Abstract
Ever since the end of the Vietnam War, when the draft was abolished and an all-volunteer army took its place, the US military has been an essentially working-class institution. In the words of military historian Andrew Bacevich, it has offered “credible paths to career success for those who were not white and not male.” Recruits overwhelmingly hail from households making < $87,000 a year, often from parts of the country where economic opportunities are scarce.
To attract them, the government has relied on what has been termed the “military welfare state,” offering a range of benefits as compensation for their service. The social safety net for civilians has been under attack for some time, but until recently, the veterans had been spared out of respect for their sacrifices in the nation's defense. Our Veterans, a collaborative effort by health policy expert Suzanne Gordon, labor journalist Steve Early, and reporter Jasper Cravens, has an unsettling message: vets are now fair game for those who hope to shrink government and privatize public services.
The timing could not be worse. After repeated redeployments, veterans of “forever wars” in Afghanistan and Iraq are coming home with unprecedented medical needs, difficulties in adapting to civilian life, and mental health issues. The severity of the latter can be seen in a chilling statistic: for the first time in history, vets are committing suicide at a higher rate than civilians.
Our Veterans suggests that the federal government's commitment to veterans has never been completely reliable. Just two years after the establishment of the Veterans Administration in 1930, vets made destitute by the Great Depression joined the Bonus Army and marched on Washington demanding relief. They were routed by federal troops. During World War II, anxious to avoid a replay of the Bonus March, Congress passed the G.I. Bill, assuring that returning vets would have access to government-subsidized college tuition and low-interest housing loans. A network of hospitals and outpatient treatment facilities was established, eventually evolving into the Veterans’ Health Administration (VHA).
The VHA “delivers care that is more integrated, more coordinated, and of higher quality and lower cost than any other health care system in America” (p. 18). It trains 70 percent of the nation's medical residents, has done pathbreaking research, and provided indispensable backup for overtaxed civilian hospitals during the COVID-19 pandemic. Its doctors, unlike most private sector physicians, have the expertise and experience to handle the complexities of combat-related illnesses like PTSD and traumatic brain injury, all too common among Iraq war vets.
For all the VHA's strengths, the willingness of Congress to fund it has not kept pace with need. Facilities are closing, staffing vacancies go unfilled, vets cannot get timely appointments, and the Veteran Benefits Administration that approves claims has a growing backlog. In response, politicians invoking the rhetoric of “free choice” have outsourced care, creating “a potential bonanza for private healthcare interests” (p. 129). A 2014 law “diverted nearly $10 billion from the VHA to private sector hospitals, doctors, and administrators, while letting in-house services suffer” (p. 168). Seven years later, outsourced care accounted for 20 percent of the VHA's clinical budget. However, access remains problematic, and there is a disturbing pattern of overcharging by private providers.
This profiteering is not confined to medical care. For-profit diploma mills suck up 40 percent of the tuition subsidies offered under the GI Bill and often leave vets without marketable skills. Young people recruited into the military straight out of high school are often financially illiterate, making them easy prey for payday lenders. Many recruits reenlist to pay off their debts. Yet military pay, while secure, is so low that 750,000 military families qualify for food stamps.
Who speaks for vets? Traditional veterans’ groups like the American Legion were often used to further a right-wing political agenda, but at least they were member organizations. As the older generation of vets dies off, old-line advocacy groups are being supplanted by the likes of the Koch-funded Concerned Veterans of America, which advocates replacing the VHA with vouchers for private care. Described by the authors as “a case study in corporate-based astroturfing,” CVA “has no grassroots infrastructure, in the form of posts or chapters. Its national leadership and staff have no accountability” to a membership (p. 123). What it has is money and influence in Washington.
Our Veterans is exhaustively researched and rich in detail—so detailed that its polemical force is somewhat lessened. But its underlying message could not be clearer: this is a class issue, part of a larger assault on public services in the name of private profit.