Expand Medicare to Serve All Veterans

The problem of long wait times for veterans seeking care at some (but not all) Veterans Health Administration facilities has been front-page news for the past several weeks, and seems to be resulting in an unusually prompt response from a normally gridlocked Congress. The wait times and the consequent attempts to cover them up seem to have multiple causes.

First, there is the uneven but growing demand for some types of services, resulting from casualties suffered in the recent Iraq and Afghanistan wars. Then there are predictable increases in the demand for services due to the aging of veterans from past military conflicts. This increased demand has been somewhat but not completely offset by the attrition in the number of veterans from past wars due to normal mortality as they age.

Then there are problems on the supply side, as the number of primary care physicians and other caregivers relative to the number of specialists dwindles in the American health care system as a whole. (I have written about this more extensively in past columns.) Like everywhere else, the VA cannot keep up with the demand for primary care physicians.

Finally, it's clear that some VA administrators, wanting to make their performance numbers look good so they would qualify for bonuses, manipulated the waitlists and their reports about wait times. Of course politics has magnified and distorted the nature of these problems.

As a way of relieving the pressure on some VA centers and providing quicker access to services by veterans facing a long wait to get into the system, both the Senate and the House are processing legislation that would require the VA to pay for services in the private sector. (Maine 2nd District Rep. Mike Michaud, a candidate for governor this year, is the ranking minority member of the House Committee on Veterans Affairs.)

In a June 2 letter to the New York Times, Dr. Philip Lee, a two-time assistant secretary for health in the federal government, and I wrote the following:

"If Congress is serious about helping to alleviate the problem and showing our gratitude to and support for our veterans, it will expand Medicare coverage to include all veterans. If that is done, our veterans could choose between the VA system and any doctor who participates in Medicare.

"Medicare is approaching its 50th anniversary as one of the most durable, successful and popular federal programs ever created. Do our veterans deserve any less?"

We believe that simply making every veteran eligible for Medicare following discharge from military service would provide a technically (if not politically) quick and simple means of providing them with access to additional resources as a supplement to those available to them through the VA. And it would eliminate the need to create a new bureaucracy within the VA to deal with private-sector doctors and other providers.

There are precedents for expanding Medicare to those under the normal eligibility age of 65. Starting in 1972, Congress opened up Medicare to all patients who otherwise met Medicare's eligibility requirements and have chronic renal failure and other disabilities regardless of age. In 2009, Sen. Max Baucus, almost on a whim, inserted a provision into the Affordable Care Act that made Medicare available to all of his constituents with pulmonary disease living in Libby, Montana.

Making every veteran eligible for Medicare would provide them with more choice of doctors, hospitals and other providers, and relieve some of the short- and long-term pressure on the VA for some routine, non-combat-related services, allowing the VA to focus more on those services only it can provide.

Even more important, it would move us toward the ultimate goal of universal coverage for all residents of the U.S. I agree with those who point out that you can't leap across a giant chasm, such as the one between where our dysfunctional health care system is now and where it should be, in two jumps. But we can take steps to narrow that chasm so as to make the inevitable final jump easier. This could be an important one of those steps.

In doing this, we should avoid sanctioning the "voucherization" of veterans' health benefits. We should rebuff those who would cast vets into the dog-eat-dog private insurance market, dismantling or radically weakening the VA in the process.

The vast majority of Americans fervently believe that our veterans deserve this kind of help. It's a shame more of us don't feel that way about everybody.