Sunday, August 28, 2011

Cost of War: Caring for Our Wounded

Ron Glasser: A Modest Proposal:
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.

Medicare for all vets needing long term care is the modest proposal of Vietnam military physician Ron Glassman:

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.

Glassman illustrates our new medical world with some examples:

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.

He praises the effectiveness of medicare as he recommends it as a solution.

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.

A reasonable sounding proposal. But I would not stop there. Lets put all of America on Medicare with its reduced costs and and eliminate the insurance companies in the middle who siphon off so much of the money that ought to be going to physicians and clinics and hospitals. We could then use the VA system for prescription drugs and vastly reduce those costs. Medicare with VA prescription drugs for All!

Wednesday, August 24, 2011

Empire Watch: How to Avoid Bush's Iraq Mistakes in Libya

How to Avoid Bush's Iraq Mistakes in Libya | Informed Comment: How to Avoid Bush’s Iraq Mistakes in Libya

Posted on 08/24/2011 by Juan

The illegal American invasion of Iraq and subsequent occupation was so epochal a catastrophe that it spawned a negative phrase in Arabic, “to Iraqize” or `arqana .Tonight I heard an Alarabiya anchor ask a spokesman for the new government in Libya whether there as a danger of the country being “Iraqized.” He was taken aback and asked her what she meant. Apparently she meant chaos, civil war, no services, etc. (Those Neoconservatives who trumpet their Iraq misadventure as a predecessor to the Arab Spring should take a lesson; no one cites Iraq among the youth movements except as an example of what must be avoided)

Juan goes on to list the mistakes in Iraq not to be repeated in Libya. Of course the basic assumption is that the US or NATO will run things or have a strong Imperial Presence and influence as Libya transitions and this is probably true considering the close relationship between the rebels (just who are they?) and those same imperial powers. But its still a good list for starters on how not to repeat some of the mistakes made in Iraq. Here are some examples:

1. No Western infantry or armored units should be stationed in the country. Their presence would risk inflaming the passions of the Muslim fundamentalists and of the remaining part of the population that is soft on Qaddafi.

2. As much as possible of the current bureaucracy, police and army should be retained. Only those with innocent blood on their hands or who were captured rather than surrendering or switching sides should be fired. The EU is doing the right thing in trying to ensure the bureaucrats get paid their salaries

There are ten points in all. you can read the article at the link above to see them all but I want to include one more as this is one of the first things done in Iraq. In the midst of the looting a insecurity Brennen was sent in to rewrite the constitution so privatization could begin and rebuilding contracts were inevitably handed to outside corporations leaving more Iraqis out of work or paying them a fraction of the money to do the whole job while the outside corporations kept the rest. This is what we have been calling "democratization".

5. Avoid a rush to privatize everything. Oil countries anyway inevitably have large public sectors. Impediments to entrepreneurship should be removed, but well-run state enterprises can have their place in a modern economy, as some of the Asian nations have demonstrated. Rajiv Chandrasekaran demonstrated in his Imperial Life in the Emerald City how the US fetish for privatization destroyed state factories that could otherwise have been revived and that could have supplied jobs.

Read the rest. Its a pretty good description of what we have been doing in Eastern Europe as well as Iraq as we follow our free market ideology and conflate it with Democracy.

Wednesday, August 3, 2011

PTSD Therapy: Restoring Honor to the Enemy

PTSD Therapy: Restoring Honor to the Enemy - Miller-McCune

VFP members, I would be interested in your comments on this take on PTSD:

One side of post-traumatic stress that not many people talk about — maybe because it’s so hard to separate from waging a modern war — is the way a nation and its military tend to dehumanize the opposing side. Erich Maria Remarque’s novel about World War I, All Quiet on the Western Front, took dehumanization as its theme, and it still has a lot to say about war trauma even if Americans have cornered the market on clinical descriptions of PTSD.

Some interesting summer reading suggested in this second quote.

The psychologist Jonathan Shay, in his essential book on combat stress called Achilles in Vietnam, points out one difference between the Trojan War and America’s war in Southeast Asia: “The Iliad contains no derogatory nicknames for the enemy used by soldiers when talking among themselves; we hear no hint of ancient equivalents of ‘Gook,’ ‘Dink,’ ‘Zip,’ or ‘Slope,’ used so freely at all levels of the American military in Vietnam.”

Shay says honor for the enemy — for his fighting skills as well as his will to live — helps a soldier maintain common sense during a war and stay sane afterward. Officers who underestimate the Japanese fighting ability, he argues, may fail to predict something like Pearl Harbor (which really happened); and a soldier who comes home feeling he fought a war against subhuman vermin is in trouble whether his side loses or wins. “The veteran’s self-respect never fully recovers as long as he is unable to see the enemy as worthy,” Shay writes. “Restoring honor to the enemy is an essential step in recovery from PTSD.”