Health-Care Reform Will Put Va Hospitals to the Test

Article excerpt

The White House 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 President Bill Clinton's health-care plan will push the system into direct competition with other health-care providers. This will decide whether all 171 hospitals run by the Department of Veterans Affairs will be able to survive.

Many VA and congressional officials believe that the VA can weather the competition. But most agree that the hospitals will have to undergo dramatic changes.

"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. Rockefeller IV, D-W.Va., chairman of the Senate Veterans' Affairs Committee, said that forcing the VA system to compete would be one of the principal attractions of Clinton's plan. "I think it can (compete), but, of course, there is no guarantee."

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

Under the plan, Rockefeller said, the VA system will remain "its own exclusive system with its own constituency." A House aide said it would operate like "a big HMO," a health maintenance organization subsidized by the government for veterans.

What worries Custis and other veterans advocates is that the VA hospitals have been so underfunded and the agency's patchwork quilt of eligibility rules have become so restrictive that many veterans have turned away from the VA, perhaps forever.

Some government surveys suggest that fully half of the nation's veterans would choose a private or non-VA hospital if given the option.

Rockefeller and others hope the VA can actually expand the care it provides by tapping the millions of veterans who make too much money to qualify for VA health care.

The Clinton plan would attempt to entice veterans to the VA by promising them a slightly-enhanced benefits package, including dental care and care for post traumatic stress disorder, treatment that would not be available elsewhere for free. …