The feel-good President's Commission, headed up by Dole and Shalala following another chapter in the Bush-Rumsfeld mismanagement of war and wartime, came out with recommendations this week.
Not surprisingly, NONE - none, none! - of the commissioners have come out recommending that we develop a short, medium or long-term plan to get veterans into private hospitals, on private health plans, and covered by those angels who sell private health insurance as a way to improve the way we "serve" patients, "support" their families, and "simplify" a system full of options, programs, and benefits types/categories/requirements.
Instead, there are quotes like this:
"Returnees tell me, 'It's like drinking from a fire hose', when all these programs are described to them." -transition coordinator, Ft. BraggREPUBLICAN HYPOCRISY
No one wants to short-change or play severe politics with caring for veterans. It's amazing that "free" veterans health-care is so "third-rail" now that it was possible to call John Kerry, for instance, 'no supporter of the military', despite his long track-record of fighting for the enlisted.
However, while Bush-43 is fighting the expansion of S-CHIP, it's worth noting that his own Commission is recommending - you guessed it - expanding benefits. Here is a sample, the full table is below:
- Provide six months leave for family members, under the Family Medical Leave Act (I wonder if Justice Alito will be hostile to that, too ...)
- Lifetime TRICARE for some (have a look at TriCare Eligibility - families are covered)
- Expand TRICARE coverage
BURIED THE LEAD?
Two 'action steps' that didn't make it to the front page ... bizarre, given their content:
- "DoD should intensify its efforts to reduce the stigma associated with PTSD."
- "DoD should address its acute shortage of mental health clinicians."
SOME COSTS WE DO KNOW
They did publish this table.
| 2,200,000 | Number of deployments |
| 1,500,000 | Number of service members deployed |
| 37,851 | Air evacuated for illness or injuries [20/day on my calcs from 10/7/2001 start of OEF] |
| 28,000 | Wounded in action |
| 23,270 | Treated and returned to duty within 72 hours |
| 3,082 | Seriously injured (TSGLI recipients)7 |
| 2,726 | Traumatic Brain Injuries |
| 644 | Amputations |
| 598 | Serious burns |
| 391 | Polytrauma |
| 94 | Spinal cord injuries |
| 48 | Blind |
The 1,500,000, such an obvious guesstimate for a figure that ought to be known to the man, arguably, is in line with those used for the medical health cost estimate in the war costs table on this page. Just to refresh, those estimates use 1.4M unique, a 2010 end date, 44% claim rate; and an 87% approval rate (see hyperlink next to figure in the table for reference).
One of the problems with the direct-cost methodology used in that estimate may be that it doesn't capture the marginal cost of a soldier in the system, because it doesn't model utilization rates, for hospitals, etc. However, to be ultra-conservative, we could cut average benefit cost in half and still end up with a hefty projected medical cost associated with the "GWOT". Of course, if we start extending and expanding benefits, which would not have been done without the conflict, most likely, we can maybe add back all that was subtracted ...
| The President’s Commission on Care for America’s Returning Wounded Warriors / July 2007 | |||
|---|---|---|---|
| Recommendation Action Steps | Congress | DoD | VA |
| 1. Implement comprehensive Recovery Plans | |||
| • Develop integrated care teams | X | X | |
| • Create Recovery Plans | X | X | |
| • Develop corps of Recovery Coordinators (with Public Health Service) | X | X | |
| 2. Restructure disability and compensation systems | |||
| • Clarify the objectives of DoD and VA disability programs | X | ||
| • Create a single, comprehensive medical exam | X | X | |
| • Provide lifetime TRICARE benefits for combat-injured | X | ||
| • Restructure VA disability payments | X | ||
| • Determine appropriate length and amounts of transition payments | X | ||
| • Update and keep current the disability rating schedule | X | ||
| • Develop flexibility within Vocational Rehabilitation and Education (VRE) program | X | ||
| 3. Improve care for people with post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) | |||
| • Enable all Iraq & Afghanistan veterans who need PTSD care to receive it from the VA | X | ||
| • Address shortage in mental health professionals | X | ||
| • Establish and expand networks of experts in PTSD and TBI | X | X | |
| • Expand training regarding PTSD and TBI | X | X | |
| • Develop or disseminate clinical practice guidelines | X | X | |
| 4. Strengthen support for families | |||
| • Expand eligibility for TRICARE respite care and aide and attendant care | X | ||
| • Expand caregiver training for families | X | X | |
| • Cover family members under the Family Medical Leave Act | X | ||
| 5. Transfer patient information across systems | |||
| • Make patient information available to all personnel who need it, initially in readable form | X | X | |
| • Continue efforts for fully interoperable information system | X | X | |
| • Develop a user-friendly single web portal for service members and veterans | X | X | |
| 6. Support Walter Reed until closure | |||
| • Assure adequate resources | X | ||
| • Strengthen recruitment and retention of needed administrative and clinical staff | X | ||
