The VA: Then and Now
How Far We’ve Come, How Far We Still Have to Go
The Department of Veterans Affairs is often discussed in extremes. It is either portrayed as an irredeemable bureaucracy or defended as an untouchable institution doing its best under impossible conditions.
Both narratives miss the truth.
The VA has improved, sometimes dramatically, over the past several decades. It has also failed veterans and families in ways that remain unacceptable. Progress and dysfunction coexist, often in the same building, sometimes in the same appointment.
If we want real reform, we have to be honest about both.
Then: A System Built for a Different Era
The modern VA was not designed for today’s veteran population. Its structure was shaped by the aftermath of World War II and later expanded in response to Vietnam. It assumed a predominantly male, older, single-theater veteran population with relatively predictable medical needs.
Over time, that assumption collapsed.
Veterans became younger, more diverse, more medically complex, and more geographically dispersed. Families became more involved in care. Conditions like PTSD, TBI, toxic exposure, and military sexual trauma demanded long-term, specialized treatment.
The system did not adapt quickly. In some cases, it did not adapt at all.
Then: Care Was Inconsistent and Accountability Was Rare
For decades, access to care depended heavily on location. A veteran’s experience could vary wildly based on which VA facility they used.
Wait times were long. Records were fragmented. Appeals stretched for years. Families were often treated as outsiders rather than partners in care.
Accountability mechanisms existed on paper but rarely in practice. Problems were managed quietly. Data was siloed. Veterans learned to navigate the system by trial, error, and exhaustion.
Now: Real Improvements That Matter
It would be dishonest to pretend nothing has changed.
Today’s VA looks very different in several key areas:
Expanded eligibility and enrollment
Increased focus on mental health
Community care options for veterans far from VA facilities
Recognition of toxic exposure through legislation like the PACT Act
Modernization efforts in claims processing
Greater attention to suicide prevention
Many veterans receive excellent care. Many VA employees work under intense pressure and still deliver with professionalism and compassion.
These gains are real and should be acknowledged.
Now: Progress Has Not Reached Everyone
Despite improvements, too many veterans and families still experience systemic barriers.
Claims remain complex and slow, especially for survivors.
Electronic health record modernization has been uneven and disruptive.
Care coordination across systems remains fragile.
Rural veterans continue to face access challenges.
Families and caregivers are still under-integrated into care models.
Progress has been real, but it has not been equitable.
Culture Change Has Lagged Behind Policy Change
One of the VA’s greatest challenges is cultural, not legislative.
Policies change faster than institutions. Guidance can be issued, but implementation depends on leadership, training, and local buy-in.
This is why reforms often feel inconsistent. A policy that works well in one facility may fail entirely in another.
Until accountability, transparency, and patient-centered culture are reinforced at every level, reform will remain uneven.
Families Are Still Treated as Afterthoughts
Perhaps the most persistent gap is how the VA engages families and survivors.
Caregivers often navigate complex systems without authority or information. Surviving spouses face benefits processes that are confusing, slow, and emotionally punishing.
Families are essential to veteran well-being. Treating them as optional stakeholders undermines outcomes and trust.
This is not a new issue. It is an unresolved one.
How Far We Still Have to Go
The next phase of VA reform must focus less on announcements and more on execution.
That includes:
Streamlining survivor and caregiver benefits
Strengthening oversight and accountability
Completing EHR modernization without harming care
Ensuring parity across regions
Investing in staff support and retention
Integrating families into care planning
None of this is radical. All of it is necessary.
The Bottom Line
The VA is not the same institution it was decades ago. That is worth recognizing.
It is also not yet the system veterans and families deserve. That is worth fighting for.
Honest advocacy does not deny progress. It demands that progress continue.
Reform is not about tearing the VA down. It is about building it into what it was always meant to be: a system worthy of the people it serves.
