Mission creep: in this era of budget cutting, why is the VA trying to expand its clientele? - Department of Veterans Affairs, Veterans Hospital System

Washington Monthly, April, 1997 by Adam Piore

The GAO panned both projects as unnecessary and wasteful. In each case, the GAO discovered that local area hospitals had, on average, 2,000 to 3,000 vacant beds that could be put to use. The GAO reports on the hospitals also warned that both construction projects could damage health care in the surrounding areas. In the case of California, the GAO noted that the VA "has not considered the likely negative effects the additional beds could have on other hospitals...particularly those [around] Travis Air Force Base that have occupancy rates of around 40 percent."

Yet the Clinton administration and the VA have continued to fight for the projects. In 1995, Congress offered a compromise: It would appropriate $25 million in both Travis and Brevard to construct two new outpatient clinics. But that wasn't enough. In 1996, the Clinton administration resubmitted its request for full funding. This time--in the election year--House members relented and agreed to dole out $32.1 million to construct a new hospital in the Travis Air Force Base. Not coincidentally, Travis' congressman, Republican Frank Riggs, was in the battle of his political life against Democrat Michela Aliota, the daughter of a politically powerful California family. (No such agreement was reached for Florida, where Brevard's Republican Rep. David Joseph Weldon--who was facing no such election battle--said his area didn't need the hospital, and accused President Clinton of making the issue "a political football.") The Senate vigorously objected, so another compromise was reached. House appropriators agreed to hold onto the money until 1998, which gives them time to study the proposal further and, theoretically, reverse their decision. However, it seems unlikely that a reversal could withstand the political pressure of the veterans groups, which now would see any change as a cut.

A Big Debt

There's no question that the country owes a debt to its veterans--especially those who put their lives on the line and came back injured. But there are better ways to repay that debt than throwing away millions of dollars to resuscitate an underutilized system that most veterans believe is substandard and avoid using.

A better course of action would be to dismantle the VA health care bureaucracy and use its $17 billion annual budget to fund a voucher system. Veterans could use the vouchers to access local health care providers of their choice, which would address the two main complaints of the current system: inconvenience and poor-quality care.

Certainly, there are plenty of local health care providers who would be happy to serve them. Since 1980, hospital admissions have declined 11 percent and nearly 1,000 hospitals have closed. In most urban areas, there is a 50 percent excess of beds. Rather than compounding the closings by luring veterans away, a voucher system would help redistribute demand for care. Selling off or leasing some of the VA's real estate and chopping the mammoth bureaucracy could also raise enough money to provide better-quality care to veterans and, in the short term, design a sensible transition plan.