The Truth About Health Care for Veterans
I’m always looking for new (or unnoticed) healthcare blogs that might interest HealthBeat readers. Recently, I discovered “What If” (American Had a HealthCare System That Worked).
The blog is run by Georgia Berner, (founder and Director) and Emily Cleanth (content manager/ researcher). Berner, who owns a small to medium size company in Western PA where she pays the entire health insurance costs for her 60 employees, has become familiar with the inequities in our system both as an employer, and by talking to voters while running for U.S. Congress in 2006. Cleanth has a Master’s in Public Policy and Management from Carnegie Mellon.
Not long ago, “What If” took a look at healthcare for Veterans. I have reprinted the post below.
I would add only that, since 2000, funding for the VA system has fallen far behind the needs of returning troops and veterans. In the 1990s, the VA was overhauled and became a very good health care system. I’ve written about it here (The VA should not be confused with Walter Reed hospital, which is run by the army. The Veteran’s Administration oversees the VA.) But over the past eight years, funding has not kept up with the needs of badly wounded vets returning from Iraq. Meanwhile, Vietnam vets are aging. This has led to impossibly long lines and, in some cases, has meant that the VA has not been able to hire and retain the medical staff that they need.
“What If “points out that conservatives have protested increased funding for the VA, pointing to and explosion in “entitlement programs.” Like Berner and Cleanth, I believe that veterans are fully “entitled” to timely, high quality care.
I also agree that the cost of healthcare for wounded troops should be included in the cost of the war. Why doesn’t it show up as part of the total cost now? “Because,” they point out, “it essentially doubles the cost of the war in Iraq.”
Shellshocked: Veterans Health Care
Originally posted on “Whatif” . . . (American Had a HealthCare System That Worked)
According to polling in the past few months, the biggest issues troubling Americans are health care and the war in Iraq. What gets talked about less often is the point where these two issues intersect. . .
Around 12% of the 47 million uninsured people in the United States are veterans and their families: this adds up to 1.8 million uninsured veterans. These 1 in 8 veterans are typically 45-year-old men who worked in the past year and are earning from $30,000 to $40,000. Almost two-thirds of uninsured veterans were employed, and nearly 9 out of 10 had worked within the past year.
Why are they uninsured?
Defense Department data released in late 2007 show that thousands of National Guard and Reserve members who had to give up civilian jobs when they were deployed overseas have now permanently lost these jobs and with them their health insurance, pensions, and other benefits. (Federal laws are supposed to protect them from being penalized for leaving civilian employment for wartime service.)
The numbers of uninsured veterans are rising and are predicted to climb further as demands for care and the costs of care outpace the Veterans Health Administration’s budget.
Why are veterans health care costs rising?
A veteran who becomes disabled during military service receives from the government anywhere from $115 a month for a 10% disability to about $2,400 a month for total disability – at least $1.4 million in their lifetime.
A November 2007 report from the Nobel Peace Prize winning Physicians for Social Responsibility predicted that providing medical care and benefits to Iraq veterans could top $660 billion: this is greater than the current operational costs of the war ($500 billion).
Why?
Advances in military technology and battlefield medicine are leading to a high survivor rate for U.S. soldiers, but more than 60,000 have been physically injured, or are medically ill.
SIDEBAR: U.S. Wounded and Killed in Iraq and Afghanistan As of October 29, 2007 |
|
# of U.S. service members who died in Afghanistan |
453 |
# of U.S. service members who died in Iraq |
3,839 |
# of U.S. service members physically wounded |
tens of thousands |
# of U.S. service members with mental injuries and/or mild traumatic brain injuries |
hundreds of thousands |
# of Operation Iraqi Freedom or Operation Enduring Freedom veterans who sought treatment from the Department of Veterans Affairs between 2002 and December 2006 |
229,000 |
% of Soldiers and Marines in Iraq who will be in a situation where they could be seriously injured or killed |
75% |
% of U.S. service members wounded in action in Iraq who are injured in an explosion |
65% |
% of U.S. service members who died in Operation Iraqi Freedom or Operation Enduring Freedom who left behind spouses and/or children |
47% |
- Iraq: The ratio of wounded to killed in combat is 8:1, compared with 3:1 for the Vietnam War, and 2:1 for World War II.
- The percentage of injured requiring amputations is the highest seen since the U.S. Civil War.
- The type of warfare soldiers are engaging in often results in Traumatic Brain Injuries (TBI), which can have symptoms ranging from headache to severe mental and physical impairment, and is difficult and expensive to diagnose and treat.
- Veterans for America cited US Army data in a recent report that found hundreds of thousands of soldiers returning from Iraq are psychiatric casualties or have Traumatic Brain Injuries (TBI). (New medical studies show that many cases of PTSDs are actually TBIs, typically caused by being near explosions.)
- Up to 30% are predicted to meet criteria for serious mental health disorders (49% for the National Guard), with a significant fraction of these being lifelong, chronic afflictions.
- As our strategic need for troops increases, soldiers are returning to the field more often, for longer, and with less rest in between. Soldiers on their second tour in Iraq are 50 percent more likely to develop a mental health problem than those on their first tour because they do not have time to “reset” between deployments given the current ratio of 15 months deployed to 12 months at home.
- Post-Traumatic Stress Disorder has been recently found to have a genetic link, which explains why some recover more rapidly from it than others.
- Improved understanding and treatments for PTSD have led to a 50% increase since 2000 in the number of World War II veterans seeking belated recognition of and compensation for related disabilities.
- Iraq and Afghanistan combined:
- About 30% of all deployed servicemembers have experienced at least one of 3 problems:
- 18.5% meet criteria for PTSD, depression, or both
- about 19% reported experiencing probable TBI during deployment
- about 7% meet criteria for a mental health problem and also report possible TBI.
- Analysts estimate that about 300,000 returning service members currently have PTSD, depression, or both and that about 320,000 may have experienced TBI.
The other issue is that these kinds of psychiatric or neurological injuries can become long-term problems. Researchers studying the effects of the Vietnam War found that in 1998 - almost 3 decades after the Vietnam War - approximately 10.5% of the surveyed veterans were continuing to experience problems with severe PTSD, down only slightly from approximately 11.8% in 1984 when they were first interviewed. (About 1 in 2 soldiers surveyed met some PTSD criteria both times.) Furthermore, the severity of their PTSD had increased in terms of its negative effects on their life.
The researchers have determined that PTSD is most strongly linked to high combat exposure i.e. being ambushed, shot at, or seeing comrades wounded or killed. Of course the more often we send the same troops into battle in Iraq - a new kind of battlefield that has been described as highly chaotic and violent - and the longer they’re deployed the more likely they are to experience these things.
What’s the solution?
1. Expand coverage
At the end of February 2008, various military and health-field experts, from the Institute of Medicine committees on Veterans Affairs, testified before the U.S. House of Representatives with a set of recommendations to improve and expand veteran health benefits. In general, they called for:
- Revisions to the rating schedule by which various bodily injuries are rated for severity and assigned compensation, including:
- A revision of the weighting of neurological and psychological disorders related to traumatic brain injuries (currently dated 1945)
- An analysis to determine whether mental and physical injuries with the same ratings receive different monetary earnings
- That compensation be provided not only for work-related impairments but for those that affect daily living and quality of life
- An expanded and verified explanation of PTSD, its causes and implications, and the need to improve compensation and treatment for the disorder
- Improved methods for determining the health effects of military service
2. Expand funding for better care
Better medical centers:
March 6, 2008 the House Budget Committee voted to pass a $3 trillion fiscal year 2009 budget resolution that would increase spending for health care for veterans, medical research, and other domestic programs by more than the inflation rate. News articles have since shown the VA system to be short on the needed funds to attract quality medical professionals. Specialists like heart surgeons, radiologists and certified registered nurse anesthetists often command higher salaries in the open markets, particularly in cities with higher costs of living, something Federal VA salary caps can’t account enough for.
Republicans criticized this spending plan for failing to address the “exploding growth” of entitlement programs. Though the budget Bush had submitted was a record-breaking $3.1 trillion, he has promised to veto the House Budget Committee resolution if it is ultimately passed by Congress because it calls for more domestic spending than he had requested.
Is health care for military veterans just another “entitlement program”? And if the brave and strong few who made the terrific sacrifice of fighting to protect the rest of us aren’t “entitled” to full health care, then who is? Do we really want this to be a country where health care is not available to those in need unless they can afford its ever increasing prices?
Better women’s care:
Despite the fact that 90,000 women have served in the military since 2001, is veterans care, as Senator Lisa Murkowski put it, “designed to be one size fits all…the male size”?
The Senator has recently introduced legislation that would expand funding for women’s health care within the VA system, an issue made more critical by recent Department of Defense data showing that a female soldier is more likely to be raped or otherwise sexually assaulted by her fellow soldiers than killed by foreign forces in our current overseas conflicts. (Even more disturbing is that this phenomenon has by all accounts been steadily increasing and the failure to respond is driving women out of the military.)
Better mental health care:
Clearly more veterans need to have full access to evidence-based mental health treatment.
While treating more veterans will cost more in the short-run, RAND researchers think it will only be a couple years before this treatment pays for itself via savings from productivity gains and a lowered risk of suicide. The total costs associated with PTSD and depression alone could be reduced by as much as $1.7 billion in that time.
3. Include these costs in the running costs of our wars
Why doesn’t the cost of the war include the true cost of health care for current and future veterans and their families?
Because it essentially doubles the cost of the war in Iraq, giving fuel to the fire in the belly of the majority of Americans who want to see a swift resolution to our involvement there and our troops returned home safely.
What’s the solution?
1. Expand coverage
At the end of February 2008, various military and health-field experts, from the Institute of Medicine committees on Veterans Affairs, testified before the U.S. House of Representatives with a set of recommendations to improve and expand veteran health benefits. In general, they called for:
- Revisions to the rating schedule by which various bodily injuries are rated for severity and assigned compensation, including:
- A revision of the weighting of neurological and psychological disorders related to traumatic brain injuries (currently dated 1945)
- An analysis to determine whether mental and physical injuries with the same ratings receive different monetary earnings
- That compensation be provided not only for work-related impairments but for those that affect daily living and quality of life
- An expanded and verified explanation of PTSD, its causes and implications, and the need to improve compensation and treatment for the disorder
- Improved methods for determining the health effects of military service
2. Expand funding for better care
Better medical centers:
March 6, 2008 the House Budget Committee voted to pass a $3 trillion fiscal year 2009 budget resolution that would increase spending for health care for veterans, medical research, and other domestic programs by more than the inflation rate. News articles have since shown the VA system to be short on the needed funds to attract quality medical professionals. Specialists like heart surgeons, radiologists and certified registered nurse anesthetists often command higher salaries in the open markets, particularly in cities with higher costs of living, something Federal VA salary caps can’t account enough for.
Republicans criticized this spending plan for failing to address the “exploding growth” of entitlement programs. Though the budget Bush had submitted was a record-breaking $3.1 trillion, he has promised to veto the House Budget Committee resolution if it is ultimately passed by Congress because it calls for more domestic spending than he had requested.
Is health care for military veterans just another “entitlement program”? And if the brave and strong few who made the terrific sacrifice of fighting to protect the rest of us aren’t “entitled” to full health care, then who is? Do we really want this to be a country where health care is not available to those in need unless they can afford its ever increasing prices?
Better women’s care:
Despite the fact that 90,000 women have served in the military since 2001, is veterans care, as Senator Lisa Murkowski put it, “designed to be one size fits all…the male size”? The Senator has recently introduced legislation that would expand funding for women’s health care within the VA system, an issue made more critical by recent Department of Defense data showing that a female soldier is more likely to be raped or otherwise sexually assaulted by her fellow soldiers than killed by foreign forces in our current overseas conflicts. (Even more disturbing is that this phenomenon has by all accounts been steadily increasing and the failure to respond is driving women out of the military.)
Better mental health care:
Clearly more veterans need to have full access to evidence-based mental health treatment.
While treating more veterans will cost more in the short-run, RAND researchers think it will only be a couple years before this treatment pays for itself via savings from productivity gains and a lowered risk of suicide. The total costs associated with PTSD and depression alone could be reduced by as much as $1.7 billion in that time.
3. Include these costs in the running costs of our wars
Why doesn’t the cost of the war include the true cost of health care for current and future veterans and their families?
Because it essentially doubles the cost of the war in Iraq, giving fuel to the fire in the belly of the majority of Americans who want to see a swift resolution to our involvement there and our troops returned home safely.
It's a disgrace to our country that we forsake those who defended her values with their lives! I couldn't agree more.
Posted by: Lari | May 08, 2008 at 11:45 AM
I've worked in a VA. A giant good luck to ya is in order.
Posted by: The Happy Hospitalist | April 27, 2008 at 12:18 PM