When the next generation looks back on Iraq and Afghanistan they will see that one of the steepest costs of these wars was the obligation we incurred to our veterans.
Two and a half million Americans have fought in Iraq or Afghanistan. Approximately 700,000 have received disability status. More than 250,000 personnel have endured a traumatic brain injury; 125,000 have received a post-traumatic stress diagnosis; and 1,500 have lost a limb.
The obligation we have to these veterans is a moral one, but it will be measured in dollar terms, a massive cost arriving just as Congress and the White House attempt to control the budget. Fortunately doing the right thing also is the prudent thing. The Pentagon and the Department of Veterans Affairs can control long-term costs by cooperating to make sure that veterans get their needed care right now.
But they're not. Instead, they're letting bureaucratic gamesmanship push private health-care providers onto the sideline as well.
Linda Bilmes, a professor at Harvard's Kennedy School of Government, has itemized the United States' financial commitment to Iraq and Afghanistan veterans in sobering detail. In April, the VA and Social Security Disability tab ran to $970 billion, of which $134 billion has already been spent and $836 billion will come over the next 40 years. Layered on top of this sum are unspecified, Pentagon-incurred costs of treating war-related health issues for active-duty veterans.
The burden we place on our armed forces and on our taxpayers will continue increasing as long as we remain in Afghanistan. Once we leave, though, it should plateau - so long as we tend to wartime wounds rather than letting them fester. Veterans' health care is no different from any other when it comes to the proverb that an ounce of prevention is worth a pound of cure. On the other hand, the converse also is true - obligations we postpone will cost even more later.
Our quick response depends heavily on programs that help civilian physicians treat, or at least recognize, service-related issues within their own communities. Military and VA facilities are the most evident care facilities, but it is common for Reservists and National Guard vets to live outside these facilities' coverage areas.
The Pentagon and VA either will have to expand their infrastructure dramatically to care for those who live outside of health-care coverage areas, or they'll have to partner with civilian providers.
Enter a Chapel Hill, N.C.,-based initiative called the Citizen-Soldier Support Program. This program trains civilian providers in topics related to traumatic brain injury and post traumatic stress. It likewise provides service members with online resources to locate appropriate care.
In October of last year it lost federal funding. Since then CSSP has continued supporting U.S. veterans' health care as fully as possible using private resources. The reasons for this loss boil down to a typical government problem: The inability of two bureaucracies, the Pentagon and the VA, to get along. Neither wants to admit to a gap in coverage or to cede turf to the other, so both just ignore the problem.
But postponed costs will grow, and they will come at the expense of other priorities. As always, it bears repeating that "postponed costs" is an accountant's term for untreated veterans.
The right thing is caring for these veterans now. It's also the prudent thing. Bilmes at Harvard has told us about the costs, and the Citizen-Soldier Support Program at the University of North Carolina has shown us a way ahead. The only thing missing is accountability for the Pentagon and VA to set aside their bureaucratic frictions and tackle the problem.
Matthew Leatherman is a fellow at the International Affairs Council of North Carolina.
He wrote this for McClatchy-Tribune.