An opportunity to build a health care network for today’s veterans — and tomorrow’s

Published by Anthony J. Principi

(Alastair Pike/AFP via Getty Images)


The Department of Veterans Affairs has just completed a major step in the congressionally-mandated Asset and Infrastructure Review, or AIR, process — a process designed to ensure VA’s infrastructure in the next few years reflects the needs of 21st century veterans, not those of the previous century.


On March 14, VA recommended 35 of its 171 hospitals be closed or completely rebuilt; 14 new hospitals constructed; and 140 community-based outpatients opened. Altogether, it will cost approximately $2 trillion to modernize the department’s facilities under this proposal.


I understand the role of members and others to advocate for their interests, but we must be mindful that without comprehensive infrastructure reform, VA’s health care system will perish. Those who have already called VA’s recommendations “dead on arrival,” or “a massive mistake,” because they represent affected communities should understand what is at stake and keep an open mind.


VA, like other providers, faces many challenges in meeting the needs of its patients in the 21st century. All health care organizations must adopt to the seismic changes in medicine now underway. These include advances in medical technology, such as telehealth; an increasingly aging population; nurse shortages and scarcities in other health professions; and increasing numbers of people suffering from multiple conditions and serious mental illnesses.


To its credit, VA has recently been in the forefront of health care change. In the 1990s and early 2000s, the department transformed itself, with remarkable speed, from a collection of inpatient hospitals characterized by a limited number of specialized facilities often far from a veteran’s home to a system based on an outpatient model and telehealth with over 1,300 sites of care.


However, VA faces the unique obstacle of continuing to modernize its care despite an enormous legacy health care system costing billions of dollars annually to maintain. The department has been trying to build a 21st century health care system on a foundation of an antiquated infrastructure.


Many VA hospitals were constructed in the aftermath of World War II. The average age of a VA hospital is nearly 60 years, compared to just 8.5 years in the private sector. These older hospitals were built before women were a significant presence in the military and have insufficient facilities for their care; are too old to sustain the strong internet connections required for telehealth; and were built at a time when inpatient care, not outpatient care, predominated — resulting in floors, even entire buildings, sitting unused.


VA is spending billions on bricks and mortar, instead of doctors and nurses. In 2004, the last full year I was Secretary, VA health care received $28.3 billion in funding from Congress. This fiscal year, the department will receive $101.5 billion — more than a 350% increase. Meanwhile, the number of living American veterans has decreased from 24.5 million to 19.2 million....


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