Our failure to plan for the return of our soldiers wounded in our Global War on Terrorism has made it necessary to examine our unprepared and overwhelmed military/veterans health care system. Much is at stake. We are engaged in de facto perpetual war that depends on volunteers for victory. On July 31, after five months of analysis and deliberation, the President’s Commission on Care for America’s Returning Wounded Warriors will present its recommendations. Co-Chairs Senator Bob Dole and former Secretary of Health Donna Shalala, both experienced and deeply committed to the task, will propose changes. The most significant effects of their recommendations upon the Nation and our maimed, cognitively impaired and traumatized service members and their families will accrue over a generation or more.
On that not yet foreseeable day when oil flows out of Iraq and international oil interests trumpet the event, wounded veterans will be reminded anew of their enduring courage and self-sacrifice, a gift to the Nation that made it possible for the rest of us to avoid conscription. Fraught with combat memories, flashbacks, and disabilities, that reminder could never be sweet, but it will not be bitter if they find themselves as welcome in rehabilitation as they were in recruitment.
When the Commission presents its recommendations, some 3,200 of our volunteer soldiers will have been killed in Iraq and Afghanistan, and about 900 will have died of “non-hostile” accidents, heat exhaustion and illness. Officially, about 28,075 have already been wounded: unofficial but authoritative analysis nearly doubles that number. But the signature wound of this war is a type of traumatic brain injury (TBI) resulting from the blast forces of improvised explosive devices (IEDs). Blast-TBI (bTBI) is invisible to the naked eye as is post-traumatic stress disorder (PTSD). Military doctors tell us that the official count underestimates the number of our soldiers who will return to their families, communities and employers with TBI’s slowed thinking, deficits in attention and concentration, headaches, memory loss, sleep disturbance, and irritability and with PTSD’s flashbacks and crippling emotional conditions. The number of invisibly wounded soldiers now exceeds the number of visibly wounded. We must not feign blindness to the epidemic we have brought home from this war.
The Commission’s charter can be read large or small. It can confine itself to the real but necessarily piecemeal procedural and budgetary fixes to a broken system; or it can do that much and, as it should, begin the national dialogue about how to restore the damaged lives and pay the astronomical societal costs of supporting those wounded in our perpetual war. The Commission can and should begin this dialogue by acknowledging that those wounded deserve perpetual restorative support.
In so doing, it may help save another system, The All Volunteer Force (AVF). For too long, we have taken for granted the gift which is the AVF. Among us are those who seek to compromise the moral obligation the Nation owes its volunteers by reducing their service to a contractual construct. But the All-Volunteer Force was not a gift to the military which resisted its establishment; instead it is a gift to all Americans, relieving them of the most harsh but sacred sacrifice of citizenship.
America, like most nations, finds ways to avoid its lasting obligations to its military veterans. Old wars, even when crowned with victory, are relics memorialized and studied — our debts for them resented. Human casualties are national debts. The closest we came to getting it right was our support of the World War II GI, whose return to productive citizenship was understood as being as important to the restoration of the Nation as was his sacrifice for its victory on the battlefield. That same restorative ethic must guide the recommendations of the Commission. There is no alternative in an all volunteer era.
Personal restoration for our wounded will be enormously costly, because restoration means lifelong treatment for our soldiers’ broken limbs, broken heads, broken homes, broken careers, and broken families. But the failure of restoration will prove even more costly than doing what is right.
Commitment to the perpetual restoration of our wounded veterans and the continued viability of the AVF are inextricably linked. Analysis of and commentary on this direct connection is perhaps beyond the Charter of Shalala-Dole, but we should not fail to understand the full implications of their Commission’s recommendations. The current deterioration of Army recruiting will accelerate and likely prove fatal to the AVF if the Nation fails to commit to credible reconstruction of the system which treats our newly wounded. If we are as innovative in funding that reconstruction as we were in devising and sustaining the AVF in the Cold War, we can continue to enjoy its gifts into the 21st Century.
The Nation’s moral obligations to this generation of soldiers and their reasonable expectations differ from that of past wars. But those obligations and expectations have been an integral commitment on behalf of the Nation since President Reagan’s Administration. An acknowledgement of this commitment and the related costs of its fulfillment must be addressed in any credible analysis of the way forward for the Nation and those who have sacrificed so much for it. The alternative is a debilitating crisis that will shatter the hopes of thousands of families and the viability of the AVF. Shalala-Dole must point the way.
Op-ed Submitted to Miami Herald
July 10, 2007