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October 11, 1995

The Future of the Department of Veterans Affairs-Reply

Author Affiliations

University of Alabama at Birmingham

JAMA. 1995;274(14):1131. doi:10.1001/jama.1995.03530140042019

In Reply.  —The proposal by Dr Moskowitz is an old one with a new twist—combine the USPHS, Medicare, and Medicaid with existing VA hospitals and clinics into a federal health care system for those too poor to afford the "first tier" of private care. When I worked in the VA Central Office in Washington, DC, across from the White House between 1971 and 1973, years when President Lyndon Johnson's Great Society still lingered and presidential woes increased, the air was rife with talk of making the VA the framework for a new federal system like Britain's National Health Service. It didn't happen in the 1970s, as President Clinton's system didn't happen in the 1990s.The VA system is already the nation's county hospital. The average income of employed VA patients is below $16 000 annually (69% unemployed),1 and the maximum allowable is $20 469.2 As emphasized by Fisher

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