Balancing the cost of war

"The Army will get its pound of flesh and blood from you, one way or another"

One of my first bosses in the Army told me this just before my first deployment, and the statement is true to this day. Regardless if you go to war or not, the military is tough work, and it takes its toll - physically, mentally, emotionally, socially.

The dynamics around Veterans Benefits are complicated - it's been that way since our Nation's founding. Revolutionary War veterans nearly mutinied due to the failure of Congress to provide their owed back pay, requiring George Washington to make the Newburgh Address.

A few days ago The Economist waded into this complicated territory with their article, "American veterans now receive absurdly generous benefits", available here: https://www.economist.com/finance-and-economics/2024/11/28/american-veterans-now-receive-absurdly-generous-benefits

Setting aside what is clearly meant to be an inflammatory and and provoking title, the piece focuses on the economic challenges of the current disability compensation payments from the Veteran Benefits Administration. Much of the response to this article has been...unhelpful to say the least. Attacks on the Economist, alleging that these benefits are our "rights" as veterans, statements that if you "never bled for someone else's freedoms" you aren't entitled to a perspective on the national budget or veterans programs, and direct attacks on the authors of the piece.

I understand where this kind of animosity can come from; the article takes a blunt, and unfair approach, to a very nuanced discussion. But we have to also hold all the truths about how the Veteran Disability Compensation systems has changed, and the impacts of that.

Some of those truths...

• The disability compensation is a part of the total benefits package that is critical in recruiting & retention, and part of the obligation of care we have for those who serve.
• The current state of disability compensation is bloated, overburdened, and is a major target in fiscal reform
• Identification of health conditions during transition is an essential piece of ensuring health care access for issues that develop related to those conditions.

First, it's important to note that the system, as designed, was meant to assign a rating to an veteran based on their lost earning potential due to military service. The more the military service impacted their long-term earning, the higher the rating, to cover the lost gap, always with the intent that for the vast majority of veterans that they would continue working after service. Over time, it's evolved now to focus on disability condition identification and assignment, and created advantages to having a higher rating. More access to Veterans Health Administration care, federal hiring advantages, and more. As these changes have been added, it's incentivized the system that having the highest rating you can is best for your competitiveness and access after service.

Second, some of the anecdotal comments on this article have alleged that that changes in battlefield care are why the disability payments have grown exponentially. That's not quite accurate for a few reasons. First, the primary driver in payments and ratings growth has been bundling ratings. Rather than a rating due to a specific condition, much of the growth has been batching more than 6 different conditions together to drive the overall rating impact higher. In total, only around 25,000 veterans have what might be considered 'major injuries' from the Global War on Terror (i.e. amputations, burns, etc). GWOT had one of the lowest casualty rates of any war period, while the system expanded to include other minor conditions as ratings eligible, and allowed for bundling those ratings.

I'm a veteran that uses this system - my sleep during the Army degrading significantly, to the point that I had chronic sleep deprivation issues. Without the disability compensation system, I would likely still have as bad of sleep, and struggle to think effectively, make decisions, or maintain composure. The authors of the article made light of sleep issues as a disability condition, but the demands and environments that military members operate under can influence chronic issues. And while a payment helps with additional care, it's the access to the equipment and medical treatment that is the primary reason why the compensation system is needed.

A big hurdle is that this system will need to demonstrate the positive outcomes that individual veterans experience from engaging with the disability compensation process. That is lacking, as much of the data still shows that disabled veterans experience higher unemployment, lower labor force participation rates, and struggles in community and social connection. Fundamentally, the legislative hurdles won't be solved because it's the "right thing to do", or due to large scale activation of the veteran community. The longitudinal impacts of integrated disability policy, and the positive social and economic factors are what will influence an outcome.

Rather than eliminating benefits payments outright, or reducing the payment structure, I think this system should evolve towards a social model of disability. A social model adds specific support to address the conditions that are identified, and works towards building the individuals skills, knowledge, abilities, equipment, or other capacity areas. Rather than treating each condition as a loss area, it creates pathways for adaptation and excellence. It integrates the disability benefit into the total quality of life support. A social model would analyze each unique veterans condition, needs, and goal areas, and design a blended approach that allows the veteran to own their opportunities, address specific challenges, and get the care and coverage they need. During the transition it might cost more per veteran, but over time it would see more disabled veterans employed, with better quality of life, and still cover the gaps they experience, while being an overall lowered cost area. Most importantly, because the costs would be part of an integrated care model, instead of just cash payments to individual veterans, it would be less of a target during budget reform discussions.

A blunt force approach to this system doesn't work, and a vague narrative won't address the prevailing economic factors that will likely guide legislators. For some disability conditions and need areas a lump sum of payment to cover gaps is the right approach; for others it might be a combination of payment, health care access, and adaptive support. For others it might be training and technology. But until we treat each veterans transition experience as unique and personalized, we will keep experiencing this tension between our obligations for care for our veterans, and the sustainability of the budget process that pays for that care.