I cringe at least once a day, including weekends, when I watch the nightly news and see pictures of the increasing number of dead and injured people, both military and civilian, in Iraq, Afghanistan, Israel, and other countries. The nightly scenes of chaos, blood, and tragedy are, unfortunately, reminiscent of watching television in the 1960s and seeing the body bags of American soldiers being loaded onto planes to be brought home from Vietnam. The Vietnam War was the first to be fully photographed on television and was dubbed by Michael Arlen as the first “living-room war.”1 Americans can still watch a war happening on television while they're eating dinner, but now the images are more immediate and more graphic. We seem destined to repeat ourselves until we get it right. As far as war is concerned, it seems that we haven't gotten it right yet.

One thing is certain, though. It's hard to get your head around the huge amount of money that is being
spent on the war in Iraq. An analysis of the legislation in which Congress allocated money for the war indicates that, so far, the total amount for the war and the occupation is approximately $318.5 billion.2 Beginning in March 2003, Congress allocated $78.5 billion for Operation Iraqi Freedom, at least $54.4 billion of which was for the war in Iraq. The amount was expanded to cover “ongoing military operations in the war on terror” and in February 2006 included another allocation of $72.4 billion, $60 billion of which was for the Iraq War.2

The United States is spending enormous amounts of money on the war on terror, notably in Iraq, seemingly without regard for the financial toll it will take on this country. The economic ramifications are rarely discussed. As noted by Martin Wolk, chief economic correspondent for MSNBC, “in the buildup of any war, financial costs rarely play a big role in the debate, especially for a superpower like the United States, which is presumed to have virtually limitless resources.”3 But no country has unlimited resources—even though the government always seems to find the money to fight wars. It is impossible for any country to pay for everything its elected officials—and its citizens—want. Somewhere, somehow, someone loses.

Costs of another kind

This editorial is not just a diatribe about the Iraq war. It is also about how much that war is costing when so many people in this country—adults and children—cannot afford decent health care.

I would like to believe that the typical PA is similar to the Roman goddess of justice, often called Lady Justice—the personification of the moral force that underlies the legal system. She holds evenly balanced scales that represent the impartiality with which justice is served. During the 16th century, artists started showing the lady blindfolded to show that justice is not subject to influence, giving us the phrase, “justice is blind.” I would like to believe that PAs, too, are “blind” in this sense—that they belong to a profession that dedicates itself to caring for the sick and injured, regardless of age, race, gender, or insurance coverage. As such, PAs can play and have played a pivotal role in improving the health of this country's citizens. It stands to reason that if more money is available for health care, to pay both for the direct costs of disease management and preventive maintenance and for the indirect costs of affordable housing, school nutrition programs, and community safety, we will have healthier Americans. And PAs will have made a significant contribution to this effort.

If a larger portion of federal funds could be reallocated to provide health care coverage for all Americans, this country would have every reason to be proud of how it cares for its own. However, 20% of the 2006 federal budget was intended for national defense and only half of that amount for health.4 America is one of the richest nations in the world and should have the resources to take care of the health of its citizens. It is all a question of priorities.

While researching this editorial, I came across a Web site that shows the real-time expenditure of the cost of the war in Iraq and how that money could have been used to pay for health-related services.5 The $316 billion already spent on the war could have insured 189,448,620 children for 1 year, or built 2,980,839 housing units, or paid for 43,848,366 children to attend a year of Head Start. Those are extreme examples of comparing the costs of waging war with those of ensuring healthy citizens, but they do highlight the financial trade-off that has to occur when difficult choices are made.

If fewer of our tax dollars are spent in one area, money can be freed up to spend in another area. There is never enough to pay for everything. Americans, too, have to make difficult choices. Clearly, how the government spends public money is more complex than how we spend our own. Yet the basic economic premise holds true—if you spend more than you have, someone loses.

Making a difference, one PA at a time

I am frustrated with the health care system in this country and distressed at how many of our citizens do not get what they need. I am angry when I turn off the nightly news after witnessing the tragic loss of those who have worn to protect us and to defend all the benefits that freedom brings. Don't misunderstand me: I am grateful for the military personnel and all they give us, including their most precious gift—their lives. But sometimes it seems to be such a waste—of human life, money, and resources. As a citizen first, and as a PA second, I want to do something to make a difference— and I want to do it now. I'm not a politician and I never plan to be one, so changing how the government runs will be someone else's job. But I do know how to take care of the health of others, I can do it soon, and I can do it for free!

The month of November contains one of the important volunteer opportunities of the year: Thanksgiving. During this holiday, we express our gratitude for all that we have, including living in a free country. In November, I can do something that improves both the physical and the mental health of others—working at the local soup kitchen. I can help to sort food, cook giblets in gravy, or serve a hot turkey dinner to the more than 100 families that the soup kitchen already serves on a weekly basis and to the many more whose faces I don't recognize. Most communities have organizations that supply Thanksgiving dinners to those who can't afford them. Take your kids to one and show them what it means to give to someone else. Gather your PA colleagues and find a soup kitchen that could use your assistance. You certainly will be improving the physical health of others, if only for a day. But the psychological benefit will last much longer than that.

One Thanksgiving, my niece, my nephew, and I made 10 dozen chocolate chip cookies and wrapped them, by fours, into cellophane packages tied with bows. We took these to the local soup kitchen and gave one packet of cookies to each family, many of whom had more than four members. We ran out of cookie packets halfway through the line. We were amazed at how much pleasure our cookies brought, and we regretted that we had underestimated the amount we would need. Yet my young relatives had learned important lessons—that some people are far less fortunate than they and that lending a hand to another person can be a very gratifying experience, for only the cost of some cookie dough.

I began this editorial with a tirade about war, health care, and difficult choices. I suppose it feels as though I have sutured two editorials together, and in a way I have. But I am a strong believer that if you're going to complain about a situation, you should also offer something you can do about it. Clearly, serving a turkey dinner to the less fortunate is not the same as trying to get the government to spend more of its money on health care and less on war. But it is something that I, as one PA, can do. Some have said that a volunteer is simply someone who didn't understand the question. That is, volunteers usually get more than they bargained for— and not necessarily in a good way. I challenge PAs to be people who DO understand the question. “What can we do, as health care professionals, to improve the health and well-being of others?” During the Thanksgiving season, the answer is clear.

REFERENCES

1. The Museum of Broadcast Communication. Vietnam on television. Available at:
http://www.museum.v/archives/etv/V/htmlV/vietnamonte/vietnamonte.htm. Accessed October 4, 2006.

2. National Priorities Project. Turning Data Into Action. Military programs and the cost of the Iraq War. Available at: http://database.nationalpriorities.org/tradeoffsources.hmtl. Accessed October 4, 2006.

3. Wolk M. Cost of Iraq War could surpass $1 trillion. MSNBC.com. Available at: http://www.msnbc.msn.com/id/11880954/print/1/displaymode/1098/. Accessed October 4, 2006.

4. National Priorities Project. Turning Data Into Action. Total federal outlays, FY2006.
Available at: http://www.nationalpriorities.org/index.php?option=com_content&task=view&id=80&Itemid=107. Accessed October 4, 2006.

5. National Priorities Project. Turning Data Into Action. The war in Iraq costs. Available
at: http://costofwar.com/index-kids-health.html. Accessed October 4, 2006.