The Long-Term Costs of War
Nearly 20 percent of military service members who have returned from Iraq and Afghanistan -- 300,000 in all -- report symptoms of post traumatic stress disorder or major depression, yet only slightly more than half have sought treatment....
In addition, researchers found about 19 percent of returning service members report that they experienced a possible traumatic brain injury while deployed, with 7 percent reporting both a probable brain injury and current PTSD or major depression.
Many service members said they do not seek treatment for psychological illnesses because they fear it will harm their careers. But even among those who do seek help for PTSD or major depression, only about half receive treatment that researchers consider "minimally adequate" for their illnesses.
In the first analysis of its kind, researchers estimate that PTSD and depression among returning service members will cost the nation as much as $6.2 billion in the two years following deployment -- an amount that includes both direct medical care and costs for lost productivity and suicide. Investing in more high-quality treatment could save close to $2 billion within two years by substantially reducing those indirect costs, the 500-page study concludes.
I'm not surprised by the aggregate level of combat stress. These numbers are high, but they are consistent with what the Army's Mental Health Advisory Team reports have been telling us. Iraq and Afghanistan are difficult places to serve, and 12- to 15-month tours will take a toll on even the toughest troops. Everyone comes home changed in some way. Whether that evolves into PTSD, or resolves itself, seems to depend on a complex combination of factors, including age, family, personality, and specific combat experiences. I've seen two members of the same squad go to war and go through the same things, only to come home with completely different reactions. Everybody's war is different.
I'm particularly worried, however, about two sets of findings by RAND. First, that so few servicemembers are receiving the care they need. Many troops still fear the stigma of being labeled a PTSD case, and they avoid treatment out of fear it will harm their careers, their relationships, their pride, etc. Others do seek counseling and treatment -- but often it's inadequate, either because the right tools don't exist or because the particular base/location isn't resourced to help. The Pentagon and VA have made tremendous strides in these areas, but it's not enough. Six years into this war and we're still letting veterans fall through the cracks. That's not right.
Second, the RAND study suggests that we haven't begun to reckon with the full costs of these wars. The study estimates the annual societal costs for Iraq/Afghanistan-related PTSD at $2 billion to $3.1 billion and the annual societal costs for TBI at $591 million to $910 million. That's just one year! Project that out over the lifetime of these young troops and you're talking about a lot of money. Even the $3 trillion estimate by Linda Bilmes and Joseph Stiglitz may end up being low, once you factor in the long-term health care costs for Iraq and Afghanistan veterans.
But these costs will come due after the sound of the guns has faded, and long after the supplemental appropriations bills for the war have been passed. VA funding is discretionary funding; it is not an entitlement like Social Security. Which means that this generation will have to fight to ensure the VA has enough money to take care of these issues over the next 50-75 years.
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