By Linda J. Bilmes
Reprinted from Foreign Policy Magazine, March/April 2008
The price tag for caring for the Americans who fight this war could exceed what it costs to wage it.
March 19 marks the fifth anniversary of the U.S. invasion of Iraq. The American death toll—nearly 4,000 soldiers in Iraq and almost 500 in Afghanistan—is well known. Much less attention has been paid to the enormous number of troops who have survived and returned home with serious injuries. Here, the numbers are truly staggering. More than 70,000 have been wounded in combat, injured in accidents, or airlifted out of the region for emergency medical care. More than a third of the 750,000 troops discharged from the military so far have required treatment at medical facilities, including at least 100,000 with mental health conditions and 52,000 with post-traumatic stress disorder. According to a recent U.S. Army estimate, as many as 20 percent of returning soldiers have suffered mild brain injuries, such as concussions. More than 20,000 troops have survived amputations, severe burns, or head, spinal, and other serious injuries.
These numbers are largely due to the extraordinary advances in battlefield medicine in recent years. Far more soldiers are surviving even grievous injuries than in previous conflicts. The ratio of wounded in combat to killed in Iraq is 7 to 1; in Vietnam, it was 2.6 to 1, and in World War II, 2 to 1. If all injuries are included, such as those from road accidents or debilitating illnesses, Iraq has produced 15 wounded for every single fatality. This higher survival rate is, of course, welcome news, but it leaves the United States with a legacy of providing medical care and paying disability benefits to an enormous number of veterans and their dependents for many decades to come. During the past six years, more than 1.6 million troops have been deployed to Iraq and Afghanistan. Even in the most optimistic scenario, assuming that the majority of U.S. troops are withdrawn by the end of 2009, the cost of providing for Iraq War veterans will match what we have spent waging the war: approximately $500 billion. If U.S. forces remain deployed at a higher level, the cost of caring for veterans will eventually exceed $700 billion.
When we think about the costs of war, we tend to focus on the here and now. But in what is already the second-most expensive conflict in U.S. history, after World War II, the costs of Iraq will persist long after the last shot is fired. Benefits were still being paid to World War I veterans until January 2007, when the last veteran receiving compensation died, nearly 90 years after the war ended. The United States pays more than $12 billion each year in disability benefits to Vietnam veterans, a figure that continues to climb, 35 years after the U.S. pullout. If these past wars are any guide, Americans will undoubtedly be paying for Iraq for at least the next 50 years.
The purpose of U.S. policy toward war veterans is, in the words of Abraham Lincoln, “to care for him who shall have borne the battle, and for his widow and his orphan.” To do this, the government provides two main benefits: medical care and financial compensation to those who have disabilities incurred or aggravated during active military service. The consequence is that the United States faces a daunting financial burden, as well as a steep logistical challenge, in providing medical care and disability benefits to all who need or are entitled to them.
Part of the challenge is that the Department of Veterans Affairs’ medical system simply lacks the capacity to cope with the demand of returning troops. The government expects 300,000 Iraq and Afghanistan veterans to seek treatment this year alone. If the current conflict follows the pattern of the first Gulf War in 1991, about 800,000 returning veterans will eventually require medical care—more than a few for the rest of their lives. Moreover, the government is ill-equipped to handle the near epidemic of mental health cases resulting from the Iraq and Afghanistan wars. Even using conservative estimates, the long-term cost of providing medical care alone to Iraq and Afghanistan war veterans over their lifetimes could approach $285 billion, depending on how long the soldiers are deployed.
After the 1991 Gulf War, some 44 percent of its veterans applied for disability benefits; today, nearly 17 years later, the United States pays more than $4 billion each year in disability compensation to 169,000 veterans from the 1991 Gulf War. We have already paid five times as much in disability pay for that conflict as we did to fight it. Even under the conservative assumption that veterans returning from Iraq and Afghanistan apply for disability benefits at the same rate as those from the first Gulf War, the cost could reach $390 billion during their lifetimes.
Other parts of the government will also pay a long-term price for the war. Veterans who can no longer hold down a job, due to physical or mental injuries, are likely to qualify for Social Security disability compensation (adding another $22 to $38 billion to the bill). For others, the injuries they have suffered in Iraq and Afghanistan will eventually swell the rolls of Medicare, as the long-term effects of injuries and chronic illnesses appear.
Staggering though they are, these costs only represent the impact of the war on the U.S. federal budget. The many social and economic costs that the government does not pay, such as the loss to the economy of so many young, productive Americans and the costs paid by state and local governments, communities, and private medical providers, could add another $415 billion to the total cost to the economy.
Americans have so far focused only on the ballooning short-term price of the wars in Iraq and Afghanistan. But we have not yet counted the cost of caring for veterans, replenishing military equipment, and restoring the armed forces to their pre-war strength. This war will prove one of the costliest in U.S. history—one whose bill we pass to the generations that follow.
Linda J. Bilmes, a lecturer at Harvard University’s Kennedy School of Government, is coauthor, with Joseph E. Stiglitz, of The Three Trillion Dollar War: The True Cost of the Iraq Conflict (New York: W.W. Norton, 2008).