Despite stiff criticism from some veterans and lawmakers who would see their local VA hospital close, Secretary of Veterans Affairs Anthony Principi says he is "optimistic" that a major restructuring of the $26 billion VA health-care system can begin next year.

The goal, said Principi, is to make VA health care more efficient, and accessible to more veterans, by closing outdated and underused facilities and opening modern hospitals and clinics where they are needed most.

Last August, VA completed what Principi describes as the most comprehensive review ever of department health facilities. Called CARES (Capital Assets Realignment for Enhanced Services), the draft report recommended major changes at 13 locations.

New hospitals would be built in Las Vegas and Orlando, Fla., new centers for the blind in Biloxi, Miss., and Long Beach, Calif., and new spinal injury centers in Denver; Little Rock, Ark.; Minneapolis and either Albany or Syracuse, N.Y.

Seven old hospitals would be closed: in Brecksville, Ohio; Canandaigua, N.Y.; Gulfport, Miss.; Lexington, Ky.; Livermore, Calif.; Waco, Texas; and Pittsburgh.

VA would open 48 new clinics and close or realign other small facilities throughout the country.

The aim is not to cut VA costs, said Principi in a phone interview, but to realign resources over the next 20 years to reflect veteran population shifts and to embrace advances in medical treatment and technology.

"We'll either be on the cutting edge of medicine in the 21st century" through restructuring, he said, or stay "on the trailing edge of the past century. We have a responsibility to make changes ... much like the private sector has to its systems, and to make sure the extraordinary amount of dollars the American people send us are being spent wisely."

Restructuring VA facilities will mean "more health care, not less," Principi said, hoping to assure veterans.

The VA health-care system has 163 hospitals but a total of 5,000 buildings on almost 20,000 acres of land. "Some facilities we inherited from the Army at the turn of the 20th century," Principi said. "At their peak these facilities may have had 2,000 patients. Today there may be fewer than 200 patients and we're maintaining 200 or even 350 acres of land."

Principi noted a recent General Accounting Office report estimated that found the VA spends almost $400 million a year on underused facilities. Redirected, he said, that money "can buy a lot of health care and state-of-the-art ambulatory clinics and sophisticated bed towers and surgical suites and more digital technology so a doctor on the west coast can be diagnosing a patient on the east coast. That's what we're tying to accomplish."

Realignment means "making difficult decisions," Principi said. "I appreciate the sensitivity at the local community [level]."

Veterans and lawmakers from impacted areas have attacked the draft recommendations. One of the last public hearings, in Canandaigua, N.Y., attracted 1,500 protesters who opposed replacing the 70-year-old VA hospital, and 700 employees, with an outpatient clinic. The 23-building campus has its own fire department, bowling alley and laundry - but only 200 inpatients, down from a peak 1,700.

Still, Sen. Charles Schumer, D-N.Y., called the closure plan "a monumental mistake."

But reaction overall to CARES, said Principi, has "gone as well as one could hope for, given the gravity and comprehensive nature of this report."— Comments are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail or visit Web site at:

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