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?
Unfortunately, the ultimate cost of this generosity to veterans with spina bifida babies will almost certainly prove vastly, vastly greater than a single billion. For the real issue here is that Congress has for the very first time made veterans' health-care benefits available to the children of former soldiers. A precedent with huge implications has been set. Evans understands that. In his March statement he went on to declare, "The connection of Agent Orange to Spina Bifida only raises troubling questions as to if there are any other medical problems that children of Vietnam Veterans may have inherited." Who can doubt, in a country ready to panic over breast implants and other unproven threats, those problems will be found?
And why should only Vietnam veterans be indemnified against their children's sickness? There were chemicals in the air in the Persian Gulf, and chemicals will undoubtedly be used or encountered in America's future wars. Future veterans will expect equal treatment. And why only medical problems? Congress last week voted a package of health-care legislation that requires employers to offer benefits for mental as well as physical illness. Surely veterans deserve the same standard of care. Which heartless Republican congressman will deny that Junior's "attention deficit disorder" might be traceable to Dad's "post-traumatic stress disorder"?
It used to be expected that as the number of World War II veterans shrank, so too would the cost and functions of the Department of Veterans Affairs. Thirteen million men and women wore the uniform of the United States in 1945; only about 1.5 million will do so at century's end. Theoretically, the Veterans Affairs apparat of 2046 should require only about one-ninth the budget of today. But canny Veterans Affairs administrators are one step ahead of us: If their department runs out of veterans to take care of, it will settle for the children of veterans.
This may sound alarmist, but it is almost impossible to be alarmist about the growth of federal entitlement programs. In the mid-1960s, Medicare was projected to cost about $ 10 billion annually by the time it was up and running; adjusting for inflation, it costs five times that sum, and will probably cost six times as much in 2001. Medicare and SSI have even more dramatically outpaced expectations. A very, very bad precedent was set with the Agent Orange bill; a precedent whose ultimate costs will be measured in the tens of billions of dollars. It is a sad final legacy of a Congress that began with such bright hopes.
by David Frum