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
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
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. …