VA hospitals grow despite drop in veterans' ranks Budget and staff swell while cuts occur elsewhere

quarter of beds are empty


PHILADELPHIA -- At a time when the federal government is driving down the cost of health care and forcing hospitals across the country to close, the Department of Veterans Affairs keeps expanding its own hospital system, the nation's largest, and spending more for health care.

Government reports call the Veterans Health Administration a bloated bureaucracy, with surgeons who have gone a year without lifting a knife, and rife with wasteful practices such as admitting patients to hospitals for conditions that outpatient clinics could treat in an hour or two.

A quarter of the beds in the VA's 173 hospitals stand empty as the surviving soldiers of World War II move into their 70s and 80s There are 26 million veterans now, down from 30.1 million in 1980.

Yet in Washington's battle over the 1996 budget, President Clinton has proposed an increase of more than $700 million for the Veterans Health Administration, mostly for new construction, and the Republican-dominated Congress has approved an increase of $400 million. Meanwhile, Medicare, the government insurance program for the elderly, and Medicaid, the program for the poor, face sizable cuts in projected spending.

VA jobs have grown with the spending. The federal work force shrank 8 percent, to 2 million, since the Clinton administration took office through September, according to the Office of Personnel Management. But the VA work force climbed 1.4 percent, to 264,000.

The veterans hospital system bucks the trends in health care because no one can touch it politically. Mr. Clinton, denounced by many veterans for avoiding the Vietnam War draft, has bent backward to court them.

Members of Congress, sensitive to jobs the hospitals provide in all 50 states, recoil at shutting one in their own. And lobbies such as the American Legion, the Disabled American Veterans and the Veterans of Foreign Wars boost the interests of veterans unchallenged by other groups.

VA officials themselves say they have too many hospital beds.

"Every place is overbedded," said Kenneth W. Kizer, the department's undersecretary for health, who is attempting to reorganize the system.

Mr. Kizer said he was also cutting his headquarters staff to 600 from 802.

But he blames Congress for some of the redundant capacity and for writing some of the regulations that discourage the department from turning to less expensive outpatient care, a development that is rapidly changing the American hospital system.

Officials in Congress acknowledge the political difficulties of cutting the budget of an agency that serves the nation's veterans, even while they are struggling with some of the deepest budget cuts in history.

"You mention the word 'veteran,' and you're supposed to pitch forward on your sword," said Sen. Alan K. Simpson, a Wyoming Republican and chairman of the Veterans' Affairs Committee.

But the veterans' lobbies "raise tremendous amounts of money," Mr. Simpson added. "They tell their public this Congress doesn't care about their vets. I'm a veteran. If I weren't, they'd have cremated me by now."

With its network of hospitals and more than 500 clinics, nursing homes and other facilities, including about 20 golf courses, the Department of Veterans Affairs runs the nation's largest health system.

It cares for about 2.6 million veterans and is in line to receive $16.6 billion in fiscal year 1996.

In defense of the system, veterans advocates say the budget, while growing, has fallen behind the pace of rising health care costs and that veterans, while declining in number, are reaching ages when they need two and three times more care than they did in their 30s and 40s.

The advocates say fewer hospital beds would be empty if the government relaxed eligibility rules for free care. To qualify for free care, a veteran must earn less than $20,469 or be deemed at least 50 percent disabled by injuries or diseases contracted in the service.

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