Abolishing VA Hospitals

Greenberg proposes to abolish the VA hospital system and use the $10 billion that would be saved to buy health insurance for our veterans. Considering that there are about 18.5 million living veterans, and dividing this number into $10 billion only yields $541 each for a yearly health insurance premium. This will not buy comprehensive health insurance in any other system of health care in the United States. Though the VA is a big, cumbersome, socialized medical system, it actually costs a lot less to deliver health care the VA way than privately.

One of the reasons that VA care is inexpensive is that, as Greenberg correctly states, employees are poorly paid. The tone of Greenberg’s article sounds rather condemnatory of the VA for having such low salaries. I suggest that it is rather the fault of the Administration, Congress and the American people.

The range of quality of health care in VA medical centers varies from excellent to poor, often depending on whether or not a particular VA has an affiliation with a university medical school. In such affiliated medical centers, all the staff physicians are medical school professors, have there salaries supplemented by the medical school, and are usually among the best physicians in town. In VA medical centers without university affiliations, the quality of care varies a lot, as it does in the private sector. Private health care does not equate with excellence. It is just private.

Assuming that the citizens of this country want to honor the social contract we have with our veterans, what is the best way to fulfill that commitment? One would assume that if we were really serious about it we would see that each veteran would be provided with a health insurance policy that would allow him or her access to excellent medical care for life. This would require an increase in expenditures of 30% to 150% over our current costs. Alternatively, and because the current VA system is not uniformly excellent, one could also significantly improve care by just increasing its funding by about $3 billion more per year.

The current VA system is not uniformly excellent, mostly because it is underfunded by at least a third when compared to other systems of medical care in the United States. If we really want to provide the best possible medical care for our veterans, we are going to have to pay more for it than we are paying now. Right now we are getting a real bargain, but we should be ashamed of ourselves.

STEPHEN BAIRD, M.D.

Chief, Laboratory Services

VA Medical Center

San Diego