Review of Jessica L. Adler, Burdens of War: Creating the United States Veterans Health System (original) (raw)
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Veterans\u27 Medical Care: The Politics of an American Government Health Service
1980
The history of veterans\u27 benefits and services in the United States is reviewed; it demonstrates their responsiveness to dominant political, economic, military and medical interests. The ideological position that social services must be deserved is also seen to be an important influence on the V.A. system. The consequent inaccessibility of V.A. medical care to most veterans and almost all non-veterans raises questions about the appropriateness of the V.A. system as a model for national health care
Physicians at War: Reply to Critics
2010
Donovan and Col. Thomas Jefferson offered comments. Subsequently, Prof. Griffin Trotter wrote a review of the book for this journal, and Davis and Donovan put their comments in writing. I am grateful to have this opportunity to respond to the three of them and further grateful for their thoughtful contributions to this volume. In what follows, I will recapitulate the core idea behind the project (�� 1) 2 and then present and respond to the critiques of my interlocutors (�� 2).
Feet for Fighting: Locating Disability and Social Medicine in First World War America
This article describes the process by which 'flat feet' became a well-recognised medical diagnosis and eventually came to be seen as an important indicator of national health during early twentieth-century America. I argue that orthopaedic surgeons—a relatively new medical specialty at the time—took a leading role in this process. During the First World War, they standardised diagnostic measures for flat feet as a way to delineate 'fit' from 'unfit' draftees, rejecting the latter from military service (a practice that persisted for the remainder of the century). But instead of sending the 'unfit' home, orthopaedic surgeons believed that they could rehabilitate rejected draftees using techniques such as stretching and strengthening exercises in order to make the flatfooted into foot-fit men. After the war, these same surgeons applied their theory of rehabilitation to the industrial workplace, where they supplanted physiologists as the new experts on bodily efficiency, a move that would eventually bring about the science of body mechanics and ergonomics. Finally, I argue that wartime orthopaedics serves as an important example of social medicine in practice during the early twentieth century. Orthopaedic surgeons contended that physical disability was as much of a threat to national health as germs and believed that debilitat-ing conditions such as flat feet should be prevented and cured for the general betterment of American society.
Veterans' Medical Care: The Politics of an American Government Health Service
The Journal of Sociology Social Welfare, 2014
The history of veterans' benefits and services in the United States is reviewed; it demonstrates their responsiveness to dominant political, economic, military and medical interests. The ideological position that social services must be "deserved" is also seen to be an important influence on the V.A. system. The consequent inaccessibility of V.A. medical care to most veterans and almost all non-veterans raises questions about the appropriateness of the V.A. system as a model for national health care. The vast and ever-increasing literature on medical care in the United States all but ignores a major component of the national medical system-the medical services and institutions of the Veterans Administration. Although the V.A. has the "largest medical-care delivery system in the United States" (National Academy of Sciences, 1977: 1), it is rare to find it even mentioned in discussions of national health policies. However, when it is mentioned in the literature, the V.A. is often discussed as a model for a potential national health system (Lipsky et al, 1976; Sapolsky, 1977; Chase, 1977). Since, despite criticisms of its quality and relevance (National Academy of Sciences, 1977; Starr, 1973), the V.A. is likely to continue to be an important segment of American health care in any type of future system, it is essential to examine the model carefully. This paper reviews available literature, the history of veterans' medical services, and recently collected utilization data in order to analyze the principles underlying the creation and continued growth of the V.A. medical system. One must examine the forces which have influenced this set of institutions if one wants to consider the possibilities for a system of national health care in the United States. One can only conclude from the paucity of literature that the V.A. medical system is considered an aberration by most students of American health care (if it is considered at all)-a federally-run national health service in a nation presumably dedicated to free enterprise 1. I would like to thank Bucknell University for a grant received to carry out this research. Thanks also to
Why Treat the Wounded? Warrior Care, Military Salvage, and National Health
The American Journal of Bioethics, 2008
Because the goal of military medicine is salvaging the wounded who can return to duty, military medical ethics cannot easily defend devoting scarce resources to those so badly injured that they cannot return to duty. Instead, arguments turn to morale and political obligation to justify care for the seriously wounded. Neither argument is satisfactory. Care for the wounded is not necessary to maintain an army's morale. Nor is there any moral or logical connection between the right to health care (a universal human right) and the duty to defend one's nation (a local political duty). Once badly wounded, soldiers enjoy the same right to medical care as any similarly ill or injured individual. National health care systems grasp this point and offer few additional health care benefits to veterans. In the United States, however, lack of universal health coverage skews the debate to focus on special entitlements for veterans without considering the health care rights that other citizens enjoy.
The Evolution of the Military Health Care System: Changes in Public Law and DoD Regulations
2000
The dual mission of the defense health care system involves maintaining the readiness of the medical branches of the armed forces to care for wartime casualties and also providing for the peacetime health care needs of active duty military, their dependents, retirees, their dependents, and survivors. The 1956 Dependents' Medical Care Act officially established the availability of health care services to active duty dependents, retirees, and their dependents at military treatment facilities (MTFs). It also authorized the Secretary of Defense to contract with civilian health care providers for active duty dependents' medical care. Legislative evolution of the system The military health care system has two missions. The first is the readiness mission to provide care for U.S. forces who become sick or injured during military engagements. The second is the peacetime mission, which includes maintaining the health of U.S. military personnel and supporting the provision of the military health care benefit to active duty dependents, retirees and their dependents, and survivors. This paper focuses on the legislative and regulatory evolution of this second mission and the costs associated with program change. The military health care benefit is a congressionally authorized program. The level of the benefit is determined in general terms by the Congress, while the actual implementation is left to the Army, Navy, and Air Force. The responsibility of designing the benefit both empowers and limits the military services. The task of giving structure, shape, and definition to federal policy empowers the services during the implementation process; however, they are limited by readiness requirements, congressional mandates ,and funding. Chronic disease Dental care Elective medical care Prosthetic devices Elective surgical treatment Hearing aids Eyeglasses Orthopedic footwear Source: [5] 1. We discuss changes to the active duty, inpatient per diem amounts in more detail in the subsection titled, Beneficiary cost-sharing and program strategies.
2013
While physicians are generally understood as owing moral obligation to the health and well being of their individual patients, military health professionals can face ethical tensions between responsibilities to individual patients and responsibilities to the military mission. The conflicting obligations of the two roles held by the physician-soldier are often referred to as the problem of dual loyalties and have long been a topic of debate. This paper seeks to enrich the dualloyalties debate by examining the embedded case study of medical civilian assistance programs. These programs represent the use of medicine within the military for strategic goals. Thus, a physician is expected to meet his obligation to his role as a soldier while also practicing medicine. These programs involve obligations inherent in both roles of the physician-soldier and thusly they serve as excellent exemplars for the problem of dual loyalties at an institutional level. This paper focuses on Medical Readiness Training Exercises (MEDRETEs). These programs are short-term, generally taking place in low-income nations in order to accomplish strategic goals including training opportunities for military medical professionals that are not possible on the home front. This form of temporary program raises ethical concerns regarding the exploitation of vulnerable populations and the value of what is termed "parachute medicine". The short-term nature of these interventions makes long-term treatment and follow-up impossible, begging the question as to whether this peak and trough approach to foreign civilian aid is of any use. Physicians are generally understood as having obligations towards the well being of the patient, which these programs do not necessarily prioritize. Rather, the programmatic intent is military, with political and strategic aims of furthering international relations, increasing US military global presence and providing austere and tropical training opportunities for military healthcare providers. This can be morally problematic for the physician-soldier.