Editor's Note
Paying the Price for War
America is at war, and we’re beginning to feel it. The mirage of a quick victory and a sleight-of-hand regime change has evaporated along with Saddam’s weapons of mass destruction, and the nasty realities of Iraqi sectarian bickering and guerrilla warfare now command headlines. The Iraq War has crept or stalked into every corner of American society, and medicine is no exception.
Not every war is felt in the same way. Our paradigmatic war was World War II, when the entire country was mobilized against evil foes. For four years, while our GIs fought in two theaters, Americans at home rationed gas, saved twine, and reused tires. To defeat the three satanic rulers, Hitler, Mussolini, and Hirohito, all Americans sacrificed. For the “greatest generation,” World War II defined war.
We really haven’t had a war like it since. The Korean War featured an ominous enemy invading across a border, but the United States employed “creeping mobilization,” and our domestic life was relatively unfazed. Vietnam blew away the rules of war—a hazy enemy that melted into the population, hazier politics that blurred the dichotomy between good guys and bad guys, and a restive home population that grew to hate the war. The 1980s and ’90s brought a series of tidy little wars, “police actions” in Grenada, Panama, and Haiti that made headlines for a few days and hardly cost the American people a drop of sweat. A little less neat and a bit longer, the Gulf War was still a relatively small hiccup in American life.
Iraq threatens to become our greatest national cataclysm since Vietnam. As American deaths climb past 2,000 and domestic protest against the war spreads, the cost of the war in dollars, lives, and morale is becoming more apparent daily. A recent Atlantic Monthly column estimated that Iraq’s price tag, including yearly expenses of $100 billion plus future debt and disability service, could exceed $1.3 trillion. Although the Dow Jones recently topped 11,000 again, dire predictions about the future of Medicare and Social Security combined with rising federal deficits have pundits asking if our economy can pay for social programs at home and a prolonged war in the Middle East. Will the diversion of billions of dollars for bombs instead of bandages nudge an already teetering health care system toward bankruptcy?
Since Saddam’s overthrow, our soldiers have confronted a Vietnam-like guerrilla war with its own twists, improvised explosive devices instead of landmines doing the maiming and street-to-street instead of hamlet-to-hamlet fighting. Minnesotans such as Paul Huddleston, M.D., have had frontline experience in this different kind of war with its different kind of injuries (see “Combat Surgeon,” p. 24), and VA facilities have had to adjust as the injured return home (see “Rebuilding Bodies and Mending Minds,” p. 30). Civilian physicians who care for returning National Guard and Reserve members are also having to think differently when assessing these patients for physical and emotional injuries (see “Be Prepared,” p. 16).
Whether any war is “worth it” is a judgment settled, if ever, by historians long after the last shot. That model war, World War II, perhaps was the last to garner an almost unanimous approval rating. Iraq’s future is unsettled at best, and the votes about the success of American involvement remain untallied. In the meantime, we have injured soldiers and a crippled economy that need tending.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at cmeyer1@fairview.org