Thanksgiving Day Post-The History of Veterans Healthcare

November 27, 2008

purpleheart.jpgBy: Erin E. Ducharme, MD  PGY-1

With deep and humble gratitude we thank our nation’s veterans for the selfless sacrifices they and their families have made to establish and preserve the costly freedoms we take for granted.   On this Thanksgiving and in celebration of Veteran’s Day we are reinvigorated in our efforts to uphold the promise made by President Lincoln in his second inaugural address, “to care for him who shall have borne the battle and for his widow, and his orphan.” As physicians it is our greatest honor to serve those who have so honorably served for us all. Here we explore the roots of this American tradition—i.e. providing healthcare to our veterans—by traveling back through history, highlighting important dates and legislation that created the framework for today’s Veterans Hospital.

• As far back as 1636, during the war between the Plymouth Pilgrims and the Pequot Indians, the Pilgrims passed a law stating: “If any man shall be sent forth as a soldier and shall return maimed, he shall be maintained competently by the colony during his life.”
• In 1776 during the Revolutionary War, the Continental Congress enacted legislation which provided half pay for soldiers wounded during service to their country, to be administered throughout the duration of their disability.
• In the beginning, individual states and communities funded the direct medical and hospital care received by veterans, but in 1811, the federal government mandated the first residential and medical facility for veterans.
• In 1865, President Lincoln commissioned the National Asylum for Disabled Volunteer Soldiers and Sailors (later renamed the National Home for Disabled Volunteer Soldiers) which included residential, hospital and medical care for disabled veterans.
• After the Civil War, incidental medical and hospital treatment for all injuries and diseases was made available to veterans, regardless of whether the condition was service related or not. Throughout the remainder of the 19th century benefits were extended to veterans of other wars (Indian Wars, Spanish-American War), to their widows and dependents.
• At the conclusion of World War I, expansion of both benefits and the veteran population led to establishment of the Veteran’s Administration in 1930.
• Between 1931 and 1941 the number of VA hospitals increased by nearly 50% (from 64 to 91) and the number of beds nearly doubled (from 33,669 to 61,849).
• Largely drawing on experience gained with WWI veterans, the VA first became a leader in providing mental health care.
• World War II created 16 million new veterans, leading Congress to create the Department of Veterans’ Affairs.
• In 1945, VA healthcare began to draw scrutiny from the media with headlines such as: “Veterans Hospitals Called Backwaters of Medicine” and “Third Rate Medicine for First Rate Men.” One reporter described the VA as a “vast dehumanized bureaucracy… prescribing medieval medicine.”
• In response to the controversy, President Truman appointed General Omar Bradley to head the VA. General Bradley together with Dr. Paul Hawley transformed the VA hospital system by spearheading what would, in 1946, be the creation of the Department of Medicine and Surgery, establishing the first affiliation between medical schools and the VA.
• Affiliations with 63 of 77 US medical schools were established and as a result, during the following 6 months nearly 4,000 doctors were recruited to join the VA hospital system.
• A previously critical reporter now wrote: “VA medicine had undergone a ‘revolution,’ and Hawley had ‘infused the whole hospital program with a spirit of modern, scientific medicine.’”
• In 1979 the Vietnam Veteran Outreach Centers were created by the VA, offering counseling to help soldiers readjust after returning from war.
• In 1989 President Bush Sr. established the VA as a Cabinet agency, responsible for veterans healthcare among other duties.
• Today, more than half of US physicians have received a significant amount of training within a VA hospital. More than 200,000 employees help provide care across 173 hospitals, more than 399 outpatient and community clinics, 132 nursing home units, and 39 domiciliaries.

History of Veterans Healthcare

Longo WE, Cheadle W, Fink A, Kozol R, DePalma R, Rege R, Neumayer L, Tarpley J, Tarpley M, Joehl R, Miller TA, Rosendale D, Itani K. The role of the Veterans Affairs Medical Centers in patient care, surgical education, research and faculty development. Am J Surg. 2005 Nov;190(5):662-75. Review.


Image of purple heart courtesy of Wikimedia Commons