Care before buildings

Few commitments in this country are more inviolate than the one it makes to caring for those men and women who were injured in battle. That commitment is being tested now as dramatically rising health care costs during the last decade have demanded equally dramatic responses to ensure veterans receive the care they need and deserve.

The National Homes Program, instituted after the Civil War, built a series of homes and small hospitals for injured and disabled civil war veterans. One of the first of these was built at Togus in 1866 and served veterans throughout the northeast, at one time housing more than 2,000 veterans. Many of those civil war veterans lived out their lives at Togus. When the Veteran’s Administration was organized in 1930, the National Homes Program was made part of the VA, and Togus became a VA hospital.

Health care in the private sector has undergone remarkable change, particularly in the last few decades. Treatment options have multiplied, technological innovations and the costs to pay for them have skyrocketed. An entire service industry, managed health care, has been created to control health expenses. The VA has been slow to embrace management of its health care expenses, and cost controls made recently have been seen as weakening its commitment.

Here in Maine, representatives of veterans’ groups express serious concern about continued downsizing at Togus. They see the number of acute inpatient beds dropping virtually every year, now down to the 50s, and, along with the discontinuation or reduction of some treatment programs, fear that eventually Togus will close. More than $3 million is spent each year to maintain the buildings at the Togus campus, and much of that space remains empty.

Jim Simpson, public affairs officer at Togus, points to a shift in the type of care veterans receive. He notes that there are now satellite medical clinics in Bangor, Machias, Calais and Rumford that allow veteran care closer to home. No longer do veterans have to travel hundreds of miles for an outpatient checkup. For those who need a hospital bed, Togus will remain an inpatient option. In fact, the maintenance of Togus is essential ti vterans’ services.

But while the Maine congressional delegation unanimously supports keeping Togus open, equally important is supporting superior care for veterans at places that best serve their needs, even if that means increased funding for satellite clinics, community support services and possibly some form of health care plan that would allow them to receive medical care at community hospitals nearest their homes and families. Rep. Cliff Stearns, Florida Republican and chairman of the veteran’s health subcommittee, has the right idea when he says, “We should be taking care of veterans, not buildings.”

Though Congress and President Clinton have been playing politics with the budget-surplus numbers all year, both know there is ample money for veterans services; the question is whether they have the commitment to allocate it, and allocate it in a way that gives vets the best care for the money. Full funding of veteran’s health care means providing high-quality treatment and services available to those patients, not simply keeping empty buildings warm.