Report on United States Veterans’ Healthcare Access and its Alignment with Sustainable Development Goals

Introduction: The Challenge of Equitable Healthcare Delivery

An ongoing policy debate in the United States concerns the optimal method for delivering healthcare to military veterans. The core issue revolves around balancing the use of the centralized Department of Veterans Affairs (VA) system with providing federally funded access to private, community-based healthcare providers. This challenge directly intersects with several United Nations Sustainable Development Goals (SDGs), primarily SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities), as it seeks to ensure all veterans, regardless of geographic location, have access to timely and quality care.

Analysis of the Community Care Program and Legislative Proposals

Current System Inefficiencies and Impact on SDG 3

The current system presents significant barriers to achieving SDG 3, which aims to ensure healthy lives and promote well-being for all. Veterans report administrative hurdles that impede access to care.

• John-Paul Sager, a military veteran, reports that obtaining VA approval for local chiropractic treatment for service-related injuries is a lengthy and frustrating process requiring multiple phone calls.
• This administrative burden creates delays in treatment, directly conflicting with the principles of accessible and timely healthcare central to SDG 3.
• The VA’s community care program is intended to bridge these gaps, but its implementation is reportedly inconsistent and bureaucratic.

Geographic Disparities and SDG 10: Reduced Inequalities

A primary driver for reform is the significant geographic inequality in healthcare access, a direct concern of SDG 10. Veterans in rural areas are disproportionately affected.

• Many of the 9 million veterans enrolled in the VA system, including 1.2 million in rural areas, live hours away from specialized VA hospitals.
• In states like North Dakota, veterans may face drives of over 400 miles to reach the single VA hospital, passing numerous community hospitals en route.
• This disparity forces veterans to choose between forgoing care or undertaking extensive travel, creating an unequal system of access based on location.

Policy Debate: Strengthening Institutions vs. Empowering Communities

Proposed Reforms to Enhance Local Access

Legislative proposals aim to streamline the process for veterans to use their benefits for non-VA care. These reforms align with SDG 11 (Sustainable Cities and Communities) by potentially strengthening the economic viability of rural healthcare facilities.

1. A Senate bill would allow veterans living near a “critical access” rural hospital to receive care there without a VA referral.
2. Proponents, such as Senator Kevin Cramer, argue the focus should be on the veteran’s well-being, not sustaining a bureaucracy, thereby promoting a more responsive system in line with SDG 16 (Peace, Justice and Strong Institutions).
3. These measures would build on existing community care programs expanded under previous administrations.

Concerns Regarding Institutional Integrity and Privatization

Critics of expanding community care express concern that it could undermine the VA’s institutional capacity, a key component of a strong public health infrastructure as envisioned in SDG 3 and SDG 16.

• Opponents, including Representative Mark Takano and the Disabled American Veterans organization, fear that diverting federal funds to private facilities will weaken the VA system.
• They argue the VA provides specialized care tailored to veterans’ unique experiences, and its erosion would represent a loss of institutional knowledge and capacity.
• The debate highlights a fundamental tension: whether to achieve health equity by strengthening a centralized, specialized public institution or by empowering a decentralized network of local providers.

Conclusion: A Multi-faceted Approach to Sustainable Veteran Healthcare

The effort to reform the VA healthcare system is a critical test of the nation’s commitment to its veterans and its alignment with global development principles. The solution requires balancing multiple SDGs. An effective policy must:

• Uphold SDG 3 by ensuring all veterans receive high-quality, timely care.
• Address SDG 10 by eliminating the geographic inequalities that disadvantage rural veterans.
• Support SDG 11 by recognizing the role local healthcare providers play in the sustainability of rural communities.
• Reinforce SDG 16 by making the VA a more efficient, transparent, and effective institution that serves its constituents without undue bureaucratic delay.

Ultimately, achieving a sustainable and equitable healthcare model for veterans will involve strengthening the VA’s core functions while simultaneously creating flexible, efficient pathways for community-based care where necessary.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article’s central theme is the accessibility and quality of healthcare for U.S. veterans. It discusses their need for treatment for service-related injuries, the challenges in accessing care through the Department of Veterans Affairs (VA), and proposed solutions to improve their health outcomes.

• SDG 10: Reduced Inequalities

  The article highlights disparities in healthcare access based on geographic location. It specifically points out the difficulties faced by “rural veterans” who live “hours from VA facilities” compared to those who may have easier access, thus addressing inequality in access to essential services for a specific population group.

• SDG 16: Peace, Justice and Strong Institutions

  The article examines the effectiveness and responsiveness of a key government institution, the Department of Veterans Affairs. It details issues of bureaucracy, such as lengthy approval processes and excessive paperwork, and discusses legislative efforts to reform these institutional practices to make them more accountable and efficient for the people they serve.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… for all.

    This target is directly relevant as the entire article revolves around ensuring veterans have access to necessary healthcare. The VA system is a form of health coverage for this group. The debate over “community care” is about the best method to provide “access to quality essential health-care services,” especially when VA facilities are distant or cannot provide the required service, such as the chiropractic care mentioned for John-Paul Sager.

• SDG 10: Reduced Inequalities

  • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by… promoting appropriate legislation, policies and action in this regard.

    This target is addressed through the discussion of geographic disparity. The article notes that “Many veterans live hours from VA facilities,” creating an inequality of access. The proposed legislation by Senator Cramer, which would “make it easier for rural veterans to seek care at local hospitals and clinics,” is a direct example of promoting legislation to ensure more equal opportunity in healthcare access for this underserved group.

• SDG 16: Peace, Justice and Strong Institutions

  • Target 16.6: Develop effective, accountable and transparent institutions at all levels.

    This target is central to the critique of the VA’s processes. Veterans and advocates describe the system as having bureaucratic hurdles. Statements like, “he sometimes must make several phone calls to obtain approval,” “It seems like it takes entirely too long,” and the need to “jump through so many hoops” point to a lack of institutional effectiveness. The proposed bills aim to reform the VA’s community care program to make it a more effective and accountable institution for veterans.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• For Target 3.8 (Universal health coverage):

  • Geographic accessibility of health services:

    The article explicitly uses travel distance as a key indicator of poor access, mentioning that North Dakota’s only VA hospital is “more than 400 miles by car from parts of western North Dakota.” Reducing this distance or the time required to travel to receive care would be a measure of progress.

  • Waiting times for care and administrative processes:

    The article implies this is a key metric through phrases like “wait months for the treatment” and the description of the approval process taking “entirely too long.” Tracking and reducing these wait times for both appointments and referrals would indicate improvement.

  • Number of people accessing services:

    The article provides data, stating, “Last year, about 3 million of them — including 1.2 million rural veterans — used their benefits to cover care at non-VA facilities.” Changes in these numbers, particularly for rural veterans, would be an indicator of the program’s reach.

• For Target 10.3 (Ensure equal opportunity):

  • Proportion of rural vs. non-rural populations accessing services:

    The article singles out the “1.2 million rural veterans” who used community care. An indicator of reduced inequality would be an increase in the proportion of rural veterans who can access local care without undue burden, closing the gap with their urban counterparts.

• For Target 16.6 (Effective institutions):

  • Administrative burden on users:

    This is implied through descriptions of the process being “complicated,” requiring “several phone calls,” and having “burdensome” paperwork. A reduction in the steps, time, or complexity required to get a referral approved would be an indicator of a more effective institution.

  • Budget allocation for specific programs:

    The article mentions a request for “$34.7 billion for the community care program in 2026,” noting it is an “increase of about 50% from what it was in 2025 and 2022.” Tracking budget allocation and expenditure for community care serves as a direct indicator of institutional priority and capacity.

4. Table of SDGs, Targets, and Indicators

Source: knkx.org