Another Relic of War

DANIEL S. GREENBERG

March 24, 1993|By DANIEL S. GREENBERG

Washington. -- The pre-eminent antiquity on the medical landscape, the nationwide chain of veterans' hospitals, is striving for a big, new role in the coming era of health-care reform. But if good sense exists in politics, this anachronism will be bunched with other war-born vestiges now on the way out.

Mainly restricted to veterans with service-connected disabilities or low incomes, the Department of Veterans Affairs' 171 hospitals should be open to all veterans, with the cost of care financed by their private or government insurance, says Secretary Jesse Brown. Mr. Brown argues that the new revenues would rescue the hospital system from its constant struggle with skimpy budgets and also enable it to serve as a proving ground for health reform and medical innovation.

The secretary rates admiration for trying to keep the central activity of his department afloat in difficult times. But the Department of Veterans Affairs and its predecessors have been in the health-care business long enough to establish that this isn't the outfit to take on great new responsibilities for medical care.

The veterans' hospital system is so heavily enveloped in patriotic bunting and congressional bombastics that its medical realities tend to go unnoticed. By and large, it is a second-rate health-care system for elderly men who are down on their luck.

Of some 26 million living veterans, including 8.4 million from World War II, only about one million a year choose to be in-patients at the veterans' hospitals. The quality of care in these hospitals has often been rated deficient. In recent years, several veterans' hospitals have been barred from performing certain complex surgical procedures because of unacceptably high death rates. Eligible veterans who are wise in the ways of health care and who can afford it rarely check into veterans' hospitals for treatment of serious medical problems.

The illusion persists that battle-scarred veterans are the main business of veterans' hospitals and outpatient clinics. The patient population does, of course, include many who were wounded or otherwise injured in military service. But to keep the wards occupied, the hospitals have also been opened to single veterans with non-service-connected disabilities who earn less than $18,844, and to veterans with dependents who earn a bit more than that. Those with even higher incomes must pay the equivalent of Medicaid rates, which tend to be skimpy. If they hold private health-insurance policies, the Veterans Administration collects the benefits.

No matter how wide the doors are opened to accommodate even more veterans at the hospitals, the fact is that this medical system was built for a bygone era and survives on political protection from legislators eager to please veterans organizations.

Last year, Secretary Edward J. Derwinski gingerly suggested that veterans hospitals in rural areas might open their facilities to non-veterans who lacked convenient access to medical care. Sensing a threat to their exclusive use of the hospitals, veterans organizations exercised their legendary political power. Mr. Derwinski was swiftly dumped as a liability to George Bush's re-election chances.

The present veterans' hospital network was founded shortly after World War I, when medical facilities were in short supply for civilians and wartime veterans. Once established, there was no stopping the expansion of the system, which eventually spread to every state.

After World War II, heavy federal subsidies for civilian hospital construction actually led to an overexpansion of hospital capacity, followed in recent years by the closing of thousands of beds. But protected by local politics, the veterans hospital system has remained intact, though funding has never been adequate to make it into a first-class system.

Would opening the hospitals to all veterans provide the wherewithal for achieving that goal? Certainly not. The 25 million who don't use the system are not pining for admission.

The relatively few who do use it would be better served if the $13 billion now expended on the veterans' health-care system were used to underwrite their care in high-quality facilities. The specialized care required by veterans with serious wounds or injuries is not a monopoly of the veterans' hospitals.

Like battleships and other obsolete relics of war, the veterans' hospitals have outlived their purpose. It's time for them to go.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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