VA Hospitals Face Competition Under Clinton’s Health Program

Under pressure from veterans advocates on Capitol Hill, the Clinton Administration has agreed to preserve the large, politically protected hospital network that has been built for the exclusive use of the nation’s 26 million veterans.

But the Administration’s health care initiative will thrust the system into direct competition with other health care providers, raising questions about whether all 171 hospitals run by the Department of Veterans’ Affairs--the federal government’s largest hospital system--will be able to survive.

Leaders of veterans groups have been summoned to the White House today to be briefed on the proposal by First Lady Hillary Rodham Clinton and others.

Many VA and congressional officials believe that the VA, frequently criticized for the quality of its care, can weather the competition. But most agree that the hospitals will have to undergo dramatic changes--from the way patients are greeted at the front desk to the type of medicine practiced.

“I think the VA is going to have a lot of trouble,” said Donald L. Custis, a health care consultant who headed the VA system in the early 1980s. “It can be done, but it will not be easy. And, at best, it’ll be a smaller system over the short term.”

Sen. John D. (Jay) Rockefeller IV (D-W.Va.), chairman of the Senate Veterans’ Affairs Committee and a key congressional adviser to the First Lady, said that forcing the VA system to compete is one of the principal attractions of the Clinton health care initiative.

What is clear to most who already have been briefed on the Clinton plan is that the VA will need a large infusion of cash and personnel if the hospitals are to successfully shift focus from in-patient care for an elderly male population to providing a broad range of preventive medical services to a more diverse population of veterans.