March 7, 2007: The recent scandal over poor care for wounded soldiers in the Washington, DC area, was yet another example of how sensitive is the issue of veterans care and benefits. Ever since the American Revolution, the issue of how veterans should be treated has been prone to excite moral outrage, political grandstanding, lurid headlines, and even a little action to improve the care for veterans. The most recent scandal involved poor administration of outpatient care for wounded troops from Iraq and Afghanistan. Some of the accommodations for the recuperating troops was not maintained properly, and the medical bureaucracy had become very patient unfriendly. After the problems hit the headlines, the general in charge was fired, as was his successor. The Secretary of the Army resigned and Congress held hearings to wring maximum political advantage out of the situation.

Meanwhile, the Veterans Administration has actually improved its care over the past decade, to the point where opinion surveys show that veterans rate their care, by the Veterans Administration hospitals, as superior to what they encountered in the commercial health care system. A study of Veterans Administration health care, by a team of medical professionals, found that health care for veterans had, indeed, risen to a level higher than that available for non-veterans.

But the war on terror has generated over 20,000 wounded, and even more sick and injured troops, over the last six years. This is a much lower casualty rate, for the size of the force, than in past wars, and you'd think that the military health care system could handle it. In terms of immediate health care, they did. It was the after care, and the services required for dependants and active duty reservists, that overwhelmed the system. The military bureaucracy has been consistently unable to cope with the blizzard of paperwork that accompanies any increase in benefits, including healthcare, provided to military personnel. Reserve troops, mobilized for active duty in the last five years, have been the chief victims of these bureaucratic catastrophes. In light of that, it's no surprise that outpatient care for a larger number of wounded troops should become a problem.

Interestingly, the marines applied their usual initiative and innovation to the problem. They established special living quarters on their bases, for recuperating marines. The marines also sent in additional clerical support, to deal with the jammed up Department of Defense medical bureaucracy. So it wasn't a problem that could not be solved, it was just one that required better leadership and management skills than the army provided. As one army official commented, the shabby housing for the outpatient troops was a failure by some senior NCOs (the first people to see the problems, and the ones who should get the fix in motion as quickly as possible.) But those NCOs work for officers, who apparently did not go see for themselves, as officers should, what the problems were, and how the solutions were being applied.

The army has an institutional hangup with these problems, which has showed up in the form of bad troop housing and paperwork hassles, many times before. These situations have been turned into headlines and career killing scandals before. But somehow, after immediate fixes are applied, the system settles back into the same routines that will create more scandals in the future. Despite lots of efforts by people in the army, the problems remain. Changing, "the system," is not at all easy. And this is just another example.