Last month, Harvard professor Linda Bilmes presented a paper at a meeting of social scientists about the cost of treating injured soldiers. She reported that 50,000 American troops had been wounded in Afghanistan and Iraq.
A few days later she got a call from a senior Pentagon official.
"The assistant secretary for Health of the DOD phoned me up asked me where I had found the numbers, and I faxed him his own Web site and that was the last I heard from them," Bilmes says.
Now both the Pentagon and the Department of Veterans Affairs have changed the number of wounded on their Web sites.
The Pentagon says the more accurate number is 23,000, and that this lower number simply makes a distinction between injuries of combat and other health problems, like the stomach flu.
Bilmes says that using the bigger number gives a more realistic picture of the health care that's going to be needed.
"Regardless of the official number the Pentagon wants to put out — whether they want to count nonhostile injuries or they don't — either way, the VA is not going to be prepared," Bilmes says.
Bilmes is a professor of public finance at Harvard's Kennedy School of Government, and was an official in the Clinton administration. She's been looking at historical comparisons.
"The first Gulf War in 1991 was a short war — it only lasted four or five weeks — and there was a relatively low number of injuries and fatalities," she says. "However, we currently spend $4 billion a year for disability for soldiers who fought in that first Gulf War."
Bilmes says that when soldiers came back from that first Gulf War, 44 percent applied for VA disability benefits. And more than half now use the VA medical system as their main source of health care.
Based on that, and current injury numbers, she estimates that the lifetime health-care costs for veterans of Afghanistan and Iraq will be $250 billion to $650 billion.
Dr. Michael Kilpatrick runs the Pentagon office in charge of protecting the health of troops. He says the Pentagon and VA already have a pretty good sense of what returning soldiers need.
"What we're seeing is about a third of those people leaving active-duty service are going to the VA," Kilpatrick says. "And the big categories are for pain in the muscles, bones and joints, which is what we see most commonly in veterans. That's about a third. Another third is for mental health. And that, to us, again is not surprising."
Kilpatrick says the Pentagon learned a lot from the first Gulf War — especially about mental health problems of war. He says that this time around, there's more care being offered, from the battlefield to when soldiers return home.
Still, many soldiers who've returned from Iraq worry about their health.
Patrick Campbell served as a medic with a National Guard infantry brigade. He lost some of his hearing in Iraq, the result of being too close to too many IEDs. And he's had mental health issues that are common of returning war veterans.
Campbell is back in law school now and is working in Washington for a veteran's group called Iraq and Afghanistan Veterans of America.
He says it doesn't matter to him that his own injuries weren't counted on some Pentagon Web site. He just wants to make sure there will be health care for him and other veterans when they need it.
"These types of injuries might not be so bad now. But in 10, 20, 30 years — when people get older and those injuries start to aggravate and they turn into disability for the VA — those injuries become a big deal," Campbell says.
There are some signs that Washington is paying more attention to veterans' health care. The VA has struggled with underfunding, but this last week, the House of Representatives passed a new funding bill that would give the VA an extra $3.6 billion.
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