In the debate over “Obamacare” and the drain of healthcare on the economy, there has not been a lot of discussion about how the system is going to handle troops coming back from combat over the next few years. Expenditures for the treatment of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) in soldiers returning from Iraq and Afghanistan has an exponential impact on the U.S. health care system. PTSD and TBI are common conditions in soldiers that witness trauma and are exposed to explosions.
Last month, Sen. Barbara A. Mikulski (D-MD) said during a Senate Defense Appropriations Subcommittee hearing that examined the health care of wounded soldiers that “[j]ust because a war is over for us doesn’t mean it is over for the soldier, or his spouse, or her children. Some bear the permanent injuries of war, but all bear the permanent impact.”
With that said, there is little doubt that increased health care spending is related to the number of PTSD and TBI diagnosed cases. The U.S. spends approximately 17% of its gross domestic product (GDP), on health care. GDP is important because it serves as an indicator of the condition, of a country’s economy. No other country spends more than 12% of its GDP on health care and the U.S. does worse than most other countries in every measure of health outcomes.
It’s estimated that PTSD occurs in 11 to 20 veterans out of every 100, for the Iraq and Afghanistan wars. Since 2000, 229,000 soldiers have been diagnosed with TBI. Since 2005, TBI has occurred in 17,000 Iraq and Afghanistan soldiers during combat theater. 89,000 deployed veterans have been diagnosed with PTSD. The Department of Defense (DoD) focuses on acute detection while the U.S. Department of Veterans Affairs (VA) focuses on long term complications. The number of TBI injuries according to data from the DoD, which provides medical care to service members while deployed, totaled 30, 380 during the fourth quarter of 2011 (October through December).
The Congressional Budget Office (CBO) did a recent study that examined costs for the Veterans Health Administration (VHA), which provides health care after service members return from deployment, for the treatment of PTSD and TBI. The findings indicated the VHA spent about $2 billion in fiscal year 2010 to treat combat veterans. The medical costs per veteran during the first year of treatment averaged $8, 300.00 for PTSD; $11, 700.00 for TBI; $13, 800.00 for PTSD and TBI combined; and $2,400.00 for recent veterans with neither condition.
In subsequent years of treatment, the costs decreased when compared to the first year. Amounts did not include initial care provided by the DoD or care by other providers outside of the VHA. The VHA has also hired more than 7,500 mental health professionals to serve the growing population of veterans and has established specialized rehabilitation centers for veterans with multiple complex injuries including TBI since 2005. This increased costs also.
It is important to estimate the required costs for providing necessary evaluation, diagnosis, treatment and management for combat veterans. However, forecasts regarding costs are ambiguous without knowing the number of veterans that will actually be diagnosed with PTSD and TBI, and without knowing the number of veterans that will seek treatment. Some policymakers have questioned whether DoD and VHA have the resources and capacity to serve the veteran population with PTSD and TBI.
There is some hope. The Affordable Care Act signed into law includes measures aimed at making health care less expensive and more accessible, including upgrades to government-run Medicare and Medicaid. There are provisions in the law for veterans with advanced appropriations to ensure efficient, timely, and predictable medical services.
Unfortunately, if the law is repealed, implications for veterans will consist of higher costs and fewer choices for services. Which is interesting considering the pro-veteran and pro-defense stance of Republicans who want to do away with it. The Affordable Care Act may actually be a tenable solution within the context of a costly health care system.