Beyond the theatrics of the VA wait-list scandal

Merrill Goozner | Modern Healthcare | May 24, 2014

The spin cycle of a Washington scandal, once set in motion, is more entertaining to watch than clothes washing at the local laundromat, even though the latter is better at cleaning up a mess. Let's not mince words. What's going on at the VA's healthcare system is a mess. The veterans who served our country proudly and well deserve to see physicians promptly and get the care they need.

A few years back, journalist Phillip Longman wrote a book about VA healthcare called Best Care Anywhere. It lauded the 1990s transformation that turned a scandal-plagued, dysfunctional system into one that pioneered the adoption of electronic health records, improvements in patient safety and coordinated care. Today, that sprawling system—151 hospitals and 827 outpatient clinics serving nearly 8.8 million vets and qualifying family members—is in crisis. The wait-time scandal is a reflection of a system that was ill-prepared to deal with a surge in demand from two huge demographic cohorts whose needs should have been fully anticipated but weren't—not by the politicians who fund the system and not by the officials in charge of running it.

The biggest surge is coming from the Vietnam-era veterans who make up fully one-third of the nation's nearly 23 million veterans. These 7.5 million baby boomers are now in or approaching retirement age—their high healthcare cost years. They bring with them a host of complicating factors that add to their medical needs. They suffer from unique conditions such as exposure to Agent Orange. Their health status reflects the fact that they are somewhat poorer and less educated than the general population since that was the first conflict where college-bound young adults were largely exempted from frontline military service...