THE VETERANS' lobby says the veterans' health care system needs more money, and both parties are struggling to comply. The vice president announced a couple of weeks ago that the administration had found an extra billion dollars in the budget; the announcement stole a headline from a House subcommittee that was preparing to vote some extra money as he spoke.
Yet, even as the politicians were vying to increase the budget, the General Accounting Office, an arm of Congress, was reporting, again, that a fair amount of the current veterans' health budget goes to waste. The giant health care system is heavily overbuilt. The accounting office told another House subcommittee only days before the funding vote that "billions of dollars" will likely "be used operating hundreds of unneeded buildings over the next five years or more."
If the Veterans Affairs Department "reduced the level of resources spent on underused, inefficient or obsolete buildings and reinvested those savings, instead, to provide health care more efficiently," veterans themselves would be the beneficiaries, GAO said. But the veterans' groups and other so-called "stakeholders" in the system, including members of the congressional veterans' committees, have traditionally resisted an "asset realignment process" such as GAO suggests. They don't want to close anything -- but the resistance hurts the veterans they purport to help.
The problem is not just that the veterans population is declining; with the passing of the World War II generation, the number is expected to decline to 16 million by 2020, a third fewer than today. The department also has followed the money-saving trends in the health care sector generally. Hospital admissions and lengths of stay have both been reduced in favor of care on an outpatient basis. The number of veterans being treated is up, but the census in the hospitals is sharply down -- by nearly 60 percent over the past 10 years. Many hospitals now have relatively few beds in service; in terms of utilization, many now are smaller, GAO noted, than many of the private hospitals that have been closed for reasons of size in recent years.
The department has set up a system to review, site by site, what ought to be done, but GAO thinks the stakeholders have been given too large a role for the process to succeed as it should. It mentions affiliated medical schools and unions as having resisted change in the past.
The veterans' health care budget is $17.7 billion this year. Under the budget rules, it can only be increased next year at other programs' expense. No one disputes the nation's obligations to its veterans. But if more health care can be provided for the same amount of money, it's veterans who win. This is a system that badly needs to be rationalized; its protectors should let it happen.