If the Veterans Administration (VA) health care system could be kept from becoming the world's worst health maintenance organization (HMO), could it serve as an expanded Public Health Service?
A number of ominous signs suggest that the VA health care system may not exist much longer. Its aging patient population, 50 percent of whom are World War II and Korean War veterans, will never be replaced, because nuclear weapons have made large standing armies obsolete. And the 90 percent of Vietnam-era veterans who don't use the VA now because they have private health insurance will not need the VA in the future, because they will soon qualify for Medicare.
It is not clear what the magic number of patients is, below which the VA's vast infrastructure of 173 medical centers and more than 300 satellite clinics and nursing homes becomes too expensive. But it is likely that hospitals will be ...
