When It Costs Too Much to Support the Troops

WASHINGTON — The comment was outrageous, but it was not the least bit surprising. A psychologist responsible for assessing returning war veterans for post-traumatic stress disorder — a psychological ailment that could entitle them to monthly disability payments — told staff members not to diagnose the illness because to do so would increase the government’s costs.

“Given that we are having more and more compensation-seeking veterans, I’d like to suggest that you refrain from giving a diagnosis of PTSD straight out,” the psychologist at a Department of Veterans Affairs center in Texas wrote in an e-mail. She suggested diagnosing a less severe disorder that would not carry the greater long-term disability costs.

The correspondence was made public by VoteVets.org and Citizens for Responsibility and Ethics in Washington, two groups that have dogged the Bush administration about our latest national disgrace: the shoddy care and bureaucratic callousness shown toward the warriors who are returning from Iraq and Afghanistan with life-altering wounds of the body and spirit.

Of course, the morally indefensible missive was repudiated by higher-ups in the Department of Veterans Affairs as soon as it was revealed last week. And, of course, the persistent congressional outcry over the treatment of veterans — not to mention the onrushing election season — makes it more likely than not that some temporary alleviation of the pain and suffering vets endure in a system that is supposed to be serving them will be addressed. Somehow, some day, that is.

That bit of politically induced relief for vets, should it come, does not change the underlying sentiment of the message. Because at bottom, it is a demoralizing reminder of the way the U.S. health care system works for just about everyone.

Certainly, the government agency in charge of caring for veterans is not supposed to behave this way, under the law or any standard of conscience.

In truth, the mind-set mirrors the unconscionable standard of the health insurance industry’s thinking that the rest of us must endure — and from which neither leading candidate for president promises much relief.

The industry’s term for paying a claim is “medical loss.” This is a disturbingly blunt but perfectly accurate reflection of reality: To make a profit, an insurer must take in more money than it pays out in claims. Denying payment on claims, or strictly limiting payments even for the most obvious or debilitating medical conditions, is how the industry stays financially viable.

“I was told repeatedly that I was not denying care, I was simply denying payment,” Linda Peeno, a doctor and former managed-care medical claims officer testified before Congress in 1996. A video clip of her testimony was included in Michael Moore’s 2007 documentary “Sicko,” the story of how the American health insurance system really works — or rather, doesn’t — for most people.

The slip-up at the veterans’ health agency comes at a propitious time, because neither of the two men who could become president next year would do anything to change the type of thinking it revealed. Democrat Barack Obama relies on the current, if uneasy — and increasingly unworkable — partnership between the insurance industry and employers to expand coverage. But Obama would not make universal coverage mandatory, and so insurers would still be able to cherry-pick among those it really wants to insure (the healthiest, and therefore the cheapest) and those it doesn’t (the sickest and most expensive).

Republican John McCain’s answer is far worse. He would effectively break the link between employers and the insurance industry and give individuals a tax credit with which to buy a policy on their own — a purchase they would make at the mercy of insurers. If you liked President Bush’s plan to privatize Social Security and move toward a do-it-yourself retirement system, you’ll love McCain’s do-it-yourself answer to the insurance crisis.

But, of course, no one can really do it himself because the whole idea of private insurance is to spread risk broadly. That’s why employers are able to purchase policies more cheaply than can individuals: The expensive employee whose child has cancer is offset by the cheaper employee who is as fit as a marathon runner.

The psychology of the cost-conscious official at the Texas veterans medical facility is the psychology that controls the health care system for all of us. If we are outraged at the hint that it might be applied to wounded servicemen and -women, we should also be angry that it is applied every day to the rest of us.

Marie Cocco’s e-mail address is mariecocco(at)washpost.com.

© 2008, Washington Post Writers Group