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Burdens of War

Creating the United States Veterans Health System

Jessica L. Adler

Johns Hopkins University Press, Baltimore, 2017, 368 pages

Book Review published on: December 3, 2021

Jessica L. Adler has written an important history of the early development of the U.S. veterans’ health system in Burdens of War: Creating the United States Veterans Health System. Her story traces those origins from the start of World War I into the 1930s, with a key focus on events during and just after the war. This is a thoroughly researched book that capitalizes on the large amount of official primary sources in innovative ways to tease out both an institutional history and many of the individual stories that illustrate it. This is not boring, bureaucratic history, but a compelling tale of human experience. Adler tells an important story that will be of interest to World War I era historians, social historians of the soldier, those trying to understand the institution of the federal government, and any veteran who uses the Veterans Administration hospitals today.

Adler is an associate professor in the Department of History and Department of Health Policy and Management in the Robert Stempel College of Public Health and Social Work at Florida International University. She researches and teaches about U.S. health and social policy, war and society, and American political development. Burdens of War is part of the series Reconfiguring American Political History from Johns Hopkins University Press. Adler continues this focus in her current research into the late twentieth-century veterans’ health program.

The origins of today’s veterans’ health care system began with the 1917 War Risk Insurance Act, which established the principle that ex-soldiers would receive necessary medical services after their release from the military. The progressive impulses of the time also promoted the ethic that soldiers would be discharged as healthy civilians and contributing members of society. From these principles, and because of the lack of definition for the responsibility to execute these goals within government, the health care system began to grow for veterans without clear direction, but still irresistibly. Adler includes the creation and growth of Walter Reed Hospital as a key part of this early story. Walter Reed was illustrative of the newly cemented importance of institutionalized medicine and those who administered it.

As soldiers from World War I left service, the early goal of having them reach a state of health before discharge proved unreachable, and Congress enacted legislation and passed funding, which made government agencies besides the military responsible for care after discharge. Principal among these agencies were the Bureau of War Risk Insurance and the Public Health Service, who cooperated in a makeshift system. Yet the system could not meet rising demand for care from veterans and the organizations that represented them, mainly the American Legion and the Disabled American Veterans. These advocacy organizations kept pressure on Congress for more and better hospitals and care. Ultimately, the inability of the makeshift system after World War I resulted in the creation of the Veterans Bureau in August 1921. Burdens of War traces the continued growth of the veterans’ health care system from there into the Franklin D. Roosevelt administration, which during the Depression tried to restrict this system but could not.

Adler explores the legislative and lobbying turning points in this growth of veterans’ health care. She outlines the provisions of each key law, and some of the debate which surrounded them. She relates the individual experience of many veterans in a way that fully illuminates both the human need and the human impact of these laws and institutions. She shows that two key components of the veterans’ population, among others needing continued care, were those with tuberculosis and those suffering from the mental illness brought on by the trauma of war. The story ultimately reminds of the human impact of military service, the cost it incurs, and the need to honor those who have served. Adler includes telling descriptions of the impact of race, class, and gender in the historical evolution of care in a way that positively connects to current issues in the United States. She provides a thorough bibliographic essay that is both a full historiography and a road map to innovative use of primary sources. This is a useful and important history that should inform every current veteran within the system that now exists in the United States. Burdens of War is an insightful, well-written history of the post-Great War era and the growth of American governmental institutions.