Politicians and officials in the Department of Veterans Affairs have debated for the last couple of years whether the erosion of services at Togus VA hospital has harmed the care vets receive. But there should be no debate about a proposed $9 million budget cut at Togus: Staff and service reductions will result in increased waits for care, greater loads on already overworked physicians and more trips to Boston for patients.

Martyn Vickers Jr. has observed the struggle to fund the hospital for the three years he has been chief of surgery at Togus. Reducing in-patient care, as proposed under the budget-cutting plan, he said, raises all sorts of questions. Primary among them is where the money for paying for care elsewhere is going to come from.

Beyond that, Dr. Vickers, a Bangor native and Army veteran, knows better than most that Maine, unlike many other states, does not have a surplus of doctors eager to accept the veterans as new patients; that vets would present medical challenges to health centers unaccustomed to treating them; that continuity of care would be threatened if Togus clinics stay open but inpatient care is cut; that many veterans would have a hard time traveling around and outside the state for care.

The problem is far larger than just a few cases to be shuffled among other hospitals. From Oct. 1, 1997 to Sept. 30, 1998, Togus had 3,183 total surgical cases; 1,242 of those were considered major. Of the total surgeries, 782 were in-patient procedures. And it is even more complicated than simply finding services outside Togus. Veterans are older than the general population, with 58 percent of patients over age 60, and they are sicker. The average vet seeking care at Togus has five identifiable illnesses. Put them in a capitated system with a voucher and see how few medical centers want their business.

Togus has been under scrutiny for the last several years, since veterans began vigorously protesting threats to care there. But after repeated visits by the congressional delegation, inspections by the VA, a 90-day improvement plan and a visit from the VA inspector general, what has changed?

This latest budget proposal in part may be a way of attracting attention to the hospital’s difficult financial conditions. But if the proposal is accepted and the staff cuts begin, Maine veterans are going to lose care as never before. And all those inspections and official expressions of concern will do nothing to help the sick and infirm.