Health plan may expand role of VA Reforms envision revitalized agency

June 08, 1993|By John Fairhall | John Fairhall,Staff Writer

WASHINGTON -- Trying to save their troubled health system, veterans' advocates appear to have won White House endorsement of a plan that would put the Veterans Affairs Department in direct competition with private hospitals and doctors for the health care business of 27 million veterans.

Under the potentially controversial proposal, President Clinton's health care reform plan would authorize the department to establish regional health plans and keep money they collect from private insurance companies.

Advocates say these reforms would allow the VA to obtain the funds it needs to upgrade its health care facilities and attract millions of veterans who don't use them today.

Signaling a possible challenge to expanded use of veterans' facilities, Richard Wade, a spokesman for the American Hospital Association, questioned the need for such a drastic step, saying, "The veterans who are getting their care elsewhere are obviously happy with it."

Despite skepticism that a government organization can succeed in the market place, veterans' groups point to the new 324-bed VA hospital in downtown Baltimore as an example of a first class facility that would appeal to any person.

"I would challenge anyone to find a medical facility in this country and perhaps in the world that's as well equipped to take care of patients as that facility is," David Gorman, a health official of the Disabled American Veterans, recently told a congressional panel.

Since opening in January, replacing the smaller 184-bed VA hospital on Loch Raven Boulevard, the $121 million VA Medical Center has been unexpectedly popular, attracting 2,600 new patients -- veterans who had previously gone outside of the VA system to receive care.

"They've seen the new technology, they've seen how nice and attractive it is," boasts center spokesman R. David Edwards.

System is shrinking

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 today 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.

Under the proposal, veterans would be free, as they are now, to join any plan. Although veterans facilities now can accept private insurance payments for treatment, the VA must turn over the money to the federal treasury. The proposed change would allow the VA to keep the money, giving it a new source of funds for improvements in care.

VA appears to "fall short"

Sen. John D. Rockefeller IV, D-W.Va., the Senate Veterans' Affairs Committee chairman, said recently 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 current 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 mainly helping 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, wrote in The Sun 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.

Mr. Wade, the American Hospital Association spokesman, suggested that the VA ought to concentrate on serving the long-term care needs of veterans, an increasingly aged population.

"Putting them in competition with health care plans in their communities would turn them away from that mission," he asserted.

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