Valor and Squalor

By PAUL KRUGMAN

When Salon, the online magazine, reported on mistreatment of veterans at the Walter Reed Army Medical Center two years ago, officials simply denied that there were any problems. And they initially tried to brush off last month’s exposé in The Washington Post.

But this time, with President Bush’s approval at 29 percent, Democrats in control of Congress, and Donald Rumsfeld no longer defense secretary — Robert Gates, his successor, appears genuinely distressed at the situation — the whitewash didn’t stick.

Yet even now it’s not clear whether the public will be told the full story, which is that the horrors of Walter Reed’s outpatient unit are no aberration. For all its cries of “support the troops,” the Bush administration has treated veterans’ medical care the same way it treats everything else: nickel-and-diming the needy, protecting the incompetent and privatizing everything it can.

What makes this a particular shame is that in the Clinton years, veterans’ health care — like the Federal Emergency Management Agency — became a shining example of how good leadership can revitalize a troubled government program. By the early years of this decade the Veterans Health Administration was, by many measures, providing the highest-quality health care in America. (It probably still is: Walter Reed is a military facility, not run by the V.H.A.)

But as with FEMA, the Bush administration has done all it can to undermine that achievement. And the Walter Reed scandal is another Hurricane Katrina: the moment when the administration’s misgovernment became obvious to everyone.

The problem starts with money. The administration uses carefully cooked numbers to pretend that it has been generous to veterans, but the historical data contained in its own budget for fiscal 2008 tell the true story. The quagmire in Iraq has vastly increased the demands on the Veterans Administration, yet since 2001 federal outlays for veterans’ medical care have actually lagged behind overall national health spending.

To save money, the administration has been charging veterans for many formerly free services. For example, in 2005 Salon reported that some Walter Reed patients were forced to pay hundreds of dollars each month for their meals.

More important, the administration has broken longstanding promises of lifetime health care to those who defend our nation. Two months before the invasion of Iraq the V.H.A., which previously offered care to all veterans, introduced severe new restrictions on who is entitled to enroll in its health care system. As the agency’s Web site helpfully explains, veterans whose income exceeds as little as $27,790 a year, and who lack “special eligibilities such as a compensable service connected condition or recent combat service,” will be turned away.

So when you hear stories of veterans who spend months or years fighting to get the care they deserve, trying to prove that their injuries are service-related, remember this: all this red tape was created not by the inherent inefficiency of government bureaucracy, but by the Bush administration’s penny-pinching.

But money is only part of the problem.

We know from Hurricane Katrina postmortems that one of the factors degrading FEMA’s effectiveness was the Bush administration’s relentless push to outsource and privatize disaster management, which demoralized government employees and drove away many of the agency’s most experienced professionals. It appears that the same thing has been happening to veterans’ care.

The redoubtable Henry Waxman, chairman of the House Committee on Oversight and Government Reform, points out that IAP Worldwide Services, a company run by two former Halliburton executives, received a large contract to run Walter Reed under suspicious circumstances: the Army reversed the results of an audit concluding that government employees could do the job more cheaply.

And Mr. Waxman, who will be holding a hearing on the issue today, appears to have solid evidence, including an internal Walter Reed memo from last year, that the prospect of privatization led to a FEMA-type exodus of skilled personnel.

What comes next? Francis J. Harvey, who as far as I can tell was the first defense contractor appointed secretary of the Army, has been forced out. But the parallels between what happened at Walter Reed and what happened to New Orleans — not to mention parallels with the mother of all scandals, the failed reconstruction of Iraq — tell us that the roots of the scandal run far deeper than the actions of a few bad men.