Caring for our wounded veterans: we are breaking trust

By Dan Smith

WASHINGTON--Loyalty, the military holds, goes both ways in the chain-of-command.

In a democratic society such as ours, there are many links--civilian and military--in that chain. But as the presidential candidates never stop reminding us, that chain goes right into the Oval Office, to the commander-in-chief himself.

Loyalty "up" is not the problem today; the problem is loyalty "down," or more precisely, the inability or unwillingness of the highest levels of the chain of command to carry out procedures that help commanders fulfill their obligation to look out for those within their units.

Loyalty down extends to those who suffered wounds during their service. Those who are being treated at Walter Reed Army Hospital in Washington, DC or the National Naval Medical Center in Bethesda, MD or Brooke Army Medical Center in San Antonio, TX are receiving first-rate care. But other wounded men and women have been less well cared for, as documented by Vietnam Veterans of America last fall. Fort Stewart, GA was a particularly bad example. Returning soldiers, mostly National Guard and reservists, were housed in cinderblock barracks without air conditioning and, in some instances, with only detached showers and latrines.

About three weeks ago, the number of U.S. wounded in Iraq topped 8,000, more than double what it was in April this year and up by 1,000 from just a month earlier. Some of the wounded will return to their units; others will be evacuated to Germany. The most seriously wounded come back to the United States to begin a process that often takes months and years of physical rehabilitation and psychological counseling, or both--treatment that is unavailable to the tens of thousands of war-injured Iraqis.

At some point in the physical recovery of the wounded, the Veterans Administration and its health care system assume responsibility. Unfortunately, to take full advantage of the system, the victim has to live near a VA hospital.

In May 2004, the Bush administration announced plans to close all or parts of 11 major VA healthcare facilities while building or expanding only eight others. An additional 20 treatment centers, including "small rural facilities," are being subject to "more study" for possible closings, reductions, or consolidation--all in the name of cost efficiency. Yet even the threat of a possible closing--let alone the probability that many of these 20 centers will close--can present veterans with a stark, potentially costly choice: move so they can be near one of the new or enlarged hospitals, or drop out of the system. Congress finally rebelled after the VA, in announcing a new "enrollment" fee for some veterans and a doubling of pharmacy co-payments, acknowledged the new fee structure could "reduce enrollment by 1.25 million and patients by over 425,000."  

While problems of inadequate funding are not new--the Vietnam Veterans of America point to caps in the 1990s that depressed VA spending by $10 billion below what they believe it should be--the problems can only worsen as the Iraq war drags on and the numbers of those needing care increase. Physicians for a National Health Program released a recent study claiming that almost 1.7 million veterans have no health insurance or are unable to access the VA system. (The VA says fewer than 900,000 are uninsured). Moreover, the study says veterans are losing coverage faster than the general public.

Because the Defense Department and the VA already have detailed data on service-connected injuries, treatments, and general health, some experts are suggesting that a possible solution is to issue veterans a "smart technology card" that would allow them to see non-VA healthcare providers if no VA center is close by--and then electronically bill the VA. This is simple, direct, and therefore likely to be rejected.

Whatever the solution, it must be simple, direct, and quick, because the ranks of veterans are swelling. It must also be comprehensive. As Abraham Lincoln said in his Second Inaugural address, the nation must "care for him who shall have borne the battle and for his widow and orphan."