Are veterans with smoking-related ailments eligible for "service-connected" disability benefits? Until a few years ago, the answer was: Of course not. But in 1993, VA legal experts ruled they should be. Then, just last summer, the VA General Counsel confirmed this ruling and instructed the VA to start implementing it. Henceforth, the VA will deem getting hooked on cigarettes to be just as much of an "injury" as stepping on a land mine -- at least for the purpose of making benefit awards.
At stake is not just Americans' support and respect for an honored national institution, but also the success of efforts to control entitlement spending. Unless Congress votes otherwise, the new ruling will cause VA spending to skyrocket. This rise, not fully reflected in any official budget baseline, is one reason why announcements of triumph over the deficit are premature.
How costly is the ruling? According to the CBO, the new cash payments to smokers and their survivors carry a price tag of up to $10 billion per year when fully phased-in-and that doesn't count several billion dollars more in new health-care benefits. By comparison, everything the VA now spends on all veterans, from pensions to hospitals to housing, amounts to just $40 billion yearly. True, the VA projects a lower cost than the CBO. But this is mostly because the VA assumes it won't be able to process the avalanche of new claims.
If anything, the CBO estimate is too low. It only considers those medical conditions with the strongest links to smoking, such as emphysema and lung cancer, and further assumes that among veterans with these conditions, only half will apply for and receive benefits.
To understand why the VA ruling is so costly, remember that we're talking about a lot of people: Anyone who once served on active duty in the military in any capacity, during wartime or peacetime, is eligible for service-connected disability benefits regardless of financial need. Also keep in mind that veterans won't have to prove that the stress or trauma of military service caused them to develop a lifelong smoking habit. It's enough that they started smoking or began smoking more while in uniform. Nor will veterans have to prove that smoking is the sole (or even the primary) cause of their disability. All that's required is that they suffer from an illness statistically correlated with tobacco use.
For the purpose of determining eligibility, it's also irrelevant whether the military encouraged smoking or knew about the health hazards. Some have noted that cigarettes were once distributed free with K rations. But this is not the operative issue. All that matters is that an injury occurred -- in this case, that the veteran's smoking habit began or "worsened" while in the service.
Thus is a program dedicated to compensating veterans wounded in their country's service being expanded beyond recognition. Apparently, a common personal habit, no matter how tenuously linked to prior service or to a current illness, now entitles you to cash payments for life. What's next? A special benefit category for veterans who ate fatty foods in the service? And should we take back money for the good habits they learned?
The Pathology of Entitlements
The VA ruling perfectly illustrates the pathology of middle-class entitlements: All too often, they set out to address a legitimate problem, but end up doing so in ways that are costly and inequitable. Government may have a role to play in dealing with nicotine addiction as a society-wide problem. But how is this role served by heaping rewards (for smoking!) on one favored group? As Medal of Honor holder Senator Bob Kerrey asks, should the mere fact veterans did their duty as citizens give them an unconditional claim on the public fisc?
Perhaps Generation X has the most at stake. On top of the rising future cost of Social Security, Medicare, and Medicaid, Xers will now have to pay smoker benefits to millions of aging Boomer veterans-benefits for which a much smaller number of Xers (a generation that never experienced the draft) will ever be eligible.
FACING FACTS AUTHORS: Neil Howe and Richard Jackson CONCORD COALITION EXECUTIVE DIRECTOR: Martha Phillips