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Veterans enrolled in the U.S. Department of Veterans Affairs (VA) health care programs have long complained of receiving inadequate treatment at poorly funded facilities. According to a 2003 Government Accountability Office (GAO) report, veterans were forced to travel long distances to receive care — about 25 percent of the vets lived more than a 60-minute drive from a VA hospital. They also had to endure long waits for appointments, especially in regions like Florida, home to a large number of aging veterans. Nursing homes for veterans were notoriously understaffed, making it difficult to keep up with the increasing population of older vets who need care. But the strains imposed by new veterans returning from Iraq and Afghanistan exposed a whole new litany of problems for the VA and the military. Citizens and lawmakers were outraged after The Washington Post exposed dismal conditions for veterans at the Walter Reed Army Medical Center in 2007. Several high-ranking Defense Department officials were fired or stepped down under pressure, and stories soon emerged about other medical facilities where veterans were placed in rooms teeming with fruit flies, slept on broken hospital beds or faced unprofessional staff. A subsequent investigation of 1,400 hospitals and other facilities for vets found more than 1,000 incidents of substandard conditions. The VA has also struggled to deal with the many young veterans complaining of mental health problems, especially post-traumatic stress disorder (PTSD). Treatment for PTSD was found to be inadequate in 2005, when only half of VA medical centers had a PTSD clinical team. Congressional testimony indicated that VA examiners felt pressure to conduct exams of veterans in as little as 20 minutes. The larger problem is that the VA’s patient workload has nearly doubled in the past 10 years; there are now 7.8 million enrollees in the VA health system. The VA “has faced difficulties in managing its resources” in the face of this rising workload, concluded the GAO. While the agency has dealt with challenges in recruiting and retaining health care professionals, it has also encountered problems in its internal budget process, the GAO found. Those issues have been exacerbated by an often-unpredictable Congressional appropriations process, which has frequently been late in delivering a finalized VA budget. The result is considerable confusion and inconsistency in the timely delivery and quality of care. A VA spokesman did not respond to a request for comment, but Gerald M. Cross, acting principal deputy under the secretary of health, told Congress in 2007 that the department is committed to “providing timely, high-quality health care to those who have helped defend and preserve freedom around the world.”

Overall funding for VA health care has improved dramatically in recent years. In response to the Walter Reed scandal, President Bush appointed the Commission on Care for America’s Returning Wounded Warriors, a group chaired by former Senator Bob Dole and former Health and Human Services Secretary Donna Shalala. The administration has now enacted most of the commission’s recommendations, including an overhaul of the disability determination system, a comprehensive recovery plan for patients, enhanced family support and improved mental health services, especially for PTSD. Nonetheless, the GAO still calls “care for service members” one of the “urgent issues” confronting the incoming Obama administration, and reports that key challenges include disability benefits, health care delivery, property management, and information technology. President-Elect Obama has indicated that he wants to make the VA a leader in health care reform, and hopes to establish a first-rate VA planning division that will help avoid future budget shortfalls.

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