Saving a Buck at the Expense of the Ill

It was always assumed that the reasons so many contractors have been used in the occupation of Iraq is that it's a sop to the Halliburtons of the world. Another unexplored side effect is that the veteran's health care system becomes less burdened with caring for hundreds of thousands more shell-shocked soldiers, saving billions for the federal treasury. The other side of that is that the contractor employees, who participate in the same war zone and feel the same effects, get thrown into the wasteland of the private for-profit health care system, where their treatment is woefully inadequate, as the great T. Christian Miller explains in a classic LA Times investigation. For all its faults, this is why I still subscribe to the Times, because you can get in-depth studies of the margins of the American condition.

Samuel Walker saw combat in Iraq firsthand: He was splattered with human flesh and shrapnel in a dining hall when a suicide bomber blew himself up just a few feet away.

When Walker got back to the U.S., he brought some of the battlefield home with him. He heard phantom screams in broad daylight, smelled gunpowder that wasn't there. A loud noise would send him into a defensive crouch. He'd been eating French fries in the mess hall at the time of the blast, and the sight of a McDonald's restaurant now brought back violent memories.

Two doctors diagnosed Walker with post-traumatic stress disorder, or PTSD, directly related to his close encounters with violence in Iraq.

But Walker was not a combat soldier. He was a civilian recreation supervisor for KBR, the largest contractor in Iraq. And instead of getting the medical and counseling help he sought, Walker, a U.S. Army veteran, found himself caught in a morass of red tape and rejected insurance claims.

A Times investigation of a taxpayer-financed insurance system, based on reviews of scores of cases, has found a pattern of repeatedly blocked claims for treatment of psychological injuries sustained by civilian workers in Iraq and Afghanistan.

The private system isn't set up to handle psychological distress like PTSD. It's bad enough that our soldiers aren't getting the care they deserve for the soul-shattering effects of combat; these contractor employees can't even come close to getting the attention and treatment they need.

Though contractors claiming psychological problems made up about 4% of nearly 1,400 serious reported injuries from 2003 to 2005, such workers accounted for 13% of the cases fought out in courtrooms.

In fighting claims, the insurance companies have relied on doctors with questionable expertise, according to court records and claimants' attorneys.

In one case, an insurance company psychiatrist who specialized in pharmacological research broadly dismissed psychology as "baloney." In another, a psychologist hired by insurance giant American International Group, or AIG, for his supposed expertise in PTSD had seen only 10 to 15 cases in a decade of practice.

The companies have disputed some cases in which their own doctors determined that workers were suffering psychological damage, court records show.

Simply put, the insurance industry will fight tooth and nail against doing its job. Every battle they win saves them millions, and they can weather a protracted lawsuit far more than an individual who is suffering. As long as they can stop providing any money to people in need, they come out on top. The inhumanity of it all is just devastating.

In the interim, the worker's compensation system for contractors working in foreign areas should be overhauled as long as these workers are forced to toil in combat zones. But this is happening in the larger context of the overall health care debate. And while I think the insurers will fight as hard as they can to maintain the status quo, and consequently their existence, ultimately I do think they will lose and we will see universal single payer health care in this country before long. Because you cannot give the image to anyone in this country of a PTSD sufferer back from Iraq having to go to court to get his insurer to pay off on their coverage, and have anyone look at that image think that this is the best we can do.