The large majority of Maine veterans do not use VA health care facilities and it is a good thing they don’t. The number visiting Veterans Affairs Medical and Regional Office Center at Togus last year jumped to 22,000 from 17,000 the year before and veterans are once again reporting long waits for service. There are 149,000 theoretically eligible veterans in Maine; the 22,000 represents about 15 percent of the total, one of the highest use rates in the Northeast.

These numbers suggest a couple of things. First, the idea that veterans need stand-alone health services for the vast majority of illnesses is almost certainly untrue, although they have been promised adequate care and without question deserve to receive it. Second, the high use rate in Maine indicates that some specialized care provided by Togus may still be crucial in some cases. The Togus budget last year, by the way, was $81 million, or $3,682 per patient. Some patients receive all or most of their medical services through the VA system; others receive only a small percentage.

Besides long waits for services and budget restrictions that force Togus doctors to send too many patients to Boston for continued treatment, the veterans hospital suffers from high turnover, with low pay being a cited as a prime reason. Similarly, the hospital has a hard time recruiting medical professionals to join its staff and currently has several key openings unfilled.

One understandable response to this from Togus is to encourage the use of the local VA clinics in Caribou, Calais, Machias, Bangor, Rumford and Saco. It would be interesting, however, to ask veterans to consider not only encouraging the use of these satellite facilities but placing them and local hospitals closer to the core of the system. With the addition of the proper specialists for specific veterans issues – post-traumatic stress or loss of limb, for instance – local or regional hospitals in Maine could serve Maine veterans without the travel or the waiting times or staff shortages or the loss of continuity of care, as a veteran is shifted from one doctor to another.

Some would argue that centralized services inevitably would be more efficient. A fair point, but with Togus tied to regional funding and regional funding either being sent to southern states or remaining disproportionately in Boston, it may be better for Maine veterans to petition to have the chance to contract with local qualified care facilities. The money paid per patient for veterans in Maine would purchase a better-than-average group-rate plan without the travel or long waits. It is an option that Maine should consider and the VA should allow.