Fiscal neglect consuming VA health care

It is my duty as a leader of America’s military veterans to share a vivid portrait of the nation’s Department of Veterans Affairs health care system, a paragon of quality in so many ways, but which is being consumed by fiscal neglect. I’ve presented this information to those who have the power to change it. Now I want to bring this situation to the attention of all Americans who may be largely unaware a problem even exists. In the past nine months, I have visited more than 50 VA medical facilities across the nation. It has been an eye-opening experience. I witnessed awesome examples of dedication, professionalism, safety cognizance and resourcefulness among VA employees. I heard profound gratitude for the quality of care received. But I also found acute frustration about the lack of timely access to VA health care, under-use of some facilities, overcrowding in others, and inconsistent budgets and budget expectations. It is obvious to me that VA health care operations are trying to do more with less. Demand has soared. Funding is failing miserably to keep up, forcing the budget-strapped system to ration access. The fiscal mess is also threatening affiliations with medical colleges and nursing schools by downsizing facilities out of proximity to these schools. The VA also faces a heavy burden when members of the National Guard and Reserve are called up. In Wilmington, Del., I was told a major call-up would likely close beds due to the deployment of much-needed Guard nurses. That hospital was not alone; facilities in several states and Puerto Rico face similar fates. I’ve seen first-hand the inconsistencies and frustration surrounding third-party reimbursement formulas placed on facility managers. The real zinger is that success is punished because new, increased reimbursement targets come right off the top of next year’s budget. The solution to this vexing problem is a mandatory appropriation-funding model, just like Social Security and Medicare. Funds must be allocated on a cost-per-veteran basis, indexed annually for inflation. This does not mean free health care for all veterans. It means all veterans with the ability to use their insurance, including Medicare, should be free to choose VA facilities for their health care, regardless of economic status or level of service-connected disability. This irony of congressional committees and VA officials continuing to visit and revisit the funding issue is inexcusable. All the commissions, task forces, committees and panels in America can debate the details and dream up new ways to cut corners for years on end, but there’s one prevailing reason for this health care crisis—the funding formula. This fiscal mess must be a concern of every American. I have testified on Capitol Hill, challenging members of the Veterans Affairs Committees to move quickly to make necessary funding changes. Our government always seems to produce billions for foreign aid, millions for pork-barrel projects and enough to keep sending young men and women off to fight our government’s battles in foreign landsand in the process creating more veterans. The Department of Veterans Affairs is America’s biggest managed-care system. It is a national treasure. Whatever one chooses to call the VA health care system—a debt, an obligation, or a promise—fundamental reason for its existence is that it is woven into our national value system. It is our sons and daughters, grandsons and granddaughters who are the newest generation of veterans. They are serving to preserve America’s freedom from terrorism and other threats. They risk life and limb every day. It is our responsibility to make certain a VA health care system, attuned to the very special needs of veterans, is put on a prescription for fiscal recovery, and it must be done now. Ronald F. Conley of Pittsburgh, Pa., is National Commander of The American Legion, the nation’s largest veterans organization. The complete Executive Summary of his findings can be reviewed at

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