Repair sought for veterans' health-care system

February 08, 1993|By Los Angeles Times

WASHINGTON -- In an effort to repair a health-care system on the verge of collapse, Secretary of Veterans Affairs Jesse Brown is proposing sweeping changes that would enable the agency to raise money, improve its medical facilities and extend treatment to millions of vets who now are shut out.

The nationwide network of 680 veterans hospitals, community clinics and other health facilities has suffered from decades of meager financing, inadequate staffing, lax management and political neglect. Barely able to address the needs of a relatively small "core group" of poor and disabled veterans, the system is generally shunned by other veterans who have the ability to obtain care elsewhere.

Now, as the Clinton administration begins work on a comprehensive national health-care reform agenda, Mr. Brown said he sees an opportunity to revitalize the health system for veterans by allowing it to compete on more equal footing with other medical providers.

"It's my goal to get [veterans'] health-care reform done in a year, and it's my vision that we want to provide access to all veterans who want it," said Mr. Brown, who headed the 1.4 million-member Disabled American Veterans organization before Mr. Clinton chose him for his Cabinet.

Mr. Brown said he wants legislative authority to obtain reimbursements from Medicare, Medicaid and other third-party payers for patients treated in veterans facilities. He also wants to begin selling health policies to veterans who are not covered by other insurers and who do not qualify for mandated free care.

The obstacles -- mostly financial -- are formidable. Mr. Brown's proposals will have to be balanced against competing pressures to develop a plan consistent with the administration's goal of reducing the federal budget deficit.

Still, said Mr. Brown, a "window of opportunity" has been created by the election of President Clinton, who made health-care reform one of his principal campaign platforms.

If enacted, Mr. Brown's proposals could bring about a radical transformation of a self-contained health-care system that dates to the pre-Civil War era. Originally designed to care for soldiers wounded in war, the system gradually was expanded to accommodate veterans with illnesses and injuries unrelated to their military service.

But in recent years, as the federal deficit has grown and funding has become more limited, the Department of Veterans' Affairs has been forced to cut back service significantly by tightening eligibility rules and, in some cases, simply turning people away.

"Quality care has been going down, bed levels have been going down, staffing has been going down. People in the priority group cannot get into the system; they are on waiting lists; there's no follow-up care," said Rick Heilman, legislative director for the Disabled American Veterans.

Under the law, the department is required to provide hospital care to a core group of about 3 million vets who suffered service-related disabilities, who have other disabilities and fall below specified income levels, or who were prisoners of war. Even members of this core group sometimes cannot obtain outpatient or nursing home care.

For the remaining 24 million vets who do not meet stringent income and disability criteria, the department is authorized to provide care at its discretion to those who agree to pay a portion of the cost.

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