http://www.boston.com/dailyglobe2/027/metro/Swamped_VA_hurt_by_its_own_successesP.shtml
THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
|
Swamped VA hurt by its own successes Many still waiting for their initial visit By Alice Dembner, Globe Staff, 1/27/2003 Since Veterans Affairs hospitals and clinics threw open their doors
to all veterans four years ago, nearly 3 million more have signed up for
care, as the VA became a safety valve for the troubled American
health-care system. But the army of patients is overwhelming what has
become the nation's largest health-care provider.
The 70 percent growth nationwide, dwarfing a 24 percent budget
increase, has forced hundreds of thousands of veterans to wait months
for even the most basic care. And last week, the crunch led to a
moratorium on enrollment for veterans without service-connected
illnesses or poverty-level incomes, the very people targeted in the 1998
expansion.
''We've got this great reservoir of need out there, and we have very
few systems that can accommodate that,'' said US Representative Stephen
F. Lynch, a Boston Democrat who sits on the Veterans Affairs committee.
''The VA has done a remarkable job, but access has become a problem. And
now, there's a retrenchment on our commitment to veterans.''
In New England, nearly 125,000 veterans have signed up for care since
1998, boosting the patient load by two-thirds. More than 14,000 people
are waiting to see primary-care doctors for the initial visit that will
allow them access to a full range of medical services. The wait in
Massachusetts is worst in the Bedford area, where veterans advocate Bob
Hogan says it can take a year to get care.
''Some of these guys and women, they need new medications now,'' said
Hogan, director of veterans services for Burlington and Bedford.
''They're losing health insurance or their supplemental insurance
doesn't cover stuff.
''If we can't take care of the veterans we have now and we're going
to be creating a whole new generation of veterans, who's going to be
taking care of them?''
George Curran, a 69-year-old Korean War veteran from Burlington, got
to see a doctor last week - 11 months after applying for coverage.
Like many of the new enrollees, he plans to tap the VA mostly for
prescription drugs because it is so much cheaper than his private
insurance. For low-income veterans, prescribed drugs are free. Those
with modest incomes, such as Curran, pay $7 per monthly dose.
''I was strictly after the pharmacy program because my medications
run about $160 per month,'' said Curran, who has high blood pressure and
heart problems. ''I have Harvard-Pilgrim Seniority but they don't cover
medications very well. This is going to be a big help. But I think it's
outrageous to have to wait this long for something all veterans were
promised.''
Under the VA's triage system, patients with emergencies get
immediate attention, but that can lengthen the wait for others. VA
secretary Anthony J. Principi said in a statement that his goal in
imposing a moratorium on enrollment was to ''maintain its focus on the
health-care needs of its core group of veterans - those with
service-connected disabilities, the indigent, and those with special
health-care needs.''
He said he hoped it would reduce waiting time for veterans already
enrolled.
Traditionally, the armed forces promised veterans that they would get
free health care if they fit one of those core categories. But in 1996,
Congress authorized an expansion - for modest copayments - to all
veterans. The VA opened 400 outpatient clinics and began caring for the
new group in 1998.
It quickly became a victim of its own success.
Nationwide, the VA is now treating 4.6 million veterans, and another
2.3 million have signed up for care but are not yet using it. About half
the new enrollees are neither disabled nor low-income. More than 150,000
are lined up for their first appointments, while 80,000 longtime
patients are waiting for follow-up care.
Waits are especially long in Florida and other states with large
clusters of veterans older than 65.
''We got aggressive about enrolling veterans, we built more clinics,
and we were just too successful at the same time HMOs were disbanding,''
said Gail Goza-MacMullan, a spokeswoman for the New England VA medical
system.
Among the big draws is the quality of care. The VA is recognized as a
leader in quality improvement and in reducing medical errors. Although
many veterans complain about the waits, nearly all praise the care.
''While the quality is good, people came because it's very low-cost,
particularly for drugs, relative to private-sector policies and
Medicare,'' said Gail Wilensky, cochair of a task force set up by
President Bush to help address the crisis.
Because of the volume of prescriptions, the VA is able to obtain
discounts averaging as much as 50 percent below average wholesale
prices. Despite the price breaks, overall VA spending on outpatient
prescription drugs rose from $2 billion in 1999 to more than $3 billion
last year, according to the General Accounting Office.
The overcrowding is starting to affect disabled veterans, in some
cases delaying badly needed care. Richard Johnston, a 72-year-old Korean
War veteran, waited hours last Friday at the urgent-care department at
the VA's Brockton hospital to find out why his right arm hurt so much he
could hardly use it. He had tried to get an office appointment with an
orthopedist, but the earliest available was in May.
''This is the only source of medical care I have,'' said Johnston.
''I'm 100 percent disabled. I need to count on these people and it's not
working out.''
Others have been discouraged from even applying for care because of
the wait lists. State American Legion commander Jim Fratolillo sees the
new moratorium as a ploy to minimize the demand, so that Congress
and the administration face less pressure to find a solution.
The moratorium is expected to turn away 164,000 veterans this year
alone. Yet, hundreds of thousands more are expected to enroll. In New
England alone, enrollment is expected to jump more than 20 percent in
the next decade.
Arlen Specter, a Pennsylvania Republican who chairs the Senate
Veterans' Affairs Committee, has announced plans to hold hearings on the
moratorium and the wait lists.
Lynch has proposed allowing veterans to fill prescriptions through
the VA without seeing VA doctors, a suggestion the VA has previously
rejected.
Officials of the VA and Medicare are also discussing allowing
veterans excluded from the VA under the moratorium to get
treatment nonetheless under their Medicare benefits, which would bring
in needed money.
Locally, the VA has been aggressively hiring doctors and trying to
shift patients from overcrowded hospitals to clinics with more space,
but in Bedford and Brockton so far, the demand has been too great.
A big boost in funding, allowing the addition of more medical staff,
could help and President Bush has requested a 7.7 percent increase for
2004.
While supporting that boost, members of the Massachusetts
congressional delegation, led by Lynch, this week asked Principi to
rescind his moratorium, writing in their letter that the VA is treating
veterans ''as impediments to fiscal soundness rather than patients who
deserve the best possible care.''
Alice Dembner can be reached at dembner@globe.com.
This story ran on page A1 of the Boston Globe on
1/27/2003.
|