The New York Times | Editorial

Friday 09 November 2007

Although many Americans believe that the nation's veterans have ready access to health care, that is far from the case. A new study by researchers at the Harvard Medical School has found that millions of veterans and their dependents have no access to care in veterans' hospitals and clinics and no health insurance to pay for care elsewhere. Their plight represents yet another failure of our disjointed health care system to provide coverage for all Americans.

The new study, published in the American Journal of Public Health, estimated that in 2004 nearly 1.8 million veterans were uninsured and unable to get care in veterans' facilities. An additional 3.8 million members of their households faced the same predicament. All told, this group made up roughly 12 percent of the huge population of uninsured Americans.

Most of the uninsured veterans were working-class people who were too poor to afford private insurance but not poor enough to qualify for care under a priority system administered by the Veterans Affairs Department. Some were unable to get care because there was no V.A. facility nearby, or the nearest facility had a long waiting list, or they could not afford the co-payments required of some veterans.

There is little doubt that lack of coverage was deleterious to their health. Like other uninsured Americans, the uninsured veterans report that they have delayed or forgone care because of costs. Half had not seen a doctor in the past year, and two-thirds got no preventive care.

And the situation has been getting worse. Despite a shrinking population of working-age veterans, the number of uninsured veterans increased by 290,000 between 2000 and 2004, propelled by a steady erosion of health care coverage in the workplace and a tightening of enrollment criteria for veterans' care.

The V.A. has long focused on caring for recent combat veterans, those with service-connected disabilities or special needs and the poorest veterans. Other veterans were served to the extent that resources were available. Unfortunately, in recent years enrollment of higher-income, nondisabled veterans shot up so fast that long waiting lists developed and budgets failed to keep pace, forcing a freeze on enrollments in this category.

One solution would be to make all veterans eligible for care in appreciation of their service to the nation. Bills pending in Congress would end the freeze, opening the way for hundreds of thousands of veterans, possibly even a million or more, to qualify for V.A. care at a cost that could reach above $1 billion the first year and almost $9 billion over five years. An even better solution would be some form of universal health coverage for all Americans. Then even veterans who live far from a V.A. facility, and a host of dependents who are not now eligible, could get the care they need.

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