VA now needs agility on health care’s front lines

Before they jetted out for their urgent, desperately needed summer vacation, our tireless, selfless, oh-so-humble representatives in Congress managed to pass a bill that will inject some $17 billion and a measure of flexibility into the Veterans Administration.

After clearing the House, the bill passed the Potomac Millionaires Club, otherwise known as the Senate, 91 to 3, which means all but a few of those 41 Republicans who enthusiastically sent Americans to war but cynically refused to pay for their wounds suddenly got religion.

The same people who five months ago refused to give more money to cut down the disgraceful waits vets face at the VA changed their minds. Maybe they finally got the memo that an average of 22 vets a day are killing themselves nationwide.

The $17 billion amounted to a compromise between the chairmen of the veterans services committees in the Republican-led House and Democrat-controlled Senate. Senator Bernie Sanders, my favorite Vermont socialist, wanted $25 billion. Representative Jeff Miller of Florida wanted it capped at $10 billion. After some bickering, they split the difference. Given what passes for compromise on Capitol Hill these days, I am nominating Sanders and Miller for the Nobel Prize for common sense.

That said, all the money can’t undo the VA’s biggest problem — it has become a huge, unwieldy bureaucracy, and bureaucracies are not made to deal with crises like the one facing American veterans.

It is beyond disgraceful that those of the next greatest generation, the men and women who served in Iraq and Afghanistan, have returned to a country that can’t or won’t take care of them. They are victims of politicians who love to send other kids to fight wars they wouldn’t dream of sending their own to fight.

As Sanders put it the other day, “Planes and tanks and guns are a cost of war. So is taking care of the men and women who use those weapons and fight our battles.”

James Palmer could have told him that. Palmer grew up in Milton, just over the Mattapan line. He tried college for a year but it wasn’t for him at the time. Nine years ago, with two wars raging, he walked into the Army recruiting office on Tremont Street, across from the Common, and asked the guy behind the desk, “What have you got for me?”

Quite a challenge, it turned out. Army Rangers are as good as they get, and Palmer wanted to be a Ranger. He earned his tab in the searing heat at Fort Benning, and in being assigned to the Third Battalion, 75th Ranger Regiment, he became part of an elite force that worked only at night, seeking what they call high value targets, bad guys who kill Americans and anybody else who crosses them.

Palmer did four combat tours in Afghanistan. Over the last five years, he spent as much time in Afghanistan as he did in the United States. He saw Afghanistan almost exclusively through the green fog of night-vision glasses, chasing bad guys. He used a shoulder-fired, 84-mm recoilless rifle that boomed next to his head like a cannon.

When he got home, Palmer had trouble socializing as he had before. An acquaintance came up to him and said, “So sorry you had to be there.” Palmer was angry.

“This is something I signed up for. I’m proud of my service,” he said. “More than anything, I’m proud of the people I served with. People say stuff and don’t realize it’s really insulting. But, with our military training, we’re not going to go off on someone. Instead, we withdraw. We isolate ourselves.”

Palmer found himself doing just that and simultaneously developed a case of debilitating migraines. His head pounded. When he managed to fall asleep, his vivid dreams were punctuated by screams.

Palmer was lucky in two respects. First, he had a supportive partner, his fiancee, Courtney Clayton. Secondly, and in part because of Courtney, he found Home Base, the program that helps vets suffering from the invisible wounds of war.

Palmer had gone to the VA in March, complaining of symptoms that were classic signs of traumatic brain injury and post-traumatic stress. The VA said it couldn’t give him an MRI until June.

“I couldn’t wait three months,” he said. “I was really hurting.”

Instead he went to Home Base and immediately got an MRI, a diagnosis, and a full work-up with a terrific young doctor named Seth Herman. He got meds for his headaches. He got his life back.

“Home Base is what the VA should be,” Palmer said. “Your first contact is with fellow vets. It’s small enough to be personal. It’s not a bureaucracy. It’s responsive. In combat, you have to improvise. Same in health care.”

The VA can’t handle it all. We need more Home Base-type programs, everywhere. We need light infantry units of care, in every state.

I asked Palmer why he was willing to talk to me, to forfeit his privacy, and he spoke simply and directly, like a Ranger.

“The stigma has to go. If one vet reads my story and says, ‘Hey, that guy seems OK. If he can admit he needed help, I can admit it.’ If one vet comes forward and gets help, that would be worth it to me.”

James Palmer is going back to college next month. He’s already smarter than anybody in Washington.