The Economics of War - Vets with Mild Brain Injuries Predicted to Incur Huge Government Costs for Care

ARTICLE IN BRIEF

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A public finance professor estimates that the medical costs for care of veterans with brain injuries from the current Gulf War could exceed $28 billion.

SALT LAKE CITY-Mild traumatic brain injuries from the long wars in Iraq and Afghanistan could end up costing the government at least $28 billion, according to an analysis by Harvard public finance professor Linda J. Bilmes, PhD.

That previously unexamined consequence of military campaigns was one of many staggering facts and figures she disclosed about the immense cost of the conflicts in her lecture here at the annual meeting of the American Neurological Association in late September.

Medical and disability costs for veterans will account for $700 billion and could eventually total more than the cost of actual combat operations, Dr. Bilmes said. And neurological disorders, including mild traumatic brain injuries and post-traumatic stress disorder, probably will contribute a growing portion of the cost of the wars, she added.

It's hard to imagine how much money this is because we're not used to even thinking about it in these terms, said Dr. Bilmes, who co-authored the book The Three Trillion Dollar War: The True Cost of the Iraq Conflict (WW Norton, 2008) with Nobel Prize-winning economist Joseph E. Stiglitz. But, for example, the amount that is spent by the federal government on autism this year will be $125 million - which is what we spend in Iraq in six hours.

ADDING UP THE COSTS

Dr. Bilmes arrived at the figure for mild traumatic brain injury - due to exposure to such hazards as bomb blasts - by assuming that 8 percent of veterans would seek treatment and claims for the condition. She also assumed that 85 percent would get medical care for one year and 15 percent for five years and that 57.5 percent would have some kind of disability claim.

Part of the scale of these costs and these injuries is simply the sheer length of time that we have been involved in this war, Dr. Bilmes said. It is the most expensive conflict we have been involved in since World War II.

She noted that World War II lasted nearly four years, while the US has been at war with Iraq for nearly six years and in Afghanistan for almost seven years.

So far, 1.72 million troops have been deployed, with 35 percent serving two or more tours of duty. Of those, nearly half have been discharged, filing 288,000 disability claims. About 347,000 of those veterans have been treated at VA medical facilities - 147,744 for mental health conditions, she said.

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Dr. Bilmes said the medical cost of the wars is often overlooked compared to the cost of actual combat operations, like weapons and supplies. But medical care, disability benefits, social security disability compensation, and social costs such as loss of productivity due to injury or death may end up exceeding those operating costs, she said.

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WHY THE COSTS WILL ESCALATE

She noted that higher rates of injuries and survival as well as better treatment would escalate those costs considerably. Making matters worse, Dr. Bilmes said, those with neurological disorders face a complex bureaucratic web as they attempt to get medical benefits.

It's a very confusing process for anyone, much less for a veteran who is coming back with post-traumatic stress disorder or a traumatic brain injury and who is in the period in which they are probably least capable of dealing with these problems, she said.

Initial claims take 177 days to process and appeals taking 657 days. Fourteen percent of all claims are appealed.

Recent studies suggest that the consequences of this delay is that it will be harder for these troops to recover, which will, of course, lead to higher medical costs, more disability claims, and higher social cost, Dr. Bilmes said.

Dr. Bilmes suggested that the claims process be made smoother, particularly for post-traumatic stress disorder patients.

She also said that veterans with traumatic brain injury or concussive events should be presumed eligible for benefits, instead of the current system that requires veterans to prove every claim.

In other words, do what the IRS does with taxes, which is to accept your tax forms up front and then audit a subset of them, she said.

She also said a trust fund should be established for veterans' health care, instead of funding it with annual discretionary money.

Commenting on the economic analysis, Hema Subbaratnam, MD, a neurologist at the Veterans Affairs Hospital in Reno, NV, suggested that veterans of wars before the one in Iraq should get the same kind of traumatic brain injury screening to try to determine whether their conditions might have had to do with a bomb blast or similar experience.

She also wondered whether contractors working in Iraq and Afghanistan - who also experience war-related injuries - should have access to the same level of care as veterans.

They're going to have traumatic brain injuries but they're not going to be able to have access to the VA system, Dr. Subbaratnam said. You're probably now going to have another subset of people who have had injuries related to the war.

Others wondered whether the traumas of the war might also lead to other neurological disorders. Jonathan Glass, MD, professor of neurology at Emory University in Atlanta, was particularly disturbed by the grim medical future that has been created by the wars. He noted that patients with TBI may be more prone to dementia as they age. I'm a great fan of the VA, he said, but it just doesn't have the capacity to deal with what's coming down the road. And it's frightening to see.