A Cabinet Post? Vets Really Need to Abolish Archaic VA Hospital Chain

If Ronald Reagan really wants to help veterans, he should pursue a simple goal: closure of the Veterans Administration medical empire, the country’s biggest and worst hospital chain.

Instead, he is pandering to the shrill veterans lobby by backing cabinet rank for the VA, an elevation that would perpetuate a system of medical care whose time has gone.

The medical part of the VA absorbs $10 billion of the agency’s $27-billion budget, but rarely are there plaudits for the quality of VA medicine.

Veterans need to get into the mainstream of modern medicine. They least of all need to be relegated to an anachronistic, heavily bureaucratized system that manages at once to be expensive, dangerously understaffed and often shoddy.

There’s little chance that the President will back off from his ill-advised Veterans Day commitment, or that Congress will spare the country and its veterans from this folly. The VA’s payroll, spread among 172 hospitals and 200 clinics throughout the country, commands reverent political attention. So does the VA’s natural constituency--the American Legion, the Veterans of Foreign Wars, the Disabled American Veterans and an assortment of other veterans groups, all notable for their political sting.

Pulling at patriotic heartstrings, and dishing out campaign contributions, these organizations depict the VA health-care system as medically necessary for many vets and morally requisite for the country that called them to service.

No one can argue about the nation’s debt to veterans who suffered disabilities in service or who are unable to afford medical care. Together, these two groups comprise about 94% of the nearly 1 million veterans who receive medical care in VA facilities. But the hospital system that supposedly recompenses them for their service is generally regarded in medical circles as a backwater of medical service.

Hedged by relatively low government pay scales in an otherwise high-priced national medical economy, the VA is frequently a caricature of a health-care system. Thus, the head of the National Assn. of VA Physicians, Dr. Paul Schafer, told Congress last April that, from office clerks through physicians, the VA is a loser in the marketplace. Nurses are in short supply in all sectors of health care, but at the VA, he said, the shortage “is so acute that we are actually in the process of closing down whole wards and curtailing many essential functions.” New medical graduates log time at the VA to satisfy residency requirements, he said, “but we can’t keep them.” And he warned that the VA system “may literally self-destruct under the weight of its own managerial and administrative burden, which has already grown to obscene proportions.”

The doctor’s complaints may sound extravagant, but a durable fact of the VA medical system is that it inspires little praise in any quarter. The head of the VA nurses’ organization, E. Elaine Lloyd, noted that even with pay supplements authorized by Congress, the VA is unable to compete successfully for nurses. Nurses, she said, are pressured into working extra shifts and to handling duties normally assigned to non-nursing staff, to the detriment of patient care.

More money for the VA would seem to be the easy answer, but the problems extend beyond the budget. There’s no medical sense in a nationwide health-care system dedicated to a class of patients consisting mainly of elderly, low-income men. The narrowly defined patient population creates an aura of medical isolation in the VA enterprise. The agency seeks to counter this by cultivating ties with medical schools and running its own research programs.

But in terms of quality of medical service, the VA does not have a good reputation. Two years ago, cardiac surgery units at four VA medical centers were closed for unacceptable performance. And a study by the General Accounting Office found a high rate of accidents and mistakes in patient care, as well as a disturbing number of unreported problems.

The real solution to veterans’ health care matches that of the rest of the population: a national financing system that will rise above the present patchwork of socialized medicine for the vets and free enterprise for most others. Until that arrives, politics should recognize that medical facilities and personnel are so abundant in almost all parts of this country that there’s ample capacity to meet the needs of the veteran population. The $10 billion that’s enmeshed each year in the VA medical system could buy a lot of medical insurance and care on the open market.

Forget about cabinet rank for the VA, Mr. President. Since you’re not running for anything, you can back what’s best for the veterans: abolition of the archaic hospital system that so often fails to meet their needs.