Doctoring for Vets

One out of every eight Americans is a war veteran; by law, he or she is entitled to free medical care under certain conditions. The U.S. Veterans Administration runs the world's biggest hospital system: 172 hospitals, 105 out-patient clinics (for dental, orthopedic and neuropsychiatric patients) and 17 "domiciliaries" (old soldiers' homes), with a total annual in-and out-patient load of 2,100,000. Estimated 1956 cost to the taxpayer: $770 million.

Key to the VA medical program's size and cost is a controversial law, first laid down by Congress in 1924: although applicants for treatment with service-connected injuries get first priority, other veterans must be taken in as "beds are available," provided they need hospitalization and show they cannot pay for private care. Result: of an average of 113,000 patients in VA hospitals on a given day, more than two-thirds are being treated for non-service-connected ailments. The law is strongly backed by the American Legion, but is damned by the American Medical Association as "an opening wedge for socialized medicine." Despite the A.M.A.'s stand, the VA hospital system's able director, Vice Admiral Joel T. Boone, USN (ret.) feels that America's generosity to its veterans is merely a just obligation. His thesis: "I don't subscribe to the idea that a veteran with nonservice disabilities is not entitled to hospitalization. He certainly is, and I intend to make sure that he gets it."

Last week Director Boone, 65 and ailing, prepared to step down after four years on the job. His hand-picked successor: Dr. William S. Middleton, 65, former dean of the University of Wisconsin Medical School and military medico of long standing (he served on loan to the King's Own Royal Lancaster Regiment in World War I, as colonel in the Army Medical Corps in Europe during World War II).

White Elephants & Research. To ease Newcomer Middleton's task and cut future costs, President Eisenhower last month ordered VA treatment for non-service-connected ailments ended for men entering the service after Feb. 1. Even so, some 21,300,000 veterans (plus 3,200,000 others still in the armed forces) stay eligible for the old free treatment; indeed, the VA hospital patient load is expected to increase 4% next year.

In meeting future increases. Dr. Middleton will be confronted by a unique set of problems. More than half his patients --and most of the waiting list of applicants--are psychiatric cases, 14% are tuberculous; "the turnover is slow, keeps 90% of VA hospital beds filled (compared with 85% for non-VA hospitals). Thanks to congressional pork-barreling, many VA hospitals are sparsely occupied white elephants, e.g., a modern, 1,000-bed general hospital in Dublin, Ga., has only 385 beds in use.

In cooperation with 72 U.S. medical schools, the VA also runs a $7,000,000-a-year research program, begun in 1946.

Typical of the big urban research-treatment centers is Sawtelle Hospital in West Los Angeles. Sawtelle's twelve buildings comfortably house some 6,000 veterans of every U.S. conflict after the Civil War. Depending on his condition, a Sawtelle patient may see a first-run movie, bowl, shoot pool, watch night baseball, attend church, get married, and be buried just a bugle call away from his buddies--all without leaving the hospital grounds. Says one 82-year-old Spanish-American War vet: "My boy, we're not just satisfied here. We're contented. I can't say enough good things for everyone."

At Sawtelle, as at other VA installations, medical researchers are experimenting with dozens of new medical techniques. Among them: putting epileptics, once considered unemployable, to work making airplane parts; studying the life and death of tissue cultures of glia (cells of the nervous system's supporting structure) to determine the causes of multiple sclerosis; a new, intensive (one psychiatrist for 20 patients) method of treating mental patients.

Appomattox & the Future. One of the most serious problems Dr. Middleton faces is the shortage of doctors on the VA staff. The VA now employs 4,427 full-time doctors, whose salaries range between $5,500 and $12,800 a year. But they are not allowed to practice on the side, which keeps many specialists out--and more specialists is precisely what the VA needs. One growing attraction to doctors is the VA's impressive research program and such well-equipped centers as Sawtelle. where ,they can go on studying anything from cancer to schizophrenia.

New Director Middleton knows that his job will not get easier in the years ahead, even if the U.S. remains at peace. As the U.S.'s vast veteran population grows older, more veterans will suffer from chronic illnesses and require their country's care. Dr. Middleton can point to a historical example: U.S. outlay for Civil War veterans reached its peak in 1898, fully 33 years after Appomattox.

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