1. Where Health Care Meets Policy with Dr. Mike Magee

2. The True Cost of War

3. What Is the True Cost of War? New study by Columbia and Harvard • Estimates cost of Iraq War 20X higher than government estimate - True figure: $1 trillion  Not $50 billion government estimated in 2003 • Billions will go to those whose health has been affected Stack of mixed bills adding up to: • $1 billion: as tall as the Washington Monument • $1 trillion: 95 miles tall Governments often grossly underestimate costs • One of the least considered: long-term health care for soldiers Sources: Bilmes L, Stiglitz JE. “The Economic Costs of the Iraq War: An Appraisal Three Years after the Beginning of the Conflict.” January 2006. Wolk M. “Cost of Iraq war could surpass $1 trillion.” MSNBC.com. March 17, 2006. Herbert, B. “George Bush’s Trillion-Dollar War.” The New York Times. Editorial. March 23, 2006.

4. A Look at the Iraq Situation Physical Toll • 2,300+ American deaths • 17,500 wounded - 3,500 major head and spinal injuries - 1,000+ amputations Not All Wounds are Visible • 35% of returning soldiers receive mental health care during 1 st yr home Sources: CNN.com. War in Iraq page. “Forces: U.S. and Coalition Casualities.” Available at: http://www.cnn.com/SPECIALS/2003/iraq/forces/casualties/. CBSNews.com “More Iraq Vets Seek Mental Health Care.” March 1, 2006. Available at: http://www.cbsnews.com/stories/2006/03/01/iraq/printable1357296.shtml.

5. The Monetary Costs • Veteran disability pay and benefits - As much as $44,000 a year - Payments can continue over a lifetime - Annual cost will be more than $2 billion • Medical care for returning veterans - VA underestimated expected number of patients in 2005 - Appealed to Congress for emergency $1.5 billion - Billions more will be needed as more soldiers return home - Soldiers with brain injuries need extensive/continual care  Costs $600,000 - $5 million a year per soldier - Will eventually total $35 billion Sources: Bilmes L, Stiglitz JE. “The Economic Costs of the Iraq War: An Appraisal Three Years after the Beginning of the Conflict.” January 2006. Media focus: $251 billion spent on combat operations thus far. Many more additional costs not being considered...

6. Mental Health Costs 19% of U.S. soldiers returning from Iraq are diagnosed with a mental health disorder within a year of coming home • post-traumatic stress disorder • anxiety • depression Speech by the wife of a Connecticut Army Reservist and mental health expert returning to Iraq for second tour of duty: “ ...he is needed over there more than he is here.” Sources: Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA . 2006;295:1023-1032. Military Families Speak Out Web site. Speech by Jessica White, given March 19, 2006. Available at: http://www.mfso.org/article.php?id=561. Greatest factor behind these diagnoses • Engaging in combat or witnessing people being wounded or killed

7. The Value of Life Government’s formula determines “ value of statistical life” • Based on value of earnings and contributions to the economy lost life would have provided • Study estimate: $6.5 million per soldier • Adds up to $15 billion for the lives already lost Sources: Bilmes L, Stiglitz JE. “The Economic Costs of the Iraq War: An Appraisal Three Years after the Beginning of the Conflict.” January 2006.

8. “ Backup could take a long time.” Additional Telling Statistics • Out of 500,000+ Iraq soldiers who have left the military - 145,000 have sought VA health care - 14% diagnosed with PTSD • Bush’s 2007 VA budget asks Congress for a record $80 billion - $3.3 billion for mental health care  $340 million increase over 2006 Sources: Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA . 2006;295:1023-1032. Baker P, Graham B. Handover’s Impact On War Uncertain. Washington Post . March 15, 2006. A14. -- Michael O’Hanlon The Brookings Institution War is far from over • Objective to turn over most of Iraq to Iraqi troops by year-end: - wouldn’t necessarily mean our troops would be coming home - our military would stay to serve as backup

9. Newsweek cover story: Cpl. Jacob Knospler • Jaw blown away by a grenade • So disfigured his mother recognized him by his tattoos • Returned home to East Stroudsburg, PA • Relationships challenge him - “I think the part of my brain they removed was the part with my inhibitions. If I think something, I just say it.” • Returns to Bethesda monthly as doctors slowly rebuild his face - He is alive, but not yet completely well - Doctors labor on him loyally, constantly, quietly The true cost of war – can’t be measured in dollars and cents Shielded from Grisly Images, We Cannot Fully Comprehend the Horror of It All Sources: Darman J. Jacob Knospler: I’m a Marine. I Had to Go In and Help Them. Newsweek . March 20, 2006. Cover.

10. We’re Lucky to Have Our Military Medical Corp Compassionate, brave, committed -- they have distinguished themselves in the face of battle in Iraq and saved many lives. Unfortunately, the ultimate, devastating toll of war is far beyond the reach of even their skilled hands.

11. Release Date: 4/19/2006 www.healthpolitics.com with Dr. Mike Magee The True Cost of War