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 - while making dramatic changes.
"I think the VA is going to have a lot of trouble," said Donald L. Custis, who once headed the VA system. "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.
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. …