSD, major depression and traumatic brain injury, Rand Corp. said, “can have a high economic toll; however, most attempts to measure the costs of these conditions focus only on medical costs to the government. … Far higher are the long-term individual and societal costs stemming from lost productivity, reduced quality of life, homelessness, domestic violence, the strain on families and suicide.” Rand recommended more capacity for mental-health care and policies that encourage more service members and veterans to seek the care they need.

At the time we talked with Peake, he said he hadn’t yet seen the report. But he advocated for essentially the same measures — early intervention and evidence-based treatment.

Peake also talked about the professionals and caregivers he’s seen at VA hospitals, about how impressed he is “with the quality, and their passion for what they’re doing.” He talked about recognizing that some vets will need lifelong treatment but making sure that others know they will recover. “You need to have the expectation that you’re going to get better,” he said.

He talked about the efficiency and focus of the VA’s medical efforts and the urgent push to take advantage of technology to deliver more and better care. He talked about the strong, bipartisan support for the VA in Congress. “Everybody’s got their own political agenda,” he said, “but I think everybody’s sincere in wanting to do right by our veterans.”

He also talked about the differences on the home front between the Vietnam era and today. Today, in debates about the war in Iraq, we’re better at distinguishing between the soldiers and the politicians who sent them off to fight.

This week, internal e-mails released in response to a lawsuit against the VA have raised questions about how forthcoming the agency has been about the mental health of returning combat vets, about whether the agency held back information for political reasons.

Given what Peake has observed himself — skilled, dedicated caregivers at the VA, bipartisan support for doing right by our veterans, more mature public sentiment — there’s no reason for anything less than clarity about returning vets. As a retired general and a surgeon, Peake is well-prepared to deal with the facts as they are, whatever they are. We trust that he will.

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