One of the more vexing problems Americans faced immediately after World War I was in crafting a health-care system to attend to the needs of the nation's four million plus veterans of the recent conflict. In her book Burdens of War: Creating the United States Veterans Health System, itself based on her completed dissertation at Columbia University, Jessica L. Adler—currently assistant professor of history and health policy and management at Florida International University—offers a detailed overview of the transitions in public thought and action in dealing with this issue. Taking stock of the promises made in the name of future veterans by Congress and the Wilson administration during the war, Adler examines how these various initiatives were enacted during the interwar years to create the foundation of a modern veterans’ health system. Following the contours of the public debate over federal and state obligations to these former soldiers and sailors, she reveals the full extent to which organizations like the American Legion and Disabled American Veterans (DAV) clashed and cooperated with government to create a new bureaucracy dedicated solely to the needs of former servicemen. The Veterans Bureau heralded a new direction in veteran entitlements, setting in motion a series of legislative and executive policies that established the foundation for the future Veterans Administration.

The last decade has seen renewed interest by historians in the problem of veterans’ postwar health care. In this regard, Adler joins a growing cadre of scholars engaging the boundaries of military institutional culture and political history. In so many ways, Burdens of War is a fine addition to this new historiography. Adler's monograph is best read as part of a larger perspective on the challenge of reclaiming wounded and disabled veterans from the margins of society after war's end, in tandem, perhaps, with Beth Linker's War's Waste: Rehabilitation in World War I America and John Kinder's Paying with Their Bodies: American War and the Problem of the Disabled Veteran. Together with these scholarly peers, Adler is creating a detailed perspective on the many variables and obstacles—and solutions—to crafting a new system of public health support and intervention that will be the foundation for future rehabilitation.

Over seven chapters (not counting the introduction and conclusion), Adler tracks the saga of federally sponsored and managed health care during the interwar years. Starting with the wartime revision of the 1914 War Risk Insurance Act, she tracks the growing dissatisfaction within the Wilson administration with the existing system of Soldiers’ Homes—the traditional social welfare venue for aging disabled veterans. The War Risk Insurance Act is presented as a Progressive-minded initiative that was intended to rehabilitate marginalized wounded and sick veterans, restoring their social and material value while also limiting the anticipated burden of permanent pensions and charity relief. Tracking through the War Department's efforts to attend to the immediate needs of disabled soldiers and the postwar activities of the U.S. Public Health Service, the end result, according to Adler, is a ramshackle system that failed to meet the needs of veterans and the promises made to them. Only after veteran organizations interject themselves into the debate is progress made in creating the Veterans Bureau.

Creating the system was one matter; satisfying the many needs of the diverse population of veterans was another. Adler goes to great lengths describing the flaws in the Veterans Bureau's new hospital network, not least of which was balancing the organization's internal mandate of rehabilitating broken veterans so they could become self-sufficient members of American society with the patients’ need for humane, quality medical care. Adding to the problems were internal debates over whom and what conditions to treat in the system, how to manage segregation within the hospitals, and the ever-present skepticism of Americans toward “state medicine.” Even Franklin Delano Roosevelt, Adler reveals, had his doubts about the veterans’ health-care system, though ultimately the veterans’ needs overcame his attempts to limit access.

Throughout the book, Adler confronts many uncomfortable questions about racism and segregation in the veterans’ health system. Likewise, she also addresses the extent to which the “100% Americanism” of the American Legion and other patriotic groups informed the drive to create a solution to the problem of veteran health care. To be sure, there are some gaps of omission when it comes to the construction and administration of the treatment centers, as well as several unavoidable comparisons with the Affordable Care Act (ACA). However, these issues do not detract from this highly detailed and well-crafted account of the political dimension behind health care. Indeed, it is a reminder of an earlier time when popular demand led the way in crafting a public health-care system that, for all of its flaws, accomplished far more good than we care to remember today.