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[MUSIC PLAYING] RACHEL REABE: Good morning and welcome to this Main Street radio special from the VA Medical Center in Saint Cloud. I'm Rachel Reabe. Minnesota has almost a half a million veterans. Our show today is going to look at the health care system designed to take care of them. It's struggling with record numbers of patients and limited funding.

At noon, we'll discuss the impact veterans have had on their communities. In many towns, the VFW, or Legion post, also serves as the community center and runs everything from the blood drive to the Baseball League. With the veteran population declining, the future of these organizations is uncertain.

Today's show is coming to you live from Saint Cloud's VA Medical Center. There are only two such centers in the state-- this one in Saint cloud, the other in Minneapolis. This facility, a collection of buildings, housing a 400 bed hospital and a nursing home, as well as mental health services, chemical dependency programs, and specialty clinics opened in 1924.

We're broadcasting from the patients dining room just down the hall from the main waiting room at the medical center, which is full of people this morning. This year, the VA Medical Center in Saint Cloud expects to see 11,000 patients. That's a record number, and an almost 20% increase from last year. Many of them are aging World War 2 veterans, now in their 70s and 80s with health problems.

Our guests this morning are Barry Bahl, director of the VA Medical Center in Saint Cloud. Bernie Melter, commissioner for the Minnesota Department of Veterans Affairs. And Al Loehr, a staff assistant specializing in Veterans Affairs for Congressman Collin Peterson. Good morning, gentlemen. Welcome to Main Street.

Good morning.

Good morning,

Listeners, our phone lines are open for your questions and comments. You can call us this morning at +1 (800) 537-5252. Our number again, +1 (800) 537-5252. Mr. Bahl, the number of patients you're seeing at the VA Medical Center in Saint Cloud continues to go up, and yet, your budget has not grown. How do you continue to deliver the services?

BARRY BAHL: Well, a large portion of our budget is dedicated to staffing. About 80% to 85% of our funding is for employee salaries. And what we've done over the last three, four years is redirected a lot of our resources in the facility. We have shifted our patient care programming more to an outpatient programming than we had before, utilizing other opportunities in the community.

At the same time, we were closing beds that no longer were needed in our facility. An example is in psychiatry, where three years ago, we had about 150 beds. Today, we have 15 beds in that area, and we're seeing more patients than we were before. We've done this, I think, with a lot of cooperation with the other VAs in our network, in the community. And it certainly worked out very well.

We haven't had to lay off any staff, as what's happened in some of the other VAs across the nation. And pretty much continue to grow. As you mentioned, we've gone up almost 20% over last year. Our numbers are expected to continue to grow in the future.

RACHEL REABE: Al, is it a major concern that we have this flatlined budget that we're working with.

AL LOEHR: Well, the flatline budget has been a problem for the Veterans Administration for quite a number of years. There are four major veterans organizations in this country. The AMVETS, the DAV, the Paralyzed Veterans of America, and the Veterans of Foreign Wars have developed and proposed a independent budget. That independent budget outlines all the criteria for our request for $3 billion in our need to provide the kind of services that are necessary to the veterans of this great country.

This year, all the organizations, all the veterans in this country that have responded to our calls-- the Congress of the United States has decided that a $1.7 billion would be authorized for our VA budget, which does assist a great deal. However, just recently, the budget proposal was proposed, and the case was made for a 1.4% cut across the board in all federal agencies. So what they give us, they take it away.

So the point is that this cut, if it was to prevail, as far as health care is concerned, it would cost the health care budget of the Department of Veterans Affairs. About $293 million, which is not acceptable. Fortunately, the President of the United States has vetoed that budget bill. So we're back on track. Hopefully, that we can sustain ourselves at $1.7 billion. It's not the total answer to our fiscal problems within the system, but it does help. It's a starter.

RACHEL REABE: Our phone number is 1-800-537-5252. If you are a veteran who has used the VA Medical Center or VA Medical services, we would be interested in talking to you today. Give us a call-- 1-800-537-5252. You can call us with your questions or your comments.

So we have increasing number of patients, flatlined budgets, and yet, at the same time, you have opened clinics in Minnesota. And I'm assuming that's nationally that this push to put the services where the veterans are and the thought, Barry, is have it within 75 miles?

BARRY BAHL: The goal, ultimately, will be to have one within 50 miles from any main institution. As you realize, we just opened a clinic in Brainerd this last month. And that has certainly started off to be very, very positive for the patients in that area.

RACHEL REABE: Now, I understand there have been problems, though, getting a doctor to staff the Brainerd clinic.

BARRY BAHL: We've had several applicants for the full-time position. We did pick up a half-time doctor, right away, so. As the beginning of the program in Brainerd is growing, right now, our staffing is appropriate for the numbers of patients that we're seeing.

RACHEL REABE: Would that be less expensive to do or more expensive? Less expensive to have these outpatient satellite clinics across the state? Is that a way of maintaining services within your current budget, or does that actually put more of a pinch on the money you have available to spend?

BARRY BAHL: The first month's numbers that I was looking at showed that it's probably about the same as what it's currently costing us here at the facility per patient. As the numbers grow, hopefully, that will decrease. A lot that will depend upon how much, really, acute usage will be generated from that area.

If some patients are hospitalized in the community that we couldn't see here, that's where the cost will go up tremendously. But as long as we can just provide the basic primary care medicine in that area, it should be comparable to what we're doing here. But you are correct. The funding for the outpatient clinics does come from the mother hospital.

AL LOEHR: If I may add to this, I think it's also important to note that the veterans throughout this country have asked and have received a positive response to the question of, how far can we travel at our age? For the most part, these outpatient clinics are set up to accommodate the veteran and take care of some of the more critical transportation problems that we have.

You take a veteran that's in his late 80s, World War II veteran for an example, it's very difficult for that veteran to provide for transportation. I have attended a number of meetings where the requests were made for additional outpatient clinics. However, the Veterans Administration needs to be extremely careful in terms of developing more outpatient clinics, I would say, because of the cost. But I think one of the big issues is to accommodate the veteran so that he is assured and she is assured that there will be a transportation factor built into these outpatient clinics when they're suggested.

RACHEL REABE: Our phone number this morning, 1-800-537-5252 You can call us at that number and join our conversation. Bob is standing by in Minneapolis with the question. Good morning, Bob. Welcome to Main Street.

SPEAKER 1: Good morning. I'm a Korean veteran and the occupation before that, and I've used the VA hospital. But I have a question. I'm what they call a category C veteran-- those of us with less than 50% disability and were means tested out of access a couple of years ago.

I've since signed up to pick up the co-pays myself. But many veterans, I would say most of us in our 70s and 80s eligible for Medicare would be much better off financially if subvention occurred. I'm sure you gentlemen know what it means. And I've talked to both senator staffs and four congressmen staffs. And it just seems to die in the committee someplace.

So the money that we-- and I pay the National Medicare amount-- that we supply to Medicare could be subvented to the VA. And then our Medigap policies would kick in, and it would be economically feasible. And it certainly would help the VA hospital here.

I'm visiting a buddy over there who came in as an emergency from Onamia a couple of weeks ago. And he was operated on a Saturday night, I guess. But it would be nice if the hospital here had a full load for economies to scale and the research possibilities. It's one of the few institutions that knows how to study and treat old men. I wonder if you would just comment, please.

RACHEL REABE: Let's give our guests a chance to respond to that. Who would like to start?

AL LOEHR: Bob, it's very interesting to note that the major veterans organizations for the last 10 years have been talking to the Congress of the United States about Medicare subvention. The question has passed in the House. It has gone to the Senate. And it hasn't been actually explored totally on the Senate side.

However, I agree with you. I think that being your a category 7 veteran, nonservice-connected veteran, and you need to have medical care, that if we had Medicare subvention in place, this would indeed be very helpful, not only to you as a veteran, but to the VA and the Department of Veterans Affairs. And my good colleague is with us here today. It would be an important advancement in the process of providing care for our veterans in this country.

RACHEL REABE: So the system needs work.

BERNIE MELTER: Well, Rachel, there is a DOD-- a Department of Defense-- Initiative on Medicare subvention that they are testing with the military hospitals in certain sites around the country. And I think that they can extrapolate that information and apply it to the VA without having the VA go out and do a duplicate test and waste time. So we hope Congress will take a look at the information that's coming back from the DOD test and apply it to the VA.

I don't think you'll find anyone that's familiar with VA medical care that would not think that Medicare subvention would be a boon to Medical Center directors, like Barry and Steve Kleinglass down in Minneapolis, because they would be able to draw that money and apply it within their facility. They could keep the money. It wouldn't have to go back to the federal treasury.

BARRY BAHL: Bob, this is Barry from the VA. I agree with you that this has been a long time coming, and we're anxiously waiting to see what happens with this. We, from the medical side, are very interested in seeing all veterans. And certainly, we feel that it's a great family here. And the more that we can do for our veterans, that would make us very happy.

RACHEL REABE: Let's go back to the phones. We have Art standing by in Brainerd. Good morning, Art. Welcome to Main Street.

SPEAKER: Hello?

RACHEL REABE: Yes, Art, go ahead with your question.

SPEAKER: Can you speak up a little bit? I can hardly hear you.

RACHEL REABE: Yes, go ahead with your question.

SPEAKER: OK, do you want me to go over it again?

RACHEL REABE: Yes, go ahead with your question.

SPEAKER: I'm a veteran of World War II, no service-connected disability. Last summer, a friend told me the rules have been changed, and I should be eligible for VA health care. I applied through my County Service Officer and was enrolled at Saint Cloud.

I called Saint Cloud for an appointment and was told they were so short of doctors, it would take six months to see a doctor. Shortly after that, I read in the paper, Brainerd now has a Saint Cloud satellite, but the clinic doesn't have a doctor yet. I'm also told that Brainerd Medical Center with some 35 doctors and excellent facilities offered to take care of the Brainerd vets on a contract basis with the VA, but was turned down.

Now, here's my question. Evidently, Congress is not providing adequate funding for VA, so why make more vets eligible if they can't be taken care of on a timely basis? Also, instead of opening a clinic in Brainerd with no doctor, wouldn't it have made more sense to use Brainerd Medical Center with less cost to the taxpayer and better service to the vet? Thanks for listening.

RACHEL REABE: Thank you very much. Let's start with the first question, which is the question of opening up the eligibility. The rules changed last October. More vets became eligible for services at the VA Medical Center. Is that like opening the doors and inviting everybody to a party but you only have a table for five and all the chairs are filled?

BARRY BAHL: Well, certainly right now that that's what we're going to experience for the first year or two years of this, all seven enrollment groups. When you look at the long range demographics of what's going to happen with the numbers of veterans, you'll begin to see probably next year sometime that the number of new people applying for care in the VA nationally will equal the number that are dropping out of the VA due to deaths and that sort of thing.

So right now, it's difficult to make that initial hurdle. But I believe we're working our way towards that.

RACHEL REABE: So this is a crunch year, you're saying?

BARRY BAHL: Right now, it's a crunch year. And let me also address the other issue. We do have a physician at Brainerd. That physician is working half time, and we are covered there. We do have some nurse practitioners that are also working out of that area. So we have ample number of clinicians to meet the patient care workload.

The issue of what happened in St. Cloud for the wait was really a very short period of time where we had several physicians retire, and then a couple had some health issues. But since then, we have hired, I think, about six new replacements for all those positions, and our waits are, again, getting shorter. So, so very just a small little blip.

RACHEL REABE: You think that a six month wait is excessive?

BARRY BAHL: Oh, absolutely. Yeah, our goal is to keep it less than 30 days for any new patient coming on board. The other thing is that if anyone needs to be seen right away due to an emergent need, we will see them that day. We have enough slots set aside for that. So a routine brand new patient coming into the system will take a little bit longer right now. But very shortly, we'll have that down to less than 30 days.

RACHEL REABE: So it might have been a better idea to hold off on opening the eligibility door until your numbers sort of peaked and started to go down. That might have been a better idea.

BARRY BAHL: Well, from the other standpoint, we're seeing a lot more veterans now than we ever have before. And that's good.

RACHEL REABE: Ah-huh, great. Anybody else want to comment on either of these questions?

BERNIE MELTER: I'd just like to say that, something that Barry may not be able to say is that that decision was made to open up category seven. So it was made by the Secretary of Veterans Affairs in Washington, DC. And I don't think that was made with the concurrent knowledge of the directors out here who are actually doing the work.

RACHEL REABE: As often happens.

BERNIE MELTER: And it came down the hill. And the people bearing the brunt of the directors and the members of vision 13.

RACHEL REABE: Hey, Bernie, have you heard a lot of similar concerns from people like Art in Brainerd who say, yes, now, you tell me I can come, but I cannot come. I cannot wait six months.

AL LOEHR: Oh, yes. And that's a continuing recurring theme that we hear in the veterans organizations as well as I hear it at the state level. And again, this comes down from Washington, and our directors are forced to do miracles with very little as you very aptly put up front.

RACHEL REABE: Let's go back to the phones. We have Jean in Eagan standing by. Good morning, Jean. Welcome to Main Street.

SPEAKER 2: Thank you. My comment is, my late father and all my uncles served in World War II. Miraculously, they all came back. And I think it's reprehensible that there is not enough funding or staffing at the veterans hospitals.

And a point I'd like to make was to ask your listeners and government officials to ask themselves the question, would you be here if it hadn't been for these veterans? Do you know whether a veteran may have saved the life of your father or grandfather in some previous war?

And I'd like to tell you about my Uncle Kermit, who served as a medic in World War II, earning two Purple Hearts and many other commendations. In his 70s, he was a patient at a VA hospital because of kidney failure. And he was in poor health. And, you know, it wasn't the greatest place in the world for him to be, but his care was taken care of.

And while he was being moved from one building to another to get his dialysis where they were going to put him in a medi van or something, some poorly skilled, most likely underpaid, undertrained, orderly did not set the brake on his wheelchair. And the wheelchair rolled down the cement, sidewalk, tipped, and my uncle didn't die of kidney disease, he died of a severe brain injury as a result of the orderly's mistake.

And so there should be better funding. And the value of the veterans can't be downplayed. And that's just what I wanted to say.

RACHEL REABE: Thank you so much for your call today. Our phone number 1-800-537-5252. Are we less patriotic? As a civilian population, are we less tied in to veterans? There are families now that do not have a grandfather or a father who fought in a war. Is there a growing gulf between the two? I know there are less members serving us in Congress that are veterans than ever before. What would you say to that, Bernie?

BERNIE MELTER: Well, I think that's absolutely true. Both in the state legislature and in the National Congress, there are fewer people who have a direct link to military service. Most of our, as you know, the World War II veterans are declining. And they were at one time the largest veteran population because of the sheer numbers. 16 million people throughout the United States were involved in World War II.

Now, we have the Vietnam Veterans are the largest group. And they're not as politically astute, I think, as World War II veterans were in passing the legislation and continuing to maintain the GI bill legislation. That coupled with the fact that we just don't make veterans. As you know, the Gulf War was a short 100-hour war. Not that they don't have specific problems of their own. And the Vietnam Veterans have those problems, and World War II veterans continue to have problems. But I just think that there are fewer folks out there that have a military heritage background.

John O'Neill, a good friend of all of ours, once said that military service is hereditary. And you can look at, hey, I had five uncles in World War II. My father was in World War I, the back half of World War I. And I have five children, and four of those were in military service. So I think there's a link, but it's just not popular to be in the service anymore.

The army last week offered a $6,000 bonus just for enlistments. You know, if you come and enlist, we'll give you a $6,000 bonus.

RACHEL REABE: So it's a different mindset.

BERNIE MELTER: It is. It is. And I don't think it's a lessening degree of patriotism. I think people still stand and salute the flag and that sort of thing. It's my country, right or wrong, but my country. But I think the problem is that we're not getting that into the legislative process.

AL LOEHR: I think also that-- excuse me. There's so much prosperity in the country today that many of our good Americans don't really understand and comprehend the absolute need that we have for care for veterans in this country. If the American people would only respond to the needs of our veterans today, there'd be no question in my mind that the political leadership of our country would recognize that immediately.

It's easy to be critical about activities within the process. But if you do not participate in the process, nothing happens. And this is one of the things we find in our organizations when we talk to our membership, please help us. Talk to your political leadership in Congress and the state legislatures, the administration, et cetera. That's how the message is accepted.

Let me give you a prime example. In 1965 when I was appointed to this wonderful position that my colleague holds, Bernie Melter, the president of United states at that time, Lyndon Johnson, put out a directive to close 33 hospitals, regional offices, and nursing homes around the country. The veterans of this nation responded so vigorously after that executive order that the president finally made a public statement on television.

Please withdraw your concerns about the closing of those facilities. I have appointed a blue ribboned commission to travel around the United States of America with representatives of the major veterans organizations to address those issues. And that executive order just kind of dissipated.

RACHEL REABE: You're listening to a Special Main Street radio broadcast from the VA Medical Center in Saint Cloud. I'm Rachel Reabe We're talking about Minnesota veterans and the challenge of providing them with health care. Our guests this morning are Barry Bahl, director of the VA Medical Center in Saint Cloud, Bernie Melter, commissioner for the Minnesota Department of Veterans Affairs, and Al Loehr a staff assistant specializing in Veterans Affairs for Congressman Collin Peterson.

NPR'S Main Street radio coverage of rural issues is supported by the Blandin Foundation, committed to strengthening communities through grant making, leadership training, and convening. We'll be back with more of Main Street after a look at news and weather.

SPEAKER 3: Membership is the single largest percentage of Minnesota Public Radio's revenue budget. Our three-day fall membership drive begins Wednesday. Because your time is important, we want to raise the same amount of money in less time. Together, we can make this happen one listener at a time.

So don't wait. Call now to become a member or renew your membership. 1-800-227-2811. Do it today.

SPEAKER 4: Good morning. It's 11:31. And in the news this morning, as expected, it's not a good day on Wall Street for Microsoft. The computer giant's shares are down following a federal judge's finding that Microsoft is a monopoly that's hurt consumers, but the broader market remains generally unhurt by the decision.

Searchers are getting some more high tech help at the site of the EgyptAir flight 990 crash. They plan on using a second underwater robot to search for the plane's flight recorder boxes once the sea is calm enough for deployment,

President Clinton makes his online debut tonight. Clinton, a self-proclaimed computer illiterate, will be participating in a 90-minute cyber chat sponsored by the Democratic Leadership Council. You can chat with the president at townhallmeeting.excite.com.

Minnetonka-based UnitedHealth Group, the nation's number two health insurer, is giving more power to its doctors. A Texas newspaper reports that the HMO is expected to announce tomorrow it will allow doctors the final say in treating patients. UnitedHealth covers more than 14 million people.

A teenager from Burnsville was the biggest surprise of the ranger M1 Millennium bass tournament in Winter Haven, Florida. 16-year-old Ross Taylor finished fourth yesterday in the co-angler division, earning $12,500. Taylor plans to turn pro after completing high school.

Well, there's a weather ridge building in the center of the country, and that is what's responsible for Minnesota's unseasonably warm November weather. Record high temperatures are forecast across much of Minnesota today and tomorrow. Cooler weather expected by the weekend, but we may see another warm up next week.

State officials are predicting a heavy deer harvest after a deer opening weekend that featured warm weather and ideal hunting conditions across much of the state. Conditions were especially good in farm country, where much of the corn harvest has been completed. Temperatures that reach the upper 50s in Northern Minnesota also made for comfortable hunting, although dry conditions in that region created noisy woods.

Today, sunny, unseasonably warm. Highs ranging from 60 in the Northeast, 80 in the Southwest, a record high of 70 forecast for the Twin Cities. That's the latest from the newsroom. I'm Maryann Sullivan.

RACHEL REABE: Welcome back to our Main Street special, live from the VA Medical Center in Saint Cloud. I'm Rachel Reabe.

We're broadcasting in front of a live audience in the patient dining room. This medical complex includes a hospital, nursing home, and numerous outpatient specialty clinics. It's one of two VA's in Minnesota. The other is located in Minneapolis.

Our guests, again, this morning, Barry Bahl, director of the VA Medical Center in Saint Cloud, Bernie Melter, commissioner for the Minnesota Department of Veterans Affairs, and Al Loehr, a staff assistant specializing in veterans affairs for Congressman Collin Peterson.

Listeners, our phone lines are open for your questions and comments. You can call us this morning at 1-800-537-5252, 1-800-537-5252. And we go to Jim who is patiently waiting in Northome on the phone lines. Good morning, Jim. Welcome to Main Street.

SPEAKER 5: Good morning. I'd like to just talk about travel for elderly veterans. This morning in Northome, a van came down from International Falls. It's sponsored by the International Falls VFW and our VFW Northome kicks in money for insurance. And they pick up veterans in Northome that can't drive. And they go down to Minneapolis.

Also, I know if you're a veteran and you're going to Minneapolis or Saint Cloud for your disability that you're rated for, you can get mileage but the mileage is at $0.11 a mile and that's what it was when I got done with service in '69. And also, I'm 100% disabled veteran. For two years, I've been trying to get a primary care physician in Minneapolis, and they just tell me that they don't have enough doctors to get me one. And I'll hang up and take it off the phone. Thank you.

RACHEL REABE: Thank you. Who'd like to respond to that?

BARRY BAHL: Well, I'll take a shot at this here. I agree with the traveler or beneficiary travel issue is one that we do hear about occasionally. That is a law that's set that figure. And that's something that we in the VA really can't do anything about. We can just pay whatever the amount that we're legally authorized to do so.

The other issue about 100% service-connected and waiting for a primary care appointment in Minneapolis-- they're working very hard on that. I've been at numerous meetings in the last several months where they are going through their whole scheduling system and changing the way they're doing things. And I'm optimistic that that should be improving in the very near future.

RACHEL REABE: Bernie.

BERNIE MELTER: You know, Rachel, we in the state of Minnesota are so fortunate to have county veterans service officers in the network. And most of the county veterans service officers provide vans for transportation for veterans to and from most of the hospitals and clinics. We have a great triad in Minnesota-- the county veterans service officers, State Department of Veterans Affairs, and the Federal Department of Veterans Affairs.

And I think this 100% service-connected veteran, I can't answer to the clinic appointments, but he's right that local posts do provide the county service officers with the mechanism for transportation, and they don't have to. They're not required.

This beneficiary travel that Barry just talked about that he's required by law, we've lost that in the past. They just cut it off. And through the hue and cry of veterans, we've gotten it back. And maybe it's only $0.11, but that's a heck of a lot better than zero. And we need to maybe mitigate for more or higher benny travel. But we have lost that in the past.

AL LOEHR: I would agree with Commissioner Melter that there was a long period of time when no transportation funds were available because of shortage or budget problems, et cetera. But I guess I want to make a comment regarding the veterans service officers in this state. We, in Minnesota, probably have one of the most outstanding records in terms of service to veterans by our county veterans service officers system under the leadership of our commissioner, Bernie Melter.

It's very rare that a veteran who has gone to his local county veteran service officer to get a question responded to regarding any issue that he may have that he wasn't covered. Jim, I want to certainly commend you for going through your service officer in this particular issue and expressing your comments. But keep working hard. We need your support out there so we can continue to provide the service that our veterans need in this country.

RACHEL REABE: And we do have an 800 number with somebody with veterans questions, specific cases, specific questions. You could call 1-800-827-1000, 1-800-827-1000. And this is a very complicated system on a federal level, on a state level, on a county level.

Sometimes, it's very difficult to know who you can call. That is a number which acts as a referral base. So if you have any questions about any of the issues we're talking about this morning, for specifics, call 1-800-827-1000. And our number here on the air, 1-800-537-5252.

We are in the patient's dining room of the VA Medical Center. You can hear the clatter in the background. They are serving lunch in here at this hour. And we do have a live audience. Our reporter Marisa Helms is in the audience with us this morning. Good morning, Marisa.

SPEAKER 6: Hi, Rachel. Bob, a veteran from the Vietnam war, has a question about availability of doctors.

SPEAKER 7: Yeah, I guess I'm concerned. I lost my doctor now. And I finally had to call in to get the blood work done and ask for an appointment to just to have my blood work done, which should be done every month or two because I know my levels. They checking my lipids and stuff.

And the doctor left to go to a private facility. And I'm concerned that the VA isn't keeping up with the outside benefits that are paying probably more to doctors or something. I don't what's going on, but I got a feeling that's part of it or something.

RACHEL REABE: Should it be this difficult, Bob? Should it be this difficult, or do you feel like, I served my country, I'm entitled to these things, and I need them?

SPEAKER 7: Well, I think the VA system is pretty good overall. It's just like I said, what I'm concerned about is, I got a feeling, at the top level, they're not paying enough to the doctors to keep them in the system once they're here. And my concern is that.

I don't think they're treating me badly. I mean, I'm 100% permanent connected. So I mean, that part I'm being treated OK. But my concern is the doctors are-- I don't have a doctor right now. That bothers me, you know?

RACHEL REABE: Let's talk about that, Barry Bahl. Is it difficult for the VA to hold on to doctors because you can't pay competitive salaries? Have you seen a large turnover? You've talked about the problem of finding a full-time physician In Brainerd. Is it a system-wide problem?

BARRY BAHL: Actually, it had not been a problem for Saint Cloud for many years. And we were very stable in our physician staffing. But what happened this last summer was some of the specialty pay that we pay our physicians counted towards their retirement for the first time. So we had numerous physicians that were staying on board up until that could happen, and then they retired and took the additional higher retirement level.

Overall, when you look at our salary structure, though, for the VA, it is somewhat lower than what you'll find in the community. But it does also offer some benefits. A lot of our physicians don't have the every other night call that they might have in the community, a little more stable schedule that they can plan.

RACHEL REABE: So you have some bargaining chips?

BARRY BAHL: Yes.

RACHEL REABE: OK. We're going back to the phones. Sharon in Minneapolis. Good morning, Sharon. Welcome to Main Street.

SPEAKER 8: Hi. I have a couple, first, a comment, and then, I guess, a question for somebody to answer. First of all, I think the veterans of our country have gone to fight for our-- like, to support our way of government and our way of life. They need the prime health care that is due them.

I'm wondering if our veterans are suffering the loss of our attention for their medical needs as more and more people, perhaps, are growing tired of armed conflict. And even in peacekeeping missions, there becomes situations where armed conflict takes place. In other words, people are getting really sick of war. And our veterans who have done their best to serve our country is suffering that kind of general mood that people are just tired of war not solving any problems over the centuries.

RACHEL REABE: Let's have our panel respond to that, Sharon. Good point. What do you think, Al?

AL LOEHR: Sharon, let me just say this, that the response to your question of having-- I lost her question now.

RACHEL REABE: She was talking about are we less interested now? Are we getting so tired of conflict that people just think, forget about the veterans?

AL LOEHR: I would only say this, Sharon, that the United States of America, the most benevolent nation in the world, certainly should have the wherewithal and the physical wherewithal to do the job for the veterans that served this country and saved our country during many conflicts.

But I guess it goes back to what I said earlier-- that we need the American people to respond to those issues. If we're going to send our men and women in--

if we're going to send our men and women in harm's way, we as a benevolent nation should be ready to provide the necessary health care to those veterans that have served us honorably in this country.

RACHEL REABE: One of the veterans I was talking to, I was asking him about veterans benefits. He was very quick to correct me and say, don't talk benefits. You use the word entitlement, not benefits.

BERNIE MELTER: Rachel, I'd just like to say to Sharon that there is an old saying that we use a lot and it's, you know, you hate the war but not the warrior. And I can tell you, as a Native American and having just come back from Fort Sill, Lawton had a very big powwow that Native Americans honored their warriors from all wars. And right after the elders and right after the flag at all powwows, the veterans are honored.

And so it's, again, you may not like war, and I don't like the idea of sending our kids over to places like Kosovo, and it's not a declared war, and Congress is not given war powers to the president, et cetera, but every one of those sons and daughters, particularly of Minnesota, are our representatives. And when they come home, we need to be respectful of their service to this country.

RACHEL REABE: Well, and the question is, if we can't do the job during this boom economy, what happens when we get going on a bust economy? I mean, if we've had a flatline in VA health care for five years, times have never been better in this country. Does it scare you, Barry, to think, when things start to tighten up-- you're not getting any money now. When they start tighten up, what's going to happen?

BARRY BAHL: It definitely will be a bigger challenge then than it is now, yes. You mentioned the spirit of the nation. And, you know, as Bernie said, when there's wars and things like that, people really step forth. But when there's a bit of a lull in the action, so to speak, they go and look elsewhere. We are always looking for more volunteers. And certainly as we've gotten further away from the World War II folks, we're not seeing the younger people coming in like the World War II people did.

RACHEL REABE: So you don't want to be a silent, forgotten population?

BARRY BAHL: Not at all. We need to get the message out.

AL LOEHR: I think something that's very interesting that should be expressed here is that today, we're losing 1,000 World War veterans in death each day, $30,000 a month. So we can probably see our veteran population decrease to something like 16 million, which is a factor.

RACHEL REABE: We're going now to Wisconsin, where Cliff is standing by on the phone. Good morning, Cliff. Welcome to Main Street.

SPEAKER 9: Good morning. I'm a family practice physician in rural Wisconsin just across the border. And we see a lot of veterans here, obviously. And they end up going to get some of their services in Minneapolis.

And I've got a very simple solution that's been suggested in the past but always seems to get shot down under the auspices of the flag. Now, obviously we have to give our veterans the best care in the world. And very simple solution to this, I think, would be to give them all a VA gold card where they just go and get their medical care wherever they want.

I think we should probably do away with most of the VA system and keep a couple of hospitals around the country for research and, you know, Gulf War syndrome specific type stuff that really isn't seen or can't be addressed in the private medical hospitals. But almost all my veterans have the common, typical problems that everybody else does and could be taken care of in the system.

I know in the Reagan administration, I believe the OMB put out a estimation that it cost 2 and 1/2 times what it would cost in the private industry to take care of our veterans in the VA system. And it seems to me we would solve just about all our problems with access to care and the inefficiencies and inconvenience and unresponsiveness of the VA system despite the best efforts of people like yourself who are really good people trying to do their best job. It's just I think it would work much better and we'd be doing our veterans just a tremendous benefit if we just let them go down to their local doctor and get their medical care.

RACHEL REABE: So the question you're bringing up, Cliff, is the one we heard from Art earlier in the hour, which is, we have a health care system in this country. Why not issue these cards or have a voucher system? Al, you work on the national level with legislative issues. Is this something that continually comes up that we could do it better and we could do it cheaper if we didn't have this VA system?

AL LOEHR: I think this has been part of our agenda for as long as I can recall. I've been involved since 1955, and just those very issues that you referred to have been part of our legislative goals and priorities.

RACHEL REABE: Why is it so difficult to get that passed? I mean, we think about it, and we think, well, that's logical.

AL LOEHR: Well, I guess there's change in political leadership. There's change in political party. It makes a difference. Those kinds of things have an impact on what will be heard, what will not be heard, what will probably be considered as a priority as opposed to something that we'll address at a time when it's necessary.

RACHEL REABE: Barry, what would you say to this? And of course, you're very involved in the system, but you're also a veteran. Does it make sense or give us your best argument for having a VA medical system instead of, as Cliff suggests, get a gold card. Go to whatever doctor you want in your own community.

BARRY BAHL: You know, there's some long and short things. We could talk really for hours on this. A couple of years ago, there was a gentleman that came through our hospital. He was a psychologist doing a tour down in Australia. And exactly what you're describing is what they did in Australia, where they issued cards to folks.

And what happened over a period of time was, more patients started going to the community. And then they said, well, they no longer need the medical facilities for the veterans there, and they were closed. And then shortly thereafter, they ended up having a crisis in their economy, and the payment systems changed. And all of a sudden, veterans were waiting as long or longer than the rest of the folks in the community. And they all wanted their VA facilities back.

RACHEL REABE: So it can cut both ways?

BARRY BAHL: Yeah, it can go both ways. There's a huge number of patients that only want to receive their care from the VA, even though they are entitled to be seen elsewhere.

RACHEL REABE: We're going back to Marisa in our audience with a question. Marisa, go ahead.

SPEAKER 6: Hi. We have Warren Determan He's a Vietnam War veteran from Saint Cloud. He has a question.

SPEAKER 10: I was just wondering if you're thinking of that maybe the VA hospital might close somewhere down the line and they have more of these centers like they have in Brainerd. You could pay for a lot of those types of centers with the money they spend at the VA in Saint Cloud. Do you see that happening five, 10 years down the road?

RACHEL REABE: Thank you. What is the future of the VA? We talk about in the year 2015, the need for services dropping off as the World War II veterans vanish. Is there talk? Is there a plan someplace on the books to perhaps downsize or close part of the system, Barry?

BARRY BAHL: There is really no plans on the books. You know, a lot of it depends upon, again, the National. Budgets and where we're going to go. I think what you're going to see in the next 10, 15 years, though, is a continual mimicking of what's happened in the community going to one-day surgeries, smaller hospitals and larger outpatient programs, the continual growth of outpatient clinics so every patient can be seen a lot quicker and faster in their own communities. So you'll see the VA hospital system gradually decrease in size pending any unforeseen wars or other external forces.

BERNIE MELTER: Rachel, I'd like to say, I'm 61 years old, and I'm a Vietnam vet. I'm a very old Vietnam vet. And my needs are getting worse as I age. And I think there are some specialty-- the good doctor in Wisconsin alluded to people coming. And I think what he's talking about is mostly ambulatory, healthy veterans that are coming for some odd things.

But as we age and as World War II veteran class has indicated, we are going to have more needs for long range, long-term health care. And Saint Cloud as a facility fits that model and Minneapolis to a lesser extent. And I think that if we were to take all of the World War II veterans that are remaining and those that have senility problems, and as we age, we get that way. I have a lot of senior moments during the day.

But we to get to that. We would not be able to-- in fact, we would overload the facilities that are available in the community.

RACHEL REABE: Well, and it's interesting to note that we talk about the number of World War II veterans dying at the rate of about 1,000 a day. But it's interesting to note, almost a third of this nation, 70 million people, including veterans and dependents and spouses of deceased veterans are eligible for VA benefits. There are widows and children of Civil War and Indian War veterans who are still drawing VA benefits. There are 939 children, widows of Spanish-American war veterans receiving VA compensation or pension benefits. So that goes on long after the veterans are gone.

BERNIE MELTER: And there's a saying for that too, and that the cost of war is not just the immediate cost in bullets, bandages, and the like. It's long-term. And we must take care of the warrior long after that war and must provide for him and his children. And that's an Abraham Lincoln saying that we will provide for the warrior and the orphan and children and the wife and widows. And we do that with a compensation and pension program. Most of this program has been devoted to medical care needs and that. But we need to maybe just take a look at the compensation.

AL LOEHR: I would just like to respond to Cliff.

RACHEL REABE: Gentleman, thank you. We are out of time though. We're halfway through this Main Street broadcast from the VA Medical Center in Saint Cloud. Our guest this morning, Al Loehr, Bernie Melter, and Barry Bahl.

I'm Rachel Reabe. Next hour, we're going to turn our attention to the organizations built by World War II veterans. VFW and American Legion posts across the country became the place where returning soldiers could talk about their war experiences and socialize. But what happens now that World War II veterans are moving into old age? We'll talk about that next hour. It's all ahead as this Main Street special from Saint Cloud continues.