In the late 1970s the author had the occasion to review the Institute of Medicine report on the Veterans Administration (VA) that advocated the dissolution of the system in favor of treating veterans in community hospitals. The title of the author's article in the New England Journal of Medicine was “How Not to Give Advice to the US Government.” The American people want more and better care. They believe that they are entitled to it. In more than one way, excessive expectations are the nub of our dilemma. Veterans, Congress, and the VA staff have expectations in terms of scale, depth, and quality of services that are far in excess of the resources the Congress has actually given or is likely to give the VA. Perhaps one will understand the author's earlier statement that the VA is in a vise. The surplus of acute–care beds, an important point, should be a key consideration in the VA’s ongoing planning.