No hasty reforms for returning wounded

• Article
• Comments ()
• Click-2-Listen
• Videos

By

Genuine scandal at the Walter Reed Army Medical Center seems to be generating potentially hasty reform proposals. Large, systemic problems are being revealed. The reformers need to understand thoroughly the entire remarkably intricate and complex process -- from the moment of battlefield wounding to stateside operations to post-op rehabilitation and outpatient care, to the mental as well as physical dimension of the wound, to the transition to veteran status and possibly life-time partial or complete disability -- and to the effect on the families throughout the process.

They need to understand how the inevitable increase in wartime demand for treatment of the wounded, which is sadly not likely to end with the current wars, ripples through the treatment resources. This affects the Defense Department, the Department of Veterans Affairs (VA), state and municipal government health-care systems, private-sector health systems, community-based rehabilitation facilities and charitable support.

And they need to understand how the total system must not only expand during war but then contract for awhile when the demand for services is blessedly lower, but must also be able to re-expand as new wars quickly require increased capacity. We need to learn once and for all from the slow responses of the system that we have repeatedly experienced in modern times, from World War I, World War II, Korea, Vietnam and to Iraq and Afghanistan now.

This will inevitably require much greater interreliance -- not only between Pentagon and VA resources, but also with the state and community level, the private sector and charitable services. Such interreliance of public-private and intergovernmental resources is not even conceptually understood at this point. Yet it is probably the vital breakthrough necessary to avoid repeating in the future the tragedies of surge and neglect that we have experienced during the last 90 years of war and peace and war.

The reformers need to understand the full financial implications that will affect the federal treasury for generations when they recommend changes in treatment and disability liability for the government. And they need to be fully seized of the drastic current shortages of available caseworkers and other health providers, before they make policy commitments that are probably not doable in the short term -- no matter our good intentions.

This is far more complex than the disgraceful conditions revealed at one of the auxiliary buildings at Walter Reed.

To respond to those scandals, Congress and the executive branch created, by our noncomprehensive count, more than 15 commissions, panels, working groups and interagency task forces, etc., ranging from the President's Commission to the Pentagon's Independent Review Group to the VA's Special Advisory Committee to so many more.

All these needed and worthy panels are feeling the hot political pressure to report back promptly and compassionately with comprehensive recommendations. They should certainly move with alacrity -- but not in haste.

From what we hear from a number of these panels, the government-political-media timetable to reach conclusions and make public reports is wildly ahead of the hard analytical process necessary to reach sound long-term policy and operational conclusions. Phrases with huge implications for both quality of service and cost are being thrown into reports without even cursory study of their impact.

In an effort to avoid political criticism that might come in a report excluding any current failure from the commitment for immediate repair, there is a danger that the various reports will not prioritize what must be done in the short term, from what needs to be done for the long term. Timeline policy triage is necessary -- but being politically unpleasant, it may not get performed.

Indeed, there is an insufficient feedback loop between the different panels. The sense that they must rush to public conclusions is denying several of the panels the time to benefit from the good work being carried out in the current panels.

Moreover, this kitchen-sink approach to listing problems and commitments to reform is leading to a failure to assign priority to the timing of different action items, as well as a failure to define objectives clearly and a failure to build in carefully focused accountability for ongoing improvements.

In future editorials we will focus on specific elements of needed reform. But for now, we urge both Republicans and Democrats, the executive and legislative branches and the press and the public to ease back their expectations for quick-review-process public conclusions.

Give the hundreds, probably thousands, of staffers and policy-makers both in and out of government a chance to get their teeth into the meat of the problem. We have a big responsibility to take care of our returning wounded and their families. It's a big problem, and it will take some time to sort through what we can do, and how and when we can rationally do it.