UCSF

The Veterans Health Administration (VHA) currently oversees the nation’s largest and only fully-subsidized healthcare system—a system that also happens to be one of the most successful by nearly any measure. And yet, in some ways, this system is fundamentally broken, exacerbating ongoing health crisis in the veteran community like suicide and persistent health and healthcare disparities. This dissertation examines the history of this system and how those who administer it utilize concepts of disability to determine care access, how that framing of disability has changed over time, and the potential ramifications of using disability as a precursor to care.

This dissertation examines the history of the veterans’ healthcare system, how it came to rest on medical authority to make disability—and thus access—determinations to create a federally-subsidized, initially hospital-based, healthcare system. It examines the role of public, political, and patient pressures in shaping that system and their implications for access. And it demonstrates how these historical forces continue to shape and affect modern issues like health and healthcare disparities and the persistent problem of veteran suicides.

While the VHA, like most modern medical organizations, is a forward-looking enterprise, this dissertation demonstrates that there is significant value in a historical perspective in examining and shaping health policy decisions in the future.