Veterans of the Iraq and Afghanistan wars won’t get proper health care until the U.S. government updates and simplifies the bureaucracy strangling benefits and outpatient care.

This is the conclusion of Donna Shalala, former secretary of the U.S. Department Health and Human Services during the Clinton administration. President George W. Bush commissioned Shalala, Bob Dole and several other experts to evaluate the care of wounded veterans after the Washington Post exposed dire conditions at Walter Reed Hospital: deteriorating, rat- and roach-infested housing for family members, neglectful staff, and a mind-numbing bureaucracy. Shalala spoke about their findings to an auditorium packed with students and military personnel Monday, March 10, at N.C. State University.

While deployed, U.S. soldiers have access to world-class health care. But as soon as they leave the hospital bed, Shalala said, “it falls apart … in the coordination of outpatient care.”

This new generation of veterans has different medical needs, yet the dated, convoluted veterans health care system fails many of them. More survivors are returning home with brain injuries and long-term mental health issues, conditions that tend to be more severe and complex. These patients suffer most as they and their families struggle to find continuity among lost records, shuffling caseworkers and miscommunication typical of the military health care system.

“We need a sensible way of transferring records,” Shalala said. Medical records are often lost or simply unobtainable because the three agencies that handle military health care have computer systems that are incompatible with one other.

The complexity likely arose from a tendency to respond to problems by adding more programs or rules, effectively creating new problems in order to fix old ones. Shalala and the commission recommended streamlining and stabilizing the system. This includes assigning each veteran a civilian coordinator, who could handle the long-term cases, instead of a military coordinator, who might be deployed at any moment. The coordinator should also have the power to cut through inter-agency red tape.

Updating the benefits and computer systems are next on the list. While many soldiers join the military to help pay for college, many don’t complete their education. “The drop-out rates for educational benefits looks like inner-city schools,” Shalala said. Many veterans are told they must go to community college, where tuition is cheaper, but they are also eligible to attend four-year universities. They need more money and incentive to finish their schooling, Shalala said, as well as a centralized Web site to clearly explain how to apply and use benefits.

Only about 10 percent of these suggested changes would go before Congress; most of them would need presidential approval. Shalala estimates that about half of the suggestions have already been implemented and the other half are in the works.

However, she said that veterans benefits aren’t the president’s top priorityand never will be without public pressure. “All of us have a stake in the quality of health care we provide for the military,” she said.