Abolish the VA Hospital System

DANIEL S. GREENBERG

May 07, 1991|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- That costly anachronism, the VA hospital system, is in the news again for low-quality and dangerous medical care. The system survives on political pull and misguided notions of what's good for those who served their country. It should be shut down.

The $11 billion a year currently spent on this antiquity could buy a lot of first-class non-government health care for veterans who really deserve it -- those with service-connected disabilities. These patients receive priority for VA care, but, as our high-casualty wars recede into history, they comprise a declining population.

Increasingly, the VA is a medical system for veterans who served without injury but who are eligible for free care if they're poor enough. In unintended fashion, the VA thus functions as a safety net for a particular slice of the population -- needy, elderly men. They are indeed fortunate to have access to this system, inadequate as it may be, but with the nation suffering from a glut of private hospital beds, the rationale for these expensive and selective oases of federal medicine is difficult to establish.

With 172 hospitals and hundreds of outpatient clinics and nursing homes, the Department of Veterans Affairs runs the biggest health-care empire in the country. In medical circles, however, the VA hospital system is not esteemed for quality.

Its patient load, 95 percent male and generally well along in years, tends to isolate the VA from mainstream medicine. Many patients who are eligible for its free services usually go elsewhere if they can afford it. Of the nation's 27 million living vets, only about 3.5 million use the VA system.

Big and expensive, but still underfunded, VA health care is an oddity on the medical landscape -- a leftover from the post-World War I era when proper medical services did not exist for veterans. And so it grew and grew, swelling even further after World War II.

But as the country went on a hospital-building boom, and health insurance became a standard benefit of employment, the justification for the VA medical system declined. It nonetheless became a permanent fixture, revered by veterans organizations as the vets' own medical system, and opportunistically supported by politicians, most of whom really know better.

Now, another evaluation of VA medical services comes up with poor marks. Following anonymous complaints of low-quality, often dangerous care at the 1,000-bed VA Medical Center in North Chicago, Illinois, the VA inspector general found deficiencies in diagnosis and treatment, questionable surgical operations, poor supervision of staff and faulty record keeping.

In the unimpassioned prose characteristic of such reports, the -- inspector general noted, ''The review substantiated the allegations that problems existed in the quality of care for certain patients and that the center's quality-assurance program needed to be improved.''

The problems in Chicago are not untypical of the VA hospital system. According to the Joint Commission on the Accreditation of Hospitals, VA institutions rank poorly in meeting established hospital standards. Unusually high mortality rates for surgery have been reported at several VA hospitals in recent years. Chronic understaffing and overloading of facilities is a constant complaint of many who work in the VA system.

The staffing and facility problems of VA medicine could be remedied with a good deal more money. But there's little chance that will be forthcoming in the current and foreseeable economic climate.

Then why not do something that would be even better and less expensive than a pure money solution? Gradually terminate the VA system and use its billions to buy first-class health-insurance coverage for veterans who earned their country's gratitude.

That's the kind of care favored by those who can afford the best in American health. Veterans deserve no less.

Daniel S. Greenberg publishes the newsletter Science & Government Report.

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