Shortchanging Veterans’ Health Care

Democratic Sen. Patty Murray of Washington has been a longtime advocate of veterans' rights. The daughter of a disabled World War II veteran, Murray serves on the Senate Veterans' Affairs Committee and is the author of the law that ensures that all veterans have the right to military funeral honors. She has been honored for her work by groups like the Vietnam Veterans of America, American Ex-POW's, the Veterans of Foreign Wars and others. She is also one of the leading voices in the Democratic Party speaking out against the Bush administration's proposed budget for veterans' health care--arguing that it fails to address the rapidly rising costs. The Department of VA predicts it will need to treat 5.8 million patients next year, including 263,000 Iraq and Afghanistan vets returning with serious injuries requiring expensive care. Murray and her Democratic colleagues believe the Bush budget will force new costs--such as increased prescription copayments and new enrollment fees--onto veterans themselves. Murray spoke with NEWSWEEK's Eve Conant about the problem, and how to solve it. Excerpts:

NEWSWEEK: Earlier this month, you grilled Veterans' Affairs Secretary James Nicholson about President Bush's proposed veterans' budget for 2008. Is the VA pushing for enough money?
Patty Murray: No. What I have seen over the last four years since the Iraq war began is an underestimation, on the part of the VA, of the number of soldiers that will be going into the VA system--from the conflicts in Iraq and Afghanistan and also from Vietnam. We have an aging population of Vietnam veterans who are having health problems for the first time and coming into the VA. They never looked at that and said, 'Oh, because of the age of this population we're going to have an increased number, and therefore we should ask for additional dollars.' In addition, health-care inflation for everyone is going up by the double digits. You would expect that if you provided health care for people that you would take inflation into account, but I don't believe the VA has realistically looked at that either.

How many vets does the VA project will be going into the system this coming year? And how far away is that from what you believe the real numbers are?
The VA, last year, was underprojecting how many men and women would come into the VA system from Iraq and Afghanistan. They expected 45,000 and ended up with over 100,000. Now they are projecting 263,000 Iraq and Afghan vets next year. But we're hearing from independent sources that the figure will be over 300,000. Without being a budget or numbers guru, you can realize that 1.5 million men and women have served in Iraq and Afghanistan and are coming home with everything from minor injuries to cases of TBI [traumatic brain injury], lost arms and limbs, and PTSD [post-traumatic stress disorder]. You know the number is going to be high. But they seem to want us to believe that the number is going to be lower. Which means we don't fund VA adequately.

But wouldn't the leaders of an organization want that organization to get more money, not less?
I've worked with the VA for a very long time and up until this point we have had the VA be very honest in their assessment of what is going to be needed, because they are the ones that turn around and serve the veterans. But I have found that over [the] past four years, for the first time, we have a VA that is just toeing the line on the numbers. I believe that the administration, from Day One with this war, didn't want the American public to recognize the cost of war. They knew that it would generate a negative impact of their moving forward on it. So they have low-balled everything from how long the war was going to [take] to how much it was going to cost. They never told the American public that we will have thousands and thousands of men and women coming home who will have PTSD, who've lost legs and arms, who have long-term disabilities and we're going to have to pay for this, it's going to cost something. It's symptomatic of an administration that has failed to tell the American public the cost of this war. What happens then is that the VA doesn't have the money it needs. Then these men and women come home and are in long waiting lines, can't get appointments, and don't get the health care they need.

What are current problems within the VA system that require the most attention?
Once you get into the VA there are excellent doctors. It is an excellent system, and by and large, once you get in you get good service. Where [VA Secretary] Nicholson and I don't agree is whether or not you can get into that system. A great health-care system is not helping a veteran who is sitting at home and cannot get an appointment. That is where we have a huge problem. We have a backlog of patients that cannot get in. The VA likes to say that everyone gets an appointment within the first 30 days. Great, that's better than it was. But I come home and talk to veterans who say, sure, after calling three times, 30 days into it, they get an appointment--for nine months later. That just doesn't cut it. Many of them can't start working until they've had their medical problems cleared. But they are sitting at home for nine months waiting to get into the VA.

What's the difference between the VA's projected budget, what the administration is signing off on--and what you think is needed?
The administration is asking for two billion less than what the independent budget request is [the independent budget request is put together by four veterans' service organizations: AMVETS, Disabled American Veterans, the Paralyzed Veterans of America, and the Veterans of Foreign Wars of the United States]. These are the organizations working with veterans on the ground and they know what is needed. We in Congress need to get a budget request that is honest; otherwise, men and women are not being served.

You've argued against a rise in copayments and other fees for veterans. Can you tell us about those?
The budget includes proposals to increase the copayment for prescription drugs from $8 to $15--and to impose an annual enrollment fee, although this time it is tiered based on income, and only veterans who make $50,000 or more a year would be subject to it. What Nicholson is trying to do is to discourage men and women going into the VA in order to keep numbers down and say to the country: this doesn't cost that much. This is a budget gimmick they have tried to throw at us, not as a way of helping veterans or keeping their promise to veterans in a time of war, but as a way of balancing the budget on backs of veterans. We will end up billions of dollars short because that gimmick is not something Congress is going to pass. So where is the money going to come from?

What should Bush or the VA do then, in your view?
It would be so much more credible to have the VA secretary or the president himself say: "We've been in this war for four years, and 1.5 million men and women have served our country honorably. We owe them the health care they've been promised. And therefore, America, we are going to have to increase the cost to everyone." But they won't do this, which is such a disservice to the men and women who are bearing the brunt of this war.

How would you score Bush in terms of leadership on veterans' health issues?
F. It's one thing to say you've been to a VA center and how everyone is so happy with their service. It is another thing to sit down with Iraq and Afghanistan and Vietnam veterans who are close to tears, with families in stress, because they can't get the care they need.

You say once a veteran gets into the VA system that it's great. But if there are such long waits to get processed doesn't that mean there are not enough workers within the VA system?
Yes. They don't have enough people tracking claims, they don't have enough processing paperwork, they don't have enough physicians, and therefore they deny care because they don't have the people to offer it. It keeps the budget down, but it keeps people out of the system.

What about mental health care? You say the VA is predicting fewer in-patient mental-health cases.
I'm very worried. The number of mental health-care patients that the VA is projecting in the budget is less than what we currently have today. I was in Iraq a year and a half ago and I was told by Commander Casey [Army General George Casey Jr., who recently stepped down as the highest-ranking military official in Iraq] that this war is going to create a high number of patients who need mental health care because it's what he called a 24/7 war. There is no front line to go back from, no place to get away from the intensity of IEDs [improvised explosive devices] going off next to you.…The VA itself has issued statements saying they do not have enough clinicians to see the people who need mental health care. There is no one within the lower echelons of the VA who predicts a lower number of mental-health patients; the only people predicting this are the president and secretary Nicholson. My perspective is they are doing it so they don't have to ask for money and show what the cost of this war is.

So what is Congress doing about this?
We passed a resolution last week to increase funding for last year's VA budget; this is being sent to President Bush now. We also believe the president's proposed veterans' budget is inadequate, and we are trying to figure out how to increase it. The bottom line is we have people who have served our country honorably and are coming home and being denied service and none of us should be sitting down for that.

Was it your father's WWII experience that sparked your interest in veterans' affairs?
My own personal experience came when I was in college during the Vietnam War and I did an internship at a VA hospital's psychiatric ward. I saw this huge discrepancy between what was happening in these veterans' lives and what I saw out on the street every day. A majority of people were not recognizing their sacrifices. I see a huge parallel today. You see people driving around and going to work and going on vacation and then you go and talk to veterans and see this tremendous sacrifice, at huge cost to them, and the rest of the world doesn't even know it's happening.