With President Bush now proposing to push the price tag for the war on Iraq up to nearly $600 billion - more than was spent on the Vietnam War - while seeking new cuts in our health-care safety net, it would appear the debate over guns and butter is over. The guns have won.

Polls before the last election found that the two issues foremost on voters' minds were the war in Iraq and our ever worsening health-care crisis. More than ever, the two issues seem linked. With record budget deficits, substantially inflated by spending on the war, resources for health care and other critical domestic needs are increasingly starved.

On the same day the president was proposing another $245 billion to prosecute the war this year and next, which would bring the five-year total since the war began to a staggering sum of $589 billion, he also called for slashing $78.6 billion from Medicare and Medicaid over the next five years.

In addition, the president wants Medicare recipients to pay higher premiums for prescription drugs and doctors' services, and to eliminate annual indexing of income thresholds, effectively another $10 billion in cuts.

Expanding children's health, preventive health programs and addressing "personal responsibility" by tackling childhood and adult obesity are supposedly atop everyone's short list of health-care priorities. But those now appear to be collateral damage.

Bush is seeking a $223 million reduction in spending for the Children's Health Insurance program, and elimination of a preventive health services block grant program, $99 million a year to the states, used for obesity prevention and programs for chronic health conditions.

He's also seeking millions in reductions for the National Cancer Institute, at the very moment some progress has been made in fighting cancer, and for the Centers for Disease Control for disease surveillance monitoring of bird flu and other approaching epidemics.

That's just the cuts. There's no mention of additional funding to address the national plight of 47 million uninsured Americans, and another 17 million underinsured; the increased closure of public hospitals and clinics, including half of the nation's poor counties that no longer have a health center, and all of the other dismal statistics that have dropped our country to 37th in the world in health-care indicators.

Imagine for a moment how else we could have spent $589 billion, the amount already devoured by the war in Iraq, plus the administration's funding request for the next two years.

With those same dollars, you could buy health insurance for 139 million people, all of the nation's uninsured for the next three years. Or you could fund the current federal program of spending on HIV/AIDS anti-retroviral drugs for the next 60 years. Or you could cover the cost of educating an additional 39.2 million registered nurses.

To make matters worse, there's the recent disclosures about the horrifying, long-term costs of caring for our nation's war wounded.

Harvard University last week released research findings predicting the United States will need to spend as much as $662 billion over the next 40 years on medical costs for the tens of thousands of injured veterans.

Sadly, the real social and health consequences could be far greater. In a July 2005 article in Harper's Magazine, Ronald Glasser, MD, wrote that a very large number of the war wounded are amputees and soldiers blinded and brain damaged, who will require extensive social support in a society that increasingly devalues our social safety net.

Army neurologists, wrote Glasser, fear that the severe brain injuries are being underdiagnosed and will leave many veterans with lasting cognitive and emotional damage that don't fit neatly into budgetary forecasts, but will be devastating to the veterans and their families.

But the veterans are already feeling the pain of cuts in our nation's health spending. According to the Department of Veterans Affairs, 263,257 veterans were denied enrollment for Veterans Administration health coverage in 2005. To cut costs, enrollment has been suspended for those deemed not having service-related injuries or illnesses.

The VA also is falling short on mental-health care for veterans, despite the fact that the VA itself counts post-traumatic stress disorder as one of the top illnesses to emerge from the wars in Iraq and Afghanistan.

"A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual doom," said Dr. Martin Luther King, and, he might well have added, endangering the health security of its citizens at home.

Deborah Burger, RN, is president of the California Nurses Association.

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