Match vets' care to modern war

The axiom about generals always fighting the last war appears to be true as well for health care provided veterans before and after their discharge.

As the military struggles to understand counterinsurgency warfare, medical and mental-health services are grossly inadequate for modern times. The concussive blasts of improvised explosive devices and the up-tempo rotations of an all-volunteer military are creating more traumatic brain injuries and post-traumatic-stress disorders. Breaking down the barrier between acute care for the wounded in battle and long-term rehabilitation of veterans is a key component of 35 recommendations from a presidential commission on medical treatment for troops returning from Iraq and Afghanistan.

A goal of the commission, led by former Sen. Robert Dole and former Clinton Cabinet member Donna Shalala, is a seamless transition between the Department of Defense and the Department of Veterans Affairs. An integrated system would track treatment and progress by a team of physicians, open access to medical records and ensure that information followed a veteran from facility to facility.

Frustration over medical records and timely information is so intense, the U.S. Senate passed a measure last week with a parallel recommendation to create joint electronic record-keeping.

The commission also wants to overhaul the current system of disability ratings and its associated pay system. Existing rules and regulations are a source of extraordinary frustration.

The commission's assignment was not about saving money, and must not be. As a nation, we have an obligation to those who stepped forward to serve their country. Too often, their courage and sacrifices have not been honored or properly respected. Doing things right could cost $500 million a year initially and as much as $1 billion in later years.

Part of the remedial program for the Pentagon and VA is an attitude change. Long after post-traumatic-stress disorders of the Vietnam era were evident, the federal bureaucracy skimped on mental-health services. The report found a shocking lack of urgency and leadership in extending help.

To its credit, the commission was sensitive to the role of families in healing and the burdens they share during treatment and recovery. New thinking is offered on family counseling, family leave and insurance benefits.

Congress is active and engaged, but many of the changes can be accomplished without legislation by the executive branch. The to-do list is clear.