Recall that when President Bush visited Walter Reed on January 17, 2003 he praised it. On that occasion, Bush said, "Having been here and seeing the care that these troops (from Afghanistan) get is comforting for me and Laura. We are--should and must provide the best care for anybody who is willing to put their life in harm's way." Either Bush was dissembling or Walter Reed has careened madly downhill on his watch.
Anyway, go figure. Bush hails conditions at Walter Reed, a military facility that is not part of the VA system and where conditions are deplorable, yet, during his tenure, he has worked to make it tougher for vets to get care at VA hospitals which, for the most part, are excellent, as this vet can personally attest.
"Ten years ago, veterans hospitals were dangerous, dirty, and scandal-ridden," The Washington Monthly reported in its January, 2005 issue. "Today, they're producing the highest quality care in the country. Their turnaround points the way toward solving America's health-care crisis."
And Business Week's July 17th last year, reported, "if you want to be sure of top-notch care, join the military. The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatments to the percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers."
Where patients in the private sector are lucky to get 20 minutes with their doctor, vets commonly get lengthy, head-to-toe annual check-ups and, when indicated, tests utilizing the latest technologies. The VA has a sterling, 99.9%-plus accuracy record for filling prescriptions, in part because of its model electronic medical-records system.
Things at VA hospitals weren't always this way. VA underwent a dramatic makeover starting around 1995 under the Clinton administration's Dr. Kenneth Kizer, VA's health under secretary.
Last year, on a budget of $35-billion, the VA provided services for 5.4-million of the nation's approximately 26-million vets, most of whom are eligible for free or low-cost care.
Many VA employees work there for idealistic reasons. One technician told me she got "fed up with the paperwork" in private sector medicine and switched to the VA to devote herself to caring for patients full-time. Generally, the attitude is proactive. At an outpatient facility to get a flu shot at the Miami VA, the clinician asked, "When did you have your last pneumonia shot?" and when I told him, he replied, "Okay, hold out the other arm." The VA cuts costs by stressing preventive medicine. And if you need eye glasses and hearing aids, there may be no better place than the VA to get tested and get quality product.
Shoddy conditions reported at Walter Reed undoubtedly are true, but this writer has seen just the opposite in visits to VA hospitals in Spokane, Miami, Orange, N.J., Roanoke, Va., and Sturgis, S.D. These impressions, of course, reflect only a small random sample, but they were all favorable. By contrast, ABC's Diane Sawyers reported on "Primetime" on April 8, 2004, of finding sickening conditions in VA hospitals and of patients waiting up to eight hours to see a care-giver.
If there's trouble in the VA, it may not be the quality of care but the Bush administration's goal to shrink the system by closing hospitals and stiffening eligibility requirements.
Reporter Rick Anderson wrote in "Home Front"(Clarity Press), VA enrollment soared from 2.9-million in 1996 to 6.8-million in 2004. While older veterans die at the rate of 1,000 per day "newer veterans are signing up for benefits at a much slower rate, in part because many are being refused services due to budget and service cuts at the VA."
And as the Pentagon outsources ever more jobs to private sector firms like Halliburton, the size of the armed forces is being cut back radically, meaning fewer veterans and fewer VA visits in the offing. In Iraq, for example, approximately one contract warrior is killed for every 10 uniformed soldiers. U.S. fatalities in the Iraq killing field is actually 10 percent higher than reported by the Pentagon.
However, as the cost of private sector health care and health insurance premiums rise, and as VA services improve, a lot of veterans are abandoning the private sector they had relied on to seek out VA medicine.
On the same day Bush visited Walter Reed, Anderson writes, his VA officials floated a plan to limit new enrollments, the idea being to suspend medical care for "better off" vets, those with incomes exceeding $35,000 a year, a plan rebuffed by Congress. Bush did succeed, though, in cutting the budgets for mental health and drug treatment by 30% amd 40%, respectively, he said. Anderson writes, "Facilities are being closed despite the real and emotional toll on veterans. The plan is to move further towards out-patient services," opening two new VA hospitals while closing seven.
Reducing facilities is an odd step to take when it is widely believed the worst aspect of VA health care is the length of waiting time vets endure to get to see a doctor. In 2003, nearly a quarter of a million veterans waited six months or longer for a first appointment or an initial follow-up, exposing the system's lack of capacity, according to one study.
The VA system may be less than perfect but, when given adequate resources, it can and does appear to provide better care than the private sector and with less paperwork. Maybe it's the prototype of the universal health care system the American people want. And maybe the Pentagon's other hospitals, such as Walter Reed, could be incorporated into it.
Whatever, canning the director at Walter Reed, a facility that got swamped with wounded from Bush's illegal wars, is no answer and likely just an act of shameless scapegoating.
(Sherwood Ross is a Miami-based columnist. For comments or to arrange for speaking engagements contact him at firstname.lastname@example.org).