1921

Creation of U.S. Veteran’s Bureau (later VA and now Veterans Affairs), which consolidated work of War Risk Insurance Bureau, USPHS, and rehab division of the Fed Board of Vocational Education (FBVE), and also instituted federally funded system of hospitals solely for health care of America’s soldiers (Linker, 166-167). “It was obvious [in 1918] to all concerned that a national veterans hospital system could not be planned in Congress without an out-and-out contest for federal funds [re location of new hospitals], with vote trading, logrolling, and the general ‘odor of pork’ . . . the only fair way to design a national hospital program for veterans was to remove it from the political process altogether. A prime ingredient of the eventual veterans hospital program, then, was the inability of Congress to design a national program itself. Consensus was to be achieved . . by the displacement of political decision making to the realm of experts, who were to be drawn from the national organizations of health and medicine” (Stevens III, 291). The “military efficiency” of the four consultants, who reported directly to Sec. Treasury Andrew Mellon, contrasted with “the sprawling muddle of the Veterans Bureau,” whose first director, Charles R. Forbes, was indicted for bribery and fraud in administration of the hospital program of the Veterans Bureau in 1923 (295). In 1924, veterans became eligible for care for conditions unrelated to their service if hospital beds were available: “With one stroke of the pen, then, the original hospital and medical program, which had been designed as workers’ compensation, was translated into comprehensive hospital insurance” (296). The AMA now became apprehensive about this extension of veterans care as “socialized” and, as of 1930, “communistic” (296). But, like Medicare after it, it became accepted as the status quo and there was little talking of turning over veterans’ care to civilian hospitals after WWII, despite concerns elsewhere about “socialized medicine,” states’ rights, etc. (297).