It’s a warm day in August and veterans are telling members of Congress of their concerns about the lack of staffing and the long waits for appointments at Togus medical center. This may sound like the meeting Rep. John Baldacci held Wednesday, but it took place in August 1997 when Togus administrators were contemplating a reduction in staff and veterans were concerned that services would be diminished further.

In the intervening years, Congress, the Veterans Administration, the regional overseer of Togus and the center’s own administration have provided plans for improving health care services to veterans, and all of these efforts resulted in, if not utter failure, at least the need for Rep. Baldacci’s meetings at Togus and at a VA clinic in Bangor. Rep. Baldacci brought along colleague Rep. Mike Doyle of Pennsylvania, who serves on the House Veterans Affairs Committee. A third-term member of Congress, Rep. Doyle knows how to hedge his language even when beginning sentences with phrases like, “Quite frankly.”

He took the trouble recently to review the conditions at Togus and came to this conclusion: “Quite frankly, from the numbers that I have reviewed, it looks as if other segments of VISN 1 are doing OK, but the flow of resources within VISN 1 to Togus is in need of adjustment.”

The flow of resources at Togus is in need of more than adjustment. Years after it became apparent that staffing shortages were causing problems for veterans, nearly 10 percent of positions at Togus remain unfilled. The average annual per-patient cost in VISN 1 is $3,500; at Togus, it is $4,371, reflecting what is said to be a sicker veteran population. Yet even as the VISN is to receive considerably more funding in the next two years, it is not clear how simply adding dollars will address the problems that veterans have raised.

Rep. Baldacci hoped that the meetings this week would give everyone a chance to hear about those problems, begin to monitor them and look for solutions. There is plenty of data available so that monitoring can include looking over recent history, as well, but if this week’s meeting served a purpose apart from being another in a long line of meetings about Togus, it is that now there is less room for excuses. And perhaps one note of caution in trying to find solutions: Whatever was tried in ’97, ’98 and ’99 didn’t work very well. Trying them again in 2000 isn’t likely to produce any better results.

Veterans have been asked over the years to have patience while VA hospitals undergo the same sorts of changes that hospitals all over the country are experiencing in the switch to managed care and outpatient services. But it is unfair to rely on their patience when they are sent to Boston for care that could be provided in Maine, when they cannot count on the doctors and staff they saw one time being there the next, when they must wait months for a set of dentures or even to obtain an initial visit. In Togus’ favor, it has tried to expand local clinics and provide more services closer to veterans’ homes, and most vets agree that the service is good when they can get it. But shortcomings persist in a way that merely adds to the burden of being sick or disabled.

The VA system will never be a model for HMOs looking for greater efficiency: Its patients are older, often have multiple ailments and usually do not enter the system until they are already sick. But despite these conditions, no one doubts that veterans are deserving of much better health care than they have been receiving. Their patience, understandably, is growing thin.