Linda Bilmes & The Hidden Cost of Iraq Veteran’s Medical Care

Stephen, Andrew. 2007. “Iraq: The Hidden Cost of the War.” The New Statesman (12 March).

“The Pentagon is trying to silence economists who predict that several decades of care for the wounded will amount to an unbelievable $2.5 trillion.”

“Thanks to the work of a Harvard professor and former Clinton administration economist named Linda Bilmes, and some other hard-working academics, we have discovered that the administration has been putting out two entirely separate and conflicting sets of numbers of those wounded in the wars.”“Bilmes and Professor Joseph Stiglitz, the Nobel laureate economist from Columbia University, have established not only that the number wounded in Iraq and Afghanistan is far higher than the Pentagon has been saying, but that looking after them alone could cost present and future US taxpayers a sum they estimate to be $536bn, but which could get considerably bigger still. Just one soldier out of the 1.4 million troops so far deployed who has returned with a debilitating brain injury, for example, may need round-the-clock care for five, six, or even seven decades. In present-day money, according to one study, care for that soldier alone will cost a minimum of $4.3m.”

“Centcom, the main top-secret military planning unit at Donald Rumsfeld’s Pentagon, predicted in its war plan that only 5,000 US troops would be required in Iraq by the end of 2006. Rummy’s deputy Paul Wolfowitz was such a whizz at the economics of it all that he confidently told us that Iraq would “really finance its own reconstruction”. Rumsfeld himself reported that the administration had come up with “a number that’s something under $50bn” as the cost of the war. Larry Lindsey, then assistant to the president on economic policy at the White House, warned that it might actually soar to as much as $200bn — with the result that Bush did as he habitually does with those who do not produce convenient facts and figures to back up his fantasies: he sacked him.”

“From official statistics supplied by the non-partisan Congressional Budget Office, we now know that the Iraq war is costing roughly $200m a day, or $6bn every month; the total bill so far is $400bn. But, in their studies, Bilmes and Stiglitz consider three scenarios …. In the first, incurring the lowest future costs, troops will start to be withdrawn this year and be out by 2010. The second assumes that there will be a gradual withdrawal that will be complete by 2015. The third envisages the participation of two million servicemen and women, with the war going on past 2016.”

“Estimating long-term costs using even the second, moderate scenario, Bilmes tells me: “I think we are now approaching a figure of $2.5 trillion.” This, she says, “includes three kinds of costs. It includes the cash costs of running the combat operations, the long-term costs of replenishing military equipment and taking care of the veterans, and [increased costs] at the Pentagon. And then it includes the economic cost, which is the differential between reservists’ pay in their civilian jobs and what they’re paid in the military — and the macroeconomic costs, such as the percentage of the oil-price increase”.”

“Look at the latest official toll of US fatalities and wounded in the media, and you will see something like 3,160 dead and 23,785 wounded (that “includes 13,250 personnel who returned to duty within 72 hours”, the Washington Post told us helpfully on 4 March). From this, you might assume that only 11,000 or so troops, in effect, have been wounded in Iraq. But Bilmes discovered that the Bush administration was keeping two separate sets of statistics of those wounded: one (like the above) issued by the Pentagon and therefore used by the media, and the other by the Department of Veterans Affairs — a government department autonomous from the Pentagon. At the beginning of this year, the Pentagon was putting out a figure of roughly 23,000 wounded, but the VA was quietly saying that more than 50,000 had, in fact, been wounded.”

“To draw attention to her academic findings, Bilmes wrote a piece for the Los Angeles Times of 5 January 2007 in which she quoted the figure of “more than 50,000 wounded Iraq war soldiers”. The reaction from the Pentagon was fury. An assistant secretary there named Dr William Winkenwerder phoned her personally to complain. Bilmes recalls: “He said, ‘Where did you get those numbers from?'” She explained to Winkenwerder that the 50,000 figure came from the VA, and faxed him copies of official US government documents that proved her point. Winkenwerder backed down.”

“Following Bilmes’s exchange with Winkenwerder — on 10 January, to be precise — the number of wounded listed on the VA website dropped from 50,508 to 21,649. The Bush administration had, once again, turned reality on its head to concur with its claims. “The whole thing is scary,” Bilmes says. “I have never been conspiracy-minded, but watching them change the numbers on the website — it’s extraordinary.”

“What Bilmes had discovered was that the tally of US fatalities in Iraq and Afghanistan included the outcome of “non-hostile actions”, most commonly vehicle accidents. But the Pentagon’s statistics of the wounded did not. Even troops incapacitated for life in Iraq or Afghanistan — but not in “hostile situations” – were not being counted, although they will require exactly the same kind of medical care back home as soldiers similarly wounded in battle. Bilmes and Stiglitz had set out, meantime, to explore the ratio of wounded to deaths in previous American wars. They found that in the First World War, on average 1.8 were wounded for every fatality; in the Second World War, 1.6; in Korea, 2.8; in Vietnam, 2.6; and, in the first Gulf war in 1991, 1.2. In this war, 21st-century medical care and better armour have inflated the numbers of the wounded-but-living, leading Bilmes to an astounding conclusion: for every soldier dying in Iraq or Afghanistan today, 16 are being wounded. The Pentagon insists the figure is nearer nine — but, either way, the economic implications for the future are phenomenal.”

“So far, more than 200,000 veterans from the current Iraq or Afghanistan wars have been treated at VA centres. Twenty per cent of those brought home are suffering from serious brain or spinal injuries, or the severing of more than one limb, and a further 20 per cent from amputations, blindness or deafness, severe burns, or other dire conditions. “Every person injured on active duty is going to be a long-term cost of the war,” says Bilmes. If we compare the financial ramifications of the first Gulf war to the present one, the implications become even more stark. Despite its brevity, even the 1991 Gulf war exacted a heavy toll: 48.4 per cent of veterans sought medical care, and 44 per cent filed disability claims. Eighty-eight per cent of these claims were granted, meaning that 611,729 veterans from the first Gulf war are now receiving disability benefits; a large proportion are suffering from psychiatric illnesses, including post-traumatic stress disorder and depression.”

“More than a third of those returning from the current wars, too, have already been diagnosed as suffering from similar conditions. But although the VA has 207 walk-in “vet centres” and other clinics and offices throughout the US, it is a bureaucracy under siege. It has a well-deserved reputation for providing excellent healthcare for America’s 24 million veterans, but is quite unable to cope with a workload that the Bush administration did not foresee.”

“There is now a backlog of 400,000 claims from veterans and waiting lists of months, some of which “render … care virtually inaccessible”, in the words of Frances Murphy, the VA’s own deputy under-secretary for health. Claims are expected to hit 874,000 this year, 930,000 in 2008. Casualties returning from Iraq meanwhile outnumber other patients at Walter Reed 17 to one, and many have to be put up at nearby hotels and motels rather than in the hospital beds they desperately need. Suicide attempts are frequent; often the less wounded end up having to care for the more seriously wounded.”

The projected $2.5 trn price tag also includes the costs of replacing and replenishing military equipment in use. Nearly 40 per cent of the army’s equipment, according to the Washington Post, is currently deployed in Iraq; as long ago as March 2005, Rumsfeld conceded that tanks, fighting vehicles and helicopters were wearing out at six times the normal rate.”

“The Washington Post reported last December that the army alone has lost more than 280,000 major pieces of equipment in the combat zones; the Army Times reported as long ago as February last year that 20 M1 Abram tanks, 50 Bradley fighting vehicles, 20 Stryker wheeled combat vehicles, 20 M113 armoured personnel carriers, 250 Humvees, hundreds of mine-clearing vehicles and the like — plus more than a hundred aircraft, most of them helicopters — have been lost. Those figures have increased considerably since then as fighting has intensified. Add something between $125bn and $300bn for these unanticipated long-term costs, say Bilmes and Stiglitz.”

“Before his departure, Larry Lindsey told the Wall Street Journal in September 2002 that “the successful prosecution of the war would be good for the economy”; the WSJ echoed his thoughts in an editorial the same day, arguing that “the best way to keep oil prices in check is a short, successful war on Iraq”. In 2002, the average cost of a barrel of oil was $23.71; today, it is hovering around $50. Dick Cheney’s chums in firms such as his own Halliburton — or ExxonMobil, Shell, BP and Chevron — have profited enormously, but Bilmes estimates that even if only $5 of the oil-price increase can be attributed to the Iraq war, that alone adds $150bn to the cost of war.”

“At present, 44 per cent of US police forces, for example, have members deployed as reservists in Iraq, and their duties have to be performed by others in America; the same goes for firefighters, medical staff, prison wardens.”

“Then there are the future illnesses that may well unfold. For instance, nobody knew that the notorious Agent Orange defoliant, used by the US in Vietnam from 1961-71, would turn out to have had carcinogenic and other effects on US troops. Today, there is mounting evidence that exposure to depleted uranium — used for firing anti-tank rounds from US M1 tanks and A-10 attack aircraft — can cause cancer, diabetes and birth defects. Many veterans are returning to the US with their health apparently in ruins from adverse reactions to anti-anthrax injections and/or consumption of experimental pills to counter chemical warfare agents. The long-term costs of looking after the likes of them make the cost of the actual war dead pale by comparison: spouses of deceased soldiers receive a “death gratuity” of $100,000. Troops are also given the opportunity to take out subsidised life insurance policies for up to $500,000 for dependants. In the dispassionate way economists assess such things, Bilmes and Stiglitz estimate the additional cost to the economy of the death of a young soldier — typically 25 years old — to be $6.5m.”

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