HEALTH CARE/Joan Retsinas

Veterans Need a Tangible Thank You

These past few months thousands of 19- to 30-year-old Americans have left their homes in obscure havens, like Pilot, W.V., to fight, and sometimes die, in Tikrit, Nasiriyah and Mosul. The news has offered up an atlas of memorable places to forget. Soon the fighters will be returning to parades, family reunions, and grateful words from the president.

We should give these newly-hatched veterans a tangible thank-you: health insurance.

Many joined the armed forces eagerly &endash;- not to fight anybody, but to get job training, or better yet a job. The Army, Navy and Air Force have marketed themselves as employment agencies &endash;- the enlistee gets to learn skills that will net him or her a job after the hitch is over, all the while getting a paycheck and maybe a chance to see the world. It beats working the counter at Wal-Mart, or waiting at home with Mom and Dad for a new plant to open.

Of course, when those enlistees start donning civvies, some will find that the skills of wartime -&endash; like manning tanks, or shooting from helicopters -&endash; are not readily transferable to the private sector. Some will find that they are still searching for a job that will support their families &endash;- the adorable children and spouses waiting for them to return. Most will still be worrying about health insurance.

Pre-Iraq, our executive-in-chief was giving the Veterans Health System the sort of diligent fiscal overview expected of a CEO. Demand for Veterans Health Services was soaring: Enrollment rose from 2.9 million in 1996 to 6.8 million in January 2003. As of January 2003, moreover, 236,000 veterans were on waiting lists, unable to schedule an appointment, or scheduling one more than six months ahead. The surge of enrollees was partly due to prescription coverage: Veterans' health service enrollees pay $7 a prescription, compared to Medicare enrollees, who pay the full tab. So a sizeable contingent of veterans who were eligible for Medicare signed up for veterans' benefits.

The executive-in-chief had two choices: First: Dramatically bolster the resources of the Veterans Administration, which means dramatically increase its budget. For the past few years the Veterans Administration has been working on a tight budget. Secretary of Veterans Affairs Anthony Principi explained, "Last year the VA treated 1.4 million veterans with 20,000 fewer employees than in 1996."

The second choice was to curtail demand. The executive-in-chief chose the latter course. The Veterans Administration has "priority tiers" of enrollees. At the top are people wounded in combat. At the bottom (priority 8) are veterans with no service-related injuries and with incomes above a threshold (roughly $25,000 for an individual). In January 2003, the president halted enrollment of "priority 8s:" The Veterans Administration would no longer accept patients in that category. In a peacetime world, the decision made frugal sense.

But this is no longer peacetime. If we continue to send young citizens into dangerous places, to fight &endash; or befriend, depending upon the vagaries of battle &endash; people who either hate or welcome us, then we should guarantee these brave warriors (or peacekeepers) health insurance when they return. If we don't want to upgrade the Veterans Health System, we can give each veteran a Medicare card. We can give their spouses and children Medicare cards too. Their parents too. Perhaps the road to national health insurance will lead through Baghdad.

This fresh infusion of veterans &endash; a few hundred thousand of them &endash; deserves more than a few parades. And the Veterans Administration needs not so much an executive-in-chief, but a commander-in-chief, who, like President Lincoln, will "care for him who has borne the battle."

Joan Retsinas is a sociologist who writes about health care in Providence, R.I.

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