The scandals and shortfalls in the military's health-care system stem from the same sensibility that produced the scandals and shortfalls in the Iraq and Afghanistan wars. It is the Bush administration's sensibility of denial—its willful disinclination to face war's true cost (in all senses of the word) and its readiness to use bookkeeping tricks to perpetuate the deception.
"I am concerned that our soldiers and their families are not getting the treatment that they deserve," President George W. Bush said today, in announcing the creation of yet another blue-ribbon commission, this one "on the care of returning wounded warriors."
No doubt he is concerned. The real scandal is that he's felt no reason to be concerned until the recent spate of news stories revealed plenty of reasons that he should be. The bureaucracies in charge of the returning wounded have been shuffling through the motions as if nothing extraordinary was happening—and the politicians who are ultimately responsible have made it clear, by not telling anybody otherwise, that they prefer things that way. They are all acting as if there isn't a war going on.
Consider the following facts from the fiscal year 2008 budget proposal, which the White House submitted to Congress just last month.
The Pentagon's Defense Health Program—which includes the Tricare health-insurance plan, used by 9.1 million veterans and involving 65 inpatient clinics, 414 medical and dental clinics, and 257 veterans centers—has actually had its budget cut the past two years. In fiscal year 2006, the program's budget for medical care went up from $15.9 billion to $21.2 billion. But since then, it's gone down slightly—to $20.8 billion in FY 2007 and a proposed $20.7 billion in FY 2008.
These numbers understate the magnitude of the cuts. To keep up with inflation in the cost of goods and payroll, the Defense Department actually had to cut medical-care programs by $1.6 and $1.4 billion in FY07 and FY08, respectively.
Money is similarly tight at the Department of Veterans Affairs. The VA's budget for medical care has risen in the past few years—from $28.8 billion in FY 2006 to $29.3 billion in FY 2007 to a request for $34.2 billion in FY 2008—but this hasn't been enough. In each of the past four years, according to a March 1 report by the Senate Committee on Veterans' Affairs, the VA has systematically underestimated the number of veterans applying for benefits in the coming fiscal year. The result is a shortfall of $2.8 billion in the FY08 budget, just to cover the current level of medical services.
The administration is trying to make up for some of this by raising deductibles on prescription drugs (from $8 to $15) and by imposing an annual enrollment fee (ranging from $250 to $750)—in short, by shifting costs to the veterans themselves. (Even so, these charges would make up only $450 million, or about one-sixth of the shortfall.)
Another instance of ignoring the wars: Despite a vast increase in the number of returning soldiers coming to the VA's veterans centers, the budget for these centers has remained flat. Similarly, despite a vast increase in the number of soldiers filing disability claims, the VA budget includes no money for additional claims processors. To justify the lack of money for trained processors, the VA's budgeteers assume that the number of new claims—and the backload of past claims—will drop in 2008. This is patently ridiculous: Elsewhere in the budget (see page 1-2), they state, "[W]e project that VA's patient caseload will peak in 2010" (emphasis added). In other words, they predict a rising caseload for another three years—but cut the money for the caseload this coming year.
An even grander sleight of hand comes in the section of the budget dealing with the "out-years"—FY 2009-12. The VA's budgeteers are projecting no increases in spending for medical care during that entire four-year period. They can't possibly believe this. (Again, they note elsewhere that the caseload won't peak until the middle of this period.) They are engaging in the political game of making the future appear less grim—and the president's budget more balanced, the need for tax hikes or cuts elsewhere less compelling—than is really the case.
This is a familiar game in peacetime. But it's a damaging, deceptive game in wartime—for the soldiers who fight the war and for the citizens who are called upon to support and fund it.