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BMJ. 2007 November 17; 335(7628): 1011.
PMCID: PMC2078656

Cost of US soldiers' health care could reach $650bn

The lifetime health care of soldiers deployed to Iraq could cost the United States $650bn (£310bn; €440bn), more than has been spent on operations in Iraq, according to projections in a report published last week.

The report, Shock and Awe Hits Home, was written by Evan Kanter, a staff psychiatrist at the post-traumatic stress disorder (PTSD) outpatient clinic of the Department of Veterans Affairs, Puget Sound Health Care System, in Washington state, for the Nobel peace prize wining group Physicians for Social Responsibility. It was presented to sympathetic members of Congress on 8 November. “Every day of continued fighting adds to the terrible price that we are paying,” the report says, before calling for an end to the war.

One reason for the huge cost is that fewer soldiers are dying in combat from their wounds than in past wars because of better body armour, battlefield medicine, and rapid evacuation. The torso is protected, the report said, but there is greater polytrauma, particularly brain injury and injuries that require limb amputation. The ratio of wounded to dead soldiers has changed from 2:1 in the second world war, to 3:1 in Vietnam, to 8:1 in Iraq.

Earlier in the week, during a presentation at the annual meeting of the American Public Health Association, Dr Kanter said, “A study of the first 100 000 veterans [of Iraq and Afghanistan] seen at facilities of the Department of Veterans Affairs showed that 25% of them were diagnosed as having mental health problems. Of these, 56% had two or more mental health conditions. The most common were PTSD, substance abuse, and depression.” He added, “The younger the veterans, the more likely they are to have mental health conditions.” There also was “a dose response” effect of multiple deployments increasing the likelihood and severity of mental health problems.

Evaluation of soldiers immediately on return from deployment indicated that 5% of staff on active duty and 6% of reserve personnel had a noteworthy mental health problem, but this increased to 27% and 42% when they were reassessed 3-6 months later. Dr Kanter gave two explanations for this. Soldiers initially lied because they wanted to get back to their families and feared that answering yes to mental health screening questions might delay that. “The other is that PTSD and other mental health conditions have an insidious and delayed onset,” he said.

Dr Kanter is guardedly hopeful that a greater understanding of post-traumatic stress disorder and the benefits of earlier intervention will result in better outcomes than seen in veterans from the Vietnam war. “Framing the discussion in terms of post-deployment stress, readjustment, and reintegration has helped to get veterans to seek and accept help on mental health issues,” he said.

Notes

Shock and Awe Hits Home is available at www.psr.org/site/DocServer/ShockandAwe.pdf?docID=3161.


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