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Ron Glasser

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A Modest Proposal

Posted: 08/28/11 07:41 PM ET

I was drafted into the Army as a military physician in August of 1968 and sent to Camp Zama Japan as a pediatrician to care for the dependents of the Military and Department of Defense personal throughout the Far East. I arrived in Japan six months after the Tet Offensive while our soldiers and marines were still being killed platoon by platoon in the rice paddies of the Mekong Delta and in the elephant grass along the Laotian boarder.

While Zama was the largest general military hospital in the Far East, its main mission was in support of the war, which meant caring for the wounded coming out of Vietnam. Whatever your specialty, the Army expects a doctor to be a doctor and during those years at Zama I saw and cared for the wounded from Nam.

That war ended, when Congress deciding after a decade of fighting -- with 58,284 dead and over four hundred thousand wounded -- that the war was no longer worth the effort, the costs, nor the increasing number of dead and wounded, simply voted to withdraw additional funding. Within six months our army began to go home and within a year we were gone.

Unfortunately, Congress also reduced funding for the care of the wounded, leaving a whole generation of Vietnam veterans to flounder in poverty, homelessness, drug abuse and anguish. We had decided both as a nation and as individuals to forget about the war and get on with our own lives.

There is little of that kind of callousness today. We are not ignoring that we have once again sent our soldiers and marines out to the very edge of empires as much as the fact that both collectively and individually we are becoming overwhelmed by what seems to have become a hopeless task along with an increasing number of terrible wounds and shockingly new medical needs.

In Vietnam you were mainly shot and died; in Iraq and Afghanistan you are blown up and live. In Nam, there were 2.4 casualties to every death. In Iraq and Afghanistan the ratio has become an astonishing 16 to one. Unlike Vietnam, our troops are surviving but with terrible injuries that clearly would have been lethal in Nam or in any of our other wars. The legacy of Iraq and Afghanistan is no longer the graveyard, but the neurosurgical unit, the orthopedic ward, the neurology treatment center and the PTSD clinic.

The Veterans Administration is currently 400,000 disability claims behind, with that number growing each month. The lack of adequate and necessary medical care for those we have once again sent our to fight our wars is also increasing exponentially. The reality of Iraq and Afghanistan is that nobody expected so many survivors with so many terrible wounds.

Part of this tsunami of wounded has to do with the effectiveness of the new body armor that eliminated the penetrating chest wounds and abdominal injuries that led to our armies, in previous wars, literally bleeding to death. Part also has to do with the more effective battlefield medicine that keeps soldiers alive during that "Golden Hour" post-trauma by maintaining airways, stopping the bleeding, and quickly replacing fluid and blood losses. In Vietnam it was said that if you keep going back, you will be killed. In Iraq and Afghanistan they tell you that if you keep going back, you will lose a limb and be brain damaged.

The explosions from the IEDs that blow off arms and legs lead to enormous blast waves that cause traumatic brain injuries and when coupled with amputations become the signature wounds of these latest wars. The brain damage from IED blasts can be more devastating than the extremity wounds, and more expensive and more difficult to treat.

The story of Congresswoman Giffords is a bit of Afghanistan brought to Arizona. She survived a brain injury but will need long-term physical therapy, occupational therapy, speech therapy and cognitive rehabilitation therapy. Brain injuries are like that -- they now account for 22 percent of overall casualties in Iraq and Afghanistan and 59 percent of all blast related injuries.

Those who work in our VA hospitals understand the problem and faced with the numbers of wounded, know they cannot do the job they want to do, or need to do, because of inadequate budgets coupled with Congressional panic over deficits.

In a desperate attempt to give veterans the care they need, VA hospitals have recently put into place what they call "The Hero's Program." It is a program as straightforward as it is simple. If a VA department decides that it does not have the personnel or the ability to adequately care for a patient, that department can outsource the patient into the private medical sector. All that is required is for civilian physicians to sign up for the program. The reimbursements are Medicare reimbursements for both hospitalizations and office visits.

But despite the effort, the program is like putting a therapeutic finger into the health care dike with that tsunami of wounded patients already coming over the horizon. The answer to the problem of taking care of our troops in both an effective and reasonable manner is to increase funding to the Veterans Administration or expand the Hero's Program to include all patients and families who may need it. Replace the Hero's Program with Medicare.

There are some 50 million people on Medicare right now. Another seven hundred thousand of the most recent wartime casualties would increase enrollment less than one and a half percent. Despite what those few detractors might say, Medicare is a proven effective and efficient system that could easily absorb the VA patients without any substantial start-up or developmental costs that would be a part of any significant upgrading of VA programs or facilities.

The "Medicarization" of the VA would give female soldiers and marines -- 44% of the 300,000 female Iraq and Afghan Veterans are expected to receive on-going health care from the VA over the next decade -- the specialized care in women's health that is lacking in VA facilities geared to both male patients and male problems.

But perhaps the greatest benefit of Medicare to those wounded, and their caregivers tied to the need of follow up care, is the problem of distance. Traveling to a distant VA is no easy task and certainly not with gas hovering around four dollars a gallon. The VA does not give travel vouchers. Simply getting to a VA for multiple visits or routine care can be a financial burden if not an almost impossible physical task. It would clearly be easier on a wounded veteran to go to a physician or clinic or hospital close to home.

Today's actuaries put the medical costs of caring for this generation of soldiers and marines at well over a trillion dollars. The health care costs of these wars and the medical responsibilities to our veterans can best be handled by using another national health care system, a system in place, already functioning well and clearly responsible to the needs of its patients while offering reasonable cost effectiveness. Medicare is not only there; it is everywhere.

Lincoln, our most famous wartime president with his usual economy of words and understanding of responsibility, said it best: "The function of government is to do for people what they cannot do for themselves."

The wounded of Iraq and Afghanistan cannot do this by themselves, nor can they do it the way things are going.

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