The bottomline is that the data are crap and few in the Executive appear actively trying to find out. There is a LOT more work to be done here to get good estimates and an accurate picture.
The CBO is out with new, if not the very first, government estimates (.pdf) of the on-going cost of medical treatment, related principally to OIF and OEF.
Their estimates are an order of magnitude lower than the low estimate from Linda Bilme's cost-based approach. (They do not adopt, however, the economic-cost-of-a-life approach). I've long been suspicious of Bilme's estimates (and only adopted the lowest one for use the in tables here), but there was no way to get data sufficient to a better estimate.
A QUICK COMPARISON OF THE DIFFERENCES
Neither researcher really lays out all their assumptions in a model format, making life especially difficult for those trying to judge soundness.
- Unique Deployments: The CBO has a higher number of "unqiue troops" deployed than does Blimes' work, coming in at 1.4 million so far (surprisingly not counted to the man, however, as of December 2006). Blimes' low estimate was 1.4 million by 2010. So far, 690K have become "eligible for VA benefits", according to the CBO. It's not clear whether in-theater treatment, therefore, counts in the CBO's overall estimates (it may simply be added in with the other theater costs).
- Claim Rate: The CBO has a lower claims rate ("sought care" or "seen by the VA"), at 33%, than Blimes, who guessed 44% (Blimes' net is at 38%, if you consider her assumption of an 87% approval rate for those who filed a claim). The CBO is restricted to VA claims, however. The unknown number of private-insurance claims makes the actual claim rate unknown. The ambiguity of what is meant by "seeking care" in the CBO terminology makes comparison of assumptions impossible.
- High Cost Care: The CBO have slashed the average cost estimates for Traumatic Brain Injury (TBI), by cutting both the incident rate for TBI (to 8% from 20%) and limiting high expenses to just two-thirds of cases that are considered severe TBI (lengthy/costly) rather than mild (short/less costly).
- Low Post-theater Hospital Utilization: the run-rates from the VA that the CBO adopts show just 3% of wounded and seeking care from the VA were hospitalized once. The out-patient nature of the treatment suggests a lower average claim cost, but it is not possible to compare these among estimates at the level of detail provided by either researcher.
- Disability and survivors compensation: The CBO offers a total cash amount paid by the VA for both benefits in 2007, but doesn't break it down into a standardized estimate (per person), so it is impossible to compare with other assessments. Using a "run-rate" from 2007 payments (which may or may not be distorted - no detail is given), the long-term estimates come down by an order of magnitude, to discounted figures in the range of $8-$10 billion.
BAKING THE CAKE
The CBO estimates that 229,000 OIF/OEF patients have been seen by the VA. That's circa 57,000 per year, if spread out evenly. Estimates for the wounded are considerably lower. Using DoD data, the CBO reports at most 32,000 requiring medical attention of any kind in total (not per year), with maybe just 10,000 not returned to duty from "in action" causes and fewer still with serious injury (circa 7,000).
Some of CBO statistics, therefore, look silly: "Of the total 229,000 OIF/OEF patients seen by the VA, 3 percent (fewer than 8,000) have been hospitalized in a VA facility at least once since 2002." Wouldn't it make more sense to express the hospitalized as a percentage of those wounded in theater or in action, i.e. compare some amount of the 8K with the 10K wounded in action? The rest of those seeking treatment ought to be compared to the general population of veterans, right?
Here's another. The VA reports an average cost, in 2006, per OIF/OEF patient of $2,610, supposedly lower than the system-wide average, because of the high incidence of out-patient treatment (mental health or otherwise, it's not specified). Taking 229,000 by the average cost of $2,610, gives a total cost for all years of $598 million. Yet, the VA is reported to be asking for circa $700 million per year, ongoing, for OIF/OEF costs. Something isn't adding up ...
More work, needed.
From the Dole-Shalala group:
| 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 |
