Veterans Health Care: Call the Funding What You May, Just Do It

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Most older and many younger Veterans qualify for life-time - albeit not necessarily free - medical benefits. This is as they were promised. While I don't know any Veteran who enlisted just for this benefit, the promise was made nevertheless. In order to give the veterans what they were promised, the federal funds must be available. Therein lies this week's tale - to have adequate, annual, funding provided the VA, or as my mother-in-law might say, "Direct assured mandatory schmandatory - a promise is a promise. Just do it already!"

Some Background - The Federal Budget

The entire federal budget can be divided into two categories: direct or discretionary programs.

Direct programs, often called entitlements because the programs have specific criteria with program-recipients "entitled" to payments, receive guaranteed appropriations - mandatory federal funding. Direct programs include: Social Security, Medicaid, Medicare, and (surprise, surprise, surprise) congressional salaries and benefits.

Discretionary programs are funded annually by, that is their appropriations are at, the discretion of Congress.

Some Background - Federal Health Care Spending

Nearly 90 percent of all federal health care spending is direct, it has mandatory federal funding.

Only Native American, active duty military, and veteran health care are discretionary.

Some Background - The VA

The VA is the largest integrated health care system in the US and has four critical health care missions:
- To provider health care to veterans
- To educate and train health care personnel (see following)
- To conduct medical research (see following)
- To support communities in a time of emergency and to backup the Department of Defense

The VA manages the largest medical education and professional training program in the US, affiliated with 107 medical schools, 55 dental schools and more than 1,200 colleges and universities. Each year about 81,000 health professionals are trained in VA medical centers with more than half the physicians practicing in the US today having received some of their professional education in the VA health system.

VA researchers have played key roles in developing the cardiac pacemaker, the CT scan, and improvements to artificial limbs - to name just three. The first liver transplant was performed by a VA surgeon. VA clinical trials established new treatments for tuberculosis, schizophrenia, and high blood pressure.

In a study published in

Medical Care Cost and Review

, December 2004, researchers concluded that the VA is able to provide a richer benefit package at lower cost than veterans would receive through the private sector under the Medicare fee-for-service program.

Yet, Congress typically provides an annual discretionary appropriation that falls far short of actual needs.

Some Background - Myths versus Reality

MYTH: Mandatory funding creates a Veteran's entitlement to health care and expands eligibility.

REALITY: Mandatory Funding would not create an entitlement to health care. It would simply shift the current funding for VA health care from a discretionary to a mandatory program. It would not expand current eligibility for VA medical care, the current benefits package, or VA's mission. Veterans would no longer have to fight for sufficient funding in the budget and appropriation processes every year as they now do. Guaranteed funding is a common sense solution to the decades-long crisis that has led to the severe rationing of health care that plagues the VA medical care system.

MYTH: Congress would lose oversight over the VA health care system if VA shifted from discretionary to mandatory funding.

REALITY: While funding would be removed from the direct politics, uncertainties, and capriciousness of the annual appropriations process, Congress would retain oversight of VA programs and health care services, as it does with other federal mandatory programs. The VA would still be held accountable for how it spends its money and how well it runs health care programs.

MYTH: Providing guaranteed funding for VA health care will not solve VA's problems.

REALITY: The VA must have a sufficient budget to effectively manage its health care programs and services and to hire the appropriate number of clinicians, nurses and support staff to meet the demand for high quality medical care. The VA must also have the ability to adequately prepare for the coming year well in advance. With guaranteed funding, the VA can strategically plan for the long term to optimize its assets, achieve greater efficiency, and realize long-term savings. Discretionary funding for VA medical care benefits neither the VA nor taxpayers, and it certainly is now having a negative impact on veterans.

MYTH: Under a mandatory funding program, VA would no longer have an incentive to find efficiencies and to supplement its appropriation with third-party collections.

REALITY: Mandatory funding will provide sufficient resources to ensure high quality health care services when veterans need it. Mandatory funding for veterans health care would be based on a formula that includes the number of enrolled patients and a per capita amount for each patient. It is not intended to provide excess funding for veterans health care. Under this method, inefficiencies in spending would be easily revealed. VA Central Office (VACO) would still be responsible for local managers using funds appropriately and efficiently. Hospital directors would still be required to meet performance standards and third-party collection goals. Current checks and balances will help ensure accountability. VACO provides monetary incentives to local managers who meet their goals and strive for the most efficient ways of delivering high quality health care to our nation's veterans.

Veterans Health Care Budget Reform Is Needed Now

In May 2003, the President's own

Task Force To Improve Health Care Delivery For Our Nation's Veterans

reported in part as Recommendation 5.1:

"The Federal Government should provide full funding to ensure that enrolled veterans... are provided the current comprehensive benefit in accordance with VA's established access standards. Full funding should occur through modifications to the current budget and appropriations process, by using a mandatory funding mechanism, or by some other changes in the process that achieve the desired goal."

Several Years ago, nine veteran groups joined together to form

The Partnership for Veterans Health Care Budget Reform - Representing America's Veterans

. They are:
- The American Legion,

- AMVETS, American Veterans,

- Blinded Veterans Association, BVA,

- Disabled American Veterans, DAV,

- Jewish War Veterans of the USA,

- Military Order of the Purple Heart,


- Paralyzed Veterans of America, PVA,

- Veterans of Foreign Wars, VFW,

- Vietnam Veterans of America, VVA,

They issued a joint open letter that read in part:

"Americans are once again deployed around the world, answering our nation's wartime call to arms. Like so many brave men and women who honorably served before them, these soldiers are fighting to preserve freedom, liberty and security. Many have already made the ultimate sacrifice. Also, like those who fought before them, today's veterans deserve the respect of a grateful nation when they return home.

"Unfortunately, without urgent changes in health care funding, our new veterans will soon discover their battles are not over. They will be forced to fight to preserve a health care system designed specifically to meet their unique needs. They will inherit an ongoing struggle to ensure that America fulfills its promise: to make the veterans health care system accessible to all veterans who need it.

"We believe it is time to guarantee health care funding for all veterans who need medical care. Health care rationing must end. It is time the promise is kept.

"The men and women who are currently deployed must be assured the VA health care system will be there for them when they need it - now and in the future. Congress should be mindful of George Washington's words '

The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the veterans of earlier wars were treated and appreciated by their nation.


Makes admiral sense to me.

Even so, as my mother-in-law would say, "Sense schmense. A promise is a promise. What's there to question?"

She too, would have a point.

--- Regards, Walt Schmidt