Some Perspectives on

Veterans’ Old‐Age Health

Ryan Edwards

Assistant Professor of Economics

Queens College, City University of New York

October 21, 2009
Roadmap of today’s tal

• A little bit about me: my perspectives and mot• Overview Overview of research research on health inequalities inequalities by • New research on the timing of education and • Questions are welcome at any point!
My bk d ac ground

• Ph.D in economics from Berkeley 2002• Population studies postdoc

– Stanford University 2002‐2004– RAND Corp. 2004‐2006

• At RAND, I was on a project to forecast TriCare 
TriCare for Life ( ) TFL

• Subpopulation is primarily military retirees ove

typically with 20 years active duty

• After 2001, a very generous generous health benefit: benefit: fu

coverage of anything Medicare does not cover

• Cost to individual = just Medicare Part B prem• Key element in cost forecast: longevity
Retired Retired officers officers enjoy a widening widening adva

adva

remaining life expectancy

1920161718

y at 65

141516

xpectancy

1213

4

Lifeex

1011

1965 1975 1985 1995 20051965 1975 1985 1995 2005

Source: Edwards (Soc Sci Med, 2008), from DMDC’s retired pay file 
Impli i cat ons

• Like Social Security or Medicare, higher status folk

costlier to the system b/c they live longer*

• If they are indeed costlier, divergent trends in long

will matter for cost forecasts forecasts

• Although Although TFL wasn t’ expanded expanded until 2001, it is surp

surp

there are stark health inequalities among military 

• This suggests health inequalities may predate mos

care interventions, reflecting earlier influences
Heal ht i li i nequalities

• Can be rel d ate to or distinct from inequalities in lo

– At ages over 65, lengthening life seems roughly to refle

lengthening healthy life*

– At younger ages, type‐2 diabetes & obesity, rising disa– Among veterans, vast i li i nequalities in di bili sa ty due to c

• Health inequalities are present in many subpopula

not just military retirees or veterans

• Recent trends: No clear trend in black‐white, but

educational or income inequalities are widening
Health inequalities inequalities by education education are w

w

Any

5556

Any

college

5354

ncy at 25

High Any college

5253

expectan

High

School

or less

High

School

or less

5051

Life

Hig

49

1981‐1988 1991‐1998

An

Source: Meara, Richards, and Cutler (Health Affairs, 2008), from the Nat’l Longitudina
Does rank just reflect ed 

uca

• Officers are almost always required to have a c

degree; enlisted men often sign up after high s

• (But final education education in old age may be very dif

dif

• The payroll d t a a d ’t on t ll e us ed ti uca on• Instead, we examined self‐reported health sta

four cross‐sectional surveys
MacLean and Edwards (AF&S, forthco

• Alair MacLean = sociologist at WA State, former RAND p

with me, and a “full‐blood” veterans researcher

• Studies show self‐reported health status (a 5‐point scal

“excellent” to “poor”) predicts mortality

• We examined self‐reported fair/poor health vs. rank in

– Two large‐scale military surveys: 2003 Survey of Retired Mil

2001 National Survey of Veterans

– Two civilian (p ) anel datasets that also measure rank among t

veteran subpopulations: 1994/2001 waves of the PSID, 2003 

the Wisconsin Longitudinal Study

– In all the data, these are veterans who may or may not be in 
Results (1 of 2)

• In a multivariate regression setting, officer stat

tends to be independently* protective against

fair/poor health

• Officer status lowers odds of fair/poor health 

40%, in the same ballpark as the college degre

• We interpret this as a health disparity by rank
Results (2 of 2)

• Estimates of the net effect of military service:

– In the PSID samples with nonveterans, the officer e

the nonveteran effect are about the same size

– One (completely unproven) interpretation: Military 

may be bad for health only if you’re an enlisted man

• Robustness of the officer effect

– Strongest in large‐scale military survey ,s weaker in 

data, maybe because of small N

– Seems to be stronger with longer service
Length of service

• If military service represents a treatment, long

service should affect health more strongly

• Why would there be differential treatment by 

– Combat exposure appears relatively orthogonal to r– But there’s a difference between issuing & receiving – Other candidates: smoking, drinking, access to care

• But there is also selection at work, and it may 

systematically by rank when length of service 
Disparities Disparities by rank in other hea

measures?

• Few datasets measure rank & health with large N• In the Nati l ona Survey of Veterans:

– Evidence that diagnosed conditions are lower among o

• In the PSID:

– Officers Officers are 10% less likely to have ever smoked or be 

currently than enlisted veterans

– No clear differential in drinking– Officers may have 0.8 less BMI, about 6 lbs, but impre– Officers are 10% less lik l e y to report sadness
Directions for this research

• Data limitations are problematic• We add de combat exposure and rank to the core o

Health and Retirement Study starting with 2008

• I discovered no significant independent relationshi

between self‐reported health and rank in the HRS!

• We have not yet used the rich data to expand our 

hand side health variables or our covariates

• But it could be that rank is only interesting for long

Education and h lh ea t

• There is a large and robust correlation between

educational attainment and adult health

• At least some of it is believed to represent causalit

running from education education into health

• Veterans Veterans are interesting interesting because because they often acquir

acquir

education later in life

• While many have studied the effect of the timing o

education on earnings, nobody has examined heal
Among all civilians, education is often acq

early in life, but not always

1415

ation

1213

s of educa

1011

age years

8

Aver 9a

14 19 24 29 34 39 

Age of the NLSY79 cohort

Source: National Longitudinal Survey of Youth 1979
Military retirees acquire much education d

after service

1516

ation

1415

s of educa

2.4 years acqui

1314

age years during service

1213

Avera

20 25 30 35 40 45 50 

Average age of military retirees

Source: 2003 Survey of Retired Military
Officers have more and get more educati

but still go back even after servic

1819

ation

1617

s of educa

1415 

age years

1213

Aver

11

15 25 35 45 55 6

Source: 2003 Survey of Retired Military Average age
Why do we see these patter

• Education is heavily subsidized for most veteran co

through the G.I. Bill and other programs

• $10,000 per 9‐month academic year• Veterans may find the transition to civilian occupat

difficult without retraining

• It is not the case that only healthy, nondisabled ve

acquire education, so probably no reverse causalit
How does ed ti uca on ti i m ng aff t ec h 

• I examine examine variation variation in the timing of education education amo

military retirees, with no nonveterans present

• Basic multivariate regression results suggest that h

benefits are strongly declining in the length of dela

• Each year of education

– Before entering military: –2.5% probability fair/poor hea

– During military service: –1.6% probability fair/poor hea

– After military service: –0.6% probability fair/poor hea

• The earlier earlier you get education education, the healthier healthier you ar
Interpreting these results

• There could be problems with selection

– Those who return may have low ability/human capital/he– But training training during military military service service might be wholly exoge

exoge

– If retraining programs were exogenous, they could help w

• But the basic result seems reasonable

– Education probably improves health via enhancing the st

knowledge or habituated healthy behavior

– Not by enhancing enhancing flows like raised earnings earnings– There is a “negative depreciation rate” on education in he

p , roduction, p p erha s because it increases earlier healthinvestments
Implications

• The G.I. Bill: still a good idea, but possibly not as g

well‐being as are subsidies subsidies to young college college studen

studen

• Diff ti l Differential rates of ed ti l ucational acqui iti s on by ran

important for explaining health disparities by rank