The Cost of PTSD

A debate has arisen over the cost of the treatment of post-traumatic stress disorder among our veterans:

In the past five years, the number of veterans receiving compensation for the disorder commonly called PTSD has grown nearly seven times as fast as the number receiving benefits for disabilities in general, according to a report this year by the inspector general of the Department of Veterans Affairs. A total of 215,871 veterans received PTSD benefit payments last year at a cost of $4.3 billion, up from $1.7 billion in 1999 -- a jump of more than 150 percent.

Experts say the sharp increase does not begin to factor in the potential impact of the wars in Iraq and Afghanistan, because the increase is largely the result of Vietnam War vets seeking treatment decades after their combat experiences. Facing a budget crunch, experts within and outside the Veterans Affairs Department are raising concerns about fraudulent claims, wondering whether the structure of government benefits discourages healing, and even questioning the utility and objectivity of the diagnosis itself.

One can only imagine how the cost will increase when more and more veterans of the Afghan and Iraq wars begin seeking treatment for PTSD. But as the costs increase, some conservatives begin to question the validity of PTSD and the integrity of veterans claiming to suffer from it:

Psychiatrist Sally Satel, who is affiliated with the conservative American Enterprise Institute, said an underground network advises veterans where to go for the best chance of being declared disabled. The institute organized a recent meeting to discuss PTSD among veterans.

"We have young men and women coming back from Iraq who are having PTSD and getting the message that this is a disorder they can't be treated for, and they will have to be on disability for the rest of their lives," said Frueh, a professor of public psychiatry at the Medical University of South Carolina. "My concern about the policies is that they create perverse incentives to stay ill. It is very tough to get better when you are trying to demonstrate how ill you are."

However, it's important to note that for every veteran who receives compensation from the VA for PTSD, countless more refuse to seek treatment and so suffer in silence:

A far bigger problem is the many veterans who seek help but do not get it or who never seek help, a number of experts said. Studies have shown that large numbers of veterans with PTSD never seek treatment, possibly because of the stigma surrounding mental illness.

In other words, the increasing costs-even factoring in those veterans who make false claims-almost certainly doesn't represent the costs we would face if all the veterans who suffered from PTSD received the treatment they deserve.

So far Republicans in Congress and the Bush administration have shown their willingness to cut benefits as the costs of taking care of the veterans of our recent wars begin to rise. Certainly this will be no different. Conservative commentators and scholars at think tanks will claim that PTSD is over-diagnosed, or that a significant number of veterans are making fraudulant claims, or they will argue that the condition isn't as serious and doesn't require lengthy treatment. They will do so in an effort to reduce the cost of providing for our veterans, as part of the larger effort to cut the deficit or avoid any cost that would threaten tax cuts. But to me it's simple. Treating veterans for what happens to them in the wars we send them to is part of the cost of going to war. We pay it because we sent them, and our government shouldn't be allowed to cheat itself into war "on the cheap" by thinking that it can get out of paying for the veterans that suffer the consequences of the wars they are sent into.