The final report of the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans makes solid recommendations to reduce waste and ease veterans' transition from military health care to Veterans Affairs (VA) health care. However, the task force should have shown more political courage in addressing severe access problems for the most deserving veterans.

In many areas of the country, they face waits of six months or more to see a VA physician. The reason is the Veterans' Health Care Eligibility Reform Act of 1996, which opened the VA medical system to all veterans, regardless of their income or whether their ailments are service connected.

So-called Priority Group 8 veterans, those with incomes in excess of a geographic means test and with no injuries or illnesses tied to their service, have poured into VA medical facilities, straining staff and resources and dramatically slowing access to care for more deserving or indigent veterans. Rather than recommend the law be changed to exclude the least needy and deserving, the presidential task force took a pass.

"The present uncertain access status and funding of Priority Group 8 veterans is unacceptable … . The president and Congress should work together to solve this problem,'' says report recommendation 5.3.

Well … duh. If 13 nonpartisan commissioners serving in part-time positions can't muster the courage to recommend more than that, how can they expect effective action from lawmakers who will stand for reelection in 2004?

The task force helpfully describes a "growing mismatch between funding and demand'' in detail. Before the 1996 law, only 2 percent of patients seen in VA clinics and hospitals fell outside the traditional VA constituency: veterans who have service-connected ailments or are poor. By 2002, enrollees who don't fall in either category reached 24 percent.

The Priority Group 8 veterans do face copayments on appointments and pharmaceuticals. The discounted drugs alone are an enormous draw. Those who seek them still strain VA appointment schedules, however, because they first must be under the care of a VA physician.

Congress in 1996 not only expanded the beneficiary pool, without a commensurate increase in VA funding, it also greatly enhanced the convenience of VA health care by creating more than 600 community-based outpatient clinics across the country. Lawmakers expected the budget strain from these moves to be eased in part by aggressive "third-party'' billing of veterans' employer health insurance plans to cover VA-provided services. That effort, however, has produced disappointing results.

Meanwhile, the strain on the VA system has been staggering. While the overall U.S. veteran population is falling, the number of VA health care enrollees has jumped from 4 million to 6.3 million since 1999. In 2002 alone, the VA enrolled 830,000 new veterans. By last January, 236,000 beneficiaries were on waiting lists of six months or longer for their first appointment or an initial follow-up. Citing this list, VA Secretary Anthony Principi has suspended Priority Group 8 enrollments.

If that suspension is lifted, the VA estimates health care enrollees will reach 8.9 million by 2012, with most of that growth attributed to veterans who, until recently, were ineligible for VA care. Enrolled Priority Group 8 veterans jumped from 600,000 in 2000 to 2 million by last year. That number is projected to hit 3 million by 2007.

The task force recommends full funding of VA care for enrolled veterans in Priority Groups 1 through 7. It declines to advise Congress or the president on what to do with Priority Group 8 enrollees though, the task force concedes, they are "exacerbating the mismatch between the demand for services in VA and available funding.''

The report also notes that health care demands of Group 8 enrollees "results in less-than-optimal care for veterans with service-connected disabilities and indigent veterans'' and this "should be resolved.''

How should this problem be resolved? The task force doesn't say, but it should have.

I served four years in the military. I have a minor medical condition that requires medicine and, periodically, physician care. It is unrelated to my years in service, and I am not indigent. The VA shouldn't provide me, or 2 million enrolled veterans like me, with discounted care or medicine. We're not the vets Abraham Lincoln had in mind when he said the government should "care for him who shall have borne the battle.''

Presidential commissions typically provide excellent political cover for the government to do the right thing, but not this time on this issue. To ensure timely care is restored to the most deserving veterans, we now need some Lincoln-like courage from the White House, from Congress, and from veterans' service organizations. 

Tom Philpott is a freelance writer and syndicated news columnist. His column, "Military Update," appears in 48 daily newspapers throughout the United States and overseas. His book, Glory Denied: The Saga of Jim Thompson, America's Longest-Held POW (W.W. Norton & Co., 2001), now is available in paperback (Plume, 2002).