Uninsured and underinsured Americans were big news in 2007: their combined ranks grew to 63 million. When President Bush visited Cleveland, Ohio, in July to give a speech on his administration's priorities, he unwittingly tripped one of health care's biggest land mines. "I mean, people have access to health care in America," he told Ohio business leaders. "After all, you just go to an emergency room."
This wasn't news to providers of emergency care. In 2003 there were nearly 114 million ED visits, a rise of 26% in 10 years, according to the Institute of Medicine (IOM) 2006 report Hospital-Based Emergency Care: At the Breaking Point. And in October Congress passed a bill that would authorize an additional $35 billion (funded by a tobacco tax) over a five-year period for the State Children's Health Insurance Program (SCHIP), initiated in 1997 and up for reenactment last year. The president vetoed the bill. As we went to press, SCHIP was funded through mid-December, and the debate continued.
Wounded warriors. Americans were shocked by Washington Post reports in February of substandard conditions and treatment delays for the hundreds of soldiers wounded in the Iraq and Afghanistan wars treated at Walter Reed Army Medical Center. Military heads rolled, and the subsequently convened President's Commission on Care for America's Returning Wounded Warriors prompted repairs and additional health care personnel and services at the facility.
Nearly 4,300 Americans have died and 30,000 been wounded in the wars in Iraq and Afghanistan, wars that have cost the country $1.5 trillion. More stunning, perhaps, were the statistics cited in a CBS News report on the suicide rate among members of the armed forces. On November 13, the network reported that in 2005 more than 6,200 people in the U.S. military committed suicide -"120 each and every week, in just one year," the network announced-and the rate was twice as high among veterans as nonveterans.
That report came just weeks after Congress had passed the Joshua Omvig Veterans Suicide Prevention Act, named after an Iowa soldier who had taken his own life. The law directs the Department of Veterans Affairs (VA) to train VA staff, assess veterans, conduct research into the problem, and establish a 24-hour hotline, among other things.
Many soldiers are showing signs of posttraumatic stress disorder and other psychiatric disorders, substance abuse, and family problems, according to an IOM report scheduled to be released this year, Gulf War and Health, Vol. 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. Also, Milliken and colleagues reported in the November 14 issue of JAMA that several months after returning home from Iraq or Afghanistan, soldiers had significantly greater mental health concerns than they did immediately after their return: 20% of active duty personnel and 42% of reserve soldiers required "mental health treatment."
Joy Jacobson, managing editor