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Burdens of War

, 368 pages

4 b&w photos, 3 b&w illus., 1 map, 6 graphs

July 2017



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Burdens of War

Creating the United States Veterans Health System


In the World War I era, veterans fought for a unique right: access to government-sponsored health care. In the process, they built a pillar of American social policy. Burdens of War explores how the establishment of the veterans’ health system marked a reimagining of modern veterans’ benefits and signaled a pathbreaking validation of the power of professionalized institutional medical care.

Adler reveals that a veterans’ health system came about incrementally, amid skepticism from legislators, doctors, and army officials concerned about the burden of long-term obligations, monetary or otherwise, to ex-service members. She shows how veterans’ welfare shifted from centering on pension and domicile care programs rooted in the nineteenth century to direct access to health services. She also traces the way that fluctuating ideals about hospitals and medical care influenced policy at the dusk of the Progressive Era; how race, class, and gender affected the health-related experiences of soldiers, veterans, and caregivers; and how interest groups capitalized on a tense political and social climate to bring about change.

The book moves from the 1910s—when service members requested better treatment, Congress approved new facilities and increased funding, and elected officials expressed misgivings about who should have access to care—to the 1930s, when the economic crash prompted veterans to increasingly turn to hospitals for support while bureaucrats, politicians, and doctors attempted to rein in the system. By the eve of World War II, the roots of what would become the country’s largest integrated health care system were firmly planted and primed for growth. Drawing readers into a critical debate about the level of responsibility America bears for wounded service members, Burdens of War is a unique and moving case study.

Jessica L. Adler is an assistant professor in the Departments of History and Health Policy & Management at Florida International University.

"The creation of a universal healthcare system for veterans is one of the untold social-welfare stories of the twentieth century. Adler rightly places World War I veterans at the center of her narrative, illuminating how their ongoing health struggles spurred sweeping reforms. Through evocative prose and razor-sharp analysis, Burdens of War details this generation’s determination to fight for the right to government-funded health care. We still live in the shadows of World War I, heirs to the veterans’ health care system that this generation forged."

"As Jessica Adler demonstrates, the Great War had great consequences for American health care and much else besides. She has written a masterful book, both deeply researched and artfully written, on the origins of the medical and social service systems for veterans. This is policy history and medical history at its best."

"Deeply researched, vividly written, compelling, this isaAn important contribution to the history of US government, social policy, and health care. The voices of needy, often angry, veterans, black and white, ring out in the book, but, as Adler makes clear, improvements to veterans’ health care are often contentious—a theme germane today."

"Thoroughly researched, logically constructed, and engagingly written, Jessica Adler’s Burdens of War sheds light on Progressive reform, the nature of expertise, and the political and cultural complexity of building social policy. Most of all, it takes the reader into the continuing debate that shaped the emergence of the Veteran’s Health System, a debate that continues to rage to this day."

"Adler's excellent book provides a definitive examination of the emergence of the modern veterans healthcare system during and after World War I. In doing so, she goes beyond existing accounts' emphasis on institutional development with a fine-grained focus on the political activism of individual veterans and their emerging organizations as the critical actors who shaped it. Superbly researched and deftly written, Burdens of War offers an extended and timely meditation on the creation both of American healthcare systems and of new government entitlements."

"Burdens of War tells the compelling story of the creation of the US veterans’ health care system in the decades after World War I. Jessica Adler skillfully blends medical and policy history to examine the ideas and actions of government, the medical profession, local communities, and veterans themselves in building what became one of the nation’s most successful yet embattled 'entitlement' programs."

"Scholars, health-care providers, policy makers, and general audiences should be highly interested in the book."

"This book is thoughtful, well researched, and timely. It is little wonder Adler earned the Bancroft Award for the dissertation version. Burdens of War will long be an invaluable resource, particularly for those studying the role of the interwar years in creating modern America."

"Adler's book deals more with the beginnings of veterans' health care than its current state and will appeal to those with a historical interest in the program. The criticisms of today, she notes, are not so different from those voiced a hundred years ago."

"Adler has produced a worthwhile work, one that helps us understand how America built its own National Health Service but for only one class of patients."

"This is a most welcoming contribution on the history of a U.S. service... The book expands the debate..."

"[A] highly detailed and well-crafted account of the political dimension behind health care."

"Adler's Burdens of War is a must-read for specialists and nonspecialists alike, and is one of the most important books on veteran policy of the twenty-first century"

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