Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 6, 1993 TAG: 9306060121
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: The Baltimore Sun
DATELINE: WASHINGTON LENGTH: Medium
President Clinton's health-care reform plan is expected to give the Department of Veterans Affairs authority to establish regional health plans and collect private insurance payments, opening the VA's doors to millions of veterans who don't use its medical facilities today.
This would put the VA in direct competition with private hospitals and doctors that also will be courting the nation's 27 million veterans. Under the president's program, veterans would be free as they are now to join any plan.
Signaling a possible challenge to expanded use of veterans' facilities, American Hospital Association spokesman Richard Wade questioned the need for such a drastic step, saying, "The veterans who are getting their care elsewhere are obviously happy with it."
Veterans groups say that without some kind of boost, the VA medical system will continue to shrink and deteriorate. Congress and the previous two administrations put the agency on a lean budgetary diet, slashing requests for staff and new equipment.
"The real danger is the VA is going to dry up and blow away," says John Hanson, an American Legion health expert. "VA is not going to be able to operate on its current level of budget. They're going to continue to provide care to fewer and fewer veterans because they can't provide more."
The VA provides medical service to 2.7 million veterans a year - just one of 10 veterans. The number is that small partly because budget-conscious administrations and Congress have generally restricted eligibility for free care to veterans with extensive service-related disabilities, former prisoners of war and indigent veterans.
Other veterans are eligible for paid care, space permitting, at VA facilities. But most veterans with private insurance or money in the bank choose non-VA doctors and hospitals. The reason, in many cases, is the VA's poor image: Some facilities are viewed as being unfriendly and second class in quality.
Senate Veterans' Affairs Committee chairman Jay Rockefeller said the VA appears to "fall short" in providing care "in as timely and as sophisticated a manner as could be done." He cited "long waiting times for appointments at outpatient clinics" and the fact that "many VA managers cannot afford to replace worn medical equipment or repair aging facilities."
The VA's $14 billion health-care budget has not kept up with inflation. If trends continue, the VA's patient population will decline to 2.3 million by the year 2010. Veterans groups worry that the system will disintegrate into a poorly funded, low-quality specialty service program mainly serving aged and severely disabled veterans.
Yet some critics say the VA should shrink. Syndicated columnist Daniel S. Greenberg, who specializes in the politics of health and science, said in March that the VA "is a second-rate health-care system for elderly men who are down on their luck." He recommended that its funds be used to underwrite care for veterans in "high quality facilities" outside the VA.
Wade of the hospital association suggested that the VA ought to concentrate on serving the long-term care needs of veterans, an increasingly aged population.
There have even been suggestions that the VA phase out its acute-care hospital services.
But veterans groups argue that the VA's focus on veterans is the only way to assure them the care they need and deserve. They say the VA offers unparalleled care to people with spinal injuries, mental health problems, loss of limbs and loss of vision.
Moreover, they say the VA is a national resource because of its research into problems affecting veterans and its close association with medical schools that use VA centers to train doctors.
Veterans groups have found a strong ally in Jesse Brown, the former head of Disabled American Veterans who was named secretary of veterans affairs by Clinton.
Hillary Rodham Clinton, who heads the task force on reforming health care, quickly assured veterans that the VA system would remain independent. And now the Clintons have agreed that the VA should be opened up to veterans it is not now serving, according to congressional and administration officials who are familiar with White House reform plans.
by CNB