VA Health System Is National ResourceDaniel Greenberg's...


May 01, 1993

VA Health System Is National Resource

Daniel Greenberg's article "Another Relic of War" (Opinion * Commentary, March 24) reflects a biased and inaccurate view of the Department of Veterans Affairs' hospital system.

L Unfortunately, in some quarters, it may be viewed as gospel.

Mr. Greenberg characterizes the VA health care system as an anachronistic "second-rate system for elderly men who are down on their luck." As a writer who specializes in the politics of science and health, he should know better.

Mr. Greenberg has been recycling this sort of fact-free opinion for several years in violation of the research responsibility that goes with the power he wields as a widely published columnist.

He should visit with veterans and their doctors in VA hospitals before he writes again.

Today's VA health care system is a vital national resource that simply does not fit his biased misrepresentation.

It makes no logical sense to dismantle VA, the nation's largest health care system, when policy makers agree that most of VA's problems today stem from an on-going underfunding that has sapped VA of the strength it needs to assume its rightful position as a premier component in our health-care system. The real challenge and opportunity lies in restructuring VA so it can perform those functions at which it excels.

VA, besides being the nation's largest health care system, is also the most scrutinized, investigated and monitored.

Because VA operates under the watchful eyes of congressional committees, federal inspectors general, the Joint Commission of Accreditation of Health Care Organizations, watchdogs in the veterans service organizations and a vigilant media, any lapse in VA quality is likely to be widely publicized, leading many Americans to generalize from isolated incidents to an indictment of the entire VA system.

Often ignored is the fact that most of the VA's 171 hospitals are affiliated with over 100 of the nation's medical schools which participate in providing thousands of veterans with compassionate care every day comparable in quality to that of any private sector organization.

Mr. Greenberg has his numbers wrong, too. Specifically, his figure that one million veterans a year are admitted to VA hospitals ignores the more than 23 million outpatient visits annually.

He also states there are 25 million veterans who do not use the VA system. More accurately, between 1987 and 1992 over six million veterans received VA health care services.

Considering that only about half of the 26 million veterans, or 13 million individuals, are actually entitled to any kind of VA health care services, and that almost half of these came to VA in the last six years, one must acknowledge that VA is too big a piece of the nation's health care system to be abolished, ignored or minimized.

As for Mr. Greenberg's statement that VA services "elderly men down on their luck," yes, VA is an important safety net for medically indigent veterans. Its primary focus, however, is on those veterans with service-connected disabilities for whose care the nation has long been committed. For many VA patients there simply is no other network of facilities that can provide them with the full array of health care services they require.

Mr. Greenberg uses rhetoric to cast VA as an anachronism of a "bygone era." He only refers to World War II veterans. Are Korea and Vietnam so long ago? And what about veterans of the Cold War, Persian Gulf war and unnamed wars to come? Will there be American veterans of a war in the Balkans? One must ignore the lessons of history to expect an unbroken peace in the future.

The VA health care budget of $14.6 billion -- not $13 billion as Mr. Greenberg cited -- would not be better used to underwrite veterans' care in non-VA facilities. The fact is that VA provides more care for fewer dollars than can be bought anywhere else in the country.

Mr. Greenberg dismisses VA's value to society as "patriotic bunting." Apparently, he is unaware of the many ways VA contributes to the entire nation's health.

It is the country's single largest health manpower production resource. More than half of the nation's physicians in practice have received some part of their training in VA facilities.

VA provides outreach programs for homeless veterans and high volume programs for victims of substance abuse.

VA provides a unique setting for the large-scale clinical trials of drug therapy for such a wide diversity of diseases as tuberculosis, hypertension and AIDS, along with the transfer of newly developed medical technology to the marketplace.

Research by VA clinicians produced the cardiac pacemaker, the basic science leading to computerized axial tomography (CAT scan), the first mechanical heart transplant, the first robotic limbs, the pioneering work with nuclear medicine isotopes and the Nobel prize-winning development of radio immune assay.

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