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!

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