Beyond The Battlefield: As Veterans Fight For Needed Care, Long-Term Funding Remains A Question Mark
"Beyond The Battlefield" is a 10-part series exploring the challenges that severely wounded veterans of Iraq and Afghanistan face after they return home, as well as what those struggles mean for those close to them. Learn how you can help here. Other stories in the series can be found here. Listen to reporter David Wood discuss "Beyond The Battlefield" with NPR's Terry Gross here. Wood and wounded veteran Bobby Henline will hold a live video chat this Friday. See more details and send them questions.
Three days after Sept. 11, 2001, Congress met to authorize giving the president the power to respond with "all necessary and appropriate force" to the terrorist attacks in New York and Washington, D.C. It was, in effect, a declaration of the war that has now lasted a decade. In a rhetorical cascade that went on for five hours, hundreds of politicians of both parties joined the war fervor, demanding that troops be sent to "crush" the perpetrators and their supporters.
Only one person, a now-retired Democratic congresswoman, took time to observe that war would create a new generation of wounded veterans who would need lifetime care, and that Congress ought to agree to pay those bills before sending young Americans into battle.
"There will be casualties, both physical and psychological," said Rep. Darlene Hooley of Oregon. "Let us ensure that when they come home Congress honors their sacrifice, not solely with parades, but for the rest of their lives."
There would be more casualties than anyone at the time could imagine -- 53,000 dead and wounded -- and there would be more severely wounded among them as well, roughly 16,000 so far. Moreover, the cost of caring for these young, severely wounded combat survivors for a lifetime would also rise exponentially.
In a report that the Congressional Budget Office issued last summer, economist Heidi L. W. Golding said future costs for the Department of Veterans Affairs to treat veterans "will be substantially higher (in inflation-adjusted dollars) than recent appropriations for that purpose, partly because more veterans are likely to seek care in the VA system but mostly because health care costs per enrolled veteran are projected to increase faster than the overall price level."
Responsibility for caring for veterans could add at least another half-trillion dollars to the U.S. debt, according to Harvard economist Linda Bilmes. Yet there is at present no long-term strategy on how to pay for it. Money for veterans' care emerges from the annual budget squabbles in Congress. Unlike a pension fund or even Social Security, Congress doesn’t actually set aside funds for future obligations to veterans.
And given the current budget-ax climate in Washington, it's unlikely that Congress will begin setting aside money for the future care of veterans who are being wounded this year.
So far, politicians generally have been loathe to cut funds for veterans. But the uproar this year over the budget and debt squeeze suggests that even annual appropriations for severely wounded and disabled soldiers such as Tyler Southern and Todd Nelson could be vulnerable.
Politicians of both parties vow to protect veterans' funding, and the White House has directed that $25 billion be stripped from the Pentagon's 10-year spending plan and set aside for veterans' medical costs. The Department of Veterans Affairs projects that its costs will drop as the generation of Vietnam veterans require less support.
But VA funding remains an enticing target as tempers fray over the ballooning deficit.
Rep. Michele Bachmann (R-Minn.), for instance, a GOP presidential candidate, proposed early this year a package of federal spending cuts that included a $4.5 billion cut in veterans' health benefits. Veterans organizations screamed in protest. The measure would, said Veterans for Common Sense, leave the war's wounded "twisting in the wind."
"While the country is at war, there's a lot of positive feeling about those who fight," said economist Bilmes, who has studied and written about the cost of veterans programs. "But it is quite conceivable to me that over a period of time, when the wars are over and the U.S. is involved in other things and budget resources are very scarce, the desire to support veterans will change."
At the close of 2001, with the war in Afghanistan barely underway and the Iraq war still 18 months away, the VA was paying compensation to 172,254 veterans who had a disability rating of 100 percent from service in prior conflicts. By the end of last year, the VA had 295,529 veterans with 100 percent disability ratings on its books, an increase of 123,275 disabled veterans in just a decade.
The increase in costs was also substantial. In 2003, the VA paid $18 million to care for veterans of Iraq and Afghanistan. By 2013, the VA projects that cost will be $3.5 billion -- and that figure will continue to grow by $1.5 billion a year.
Among many reasons -- more wounded veterans, more generous allowances and more veterans who are aggressively seeking help -- is this: The growing number of severely wounded soldiers and Marines coming off the battlefield require more expensive services and compensation over the five decades or more of their lifetimes.
Because Iraq and Afghan war casualties are more severely wounded than veterans of past conflicts, the cost of their lifetime care may be underestimated. A recent Army study reported that the severely wounded experience "prolonged and profound dysfunction (physical and emotional) that is oftentimes underestimated by health care providers."
As President Obama observed in a speech last summer to the American Legion: "Thanks to advanced armor and medical technologies, our troops are surviving injuries that would have been fatal in previous wars. So we're saving more lives, but more American veterans live with severe wounds for a lifetime. That's why we need to be there for them for their lifetime.”
Prosthetic legs, for instance, have grown in sophistication and capability in the past decade. Instead of the "dumb" peg-legs seen in pirate movies, today's powered legs come with microprocessors, accelerometers and gyroscopes to mimic the complex motions of walking, as well as a carbon-fiber foot that enables amputees to run.
One such prosthesis, the Otto Bock X2, costs $30,000 for the knee joint alone. Tyler Southern has two of them. Otto Bock HealthCare of Duderstadt, Germany, developed the joint working with the Defense Advanced Research Projects Agency and the U.S. Army Telemedicine & Advanced Technology Research Center.
The entire powered leg, from hip to toe, can cost up to $100,000 -- and most amputees are given three or four of them for different uses. The prostheses have to be replaced after three to five years, depending on how much they are used.
Still in the experimental phase is a mind-controlled arm that will replace the static hook commonly seen today. The new arm, a collaboration between Otto Bock and U.S. researchers funded by the Defense Department, uses signals from the brain, re-routed through nerves transferred from chest muscles to the arm stump, to rotate and open and close the hand and to flex the elbow. A prototype has advanced sensors implanted into the prosthetic index finger to feel heat and cold, judge the strength of the grip and, it is said, feel the difference between a grape and a raisin.
Such devices are developed to deliver maximum benefit to military amputees, not necessarily to control costs. "We'll do everything we can to return you to the highest level of function," is the way Chuck Scoville, chief of amputee patient care at Walter Reed National Military Medical Center, describes his work.
Each new generation of a prosthetic limb has been "radically more expensive" than the device it replaced because of its increasing complexity, said David McGill, a board member of the Amputee Coalition and a prosthetics industry official. "With increased sophistication of the device you see an increase in the cost," he says.
Aside from hardware, the cost of caring for veterans is rising because veterans are increasingly demanding mental health services and disability payments, among other benefits. According to Army studies, the levels of acute stress among combat troops deployed in Afghanistan is "significantly higher" than in previous years, suggesting the demand for mental health services will continue to grow for years.
Past wars have shown that the cost of caring for the wounded rises and peaks long after the war is over and largely forgotten by the general population. Disability payments for veterans of World War I didn't peak until 1969, according to Harvard economist Bilmes, who teaches public finance at the Kennedy School of Government.
The VA is still making disability payments to a dependent of a soldier who fought in the Civil War 150 years ago, according to VA officials who declined to provide details because of privacy guidelines.