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

In rural areas with limited access to major private care providers, VA hospitals could be transformed into public hospitals and opened up to everyone--rather than operating well below capacity for the benefit of a few, as is so often the case now. There are already at least 50 VA hospitals with an occupancy rate of 50 percent or less, according to Marjorie Quandt, a former VA employee who testified before Congress. And as the VA moves away from regulations that encourage long hospital stays, occupancy rates will likely fall at scores of other VA facilities. All told, Quandt estimates, there are probably about $33 billion in assets in VA facilities.

VA officials warn that their hospitals specialize in the treatment of injuries common among veterans, such as spinal cord and mental health problems. They argue that dismantling the VA system would leave a gaping hole in service for veterans who suffer from such problems. Certainly, there should be no question that veterans injured while fighting for the United States should receive the best care available. To this end, the VA could either maintain a handful of specialty centers to treat veterans with injuries requiring treatment not available at most private facilities, or, alternatively, consider subsidizing specialists in these areas (with the money saved by moving to vouchers) so that private hospitals can afford to keep them on staff, regardless of the overall market demand.

For the vast majority of veterans, however, the voucher system would allow them to be absorbed into the local health care system of their choice. Money could even be set aside to set up programs in local community hospitals for outreach programs to help large populations of homeless and mentally ill veterans, who might have trouble signing up for vouchers and shopping for care on their own.

Of course, veterans' service groups would likely at first vehemently oppose any such change. It's not hard to see why. Many fear the destruction of any tangible infrastructure would make it easier to cut care for vets in times of fiscal crisis. But provisions could be written into the bill to guarantee VA health care for years to come. And the money saved from the voucher system would improve the quality and scope of care for veterans.