Contrite, apologetic and vowing change, top Army brass came to Capitol Hill last week vowing immediate reform in the wake of devastating reports of substandard care at Walter Reed Army Medical Center.

    General after general apologized profusely and promised immediate reform, while at the same time asserting that there were no warning signs about the gross mismanagement, excessive red tape and inadequate conditions that wounded soldiers seeking outpatient care at the hospital have been subjected to for years.

    Excuse me for remaining skeptical about their contentions. The problems at Walter Reed are a microcosm of the problems I have forewarned my colleagues and the administration about for years regarding health care for our veterans and service personnel.

    The fiasco at Walter Reed was avoidable. For far too long, Congress and executive branches headed by both parties have sought ways to cut corners and skimp on health care for our wounded servicemen and women, as well as our nation’s veterans. 

    As the adage goes, you get what you pay for.

    Health care cannot be provided on the cheap. If you do not invest in modern facilities, accurate staffing levels, and necessary equipment you end up with inadequate care. In military and VA medical systems, that maxim is worsened by excessive bureaucratic red tape.

    This is an argument that I—with the help of our nation’s Veterans Service Organizations—desperately made time and time again during my tenure as Chairman of the House Veterans Affairs Committee. We made some advancements and improvements, but too often our argument fell on deaf ears.

    During my 24 years on the House Veterans Affairs Committee and my time as chairman—from 2000 to 2004—I constantly ran into barriers in my efforts to modernize the VA health care system and ensure a seamless transition for wounded servicemen and women as they left Department of Defense-operated hospitals and sought continued care in VA facilities.

    I worked to successively pass legislation to promote information sharing between the DOD and VA medical systems to reduce bureaucratic delays—just like those experienced by soldiers at Walter Reed—only to see those programs shortchanged by Congressional appropriators. When I authored and passed legislation to overhaul outdated VA facilities in 2001, it died in the Senate. A similar bill I wrote finally became law two years later—but during that two-year lag, conditions only deteriorated further at many VA facilities.

    Despite these obstacles, I led the fight that successfully increased funding for veterans health care by 42% over four years. After years of study, research and investigation, I knew that more still needed to be done to close the gap between the health care needs of veterans and the funds provided to properly address those needs.

    When push came to shove, in July of 2003, I urged my colleagues on the committee to dig in our heels and tried to force the leaders of Congress to provide the necessary $1.2 billion that our due diligence and thorough research showed was necessary to adequately fund VA health care programs. I convinced 59 of my Republican colleagues—including 5 committee chairmen—and only 50 Democrats to join me in voting against the leadership’s proposed VA spending bill because it did not include enough money to cover the shortfall.

    As a result of that vote, my Republican colleagues that joined me lost funding for their district projects, I lost my chairmanship and—worst of all—veterans lost much-needed resources to provide essential medical care. Within six months of losing my chairmanship, however, the Bush Administration and Congress were forced to admit that the monies provided were short for that year—the exact the amount that the VA committee under my leadership had predicted.

    My argument was—and continues to be—that the needs of veterans must come first in the queue for funding. If you are not here for those that volunteer to put their lives on the line for our safety and security, then you do not belong in Congress.

    Whether it be proper compensation for service connected injury or disease, a lifeline to our homeless vets, or cutting edge research for traumatic brain and spinal cord injuries, post-traumatic stress disorder (PTSD) or those in need of world class prosthetics, Congress has a sacred obligation to meet those needs.

    One way to meet this commitment is to reform the funding mechanisms for VA and military health care. Medical needs comprise one-half of the VA budget, yet it is this portion of the department’s budget that receives discretionary funding which has been consistently shortchanged.

    Programs like the GI Bill—which was increased by an historic 60% percent through a law I authored—are funded through mandatory spending mechanisms. Education benefits from the GI Bill will be funded at up to $37,000 per participant this year and that money will be there.

    Surprisingly, the same cannot be said for crucial VA health care programs. The funds for the health care programs are not set and are instead politicized every year.

    The amounts budgeted by the administration and Congress for veterans’ health care vary annually and the total eventually appropriated by Congress is often radically different than the budget request. However, the one thing has remained constant in recent years—the final amount allocated to veterans’ health care has consistently been low-balled.

    As I have done in the past, I will continue to work to change this inequity and ensure mandatory, full and predictable funding for VA health care. Let’s change the process. Let the actuaries and health care professionals at VA—not the Office of Management and Budget—tell us what is needed. That same approach should be mandated for DOD health care spending. When it comes to budgeting for health care, timeliness, predictability and delivery are as important as funding levels.

    Let’s be clear. The acute care at Walter Reed is top notch. Gravely injured soldiers are receiving life-saving care and state of the art prosthetics from some of the best doctors in the medical profession. It truly is a world-class operation. The same commitment should be afforded to every patient at Walter Reed, whether they are there for inpatient or outpatient care.

    And likewise, VA health care gets higher marks than most private and public hospitals when scored by the Institute of Medicine. The professionals that work in VA hospitals and outpatient clinics around the country are of the highest caliber. However, in many cases, they cannot provide the care expected from them due to a lack of equipment, poor record keeping, inadequate facilities and delayed or denied funding.

    Talk is cheap. Congress must come to the realization that you cannot put a good face on a broken system.

    Now it is time for years of unheeded recommendations to be acted on. No more excuses. We must honor our commitment in more than words. We must honor our obligation in deeds—and most importantly in this case—in funding.

U.S. Rep. Chris Smith is in his 27th year representing the 4th Congressional District of New Jersey.