SMASH - abolish the veterans hospitals

Washington Monthly, May, 1992 by Eric Konigsberg

Don't fix those deadly veterans hospitals. Abolish them.

What was a nice former beauty queen doing in a place like this? A room where shell-shocked, quadriplegic patients languished unfed for three days, swimming in feces and tied to their beds? Where uncertified doctors accidentally killed some vets with faulty CPR treatment and subjected others to blood-tainted needles and bacterially infected gloves? She was making a segment of "PrimeTime." And after Diane Sawyer and her pen-sized camera got through with America's veterans hospitals, only one logical conclusion could be drawn: Old soldiers may never die, but the VA keeps trying.

Add to those memorable TV images the revelations of Ron Kovic and the film Article 99, and you've got the average American's mental picture of the average American veterans hospital: half infirmary, half inferno. And this popular image isn't off base; it's just incomplete. The root problem with Veterans Administration hospitals doesn't lend itself to video treatment: It's how much American citizens are paying for this substandard care. Thanks to unnecessary testing, overly long stays, mind-boggling logistics, and way too many empty beds, caring for the average VA hospital patient now costs nearly twice what it would at the average community hospital. And who's paying for that waste? You are, to the tune of hundreds of millions of dollars.

If figures like that don't move you, consider James Williams' story: When the 25-year-old Nebraskan needed a kidney stone removed last year, he might have driven to Omaha's Methodist Hospital, a top-flight private institution where he could have gotten a simple lithotripsy as an outpatient for about $5,000. But Williams, a veteran of the Air Force, qualified for free treatment by the VA. So instead he was directed to fly 500 miles via commercial jet (at taxpayer expense) from Omaha to Milwaukee, the nearest vets' facility capable of performing lithotripsy. Unfortunately, Williams first had to wait three months for a slot to open in Milwaukee, so the folks at the Omaha veterans hospital decided to insert a silicon catheter into his kidney (at risk of infection) until the Milwaukee hospital was ready to admit him. After the lithotripsy, Williams had to check back into the Omaha VA to have the catheter removed. Done? Not quite. Williams has since learned he has another stone. He'll likely be forced to retrace the same medical odyssey this summer.

Hedged vets

The Sununuesque habit of airbusing vets across the country for routine procedures may seem trivial compared to the billions spent on health care annually, but replay that type of wasteful spending a dozen different ways at dozens of VA hospitals around the nation, and the bill adds up. Today, the VA spends nearly $14 billion a year to care for a mere 3 million eligible vets.

Why are we paying Connoisseur Class prices for a third-rate medical system? Thanks goes to a Congress unwilling to say no to the 5-million strong veterans' lobby, which is quick to invoke Normandy, Inchon, or Khe Sahn whenever the question of over-spending arises. Of course, as a result of Ronald Reagan's means-testing enactment, many heroes of these battles don't actually get to use the VA system-its patients include only veterans poor enough to qualify (those with an annual income of less than $18,000) or those injured while serving. And many who do use it might jump at the chance to get free care elsewhere. Nevertheless, to the veterans' lobby and the congressmen who serve it, overhauling the system seems a betrayal of a sacred contract made in the wake of World War I: In return for serving their country, veterans should have their own hospital system to meet their needs.

Certainly, all Americans should be accorded affordable, quality health care, and until we create a universal system that works, we should make especially sure our former soldiers' health needs are met. But by clinging to a bureaucratic arrangement that's about as up-to-date as leech therapy, the VA isn't just wasting money, it's hurting the very constituency it's supposed to help. If we really want to help America's needy vets, we need an entirely new approach to providing good, free health care-an approach that would replace the VA hospital system with our underused, more efficient community hospitals.

The VA will tell you that it provides an important service to veterans, but what it won't volunteer is how few veterans use its hospital system. In fiscal year 1990, nearly one third of VA hospital beds were empty. As veterans' groups are quick to point out, the number of old and sick vets is likely to increase during the next few years, as more and more World War II veterans reach their seventies. Even so, the overall veteran population has been declining rapidly since 1980.

This shrinkage and the slew of empty beds don't leave much opportunity for economies of scale-even if the VA were interested in economy. But thanks to the peculiarities of the federal budget process, the 60,000 administrators employed by the VA have little incentive to be worried about savings. In fact, too much financial worry would put those same bureaucrats out of a job.