Care of the elder veteran: new directions for change.

Abstract

Prologue: The medical care system that serves the nations military veterans occupies a unique place in American society. Publicly financed and centrally administered by the Veterans Administration (VA), the system is designed to fulfill what society has determined is its obligation to, as Abraham Lincoln declared so eloquently a century ago, “care for him who shall have borne the battle and for his widow, and his orphan. ” The VA is a vast federal agency — the third largest with an annual budget nearing $30 billion —and it enjoys broad support in Congress. Increasingly, though, because of its size, the aging of its contituency, the federal governments budget-cutting exercise and questions about its appropriate future role, the VA has come under sharper scrutiny. A variety of reforms of the VA's medical care system have been proposed, such as tightening its eligibility requirements, establishing a voucher system that would entitle veterans to care in the private sector, and narrowing the VA's focus. Most proposed reforms have run into a stonewall of opposition from VA's vaunted lobby and the reformers stymied. Nevertheless, the pressures that suggest some future changes will be necessary remain. In this essay, authors Mark Schlesinger and Terrie Wetle advance a different proposal for reform which, they say, is more in accord with the VA's capacity and political reality. The proposal seeks to draw upon the strengths of the current VA medical care system and encourage a more active collaboration with other public and private systems of care. Schlesinger and Wetle both reside at Harvard University; Schlesinger is at the John F. Kennedy School of Government, and Wetle is assistant professor at the medical school. They have been working closely with a variety of members of Congress on VA reform. Schlesinger holds a doctorate in economics from the University of Wisconsin and is research coordinator for the Center for Health Policy and Management at the Kennedy School. Wetle holds a doctorate in urban studies from Portland State University and is assistant director of the Division on Aging at Harvard Medical School.