WASHINGTON — Even as the country heads into an era of tighter budgets, John McCain and Barack Obama are united on giving more help to the nation's veterans and overhauling the agency that cares for them.
McCain, one of the nation's most celebrated veterans, and Obama, who never served in uniform but became an advocate for veterans issues soon after entering the U.S. Senate, generally agree that the Department of Veterans Affairs does some things well and other things quite poorly.
And while veterans issues have come into the limelight only briefly during this election, the two campaigns have sparred over how best to improve access to the VA's health-care system.
"We expect whoever becomes president to take care of America's veterans," said Joe Davis, a spokesman for the Veterans of Foreign Wars, the oldest major veterans' advocacy group in the country.
The country has an estimated 24 million veterans, with World War II and Korean War veterans rapidly dying off and soldiers from Iraq and Afghanistan quickly adding to the rolls. Vietnam veterans, many now in their 60s, are the largest group and are steadily increasing the VA's health-care tab.
The VA's budget has risen substantially in recent years, driven by an increasing number of veterans receiving disability payments for mental and physical injuries suffered while in the service, and by the cost of the VA's health-care operations. Those two functions make up the vast majority of VA operations, although the department also funds veterans' education and insurance benefits, as well as a nationwide network of cemeteries.
When it comes to the VA's disability compensation system, the candidates and major veterans' groups are in agreement: The VA system is broken.
The agency has been struggling with a backlog of claims that has hovered near 400,000 for the past few years. The time it takes to process a new claim is about 180 days, far higher than the department wants.
In addition, both candidates say that the government needs to fully fund the VA's far-flung health care system, and they both support a bill now in Congress to approve VA medical funding a year in advance to allow for smoother operations.
However, expanding veterans' access to health care is also a point on which the candidates disagree.
The VA treats 5.6 million veterans at more than 150 hospitals and more than 800 clinics scattered across all states. The system has undergone a major transformation over the past decade, boosting outpatient and preventive care in its growing network of outpatient clinics.
While the transformation has generally received favorable reviews from medical experts, there still are pockets of the country where veterans have trouble getting in for treatment. In Western and rural states, veterans sometimes have to drive for hours to reach the nearest clinic or hospital. In other locations, waiting times may be far longer than the VA itself considers acceptable.
McCain wants to provide a veterans care "access card," which is intended to allow veterans to access private doctors if they aren't able to get into a VA facility in a timely manner. He said it would be a supplement to VA care, not a replacement for existing programs.
The Obama campaign has criticized McCain's plan, saying it would take resources and patients out of the VA system, thus hurting the economies of scale that let the VA provide cost-effective care.
Joe Violante, the national legislative director for Disabled American Veterans, said details for McCain's plan are sketchy, but that any attempt to move patients out of the VA "concerns us because it costs more to provide care outside the system, and moving patients out undermines the critical mass that the VA needs to provide a full continuum of care."
Lang Sias, McCain's veterans director, said the plans have been distorted by Obama's campaign. The card, he said, "is an additional option, not privatization."
The other main health access issue concerns what are known as "Priority 8" veterans. Since 2003, many of those veterans haven't been allowed into the VA's health care system because they make too much money and don't have severe enough disabilities.
Obama said one of his first acts as president would be to sign an executive order allowing those veterans into the VA system. McCain believes that opening the doors to all those veterans at once could risk clogging the system. Instead, McCain wants to "aggressively increase capacity" in the system while adjusting the income tests to gradually absorb Priority 8 veterans.
The department has struggled for years to improve its disability system. In fact, the wide variation in disability payments from state to state is one thing that Obama focused on in 2005 after joining the Senate. Obama is a member of the Senate Veterans' Affairs Committee.
The VA doesn't have as many workers as it needs to process claims, said Phil Carter, the Obama campaign's veterans director. "The people there aren't staying long enough, and they are not getting good leadership," he said. "They need better management."
The claims process, he added, has become "far too adversarial," with veterans feeling they have to fight — and often wait for years — to receive benefits they are due.
Obama said he'd hire additional claims workers, revamp the training system, and bring the VA's paper claims systems into the digital age.
The McCain campaign agrees that there should be a complete review of the VA's disability system, both in the processing of claims and the guidelines for how disabilities are evaluated. "I think you need clear, predictable and understandable standards," said Sias, McCain's veterans director.
The campaign said that the VA's disability system is "tragically broken" and that "too many of our wounded veterans come home to an administrative nightmare rather than a hero's welcome."
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