MORTAL COMBAT AT THE VA

By JAMES S. KUNEN

CYRIL WINSICK WAS SERVING AS A forward spotter for a mortar crew when he was captured by German troops near the town of Aachen in October 1944. He spent much of the following winter being force-marched across Germany before he was liberated in April 1945. A half-century later, Winsick still can't speak of his ordeal without crying, but at least it did earn him one benefit: as a former pow, he was entitled to lifelong free medical care from the Department of Veterans Affairs. Or so he thought.

Winsick's doctors at the Long Beach, California, VA hospital discovered a benign tumor growing in his brain five years ago but decided he could not survive surgery to remove it because of a heart condition, which had required a quadruple by-pass operation. Fortunately, there was a life-saving alternative: he could undergo "gamma knife" radiation. The VA hospital didn't offer that particular treatment, but the nearby private Hospital of the Good Samaritan did. Winsick's VA doctors set out to arrange VA funding for Winsick's treatment there.

Five years later, they are still trying. VA bureaucrats insist that Winsick does not qualify for such funding and should rely on his Medicare medical coverage. But Winsick, thinking he was covered by the VA, never signed up for Medicare. He is eligible to sign up in January 1996, but his coverage will not begin until next July. By then he could be dead. "I fought in the war, and I was a prisoner," says Winsick. "I expected humane treatment afterward. I'm getting shafted."

This Saturday marks the 50th Veterans' Day since the end of World War II. Church bells will peal at 11 a.m., 50,000 active and veteran servicemen and -women will march up Fifth Avenue in New York City, and President Clinton will dedicate the site for a World War II memorial on the Mall in Washington. Wreaths will be laid, flags saluted, taps blown and countless speeches delivered to honor those who served in what's been called the Good War. Then the nation will get back to business, and the business of the nation these days is balancing the budget, and if balancing the budget requires cutting back on veterans' medical care--well, c'est la guerre.

According to Richard Robinson, benefits-services director of the Eastern Paralyzed Veterans Association, Winsick's special status as an ex-POW obligates the VA to get him the treatment he needs by contracting with a private provider if necessary. "We run into this type of wrongful, dollar-driven disallowance all the time," says Robinson. "They're trying to cut corners. The name of the game is to try to save money and to hell with the veteran."

Access to free health care from the VA Department, once available to all honorably discharged veterans, has since 1986 been restricted, for the most part, to low-income veterans and those with service-connected disabilities, categories that include 10 million of the nation's 28.5 million veterans. Almost 3 million individual veterans utilized VA care in fiscal 1994. Now Congress's budget bill projects flat spending of $16.2 billion annually for VA medical programs through the year 2002, with no provision for inflation or mandated salary increases or an influx of patients owing to reductions in Medicare and Medicaid. In real dollars, this amounts to a massive cut; President Clinton's budget proposal would have tightened the screws even more.

Paradoxically, the VA, notorious as a pork pipeline and bastion of bloated bureaucracy, is at the same time starving for resources. Its medical-programs budget has been declining in real dollars for 16 years. Some congressional mandates restrict access and ration care in often misconceived efforts to keep costs down, while others keep federal dollars flowing to unneeded facilities in Congressmen's districts, driving costs up. Long-forgotten political horse trades, now enshrined in law, make it difficult for the VA to deploy its resources rationally to best meet the real needs of veterans.

So as 7.7 million World War II veterans enter their years of peak medical need--their median age is 73--the VA may be decreasingly able to serve them. "If you lock us into the 1995 spending levels for the next seven years, you make some assumptions almost as though there's nobody out there to treat," says Jesse Brown, Secretary of the Department of Veterans Affairs. "A lot of people are behaving as though our veterans are already dead."

Eight and a half million veterans are 65 or older. Twenty-five thousand of them suffer from paralyzing spinal-cord injuries or diseases, and in many cases, their spouses are growing too frail to care for them at home. Six hundred thousand veterans, by VA estimate, will be suffering from Alzheimer's and other severely dementing conditions by the year 2000. Yet the VA and state veterans homes today can provide fewer than 40,000 nursing-home beds. "The demand for long-term care is going to skyrocket over the next five to 15 years," observes VA Under Secretary for Health Dr. Kenneth Kizer, who estimates that in the year 2010, 1.6 million vets will be 85 or older. "If you don't have the money, you can't provide the service."

The VA's medical system, which claims a backlog of $870 million in unmet needs for equipment and $800 million in deferred maintenance and repairs, will lay off 5,000 to 10,000 employees next year, and not all of them will be bureaucrats. As it is, the care-giving staff is stretched so thin on some wards that quadriplegics complain of spending days in bed for lack of anyone to help them up. Gerald Barba, 39, a peacetime Navy veteran who broke his neck in a swimming accident, praises the dedication of the staff at the VA Hospital in the Bronx, New York, but says they are shorthanded. "Sometimes when I need to have my lungs suctioned--I cannot cough--no one comes until I'm bubbling over, gargling for breath." Winsick confirms that in Long Beach, staff and services are being "nibbled away all the time.'' A diabetic who usually sees a podiatrist once a month, Winsick says none has been available for several months.

Representative Bob Stump, Republican from Arizona and chairman of the House Veterans' Affairs Committee, calls the charge that Congress has balanced the budget on the backs of veterans "just plain mean, disgraceful." He argues that a declining veteran population, coupled with streamlined management and reform of the arcane eligibility rules that keep veterans' hospitals from delivering care in the most efficient way, should enable the VA to maintain its level of service. "Without a balanced federal budget," he adds, "rising interest payments on the national debt would soon crowd out our ability to continue providing for the nation's veterans."

Veterans' advocates and the VA itself agree that relief from congressionally mandated rules that tilt the system toward expensive in-patient care could squeeze far more bang from the buck. (Under the present system, for example, many veterans cannot receive treatment for hypertension as outpatients. They have to wait to be admitted as in-patients for a heart attack or stroke.) But while the House has passed eligibility reform, the Senate has not.

Given its many Byzantine rules, it's not surprising that the VA has been the health-care provider of last resort for many vets, who turn first to employee benefits, Medicare or Medicaid. But according to estimates announced last week by the VA and the Department of Health and Human Services, as many as 172,000 veterans could lose their Medicaid coverage in 2002. At the same time, increasing premiums and copayments for Medicare could spur an additional 400,000 veterans to head to VA medical centers. The numbers are debatable, but the basic dynamic is not: all three systems of medical coverage are cycling down together.

"People think of the VA as that red brick building up on the hill, where Uncle Charlie died," says Richard Fuller, director of health-policy program development for the Paralyzed Veterans of America. "They don't realize that the VA is an integral part of the health-care network. With the VA budget being cut and Medicare and Medicaid being capped below existing growth rates, you have people going into health-care limbo."

Under Secretary Kizer was brought in last year to try to make the VA system more efficient, consolidating redundant facilities and shifting the emphasis from in-patient to outpatient care to the extent the law allows. But if demand begins to dwarf resources, he says, the VA will circle the wagons around its core mission of providing for veterans' service-related disabilities. Other services, such as nursing-home care, says Kizer, "are subject to being diminished." The extent to which the VA will be able to treat the poor or nonservice-related maladies will depend on the political decisions Americans make--after the Veterans' Day hoopla fades.

--Reported by James Willwerth/La Mirada

With reporting by JAMES WILLWERTH/LA MIRADA