The Magazine

AN ENTITLEMENT IS BORN

Oct 14, 1996, Vol. 2, No. 05 • By DAVID FRUM
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HOW PANICKED IS THE Republican retreat? This panicked: On Sept. 25, the Republican Congress -- remember, the one filled with extremists -- voted to create what will likely prove the biggest and costliest new entitlement program since Congress enacted Supplemental Security Income in 1972.


The new entitlement serves an almost irresistibly sympathetic cause: crippled children of Vietnam veterans. Proponents promised that the new entitlement's cost would be modest, perhaps a billion dollars at most. To a Republican Congress determined to prove its compassion before hitting the hustings, it must have seemed suicidal to say no.


They ought to have read the fine print. SSI was also a modest program at the beginning, a small supplement to the pensions of the poorest and most disabled elderly. It quickly metastasized; the cost of SSI in 1997 will be $ 30 billion. Most of that money, 60 percent of all the new SSI pensions granted in 1993, goes to an unanticipated group of recipients: disturbed, disabled, and drug-addicted young people. Along the way, SSI has earned a reputation as perhaps the most fraudplagued transfer program in Washington. There is every reason to think that this new entitlement will follow the same sorry course.


The Agent Orange Benefits Act of 1996, to give the new entitlement its full name, assumes responsibility for the surgical and rehabilitation expenses of Vietnam veterans whose children were or will be born with spina bifida. Spina bifida is a particularly gruesome affliction, a failure of a baby's spine to join properly in the womb. It can cause paralysis, brain damage, and the loss of control of bowel and bladder. In the past, spina bifida was usually fatal; it's now often possible to save the child's life, but the cost of the necessary surgery can easily exceed $ 250,000. Lifelong nursing care for the most severe cases can cost much more.


Until now, the cost of caring for spina bifida babies has been largely borne by insurers, state Medicaid programs, and charities, notably the Shriners. Democratic congressmen, led by Lane Evans of Illinois in the House and minority leader Tom Daschle in the Senate, decided that it was time for the Department of Veterans Affairs to begin picking up much of the tab. They argued that Vietnam veterans are fathering an above-the-norm number of spina bifida babies, and they blamed the much criticized herbicide used to defoliate jungle in the Vietnam War, Agent Orange. "These children were just as wounded by the war in Vietnam as their fathers," Evans declared in March. He estimates that as many as 3,000 veterans' children have or will be born with spina bifida.


Proponents of the new benefit are undaunted that the scientific case against Agent Orange is flimsy to the point of wispiness. In 1991, Congress directed the National Academy of Sciences to sponsor studies to investigate the connection between Agent Orange and spina bifida. Two years later the Academy reported: It deemed the evidence for the correlation "inadequate" and "insufficient." That ought to have been good news for veterans exposed to Agent Orange. But it was very bad news indeed for their would-be congressional champions. So the Academy was sent back to work. Earlier this year, it produced a new report, upgrading its description of the correlation from "inadequate" and "insufficient" to "limited" and "suggestive." That " limited" link is even weaker than it sounds: It is based on a new study that the study's own author warned was inconclusive and uncertain.


Conscientiously, the National Academy of Sciences festooned its 1996 Agent Orange update with warnings against premature conclusions. The new spina bifida evidence, the academy cautioned, "[suffers] from methodologic limitations, including possible recall bias, nonresponse bias, small sample size, and misclassification of exposure." Nor is the academy yet convinced that Agent Orange was all that dangerous in the first place: "The toxicity of the herbicides used in Vietnam remains poorly studied." Nor can it say how many or how few Vietnam veterans were exposed to herbicides, or in what quantities: "The definition and quantification of exposure are the weakest methodologic aspects of the epidemiologic studies."


Oh well, one might shrug: Congress has written many billion-dollar checks on weaker rationales than that. And the families that have given birth to spina bifida babies unquestionably need the help, even if Agent Orange turns out to be a hoax. Why begrudge the billion?