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In the Defense Department, a “unified medical command” means a health system combining the assets of the Army, Navy and Air Force medical branches.
But for some members of the Military Retirement and Compensation Modernization Commission, the phrase could describe a unified Veterans Health Administration-Defense Department health system, a behemoth that would erase divisions between the two and care for troops and veterans from boot camp to grave.
That idea was among several floated by commissioners as they listened Nov. 4 to veterans service organizations discuss the concerns of ill and injured troops during one of the commission’s first public hearings at Fort Belvoir, Va.
“If [VA and DoD] can’t work together, put one of them in charge. Pick your poison, I don’t care which one. Create a unified command with DoD or put VA in charge,” said former Nebraska Sen. Bob Kerrey, a Medal of Honor recipient who served on the Senate Appropriations Committee and later the 9/11 Commission.
“If you had one chief information officer in charge of budget and line items for both, this problem and many others would not be an issue,” agreed former Indiana congressman and Army veteran Stephen Buyer, who once sat on the House Armed Services Committee.
The idea surfaced after veterans service organizations discussed the failure of VA and the Pentagon to create a single electronic health record system. The $1 billion program, launched in 2008, largely was abandoned in February in favor of a less expensive system built on existing technology.
The Pentagon has yet to award a contract for its portion of the information technology.
Continued problems with the VA and DoD joint disability system, the transition of care from active duty to veteran status and disconnects when veterans leave active duty are among the issues the organizations pressed commissioners to consider when drafting their recommendations.
Tom Tarantino, a policy associate with Iraq and Afghanistan Veterans of America, said there is a need to “push for uniformity.”
“We have fixed the cracks in the facade but ... we have been just tweaking things. It’s time we do a single unified push all they way through the system to get it right,” Tarantino said.
A health care overhaul also should consider incorporating private-sector care for those who seek it, recommended retired Army Brig. Gen. Jack Hammond, executive director for the Red Sox Foundation and Massachusetts General Hospital Home Base Program.
Hammond said about a quarter of veterans seeking care at Mass General do not have health insurance.
“They may have been eligible for VA coverage, but it doesn’t mean they’ve applied for it,” he said. “When it comes to mental health, they might not want a public-sector record that they’ve had mental health issues, so they come to us.”
A comprehensive health program should incorporate private-sector care and also make it easier for charities and the private sector to provide services to the government as well as troops, Hammond said.
An overhaul also may require a complete review of the disability ratings system, which Buyer pointed out includes compensation for those diagnosed with service-related conditions who would lose their monthly checks if they are cured.
“It’s almost like this is the rail no one wants to touch because it involves mental health,” Buyer said. “But something is not right within our disability system that we have a financial disincentive to get better.”
Commissioners acknowledged that much of their discussion would receive push-back from VA and the Pentagon, but said there was no room for sacred cows.
“People look at this commission as nine Scrooges who want to take something away from them. I hope this is not the case ... we have a pretty broad brush and we’re trying to learn,” said Larry Pressler, a former South Dakota senator and the first Vietnam veteran elected to the Senate.