March 7, 2007:
The recent scandal over poor care
for wounded soldiers in the Washington, DC area, was yet another example of how
sensitive is the issue of veterans care and benefits. Ever since the American
Revolution, the issue of how veterans should be treated has been prone to
excite moral outrage, political grandstanding, lurid headlines, and even a
little action to improve the care for veterans. The most recent scandal
involved poor administration of outpatient care for wounded troops from Iraq
and Afghanistan. Some of the accommodations for the recuperating troops was not
maintained properly, and the medical bureaucracy had become very patient
unfriendly. After the problems hit the headlines, the general in charge was
fired, as was his successor. The Secretary of the Army resigned and Congress
held hearings to wring maximum political advantage out of the situation.
Meanwhile, the Veterans Administration has actually
improved its care over the past decade, to the point where opinion surveys show
that veterans rate their care, by the Veterans Administration hospitals, as
superior to what they encountered in the commercial health care system. A study
of Veterans Administration health care, by a team of medical professionals,
found that health care for veterans had, indeed, risen to a level higher than
that available for non-veterans.
But the war on terror has generated over 20,000
wounded, and even more sick and injured troops, over the last six years. This
is a much lower casualty rate, for the size of the force, than in past wars,
and you'd think that the military health care system could handle it. In terms
of immediate health care, they did. It was the after care, and the services
required for dependants and active duty reservists, that overwhelmed the
system. The military bureaucracy has been consistently unable to cope with the
blizzard of paperwork that accompanies any increase in benefits, including
healthcare, provided to military personnel. Reserve troops, mobilized for
active duty in the last five years, have been the chief victims of these
bureaucratic catastrophes. In light of that, it's no surprise that outpatient
care for a larger number of wounded troops should become a problem.
Interestingly, the marines applied their usual
initiative and innovation to the problem. They established special living
quarters on their bases, for
recuperating marines. The marines also sent in additional clerical
support, to deal with the jammed up Department of Defense medical bureaucracy.
So it wasn't a problem that could not be solved, it was just one that required
better leadership and management skills than the army provided. As one army
official commented, the shabby housing for the outpatient troops was a failure
by some senior NCOs (the first people to see the problems, and the ones who
should get the fix in motion as quickly as possible.) But those NCOs work for
officers, who apparently did not go see for themselves, as officers should, what
the problems were, and how the solutions were being applied.
The army has an institutional hangup with these
problems, which has showed up in the form of bad troop housing and paperwork
hassles, many times before. These situations have been turned into headlines
and career killing scandals before. But somehow, after immediate fixes are
applied, the system settles back into the same routines that will create more
scandals in the future. Despite lots of efforts by people in the army, the
problems remain. Changing, "the system," is not at all easy. And this is just
another example.