Two and a half million Americans have fought in Iraq or Afghanistan. Approximately 700,000 have received disability status. More than 250,000 personnel have endured a traumatic brain injury; 125,000 have received a post-traumatic stress diagnosis; and 1,500 have lost a limb.
The obligation we have to these veterans is a moral one but it will be measured in dollar terms, a massive cost arriving just as Congress and the White House attempt to control the budget. Fortunately doing the right thing also is the prudent thing. The Pentagon and VA can control long-term costs by cooperating to make sure that veterans get their needed care right now.
But they’re not. Instead, they’re letting bureaucratic gamesmanship push private health-care providers onto the sideline as well.
Linda Bilmes, a professor at Harvard’s Kennedy School of Government, has itemized the United States’ financial commitment to Iraq and Afghanistan veterans in sobering detail. In April the VA and Social Security Disability tab ran to $970 billion, of which $134 billion has already been spent and $836 billion will come over the next 40 years. Layered on top of this sum are unspecified, Pentagon-incurred costs of treating war-related health issues for veterans still on active duty.
The burden we place on our armed forces and on our taxpayers will continue increasing as long as we remain in Afghanistan. Once we leave, though, it should plateau – so long as we tend to wartime wounds rather than letting them fester. Veterans’ health care is no different from any other when it comes to the proverb that an ounce of prevention is worth a pound of cure. On the other hand, the converse also is true – obligations we postpone will cost even more later.
Our quick response depends heavily on programs that help civilian physicians treat, or at least recognize, service-related issues within their own communities. Military and VA facilities are the most evident care facilities, but it is common for Reservists and National Guards to live outside these facilities’ coverage areas. A McClatchy investigation in March found a population of 675,000 Reservists or National Guards that have concluded their service and therefore have no routine interaction with the military.
The Pentagon and VA either will have to expand their infrastructure dramatically to care for those that live outside of health-care coverage areas, or they’ll have to partner with civilian providers.
Enter a Chapel Hill, N.C.,-based initiative called the Citizen-Soldier Support Program. This program trains civilian providers in topics related to traumatic brain injury and post traumatic stress. It likewise provides service-members with online resources to locate appropriate care.
In October of last year it lost federal funding. Since then CSSP has continued supporting U.S. veterans’ health care as fully as possible using private resources. The reasons for this loss boil down to a typical government problem: the inability of two bureaucracies, the Pentagon and the VA, to get along. Neither wants to admit to a gap in coverage or to cede turf to the other, so both just ignore the problem.
CSSP is not the victim here, of course. Veterans that live outside military and VA coverage areas suffer most. And, down the line, so too will American taxpayers that are missing out on a chance to control these costs now as part of doing the right thing.
There is no way to estimate the way costs will grow as we postpone them, but today’s fiscal circumstances are very clear. Austerity is the new norm. Congress and the White House agreed in August 2011 to the Budget Control Act, which cut $900 billion from the federal departments immediately and an additional $1.2 trillion from them over the following decade. The VA is exempt from these calculations, but growth in its accounts doesn’t change the overall savings target.
Every dollar in VA growth is taken from another department. Were it not that way, this growth would just go straight into our debt. Irrespective of how sequestration and other Budget Control Act mechanics may be amended, the principle will remain true: postponed costs will grow, and they will come at the expense of other priorities.
As always, it bears repeating that “postponed costs” is an accountant’s term for untreated veterans.
The right thing is caring for these veterans now. It’s also the prudent thing. Professor Bilmes at Harvard has told us about the costs, and the Citizen-Solider Support Program at the University of North Carolina has shown us a way ahead. The only thing missing is accountability for the Pentagon and VA to set aside their bureaucratic frictions and tackle the problem.