Veterans Day this year is predictably higher-profile than usual. Americans overwhelmingly support the U.S. troops who battle in Afghanistan. Meanwhile, GIs from the Greatest Generation, who defeated Adolf Hitler and Hideki Tojo, are universally revered.
Today’s veterans in the making and those of past conflicts deserve medical care worthy of their patriotic sacrifices. Unfortunately, the Veterans Health Service often is to modern medicine what barracks are to lodging. While the system still satisfies many patients, eligible veterans should be offered optional vouchers to expand their choices through private medical insurance.
“It seems to me it would be a good idea,” retired First Lieutenant Carwood Lipton says. The sprightly 81-year-old is a veteran of Easy Company, the legendary World War II Army airborne infantry unit celebrated in the Stephen Ambrose book and HBO mini-series, Band of Brothers. The recipient of three Purple Hearts adds by phone: “If the system isn’t working, it is important for veterans to have those options.”
The Veterans Administration has made improvements lately, such as 25 new community outpatient facilities in 17 states and more generous pharmaceutical benefits for vets with low-incomes or service-related disabilities. Nonetheless, the VA struggles to serve its roughly 4 million patients.
“I think their care has gotten better in the last six months or so,” says retired Private First Class Ralph Spina, an 81-year-old Bronze Star recipient and former Easy Company combat medic. His VA visits are rare — mainly for flu shots and treatment of a foot ailment. Still, he complains, “The last time I made an appointment, I had to wait 10 days to see a VA doctor. When I want to see my private doctor, I just make an appointment and go right in, or maybe wait a couple of days.”
This is a common concern. General Accounting Office auditors toured 17 primary-care clinics and 54 specialty clinics at 10 VA medical centers. They found last August that “two-thirds of the specialty clinics we visited continued to have long waiting times” for appointments, often due to “poor scheduling procedures and inefficient use of staff.” Seeing specialists took “from 33 days at one urology clinic to 282 days at an optometry clinic.”
The House Veterans Affairs Committee discovered in July 1999 that the “VA health care system wastes over $1 million a day” on antiquated real estate. “The high cost of maintaining outmoded facilities is reducing the availability of healthcare for veterans,” the committee concluded. Cato Institute health analyst Tom Miller suggests that a VA hospital closing commission could help Congress padlock obsolete properties.
After a July 27, 2000 hearing outlined “disturbing reports of many avoidable patient deaths and other adverse events in VA hospitals,” the same committee noted that the VA implemented a “first of its kind patient safety program…to identify and eliminate whenever possible the systemic causes of serious medical errors through a no-fault reporting system.”
Despite these failures, retired Rear Admiral Steve Barchet says: “I’m not a downer on the VA.” The former Navy medical officer and decorated Vietnam veteran believes “the VA is unparalleled for its amputee services, long-term care and work with paralyzed and quadriplegic veterans.” Still, he favors a voucher he would call the “Veterans Health Allowance.”
Barchet proposes that eligible veterans use VHAs to shop for and finance private insurance plans. Any remaining savings, he envisions, could purchase VA services not offered privately.
“The reason for the voucher is not because of quality problems,” Barchet says, but “to introduce personal responsibility, engage individual decision making and enhance competition between the public and the private sectors.”
Such vouchers could reduce usage of VA facilities for routine care. The VA’s defenders might fear that this will lure healthier patients into private medicine while tough cases remain trapped within the public system. Perhaps, but focusing federal resources on the most seriously ill veterans also could improve their care.
Some might reject this idea for “abandoning America’s heroes in uniform.” Medical vouchers would do no such thing. The G.I. Bill of Rights did not “abandon” the Greatest Generation by letting them study wherever they wanted. Uncle Sam simply financed tuition rather than construct special VA universities.
Many veterans like the VA health apparatus and its opportunities to associate with former co-combatants. That choice deserves respect and serious consideration. But those vets who would prefer to find the best treatment available through private insurance should receive medical vouchers as a grateful nation’s ultimate sign of appreciation.