New VA problems get the same old 'solutions'

• The chronic problem facing VA hospital system is the periodic strain on services caused by aging war-vet populations
• By 2017%2C claims for service on the VA will have grown more than 40 percent in just eight years
• More brick and mortar isn%27t the solution%3B fundamental reform is

Give the Department of Veterans Affairs some credit for realizing the challenges it faces.

Now, if it just could open its eyes to the obvious resolutions.

For the VA, American wars begin straining the agency's medical resources 30 to 40 years after the guns go silent. A profound accordion effect takes place.

As the nation's VA hospitals began straining to provide adequate health-care services to aging veterans of World War II, for example, quality-of-care issues dominated headlines until Congress flooded billions of new dollars into the agency.

Now, in the midst of yet another quality-of-care crisis, VA Secretary Robert McDonald tells us VA hospitals are being swamped with a new flood of aging vets, this one from the Vietnam War era.

And, just as we saw with every expansion of the VA accordion in the past, the solution, according to McDonald, is more funding.

Our veteran population, particularly those who fought in Vietnam, is aging, McDonald told the Association of Health Care Journalists in California last week. "And the aging of that population is what created the stress on the system. Sound familiar? The VA is the canary in the coal mine."

McDonald then issued a warning to Congress, which is considering a VA request for a $1.4 billion budget increase: Failure to comply will prompt more delays in the delivery of health care, and will stymie efforts to reform the agency (however limited those reforms may be).

There is no doubt health-care demands on the already overstressed VA are about to explode. According to agency records, the VA in 2009 processed 989,000 health-care claims involving 2.7 million medical issues. By 2017, the VA is expected to process 1.4 million claims involving over 6 million medical issues.

How does any organization, much less one as sclerotic and hidebound as the VA, deal with such an upsurge? How does it promise quality health care to all vets under such conditions?

According to McDonald, the answer is mostly in more bricks and mortar. He wants a more aggressive hiring program for more doctors and nurses. And more and bigger facilities.

How many times does this accordion have to play before VA administrators realize they are failing veterans at the most vulnerable moments in their lives, when their health is failing?

Yes, the VA needs to expand, but as a military version of Medicare, directing qualified vets to the private-sector health-care providers of their choice and paying the bills it is responsible for paying. It doesn't need to create a government version of a health-care system that already exists.

To McDonald's credit, part of his expansion plans include more emphasis on the Veterans Choice program, which refers some veterans to private-sector providers. The bad news is that enlarging the VA fiefdom is his primary mission.

In his address in Santa Clara last week, McDonald spoke of what he saw when he took over the agency and toured the Phoenix VA, the epicenter of the agency's current quality-of-care scandal: "I discovered we were short 1,000 (medical) providers. And we were short clinical space."

McDonald's response was to launch a hiring program. One wonders where McDonald thinks all those missing medical personnel spring from? Even the private sector in Arizona is straining to find doctors and nurses to meet demand.

The answer is not to create competing health-care systems.

As we have said many times before, the VA must focus its specialized medical skills on those treatment protocols it does best: treating war wounds and post-traumatic stress disorder. And advancing research into brain traumas.

The rest it should farm out to a complimentary private sector. With every word from the top about what ails the VA, that path to reform becomes ever more clearly the only sound choice.