Paying for the Wars' Wounded by Col. Daniel Smith

Paying for the Wars' Wounded
by Colonel Daniel Smith, USA (Ret.)

The Bureau of the Census has issued a lengthy summary of "facts" about the nation's 23.7 million veterans in time for Veteran's Day. Considering that there are two significant ongoing armed conflicts involving U.S. forces, I expected that there would be some "facts" dealing with Iraq and Afghanistan.

Nothing was disaggregated. Well, nearly nothing. Where detail was provided, it rarely was framed by war as opposed to education, age or ethnicity.

One statistic I did expect was the number of troops "wounded in hostile engagements" who had been discharged from service and transferred to veterans' medical care. (According to the Pentagon, total U.S. wounded from enemy action in Iraq is 28,327 and in Afghanistan 1,708.) But this also was not there even though that number – along with projections for future years – has to exist within the Veterans Administration (VA) so its staff can prepare their annual budget request.
Medical Care

Thinking these two items might be linked, I re-read the notice looking for spending just on veterans' medical care. Dead last was total spending by the VA in 2006 and a breakout between medical and non-medical spending for that year.

As a veteran who uses the military medical system, I could not help but wonder if the placement of this information was nothing more than happenstance, a fading echo of the recently revealed mishandling of war wounded and not a harbinger of the how the wounded from Iraq and Afghanistan will be regarded in the priorities of future administrations.

Actually, the census report raised more questions than it answered. Looking through the Bush administration's proposed Fiscal Year 2008 Budget submission turned up the following:

* In 2006, the Bush administration's budget request for the Veterans Health Administration (VHA) was still less than half ($31.3 billion) the total request ($75.7 billion) for the Department of Veterans Affairs.
* In 2007, the VHA's budget request actually dropped from about 43% of the total Veterans Administration proposed budget to 40%. Congress added $1.8 billion in the 2007 supplemental.
* The White House however, does not seem able to fathom the long-term medical costs of the Iraq War and its Afghanistan operations. Although it appears that VHA will be funded at $37.2 billion for 2008, the administration projects a 2% drop in funding for 2009 and a repeat of this lower level in 2010. That's just incomprehensible given that the wars are not likely to be over by then.

Supporting the Troops

The public comprehends the principle that if the nation sends its youth to war, it owes those young men and women the best medical care regardless of cost should they be wounded. This distinction is a variation of the classic "support the troops – support the war" dichotomy that scares and scars politicians. In an age of 15-second sound bites, all that need be said is "Senator (or Representative) X voted against funding our troops in the field," letting the silence of the syllogistic "therefore" be completed by the voter: that in refusing to vote for the military's budget request the congressional incumbent doesn't care about either the dead or the living.

Regardless of the precipitating event, once the armed forces are "on the ground," the president of the United States is in the enviable position to blackmail Congress into providing funds for the troops fighting for "God, country, and the American way." It doesn't seem to make any difference which party controls Congress or occupies the White House. The worst political sin is to be susceptible to the charge of "not supporting the troops."

Ironically, even when the wars they wage are as widely unpopular as today's operations in Iraq and Afghanistan, presidents can blackmail the American people the same way – and they get away with it for the same reason: no one wants to be accused of not standing up for the troops or appear to be unwilling to give them the best of everything. This stems from the belief that the United States is always justified in going to war, that God is on "our side" (or at the very least, is not on the "other" side).
The Warriors

In accepting the demise of the conscript army and the emergence of the modern military professional, the American public assigned the responsibility for military defense to a class of people – the Warriors – and in typical fashion, turned their attention elsewhere. This left as the main advocates for post-military service benefits (other than the formal institutions of government) the traditional veterans' advocacy organizations such as the Veterans of Foreign Wars (VFW), AMVETS, and the American Legion.

In peacetime, this façade of a "caring" nation could be maintained with little more than the ritual appearance by the "commander-in-chief" (and in election years by candidates for president) at veterans' conventions and the odd extra half-billion or billion dollars in additional spending that was never enough to catch up with needed improvements in the military and veterans health systems.

Under pressure from two wars, the "center" could not sustain itself or conceal the dichotomy between excellent medicine and paralyzing administrative requirements.
Walter Reed Effect

Then came what could be termed the "Walter Reed effect": the "fall-out" from investigative reporting by The Washington Post of substandard living arrangements for seriously wounded soldiers, of insufficient numbers of trained case workers for the number of wounded, and the expectation of hospital administrative staff that the wounded could traverse a very convoluted medical bureaucracy without substantial help. All this, together with the seeming indifference of general officers and administrative personnel toward those with psychological trauma or more evident brain injuries, rekindled empathy for the war-wounded among large segments of the U.S. public.

Initially, this renewed concern for the warriors and the question of why their care was so remiss did not cross into questioning the war itself, perhaps because one could, in the early days, talk war without having to talk veterans. And when veterans were mentioned, the traditional veterans groups stepped forward, as they had in the past, and generally supported the president's policy.

It would not be too long, however, before voices of returned soldiers, wounded or not, and of the survivors of those killed in Iraq and Afghanistan were raised in protest – first singly and then collectively in new groups such as Iraq Veterans Against the War, Veterans Against the Iraq War, and even among the veterans of the Vietnam War.

As the extent of the deficiencies became clearer, as more and more members of Congress visited hospitals and saw first-hand the extensive physical and mental injuries, as they learned of the extensive treatments that would have to last a lifetime, they at last began to fathom the woeful under funding of veteran's health and rehabilitation costs.

The apparent callousness of top Army officials to the status quo did not sit well with the public. This perception of official indifference acted as a catalyst to re-engage the American public on the issue of why these wars with their ever-increasing casualties hadn't ended.
Vets Find Their Voices

Veterans of the fighting in Iraq and Afghanistan began to find their voice-in-opposition and to take on the issue of inadequate care for the wounded. And since the wounded remain distinctive personalities, because they are not hidden away from society, they cannot be treated as an undifferentiated class – like those who are killed and usually become, other than for their loved ones who remain, more of a statistic than a memory.

Indeed, today's wounded (and today's 3,858 dead in Iraq and 459 in Afghanistan) present the public with an opportunity to start to end the fighting, the dying, and the maiming that seem to be endemic in the "social contract" of modern nation states. How? By bringing face-to-face those who serve with those who first asked them to serve, sent them to "care" for (that is, to fight for) the nation, and in so doing created a moral and even a legal reciprocal obligations to care for the wounded who "cared" for the nation when asked.

While this approach might seem to leave a huge gap through which to drive a tank army, it would strip away the sterile masks that protect those who make war from those who "do" war – at the maker's behest and in the name of the "people" who often have absolutely no say in the decision for war.

It's different today than during the Vietnam War, when even wounded veterans were sometimes reviled and taunted as "baby-killers." Vietnam may have been the tipping point, for that was the first U.S. television war. The horrendous wounds from Iraq and Afghanistan have moved the public beyond the halfway point of transitioning from a warrior mentality and myth to a culture and outlook that celebrate peace.

The challenge is how to keep together the need for adequate appropriations to care for the wounded for as long as necessary with the realization that those who need long-term care once were able-bodied men and women. Still to be traversed is the gap between the recognition of the cost of caring for the wounded and caring about – that is, rejecting – the reasons why politicians opt for war in the first instance.

Meanwhile, the number of mercenaries (politely termed "security contractors" in the mainstream media and political debate) just in Iraq is reportedly between 20,000 and 30,000. That's more than some countries have in their whole armed forces.

So now there is another consideration: will the public, and the Congress, in rebelling against the cost of paying for war and the war-wounded, opt for a fully mercenary force to wage our wars?

That was what Rome did. History records the outcome.