We Owe Our Veterans Health Care

Last April, President Bush told members of American Legion Post 177 that "we owe the families and the soldiers the best health care possible."

That debt is still unpaid. According to a new report by Harvard Medical School researchers, published yesterday in the peer-reviewed American Journal of Public Health, millions of veterans and their family members have not been getting the medical care they need.

People assume that veterans automatically get health care from the Veterans Affairs (VA). They don't. Despite their military service, the Bush Administration requires most veterans to pay additional money for insurance in order to get care. But many veterans don't earn enough money to be able to buy health insurance. At the same time, they aren't poor enough under Bush Administration guidelines to get VA care or to qualify for Medicaid. Abandoned, these veterans struggle alone to find health care. In the insurance marketplace, our veterans remain in harms way--their service, and our debt, forgotten.

Why haven't we made good on our obligation? Our moral debt to our veterans, based on mutual need and shared responsibility, goes unpaid in the current health insurance system because it is based upon corporate self-interest. An insurance company's responsibility is to maximize profit, even when that means denying care to veterans. Clearly, our national moral responsibility is not the same as an insurance company's corporate fiduciary duty to maximize profits. (This concept is discussed further in our Rockridge Institute paper, The Logic of the Health Care Debate).

In fact, as the veterans' predicament demonstrates, these obligations can be quite contradictory. A vet is a national hero. Soldiers risk their lives. Many will be injured. Some will die. In return, we promise to support our troops in whatever way possible--both on the battlefield and when (or if) they return as veterans. Certainly, our support includes medical care.

There is no price that can be put on the risks a soldier takes. Nor is there a way to estimate the care a veteran will need during their lifetime. Our mutual obligations are easily understood, but impossible to quantify.

But a health insurance company's duty is to its shareholders. Its legal and contractual obligation is to maximize profits. Health insurance companies do that by quantifying likely health costs, and selling the policies for more than they will pay out in benefits. If you cannot afford their policies, then they will not sell you one. Simply put, a veteran is just another potential customer.

The national failure to meet our shared obligations to veterans - who risked life and limb on our behalf - is a disgrace. It betrays the moral vacuum at the center of our current health care system.

Let's simplify to make this ugly circumstance as clear as we can. Imagine a town. Inside the town live health insurance executives and the politicians who serve their interests. Soldiers risk life and limb to protect the town. Later, a soldier gets sick. "Sorry, you don't earn enough to afford our insurance policies. Try the next town," say the insurance executives. Except, in America, there is no "next town."

One way that we could meet our national obligation to support our troops is for the government to provide or guarantee medical care for all veterans. A version of this idea occurred through the Veterans' Health Care Eligibility Reform Act of 1996 (Public Law 104-262). The Act opened VA care to all veterans, with copays for those veterans considered to be "non-poor" (generally those making $30,000 and higher). In January 2003, however, the Bush Administration ordered a halt to the enrollment of "non-poor" veterans. The VA facilities were "full." To date, it's no better. As a result, according to the Harvard Medical School study, millions of vets and their family members cannot afford health insurance and go everyday without needed medical care. That is tragic. Something must change.

The authors elegantly summarize the central role that veterans and health care play in our national community:

The disturbing scene of returning soldiers left without care is a stark reminder that America is a nation bound by mutual obligations and shared responsibility. We owe veterans care not because they can pay for it nor because they are heroes but--as their sacrifices remind us--because members of a society are obligated to serve and protect each other.

In America, we don't have a health care system; we have an insurance marketplace. Until we understand the difference, no reform will work. To our low-income veterans, that is a daily hardship. We should make their hardship our problem too. One we solve together. Now. We owe that to our veterans.

Comments

[emhaas]

Lots of interesting comments to my piece.
A few thoughts.

My intent is to say that as Americans we give and receive mutual benefits and obligations as a community that do not work well as commodities in the marketplace because communities and markets operate with different values. When these values don't overlap well, people get caught in the gaps and that can cause real harm. Health care and our vets are a prime example.

So, agree or disagree with our Iraq occupation and the role of our soldiers, we should bear in mind that we as a nation send our soldiers into harms way as a form of patriotic service to the national community while having no real communal system for repaying that service where our institutions operate only on profit and market principles. Similar problems occur with how we treat fire fighters, teachers, and nurses.

Some other thoughts:

I agree that the VA was made available to all vets in 1996, and that it has not been funded sufficiently to serve them. However, I think this lack of funding is because the Bush Administration is following a conservative logic that for-profit health insurance is the only way to deliver health care; that government support that is based on need rather than wealth is immoral (see the Rockridge Institute's Thinking Points (www.rockridgeinstitute.org)). This creates the disconnect between service to our nation and how our nation provides for those who serve.

Also, the VA is leaving out all vets, not just those involved in Iraq. I see the significance as larger than just the Iraq occupation. However, the strong reactions to our soldiers' involvement in Iraq, raises important issues about the relationship between the actions of a specific administration (here, the Bush Administration) and the beliefs of the national majority. That is an important discussion that is beyond my piece, but certainly an essential part of any discussion of national community.

Eric Haas

[DrColes]

Our Veterans have FREE health care poor or rich, they always have. It's the VA. Its congress job to properly fund the VA. This issue has nothing to do with the national health care issue. The government caused the problem with health care in America by over socializing medicine to the extent it is not completive. http://www.inteliorg.com/

[Larenzo]

I know I'll get attacked for this, but ask me if I care. Those stupid enough to believe the lies leading to the illegal attack and occupation of iraq.....for the oil!!!!!! are to be pitied. And pitied even more for trusting that the lying dubya regime cares a rat's ass for them. They have only themselves to blame. Sorry, tough love here for you, but that's the way I see it. Stop whining and just admit that you were gullible fools and got screwed in the worst way.

[Larenzo]

Let me get this straight now....volunteers in the military, while swearing to uphold the Constitution, are fighting in a clearly illegal war in Iraq. With all the bonuses and bribes they received, they still want to appear as patriots protecting their country. BS....they are just mercenaries taking their chances, rolling the dice. They may only be makine 1/3 what the Blackwater true mercenaries are making, but we are still talking major bucks. While I don't wish harm on any of them, I really feel my heart strings being pulled when the roll of the dice comes up bad. Just refuse to fight....demand to get out....do something....those guys are acting illegally, and the last I heard, ignorance of the law is no excuse for breaking it.

It's kinda like....when you read a story about an armed intruder breaking into someone's home, and he is shot by the homeowner....where does your sympathy lie?

[LeftRight]

While I disagree with the fact that the president cut off the option for "non-poor" veterans, I understand the reasoning. As a service-connected disabled vet, who luckily is still able to work, I qualify for VA care even though I'm not "poor". However, when I call to make an appointment, I'm at least 3 months out, and that's when they are not slammed. When they start getting too many people, it can be as much as 6-7 months wait for an appointment. In addition to the slow response time for the medical personell, it's even worse for the non-medical people. I lost my wallet, including my VA ID card, and when I called to get a new one, it took them three months just to get a new one produced and sent to me.

[Lt]

the 'presidents' Veterans Disabilty Benefits Comission recently recommended an immediate 25%
increase in compenstaion to disabled Veterans.
This would help solve this problem.

Of course Bush plans to veto it.