Whatever happens in the general health care system in the United States, happens more intensely in the VA health system because the veterans it serves are older, sicker and are more likely to have mental and behavioral health problems. Access to health care overall is getting worse; for many veterans, it is already terrible.

National Adjutant Arthur H. Wilson of the Disabled American Veterans recently estimated that the Department of Veterans Affairs would need an additional $3.2 billion in 2003 to offer adequate medical services to veterans. The Independent Budget (“created by veterans for veterans”) shows that more than mere medical inflation is driving the need for more dollars. The number of veterans enrolled in the Veterans Health Administration is up sharply since 1999, from approximately 4 million to 5.5 million last year, and with the number treated up just as steeply.

The shortfall in veterans’ health care funding is supposed to be made up, in part, by a 2 percent gain in efficiency. What this might mean, according to National Adjutant Wilson, is the loss of thousands of full-time employees. The Independent Budget’s report on the 2003 budget concludes, “There are no more ‘efficiencies’ to be wrung out of the system. For the last five years, VHA has served a constantly growing number of veterans with appropriations that have been steadily declining in purchase power.” The inflation-adjusted appropriation per user seems to support this idea: In 1994, $7,400 was spent per user; last year, the number had fallen to $5,700 as the average age of veterans increased.

If all of this seems dismal, hold on – it actually gets worse. Most of the region of which Maine is a part, VISN 1, is losing veterans to warmer states, but in Maine the numbers keep going up, with this state having one of the highest participation rates in VHA programs. And that is the crux of the problem in Maine: The national payment system, already underfunded, does not properly recognize the growth in Maine. Medical facilities here see a looming funding crisis almost annually and, almost annually, Maine’s members of Congress complain and get just enough money to keep things going.

This year, the VA hospital at Togus will get, as it does every year, the money it needs to keep operating at the level of the rest of the nation, but not before it has announced some $6 million or $10 million shortfall that scares those dependent on the hospital and harms confidence in the VA. That may constitute a funding system by some definitions, but it isn’t a good one.

No one knows how many more veterans will require extensive care once the war on terrorism ends but certainly the answer will be more than now. And it is important to consider that, according to the Government Accounting Office, the VA is the “primary backup to other federal agencies to national emergencies.”

That should qualify it for some of the billions Congress is willing to spend for national security and make it the target this year of an especially generous and grateful Congress. At the very least, it should inspire the VA to throw out its current funding system and devise one that reflects its growing importance.