By Stephen Barr
November 11, 2002
Today is a big day for Anthony J. Principi, the secretary of veterans affairs. A "full day," as he puts it.
Principi kicks off Veterans Day 2002 with an early morning White House reception. He escorts President Bush to Arlington National Cemetery, then stops by the Vietnam Veterans Memorial. He wraps up the day at a reception hosted by the Blinded Veterans Association.
"It's an inspiring day. Arlington is always inspiring, always emotional," Principi says.
He talks while leaning forward in a high-backed chair on the 10th floor of the Veterans Affairs Department headquarters off Lafayette Square. A Dallas Cowboys helmet rests atop a cabinet near his desk, a reminder of his friendship with his U.S. Naval Academy classmate Roger Staubach.
Approaching Veterans Day, he looks across the vast VA bureaucracy and sees marked improvement in how the agency processes benefits and pension claims and provides health care. But he also sees a VA stretched thin and worries about the agency's primary mission: serving those injured in war, especially the severely disabled.
Principi's concerns grow out of what he calls "a test" conducted this summer. He told Gordon H. Mansfield, an assistant VA secretary, to "put on your oldest jeans and oldest T-shirt and wheel yourself into outpatient clinics."
Mansfield, who has been paralyzed since being shot during the Tet Offensive in the Vietnam War, rolled his wheelchair into eight VA clinics in two states. Six clinics told him "that they were oversubscribed and that he basically could not get in," Principi said.
"One clinic told him to drive to the nearest VA medical center, which was 60 to 90 miles away. At another clinic, a clerk mentioned to him that he was no different than any other veteran, because every veteran was created equal.
"I got quite upset when he reported back to me what had happened. I said, 'We're losing our focus.' I would like to take care of as many veterans as possible, but our first responsibility is 'to care for him who shall have borne the battle' -- the words on the building downstairs, Lincoln's words. That's why we were created, for the guy who took the shot."
Principi punctuates the last few words by curling his fist and delivering a mock blow to his stomach.
Mansfield's experience underscored what many know -- that numerous VA clinics are jammed. Nationwide, Principi estimates, 285,000 veterans are on waiting lists to see VA doctors.
Perhaps most troublesome to Principi, the department faces an increasing demand from veterans allowed into the VA system in 1996. That year, Congress and the Clinton administration expanded VA care to any of the nation's 25 million veterans, including those who do not have service-related ailments.
That group of veterans -- most are not disabled and many are not poor -- has grown from 3 percent of the VA workload in 1996 to 33 percent today, and Principi estimates that they will make up more than 40 percent of the workload by the end of the decade.
The reason for the heavier workload: prescription drugs. Most pay only $7 for a 30-day supply from the VA.
"Many of them are older. They need pharmaceutical coverage. And we've told them they can come to the VA and get those prescriptions filled, and they have done so. It has put a great burden on the VA to meet that demand at the same time ensuring the service-disabled and those that need specialized services get the care," Principi says.
The VA, the nation's largest health care system, has used its leverage to hold the line on drug costs. Still, the growing demand means the VA will spend more than $3 billion this year on pharmacy services.
After Mansfield's tour of clinics, Principi told his staff to set up a "priority schedule" at clinics so veterans who are 50 percent or more disabled can receive prompt attention. The decision has been well received in Florida, New England and in the West, he says.
"Not managing our growth is a prescription for failure," Principi says. "We should not let that happen."
Stephen Barr's e-mail address is
barrs@washpost.com.
© 2001
The Washington Post Company
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