Health Care, Security, Military

Cost of long-term medical benefits to Afghanistan and Iraq veterans

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Last updated: January 4, 2013

(U.S. Department of Defense)
(U.S. Department of Defense)

To understand the true cost of war, one must consider not only the military operations themselves, but also the loss of life and the need of returning veterans for long-term medical and disability benefits. Indeed, even as overseas troop levels and operations costs begin to fall — the Obama administration has stated that it anticipates keeping approximately 10,000 troops in Afghanistan after 2014, down from a high of 100,000 in 2011 — certain long-term costs continue to rise as soldiers return home and begin to claim benefits. A March 2013 Associated Press analysis found that 45% of veterans of the post-9/11 wars are seeking disability benefits.

Moreover, as technology has improved — better protective gear and first aid, faster evacuations, and more effective surgical techniques — soldiers are now surviving injuries that would have killed them in the past. According to a 2007 paper from the Harvard Kennedy School of Government, “Soldiers Returning from Iraq and Afghanistan: The Long-term Costs of Providing Veterans Medical Care and Disability Benefits,” as of 2006 — when intense fighting was taking place in the Iraq War — 16 service members were being wounded for every one killed. This is by far the highest ratio in U.S. history — in Vietnam an average of 2.6 soldiers were wounded for every one killed; in World War II the ratio was two to one.

The nature of the Afghanistan and Iraq wars have affected the kinds of injuries soldiers suffer. More lose limbs, and while new technology should allow many to have a higher quality of life, research is still evolving on that issue. A 2012 study, “Combat-incurred Bilateral Transfemoral Limb Loss: A Comparison of the Vietnam War to the Wars in Afghanistan and Iraq,” indicates that other factors such as depression and social support networks can play a significant role in how a veteran adapts. All service members’ injuries aren’t visible, of course. What is now called post-traumatic stress disorder (PTSD) was once dismissed as “shell shock.” Further, medical understanding of mild traumatic brain injury and later effects on veterans who served in the post-9/11 wars is still being studied and refined, as a 2011 study published in the Archives of General Psychology suggests.

While the war in Iraq officially ended in 2011, operations continue in Afghanistan. Calculating the long-term cost of medical and disability benefits for veterans is dependent on wide range of variables — when soldiers retire, the kinds of benefits they claim, and how long they live. The author of the 2007 Harvard paper, Linda Bilmes, stated: “All 1.4 million servicemen deployed in the current war effort are potentially eligible to claim some level of disability compensation from the Veterans Benefits Administration.” (Not all do, however: A 2012 report, “Uninsured Veterans and Family Members: Who Are They and Where Do They Live?” found that approximately 1.3 million of the country’s 12.5 million nonelderly veterans did not have health insurance coverage or access to Veterans Affairs health care as of 2010.)

A 2010 paper by researchers at CUNY Queens for the National Bureau of Economic Research, “A Review of War Costs in Iraq and Afghanistan,” looked at a range of research on the potential long-term budget impact of caring for returning service members. Included were the Harvard study, research by the RAND Corporation, the Congressional Budget Office, and other sources. Estimates for the present value of the cost of care over 40 years range from $57 billion to $717 billion.

The RAND project and report, “Invisible Wounds of War,” estimated that, among the 1.64 million servicemembers involved with the Iraq and Afghanistan conflicts as of 2007, “approximately 300,000 individuals currently suffer from PTSD or major depression and that 320,000 individuals experienced a probable TBI [traumatic brain injury] during deployment.” For a given servicemember, two-year costs for PTSD treatment range from $5,904 to $10,298; two-year costs for major depression range from $15,461 to $25,757; one-year costs for servicemembers with a diagnosis of moderate to severe TBI can range from $268,902 to $408,519, in 2007 dollars. Overall, the RAND researchers note, the total PTSD-related and major depression–related costs for the United States, in 2007 dollars, “could range from $4.0 to $6.2 billion over two years.” The report also notes that better evidence-based treatment and screening “could save as much as $1.7 billion, or $1,063 per returning veteran; the savings come from increases in productivity, as well as from reductions in the expected number of suicides.”

Further, a 2011 study from Georgia State University and San Diego State University, “The Psychological Costs of War: Military Combat and Mental Health,” estimates that, for the 2.16 million U.S. troops deployed in combat zones between 2001 and 2010, the total potential two-year costs of treatment for combat-related PTSD are between $1.54 billion and $2.69 billion. But the authors note that these estimated costs are likely conservative and do not account for the full range of effects that will unfold for the veterans population: “It is important to keep in mind that our cost estimates are lower-bound estimates of health care costs because they represent costs only for younger soldiers measured in the short-run. Moreover, our costs do not capture the effects of combat-induced adverse mental health on future labor market, marriage and other socioeconomic outcomes.”

The CBO’s 2011 estimate of war costs is between $40 billion and $55 billion just for the period 2011-2020. The total cost for care through 2040 is likely to be considerably higher — most Iraq and Afghanistan service members are relatively young and the cost of benefits will rise over time as they age. Additional information in the CBO’s report, “Potential Costs of Health Care for Veterans of Recent and Ongoing U.S. Military Operations,” delivered as testimony to Congress, includes:

  • As of the end of March 2011, 2.3 million military personnel and reservists had been deployed to combat operations in Iraq and Afghanistan since the start of operations. Of those, 1.3 million were eligible for VA’s health care services. Since 2002, more than 680,000 (52%) had sought medical care from VHA.
  • Through June 2011, more than 44,000 service members had been wounded during the Iraq and Afghanistan operations. While many were able to return to service after care, more than 1,500 required amputations.
  • Among Iraq and Afghanistan veterans who had received medical care from the VHA by the end of March 2011, approximately 187,000 (27%) were diagnosed with PTSD. VHA personnel diagnosed traumatic brain injuries (TBI) in approximately 26,000 patients (7%) from 2007 through 2009. Most of these were determined to be mild TBI — also known as a concussion — from which patients generally recover within a month.
  • The cost for treating all enrolled Iraq and Afghanistan veterans in just 2020 could range between $5.5 billion and $8.4 billion in 2011 dollars. By comparison, the VHA spent $1.9 billion spent in 2010 and a total of $6 billion between 2003 and 2010.

Additional information is available in an October 2010 CBO report, “Potential Costs of Veterans’ Health Care.”

The projected increase in the number of veterans seeking care is more than just an issue of money. As the author of the NBER study, Ryan D. Edwards, points out, the VA’s enrollment process is “long, cumbersome, inefficient and paperwork-intensive.” Problems reported by the General Accounting Office included large backlogs of pending claims, lengthy processing times and high error rates: “In a 2005 study, GAO found that the time to complete a veteran’s claim varied from 99 days at the Salt Lake City regional office to 237 days at the Honolulu, Hawaii, office.”

Another complication is that veterans’ benefits aren’t paid out of a trust fund like those for Social Security and Medicare, but instead are a discretionary part of the U.S. budget: “[This] has meant that Congress can and typically does follow a wait-and-see approach rather than a more proactive stance as with Social Security and Medicare, both of which have trust funds.” Given that the growing number of veterans are certain to put considerable strain on the V.A. system in the coming decades, Edwards suggests that the agency “produce long-term forecasts of disability and health care needs that could inform policy.”

For a detailed look at the specific problems veterans are facing within the government bureaucracy, see the Center for Investigative Reporting’s series “Returning Home to Battle.” The Center provides an interactive map that shows the locations where the backlog of veterans benefits cases is particularly acute.

Tags: PTSD, war, veterans, research roundup


Writer: | January 4, 2013

Analysis assignments

Read the issue-related Center for Investigative Reporting article titled "Number of Veterans Who Die Waiting for Benefits Claims Skyrockets."

  1. What key insights from the news article and the study in this lesson should reporters be aware of as they cover these issues?

Read the full study titled “Uninsured Veterans and Family Members: Who Are They and Where Do They Live?”

  1. What are the study's key technical term(s)? Which ones need to be put into language a lay audience can understand?
  2. Do the study’s authors put the research into context and show how they are advancing the state of knowledge about the subject? If so, what did the previous research indicate?
  3. What is the study’s research method? If there are statistical results, how did the scholars arrive at them?
  4. Evaluate the study's limitations. (For example, are there weaknesses in the study's data or research design?)
  5. How could the findings be misreported or misinterpreted by a reporter? In other words, what are the difficulties in conveying the data accurately? Give an example of a faulty headline or story lead.

Newswriting and digital reporting assignments

  1. Write a lead, headline or nut graph based on the study.
  2. Spend 60 minutes exploring the issue by accessing sources of information other than the study. Write a lead (or headline or nut graph) based on the study but informed by the new information. Does the new information significantly change what one would write based on the study alone?
  3. Compose two Twitter messages of 140 characters or fewer accurately conveying the study’s findings to a general audience. Make sure to use appropriate hashtags.
  4. Choose several key quotations from the study and show how they would be set up and used in a brief blog post.
  5. Map out the structure for a 60-second video segment about the study. What combination of study findings and visual aids could be used?
  6. Find pictures and graphics that might run with a story about the study. If appropriate, also find two related videos to embed in an online posting. Be sure to evaluate the credibility and appropriateness of any materials you would aggregate and repurpose.

Class discussion questions

  1. What is the study’s most important finding?
  2. Would members of the public intuitively understand the study’s findings? If not, what would be the most effective way to relate them?
  3. What kinds of knowledgeable sources you would interview to report the study in context?
  4. How could the study be “localized” and shown to have community implications?
  5. How might the study be explained through the stories of representative individuals? What kinds of people might a reporter feature to make such a story about the study come alive?
  6. What sorts of stories might be generated out of secondary information or ideas discussed in the study?

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