18 sep. 2008

Health’s Gain May Be Army’s Loss

Call it the law of unintended consequences. When you fix one thing, it messes up other things.
If the Democrats win the election this year, and are able to enact a health care plan that extends adequate coverage to all Americans, the loser could be the Army. Getting enough people to enlist could become a major problem for the next president.
Senator John McCain, the Republican candidate, has already pointed out that Senator Barack Obama, the Democratic candidate, never served in the military. It remains to be seen how potent that will be as an issue, given the fact that the last four presidential elections have been won by the candidate with the less impressive military resume.
But there is something else that distinguishes Mr. Obama from all recent candidates for the presidency. He would be the first presidential nominee to come of age after the draft was abolished in the administration of Richard M. Nixon. He never had to decide how to deal with the draft, and legally was under no more pressure to enlist than he was to go to medical school or become a bus driver. Joining the military was a career option like any other.
And that has made it harder to put the Army together. Government polls show that the proportion of young people who think they might enlist is roughly half what it was in the late 1980s. The military has responded with more recruiters and higher cash enlistment bonuses, and has met its goals. A significant factor for many recruits, it turns out, is the military’s generous health benefits for dependants.
Michael Massing, writing in the April 3 issue of The New York Review of Books, tells the story of one part-time college student from Brooklyn, who was holding down two jobs but still going into debt. “Meanwhile, he got married, his wife got pregnant, and he had no health care. From a brother in the military, he had learned of the Army’s many benefits, and, visiting a recruiter, he heard about Tricare, the military’s generous health plan.” He enlisted.
It seems a bit perverse that the incentives for a young person with children to join are greater than the incentives for his childless friend. But that is the way it is. All that could change if the push for some kind of national health insurance program were to be successful.
It is true, of course, that Democrats have been talking about such things for generations. The failure of health care legislation during Bill Clinton’s first two years in office left some viewing the issue as political dynamite — good for a campaign but fatal to anyone who tries to pass a specific program. It is quite unclear how the government would pay for a comprehensive program, and no candidates seem eager to discuss ways to hold down health care spending.
But if such a program were adopted, it seems likely that the military, and particularly the Army, would feel the immediate effect. To expand the Army, as all the candidates say they want to do, would require some other incentive for enlistment, particularly when the economy recovers.
In the near term, it is possible that a recession will improve the military’s recruiting success. The official unemployment rate is growing but still low, however the proportion of Americans who expect the job picture to improve is at its lowest level in a quarter century, according to the Conference Board’s consumer confidence survey. That survey shows that younger people are still more confident than older ones, but the confidence of both groups has fallen sharply this year.
One partial solution to the negative effect on enlistment of a health care plan for all could be a new G.I. education benefit. Both the House and Senate have approved such a plan, but as part of the Iraq funding bill on which there are major differences. President Bush is opposed to the legislation (and so did Senator John McCain), which its sponsors say would cost $50 billion over 10 years, and it is far from clear it will be enacted.
The bill approved by the Congress would give enhanced education benefits to all veterans who spent three years in the military after Sept. 11, 2001. They would be eligible for full tuition at a public university, and about $1,000 a month for living expenses and more for books.
Senator Jim Webb, a freshman Democrat and Vietnam veteran, is the principal Senate sponsor of the legislation. He argued — with something less than precise data — that passage of the bill would increase enlistment by 16 percent, and bring in more high-quality recruits who valued the education benefit. Both Senator Obama and his former Democratic rival, Senator Hillary Rodham Clinton, support that bill.
Senator McCain has proposed a less costly alternative that would provide better benefits to those who stay in the military longer. The try until you die principle. He should have a point if joining the army is healthy. Last year about three-quarters of Army volunteers who completed their first term of enlistment, and nearly as many marines, chose not to re-enlist. Offering better education benefits after three years could encourage enlistment and discourage re-enlistment.
If we get a real health care plan for all Americans, it might require something like the Webb bill — or a very unpopular revival of the draft — just to keep fighting in Iraq and Afghanistan. The backers of health care legislation do not want to hurt the Army, but that is what could happen.