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Health Care Eludes Veterans

Chicago Tribune, May 21, 2003

PUEBLO, Colo. - Two and a half years ago, World War II veteran Ernesto Tafoya decided to enroll as a new patient in the Veterans Health Administration system. His hearing was failing and his back was giving him trouble. Many of his friends who were VA patients were getting drug prescriptions filled at dirt-cheap prices. It seemed like a good deal.

Tafoya, 77, is still waiting for the VA to give him a doctor's appointment.

He is one of almost 120,000 American veterans languishing on Department of Veterans Affairs waiting lists as its vast, persistently underfunded health system struggles with an unprecedented demand for services amid a national crisis of skyrocketing medical costs.

With a flood of aging veterans wanting low-cost prescription drugs or other services such as vision and hearing care, the number of patients at VA hospitals and clinics soared nearly 66 percent to 4.3 million from 1996 to 2002.

During the same period, funding for VA health care increased about 35 percent to $22.2 billion, failing to keep pace with demand as health-care costs climbed.

Requests for service have expanded so dramatically that the VA last year stopped medical outreach efforts and this year closed enrollment in its facilities to higher-income veterans without service-related medical conditions.

Like many other veterans, Tafoya is wondering how this government-run health system is going to handle service members returning from Iraq and Afghanistan who need medical care when it cannot accommodate former troops at home.

"They're going to rebuild Iraq and they don't have money to take care of us when we get sick and old? They're going to give those rich folks a tax cut, and they're not even going to help all the veterans who were promised help?" Tafoya said, referring to the Bush administration and Congress.

"I feel sorry for those young ones coming back from the gulf, if they have to go through what we're going through. I feel a total disappointment," said Tafoya, who served with the Navy's amphibious landing forces. Tafoya enlisted at age 17, volunteered for hazardous duty and saw action in the Philippines and Japan.

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In the aftermath of the war in Iraq, problems in the VA's health system - the nation's largest, with 163 hospitals, more than 850 clinics and 137 nursing homes - are drawing attention.

While a lack of adequate VA funding is nothing new, the extent to which capacities are strained by aging veterans who served in World War II, Korea and Vietnam is notable and, to many observers, alarming.

The most telling sign is the waiting list of veterans trying to get into the VA system as new patients.

According to department data, 119,248 former service members were waiting more than six months for an initial appointment at the end of March, down from more than 200,000 in February and 310,000 in July.

The list has shrunk in the past year as the agency has turned its attention to the issue.

A recent survey by the American Legion of more than 3,100 veterans found that it took seven months, on average, for new patients to get an appointment with a VA primary care doctor. Almost 60 percent of patients' appointments were rescheduled, requiring a further wait of 2 1/2 months.

"If the VA's systems are over-stressed today, just imagine what it's going to look like when our troops start coming home in large numbers," said Ronald Conley, national commander of the American Legion.

Service members returning home from combat zones get two years of free care from the VA when they leave the military under policies recently affirmed by the agency. There were more than 250,000 U.S. troops in the gulf region during the war.

"We're doing the best we can with the resources we're given by Congress," said Anthony Principi, secretary of the Department of Veterans Affairs, noting that this year's budget raised VA health-care spending by more than $2.5 billion.

As for troops returning from Iraq, "We're prepared to take care of them," he said.

Health care for veterans is not an entitlement, although veterans groups would like it to gain that status.

Conley and others suggest the VA's numbers underestimate the extent of veterans being shut out of its health system.

Not included are an estimated 164,000 Category 8 veterans - those with minimal service-related disabilities and incomes ranging from $25,000 to $45,000 - who are excluded from applying for health benefits this year under a January decision.

Only new applicants are affected, including more than 7,100 Category 8 veterans in Illinois.

By the VA's estimates, 1.2 million veterans will probably leave its system if they must pay an annual enrollment fee of $250 and higher co-payments for prescription drugs and doctor's care, as suggested in the agency's current budget request.

Of these, 425,000 are listed as current patients.

These user fees, a way to raise money and ease budgetary pressures, would apply to veterans without service-related medical problems.

"Here's our problem: Congress has made all veterans eligible for care but no one entitled. We can only provide care within the resources that are available. And yes, indeed, we have to set priorities, and we've clearly decided veterans disabled during service, low-income veterans and veterans with special health-care needs have to come first," Principi said.

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Last year, 900,000 former service members entered the system; 200,000 new enrollees are expected this year, Principi said. There are 7.1 million enrolled in the system.

"This is a system being stretched beyond its capacity" by factors that constitute "a perfect storm," Principi said.

Consider: Health-care costs are rising at double-digit rates, the largest increase in the past decade. National shortages of nurses and some specialized physicians have driven up labor costs. With a weak economy, veterans are losing jobs and health benefits.

Forrest Costner, 55, who served in the Army's 1st Infantry Division in Vietnam from 1966 to 1969, tried to sign up for VA health care in November 2000 when he began to worry about losing his job.

Costner was still waiting for a VA appointment when his employer let him go in October.

A cancer survivor who takes medication for diabetes and high blood pressure and who is still jobless, Costner has been paying $700 a month for insurance while the VA keeps him in limbo.

"The government tells you, `We'll always be there for you when you need us' when you go into the military, but it seems like once you've done the job for them you really don't matter that much anymore," said Costner, who lives in Conover, N.C.

Reforms that extended non-hospital medical care to all veterans instead of a select group and a late-1990s expansion drive - 450 community-based clinics were built - also contributed to the problems. VA coverage became more attractive and care more accessible, and demand swelled.

"We built it, and they came - a lot more patients than we expected," Principi said.

Meanwhile, America's population of about 26 million veterans is growing older and needs more medical services, especially prescription drugs. The VA's low-cost, comprehensive prescription plan is especially attractive to senior veterans on fixed incomes.

Although all U.S. citizens 65 or older are covered by Medicare, the federal government's health program for the elderly, it does not pay for prescription drugs.

Under VA policy, new enrollees have to see a VA doctor before getting a prescription. That puts pressure on the burdened system.

Art Richoz of Elgin, Ill., recently encountered the frustrations of trying to get timely care from the VA.

A World War II Army infantryman, Richoz took three bullets from an enemy machine gun in Germany, earning him a Purple Heart but costing him his right eye.

At 80, he is struggling with diabetes, the aftermath of open-heart surgery and a stroke, and cataracts on his left eye that have made him legally blind.

A few weeks ago, Richoz contacted the VA to gain admission to a program that would train him to walk with a white cane and acquire other skills needed by the blind.

He was told the wait was eight months.

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"I thought that was a long time. A very long time," Richoz said at a recent American Legion town hall meeting in Batavia, Ill., one of six held across the country in the past month to call attention to veterans' health concerns.

Agency officials say they are working to shorten waiting times for appointments and get more new patients in the door.

At the VA's Sunshine Healthcare Network, administrators have lengthened clinic hours, started offering appointments on Saturdays, hired more than 350 doctors, nurses and technicians, and reduced doctor visits to an average of 20 minutes - down from 30 minutes - to squeeze in more patients. The network covers most of Florida and Puerto Rico.

Robert Faye Thomas, 72, a Korea and Vietnam War veteran from Arcadia, Fla., who served 21 years in the Navy, never anticipated needing VA medical care until he realized that Medicare and military health insurance did not cover services for vision or hearing.

After trying to enroll in his local VA health system in early 2000, Thomas got his first appointment with a doctor in February 2003, almost three years later.

The doctor told him he had severe hearing loss. But, the physician said, the Ft. Myers VA center could not help him because it had stopped paying for hearing aides due to budget limitations.

With a bank loan, Thomas bought $5,000 worth of digital hearing aides.

"You do what you have to do," he said. "I only wish the VA had enough money to do what it needs to do."


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