Sunday, July 10, 2005

$50,000 a Leg. Luckily, We Get the Bulk Rate 

In Iraq eight U.S. soldiers have been wounded for every one killed, double the rate in Korea and Vietnam; the amputee rate is twice that of past wars; a fourth of all wounded troops suffer from traumatic head injuries, a vast increase from previous conflicts. Ronald Glasser, writing in the July Harper's (not, alas, online), notes that "medical advances have decreased lethality even as weapons have become increasingly deadly," and as a result, soldiers today are surviving injuries that would surely have killed them a generation ago. So what happens when they come home?
The hidden economic costs of the war in Iraq will not be found in the immediate treatment of the wounded or in increases to military death benefits. As expensive or labor-intensive as these might be, the largest monetary costs will involve the long-term care of thousands of severely and irrevocably damaged veterans; and these costs will only increase as the years pass.We are going to have to care and pay for a very large number of persons with what are, in any honest prognosis, lifelong disabilities. The price tag will be staggering. An above-the-knee computerized limb prosthesis -- made of graphite and titanium, and battery powered with a microprocessor built in to better control movement -- costs $50,000. A below-the-knee prosthesis is priced at between $10,000 and $20,000, and then there's the constant attention and ongoing readjustments needed to keep the prosthesis operational. The three types of upper-extremity prostheses offered by the military range in price from $5,000 to $100,000; patients are given one of each, in order to use them in different situations. In the past two years, there have been numerous multiple amputees who have needed double and triple prostheses.

Traumatic brain injuries also will create long-term economic problems. Not only are these injuries more likely to go undetected; they also leave veterans with lasting cognitive and emotional damage. Then there are the serious psychological problems, including post-traumatic stress disorder (PTSD), which are brought on by the unpredictable IED attacks, the protracted urban combat, and the high incidence of casualties. A New England Journal of Medicine study found that roughly one in six soldiers who had served in Iraq suffered from major depression, general anxiety, or PTSD; many expect the numbers to go much higher . . . .

But the wounded stay within the DOD military health-care system only as long as they remain on active duty. Every wounded soldier will soon become a veteran and will -- unless he or she is old enough for Medicare or miraculously lucky enough to find a managed-health-care company that will take on patients with extreme pre-existing conditions -- be forced to receive any ongoing care through Veterans Affairs. There is little to suggest that the VA -- an overburdened and underfunded system -- can handle the wounded from Iraq once they are released from Department of Defense care.

The VA now serves 7 million of the country's 25 million veterans' in the last year alone, the VA provided 6,000 new prostheses and more than 40,000 adjustments. The average wait for a VA decision on an initial claim for disability benefits is 165 days; to rule on an appeal of one of its decisions, the VA takes, on average, three years. (In the last ten years, some 13,700 veterans have died as they were waiting for their cases to be resolved.) In Minneapolis the waiting period for an orthopedic appointment at a VA hospital can be more than six months, and patients there have been told to expect a further decrease in services over the next budget period . . . . Hundreds of billions have been given to the Pentagon to pay for this war; to pay for the war's aftermath, VA discretionary funding for 2006 is to be increased by only one-third of one percent.

"Based on what we should be doing, the VA is simply underfunded," former Georgia senator Max Cleland, a triple amputee from the war in Vietnam and head of the Veterans Administration under President Carter, told me. "The budgetary constraints put into place by this administration's tax cuts have proved a disaster for the whole system. The VA can't handle what they have to do now; how are they going to handle the flood of physical and emotional casualties, many of whom will be the responsibility of the VA for the rest of their lives?"

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