VA Must Revamp System for an Aging Clientele

American military veterans are growing older as a group, so the Veterans Affairs Department is re-evaluating their system of medical care for the first time in 25 years.

VA Secretary Edward J. Derwinski will soon name a commission to review the “mission” of the system’s 172 hospitals and its hundreds of outpatient clinics, nursing homes and other facilities.

Medicine has changed greatly since 1965, but the politics of closing a hospital have not. In 1965, the VA barely managed to close seven of the 15 hospitals and old soldiers’ homes it had recommended should be shut down. The emphasis has shifted from in-hospital care to outpatient, extended and preventive care.

Government-sponsored medicine, as well as private care, costs more today. VA hospitals must compete for the federal tax dollars needed to pay doctors and nurses adequately and maintaining up-to-date equipment.

Members of Congress say that for the last 10 years, the VA system has had insufficient financial support, and that it needs $250 million more this year just to run a bare-bones operation through September.

Derwinski’s proposal for the next fiscal year is a record $31 billion for medical care.

The cost of care rises with the age of the patient. And the main point that Derwinski has driven home, in one congressional hearing after another, is that the veteran population is aging.

More than a third of the nation’s 27.1 million veterans served during World War II; their average age is now 68. The number of veterans 65 or older is expected to peak, at 9 million, in 1999, according to the VA.

The number of veterans 75 and older will rise to 2.6 million in 1995 from 1.4 million today, and will reach 4.4 million by 2010, the VA says.

“By the year 2010, veterans 65 and older will comprise 40% of the eligible veteran population, as compared to 26% in 1989,” Derwinski recently told the Senate Veterans Affairs Committee.

By that year, he said, 35% of VA hospital patients will be at least 75 and 60% of them will be older than 65.

“Major adjustments” to the VA system may be needed to meet these veterans’ needs, Derwinski said.

Like the rest of the population, some retired veterans are moving from homes in the Northeast and Midwest, where many of the older VA facilities are, to Arizona, Florida and other states of mild climate. The VA has not kept up with this population shift.

With those trends in mind, the VA Commission on the Future Structure of Veterans Health Care is to begin meeting in May and come up with a set of recommendations by October, 1991.

Derwinski has already promised that no facility will be closed, even though some cities, such as Chicago, may have three hospitals with overlapping services.

VA facilities, like dams and highways, are prime cuts of political pork. Congressmen gave Derwinski a cool reception last summer when he proposed legislation to have them choose the commission members, preferring to keep their distance from a group that could recommend closing facilities in their districts.

Congress was still up in arms over another panel’s recommendation that domestic military bases be shut down, so Derwinski decided to appoint his own commissioners.

What the VA can do is convert a hospital to another use, such as nursing care, and have only one hospital per population center offering expensive, specialized equipment or surgery.

Still, members of Congress and other groups are wary of the VA in light of past budget-cutting, when the agency was dominated by the Office of Management and Budget. Also, there are questions as to how independent the commission will be, especially since its support staff will be drawn from within the VA.

“All too often in the past, when there was talk of re-examining the VA’s mission, reducing services was the hidden agenda,” James N. Magill of the Veterans of Foreign Wars recently testified.

There is a major reason for leaving some slack in the system, one that few like to think about: Another war or large-scale armed conflict could expand the veteran population.

“If the work of the commission will be undertaken with the assumption there will not be a new generation of wartime veterans by the year 2000, then the final report of the commission may not be totally germane by the beginning of the next century,” John F. Sommer of the American Legion said in recent testimony.