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February 13, 2007

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Geez hilzoy, you didn't actually think "support the troops™" meant, you know, actually giving them the resources, tools, care and aid such that they could actually do their job and be taken care of when they suffer for it, as opposed to clapping louder for the MBF in the white house, did you?

...

Okay, I don't know what to say. I'd scream but no one would care, or hear me.

I'm just going to walk away for a moment and hope that this intense shudder of cold in the base of my chest goes away.

Thank you Hilzoy.

Cynics (not me) call stories like that the "biological solution". Delay treatment until the patient dies and you save the money for the treatment (also a favorite tactic used by the post-war German government to avoid paying victims of the 3rd Reich, still used today).

Reminds me that the Pentagon deliberately* avoided the general medical check-up of troops going to Iraq in order to avoid having to pay for treatment for disorders the soldiers couldn't prove were not already there before they deployed.

*I have no link but I think I read some leaked info that this was indeed not accidental.

$10 says you can find that second story attached to someone screaming "See, this is a perfect example of why govt-run healthcare can never work!"

Not connected to that story specifically but during the last big cutting discussion for VA budgests that was indeed an argument brought forth.
Make it not work then claim that it does not work is the most favorite tactic used on the right.
I will not answer to any rebuttal that contains the word "Surge" ;-)

Dear hilzoy,

I hate to be a nuisance, but I would appreciate it if you would kindly contact me.

Thank you.
Dr. George Hunsinger
[email protected]
609-252-2114
http://www.nrcat.org

"Yes, they do."

This kind of thing (like not raising military pay and not increasing the size of the military after 9/11....or even now) is why Bush is so frustrating. If you are going to conduct a war, you need to actually bother doing all of things involved in doing that.

$10 says you can find that second story attached to someone screaming "See, this is a perfect example of why govt-run healthcare can never work!"

I’d be dishonest if I said it did not cross my mind. But others around here have given me enough evidence that the VA is in fact working very well today (as opposed to my old rust memories of 20 some years ago) so I resisted the impulse.

Meanwhile a man like John Kerry, who has been one of the foremost advocates for veterans' health care and benefits, is smeared as someone who hates the troops. Depressing.

Dear hilzoy:

Not to pile nuisance to the ceiling, but can you please contact George Hunsinger? The answering machine is getting full.

Tnx,

Slart

Perhaps the saddest thing about this post is that much of it, including the second half (with different names) could have been written two years ago.

Mental health care in the military is erratic, but not always terrible. The main obstacle to its effectiveness is a culture that discourages seeking such care, and ostracizes those who do. If you can get past that -- and most don't -- then there are a surprising number of competent psychiatrists on active duty.

VA mental health care, by contrast, is frequently awful. Risible and bad. Example one is in this piece: a patient reporting suicidal symptoms should never, ever, ever be turned away -- even if you have to set up a bed for him in a hallway. That's just shocking. Someone should lose his or her job. For starters.

Unanswered question in this piece: did the Marine seek recourse to any civilian treatment facilities? He and his family may not have known better; but I would be surprised to find that there was simply no care available for him anywhere at all.

He and his family may not have known better;

Or been able to afford it...

Anyone can get "stabilized" at any hospital regardless of ability to pay. I don't know whether suicidal inclinations qualify as a condition demanding stabilization in Minnesota. Common sense says it would, but we're discussing laws and regulations here....

JT - true enough.

That's what gets me: does the VA not have the phone # of the nearest civilian emergency room and a standard evaluate-the-risk-of-suicide protocol?

Exactly right, Katherine.

I really do loathe the VA.

I don't know whether suicidal inclinations qualify as a condition demanding stabilization in Minnesota.

It doesn't in Wisconsin, so I assume it doesn't in Minnesota either as the two states are fairly similar. Having helped a couple of friends through some rough spots, the rule here is that you actually have to be on the verge of, maybe even in the process of, attempting suicide before you can call 911; mere "inclinations" don't cut it. Putting it bluntly, Schulze would have been able to call 911 for hospitalization once he had the rope in his hand but probably not before that.

Josh: VA mental health care, by contrast, is frequently awful. Risible and bad. Example one is in this piece: a patient reporting suicidal symptoms should never, ever, ever be turned away -- even if you have to set up a bed for him in a hallway. That's just shocking. Someone should lose his or her job. For starters.

Well, yes, I agree. But, is this symptomatic of VA health care or Minnesota health care? If what Anarch says is true, he would have been turned away from any hospital because, until he was actually about to commit suicide, his needs weren't urgent enough to qualify for emergency health care - which is shocking, yes! and the person who should lose their job over this is whoever decided that policy: then VA didn't have the funding to accept more than 12 "non-emergency" cases at one time: and if he couldn't afford to pay, he couldn't go anywhere else... and so on. (FWIW, the system in the UK is that if you are truly desperate you can ask to be Sectioned - detained in hospital for assessment for up to 28 days - but this system too has been known to fall through. Still, the principle is that if you know you need that kind of help you ought to be able to get it.)

But the point of the story, aside from the sheer awfulness of anyone who needs mental health care being turned away and killing themselves, is that people coming back from military service in a war zone are at risk from mental health problems. Known fact. Had Bush & Co actually meant their "support the troops" mantra, they would have begun funding extra facilities for mental health services for the troops returning, in June 2002 or whenever they had made up their minds to invade. Just as they would have begun funding armored Humvees, body armor, and so on. Just as they would... all the hundreds of other things they didn't do that would have saved lives in Iraq and the US. But they didn't care, and they didn't do it, and people died.

Update: All my direct experience of stressed/mentally ill people in the UK, and mental health services in the UK, has been with civilians. It looks like when it comes to mental health services, the UK military is just as bad as the US: as far as I can see, there is just one in-patient military psychiatry unit.

Well, at least we've arrived at where we should be: bitching about the Bush Administration.

Cripes.

Well, at least we've arrived at where we should be: bitching about the Bush Administration.

Who else is responsible for the underfunding of VA mental health services over the past six years, Josh?

We can also bitch about the state of Minnesota's attitude to mental health patients, if you can find some direct evidence of what that attitude is.

And I'm happy to bitch about the UK government/military underfunding of UK mental health services for the military, too. Blair sucks. There you go. Join me in a big ol' "Bush sucks!" and you'll feel better for it.

Eh, outside of the particulars of this story and the question of Va funding, mental health care in the US sucks generally. For example: If I want to get, say, an MRI or an X-ray and have it covered by insurance, I simply call up -- whatever provider I want -- and make an appointment. Don't even need a referral from my primary care doctor, nor do I have to pre-pay and get reimbursed.

If I want to see a mental health care provider, I have to call my insurance company and go through a half-hour or more of very personal screening before they will approve me seeing one of two or three people that they recommend.

Anyone can get "stabilized" at any hospital regardless of ability to pay. I don't know whether suicidal inclinations qualify as a condition demanding stabilization in Minnesota. Common sense says it would, but we're discussing laws and regulations here....

the marine in question was "stable" in a medical sense. And, insofar as it appears that his only insurance coverage was through the VA, no civilian hospital is going to provide an emergency admission to someone who is uninsured and medically stable.

Well, at least we've arrived at where we should be: bitching about the Bush Administration.

"supporting the troops" means taking care of their medical needs once they've returned home from a war zone. This marine was not an anomoly by any means when it comes to the failure of Bush and his buddies to provide adequate treatment for veterans -- so you beter get used to the fact that people are going to criticize Commander Codpiece despite your crush on him.

Late to this conversation, but: can we get some sourced numbers on VA spending? As best I can tell, looking at the budget history, the line item "Veterans benefits and services" has increased by over 50% since 2000, and the rate of increase is 13% (2002), 12% (2003), 5% (!, 2004), 17% (2005), -0.4% (2006), 3.6% (2007, estimate), 15% (2008, estimate).

Isn't the real question whether the VA budget has grown appropriately, rather than whether a cut in the previous planned growth is well-considered or not? I'm guessing that the growth probably hasn't been appropriate, and that planning has been inadequate, but that's a significantly different conversation than Bush cut the rate of growth of the VA budget.

Probably a bit more difficult to get at the meat of that argument, though.

As Slartibartfast notes, it's not at all established that the VA is, in fact, "underfunded." Nor is it established what constitutes "underfunding" for the purposes of this discussion.

All that is established is that one particular VA facility did not have a bed (which is not ipso facto evidence of "underfunding," except inasmuch as finitude is); that the staff at that particular VA facility was probably negligent; and that the family of the deceased were apparently unaware of the full range of options for mental-health treatment.

Somehow, this is all the fault of George W. Bush.

I know some of the caregivers -- and recipients of care -- for those physically wounded in the present war, and it seems to me that the standard of treatment and followup there is pretty good. (These are, admittedly, in the active-Army health care system, and therefore not necessarily reflective of VA care.) In that light, I'm not prepared to gnash my teeth and bewail the Bu$h Administration for not "supporting the troops" in the medical sphere. VA mental health care is historically substandard -- believe me, it was in the Clinton years -- and it is therefore difficult to ascribe that state to a particular President. This Marine's story, tragic and appalling as it is, does not go far in making that case.

Slarti: I was assuming that since we're fighting two wars, we could expect the need for medical care for vets to increase.

Of course it should increase, and has. But...how much is enough?

Note I'm not arguing that we're doing enough, just that VA funding has increased. How much of that increase has gone to disabled veteran healthcare, rehabilitation, etc, and is it enough? I have no idea.

"Support the troops" doesn't translate into support for vets, and never has.

Republicans have always tried to cut funds for vets, always, even as they bang the "patriotism" drum. It's Democrats who have consistently worked to increase funding for the VA.

Vets have performed their part, and are now expendable. If they can no longer fight, and especially if they have been so badly injured that they can no longer work, they are just another drag on society, according to the survival-of-the-fittist credo that Republicans hold dear.

Kids, don't believe the military recruiter. They will lie to get you to sign, and then abandon you, even if you've given your heart's blood.

Trevino: As Slartibartfast notes, it's not at all established that the VA is, in fact, "underfunded."

Actually, what Slartibartfast noted was the percentages by which the line item "Veterans benefits and services" was increased or decreased by in budgets since 2000. Although Slarti summarizes this rise as "over 50%", this is a "how to lie with statistics" kind of summary: better to keep your eye on the breakdown of figures, which looks rather different:

2002: 13%
2003: 12%
2004: 5%
2005: 17%
2006: -0.4%

I don't know how much the budget for VA should rise by every year: but any health care system with an increasing number of clients must have their budget rise, each year, well above the cost-of-living rise: and except when there is a sudden large influx of new clients (as naturally there will have been in the US VA system from the end of 2001 onwards) the rise ought to be fairly steady - a simple upwards line.

It ought not to zag downwards unless there is some external reason why the costs (or the number of clients) are going down - and if that's the case, the downwards slope should be as steady as the upwards slope. Any sudden jag downwards, as happened in 2004 and as appears to be happening again in 2007, is a prophecy that people already in the health care system, and people who will be in the health care system, will have had necessary services cut.

And while it's possible that this veteran - and the many other veterans who were on the waiting list for beds at this treatment facility - were turned away for other reasons than the budget cut in 2004, it's certainly not impossible that, following a year of underfunding when what was needed was a continuing steady rise to cope with the influx of new clients, this treatment facility is one of the places that felt the bite.

And I'm still waiting to hear who else Trevino thinks is to blame...

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