The Unlikely Fix For Systemic Problems Facing Veterans Health Care: Fewer Wars, More Funding

Wars are expensive and, as the United States is learning the hard way, the costs don't disappear after the conflict has wound down and the battles have moved off the front pages. The Department of Veterans Affair's Office of Inspector General confirmed Wednesday in a preliminary report some allegations of chronic delays and denials veterans face while seeking health care. As the scandal continues to unfold, many lawmakers suggest the fix could be as simple as a change in management. But winding down the fighting of two long wars, as a majority of Vietnam veterans are reaching advanced age, has given the government more wounded veterans to take care of than it can afford.

At the start of the Iraq and Afghanistan wars, the VA realized it couldn’t pay for health care for all enrolled veterans and changed its policy to exclude from coverage those with a yearly income above roughly $24,000. As the wars progressed, injured soldiers returning from battle became the fastest-growing segment of the VA's health care population.

In 2010, the Congressional Budget Office estimated more Iraq and Afghanistan war veterans will seek medical care “as those enrollees age and their service-connected medical problems worsen.” If history is any indicator, the true cost of those wars won't be realized for another 40 to 60 years when the nation reaches the "second peak in veterans' expenditures," according to the 1956 Bradley Commission Report. The commission found the costs of caring for Civil War veterans was double the cost of fighting that war.

Veterans suffering from war-related injuries are the most expensive to treat on a per-patient basis and those costs are expected to rise. The estimated increases vary widely, however. The CBO projected per-year expenditures on health care by 2020 and found the “VA’s potential costs are very sensitive to the assumption about growth in expenditures per enrollee, which accounts for $13 billion of the [roughly] $15 billion difference between the two scenarios in 2020.”

Despite the need for additional funding, the agency is already looking at suggestions on how to cut costs. In late 2013, the CBO investigated how the VA could save $48 billion from 2015 to 2023 by excluding another 2.3 million veterans from its health care program. Just a few months later, Republicans killed a $24 billion bill designed in part to build 27 new medical facilities.