ROBERT KLEIN's Wounded Men, Broken Promises provides a compelling account of the Veterans Administration's performance in meeting the healthcare needs of America's veterans. It is a deeply disturbing book. Klein, a PhD in clinical psychology and winner of the Albuquerque Press Club Award for a series of articles on VA hospitals, has succeeded in making clear the stark contrast between the VA's official rhetoric and its actual performance. Besides chronicling the checkered history of the Veterans Administration from its scandal-ridden beginnings as the Veterans Bureau in the Harding administration to the present, Wounded Men, Broken Promises destroys the VA medical system's claim of "health care second to none" for American veterans. Klein's shocking indictment of the VA is a grim reminder to all veterans that their dependency on its medical system may be dangerous.
As Klein note, though there are more than 30 million veterans in the United States today, only about 3 million regularly rely on the VA to meet their medical needs. However, of this smaller number seven out of eight possess no other health-care insurance whatsoever. In short, without the VA's medical system (hospitals, out-patient clinics, domiciliaries, etc.) these veterans would be compelled to rely on their own resources to pay for medical care or, lacking the financial means, on welfare or charity. Further, the 3 million total represents an annual growth, over the last several years, of 6 to 8 percent. This increase, due partly to sky-rocketing health costs not completely covered by health insurance and the increased medical problems of America's aging veterans population, threatens the very existence of the VA's medical system.
In dealing with these and related issues Klein provides both friends and foes of the VA's medical system with considerable ammunition aimed at what the VA needs to do to put its house in order or, obversely, the justification to close it down. Klein documents, in case after case at hospital after hospital, reports of patient abuse and neglect. These horror stories are reinforced by others, which demonstrate that unsuspecting veterans have also been used as human guinea pigs in drug-testing programs or as subjects of unneeded surgery. As Klein points out, veterans who lack strong family support or outside clout from a veterans' organization are the ones most likely to be selected for these nefarious programs. The "informed consent" of these veterans, which is ostensibly a precondition for surgery, drug experiments and so forth, is often secured by deceit and coercion.
Klein's analysis raises the important question whether, in fact, the VA medical system can or should be allowed to survive. His evidence indicates that in spite of increased demand for VA medical system services the capacity to provide them is deteriorating at an alarming rate. In this regard, the Reagan budget would strip the VA of 12,000 hospital beds and slash 20,000 full-time medical positions within the next six years. These cuts have produced an outcry of protest from the veterans' service organizations such as the American Legion and Disabled American Veterans. Whether this protest will succeed is hard to say. However, Wounded Men, Broken Promises constitutes an important point of departure in any rational debate about the future of the VA medical system.
As Klein shows, the shabby medical treatment veterans receive or have received from the VA is part of a larger problem, namely, how we as a nation keep faith with those who are called upon to defend our country and fight its wars. Failure to keep that faith is a very risky course of action. The veterans interviewed by Klein are consistently bitter. Their bitterness is not based on self-pity, but reflects their anger over the mockery made of their military service. This anger is by no means confined to Vietnam veterans. Those who fought in World War II and Korea and now need proper medical care from the VA are unable to get it. This radicalization of veterans from America's more popular wars is an important theme of Klein's book. It suggests a growing cynical disbelief among veterans and their families in the words and deeds of their government. Klein's arguments are most persuasive. By opening the closed doors of the VA hospitals, Klein demonstrates for all to see what lies behind that disbelief.
Wounded Men, Broken Promises is an important book. It deserves to be widely read. Klein's diagnosis of what ails the VA medical system will no doubt stir calls for a congressional inquiry, or perhaps establishment of yet another presidential commission. That's all to the good; however, these efforts, like similar ones in the past, will come to naught as long as we persist in thinking that the costs of meeting veterans needs can be separated from those providing for the national defense. At present, the VA medical system, like the Department of Defense from which it derives its patients, is in a state of disarray, and the one can't be fixed without the other. It is sheer folly to think that the conditions which Klein describes do not and will not have any influence on those President Reagan is counting upon to fill the ranks of the all-volunteer force. No veteran joined the military with the expectation of being hurt, but when it happens he or she has every right to believe that the VA will be there to help. Today the VA is not able to provide that help, and we all suffer as a result.