News | Jan. 16, 2023

Cultural Change, Tuition-Free College, and Comprehensive Health Care: Emerging Challenges to National Defense?

By Chad Peltier, Grace Hand, Nathaniel Peterson, Louis Deflice, Kyle Smith, and Justin Handy Joint Force Quarterly 108

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Lieutenant Chad Peltier, Ph.D., USN, is a Life Sciences Researcher at Leidos and worked from 2018 to 2021 as a Research Psychologist at the Naval Submarine Medical Research Laboratory (NSMRL) in Groton, Connecticut. Grace Hand is a Doctoral Student in Clinical Psychology at the University of Connecticut and was a Research Assistant at NSMRL from 2018 to 2020. Chief Warrant Officer 3 Nathaniel Peterson, USN (Ret.), is a Shops Supervisor, U.S. Army Corps of Engineers, and served as a Facilities Manager and Facilities Engineer at NSMRL from 2018 to 2021. Command Master Diver Louis Deflice, USN (Ret.), served as the Diving Research Department Head at NSMRL. Navy Diver 1st Class Kyle Smith, USN, works at the Naval Submarine Support Facility, SUBASE New London, and served as the Diving Department Head at NSMRL. Justin Handy, Ph.D., is a Research Psychologist at NSMRL.
Armed Services Vocational Aptitude Battery examinees from Yokota High School take test at Yokota Air Base, Japan

Since the inception of the all-volunteer military in 1973, recruiting has been an essential task in maintaining U.S. military staffing. Although recruiting efforts—including social media campaigns, television advertisements, and visits by recruiters to schools—have kept staffing on pace with requirements, overall interest in joining the military is decreasing, potentially because of military and societal values becoming less aligned. Despite increasing recruitment budgets,1 the number of enlisted applicants has dropped steadily, from 800,103 in 1981 to just 247,785 in 2017—a 69 percent decrease—while new accessions dropped from 304,506 in 1981 to 159,583 in 2017—a 48 percent decrease.2 The number of applicants has decreased faster than military staffing needs, resulting in the military’s accepting 64 percent of those who apply today, versus 38 percent in the past. This higher acceptance rate potentially indicates that the military is less able to be selective in whom it allows to enlist. Maintaining a robust and ready military is critical for the United States to be able to provide constant protection to its people and interests while maintaining military superiority over its rivals and navigating global threats. Here we will outline factors that may have contributed to a decline in the number of people attempting to enlist, the increasingly strong appeal of education and health benefits to potential recruits, the impact that the loss of these unique incentives may have on military readiness, and proposed solutions to mitigate the potential loss of these incentives and the general decreased interest in service.

Recruiter paints Rutgers logo in basement of Reserve Officers’ Training Corps building

Military Recruiting: Current and Future Challenges

Structural Barriers to Enlistment. Approximately three-quarters of America’s 17- to 24-year-olds are not eligible to serve in the military based on current standards of health, fitness, education, criminal history, and cognitive abilities, reducing the pool of applicants from which the military can access new recruits.3 The most common exclusionary criteria are health, fitness, and education. About one-quarter of young Americans are ineligible to serve because of health problems, which range from vision deficits to mental health issues.4 Another quarter of young people were too overweight to enlist in 2009, and this problem has likely only worsened as Americans continue to become more overweight.5 The third largest disqualifier for service is the lack of high school diploma or general educational development (GED) certification, accounting for another 12 percent of 18- to 24-year-olds.6 With structural barriers to entry keeping so many young Americans from being able to serve, even if willing, the military should be concerned with factors such as cultural change that may make military service less desirable for those who do meet its standards.

Societal and Cultural Changes. In addition to decreasing eligibility, military enlistment may also be less appealing today than it has been in years past because of differences between military and civilian cultures, a topic that is receiving increased attention. These differences in culture include mental health awareness and treatment, sexual assault awareness, political affiliation, and tolerance of cannabis use.

While broader society has become more aware and accepting of mental health problems, mental illness remains a highly stigmatized topic in the military. For instance, one sample found that less than 40 percent of Servicemembers with mental health problems use mental health services.7 Furthermore, there is evidence to suggest that Servicemembers who admit to problems are more likely to face personal and professional repercussions,8 a potential driving factor contributing to the elevated risk of suicide in Servicemembers relative to their civilian peers.9

Similarly, during a time of increased sexual assault awareness, the military—an organization in which women already experience higher rates of sexual assaults than their civilian counterparts10—reported a 38 percent increase in sexual assaults between 2016 and 2018.11 Events of note include high-profile incidents such as the circulation of a “rape list” aboard the USS Florida12 and the release of the Fort Hood independent review following the murder of Private First Class Vanessa Guillen, which stated that Fort Hood had a permissive environment for sexual assault and harassment and found evidence suggesting these violations were underreported for years.13 The frequency and severity of these incidents may further dissuade women, already a minority in the military, from joining.

As political polarization is increasing, political affiliations may play a larger role in determining whether someone is interested in military service.14 Today’s young adults increasingly identify as politically liberal; only 45 percent of 18- to 30-year-olds identified as liberal in 1990, compared with 62 percent of 18- to 30-year-olds in 2010.15 This trend is notable given that those who identify as liberal are half as likely as those who identify as conservative to have the propensity to serve.16

Finally, cannabis consumption has increased in those 21 years and older following the legalization of recreational use in some localities, but the standards for enlistment follow Federal regulations regarding the legality and impermissibility of the drug.17

With these issues only becoming more pronounced over time, the number of high-quality enlisted applications may decrease, in turn reducing the effectiveness of the military. These potential downward trends in military interest are countered by two incentives that are increasing in value over time: educational benefits—specifically, the Post-9/11 GI Bill and Tuition Assistance—and health care—namely, TRICARE.

Educational Benefits

For those who are financially motivated, there is a strong incentive to get a college education. Those with bachelor’s degrees have more employment opportunities and have been estimated to earn 60 percent more per year than those with only high school diplomas.18 However, the cost of college tuition has increased by approximately 3 percent per year over and above the inflation rate since 1985, making it increasingly difficult for those who are not from a prosperous background to afford college without the threat of long-term debt.19 Given the high potential value but great expense of attending college, the military’s Post-9/11 GI Bill and Tuition Assistance have offered strong incentives to enlist, with 84 percent of new enlistees stating that money for education was a primary motivator to join.20 For the most part, these recruits follow through: approximately 60 percent of those who qualify to use the GI Bill do use it.21

Because new enlisted Servicemembers earn, on average, well under $200,000 cumulatively during a 5-year commitment, the GI Bill could nearly double their compensation package; its estimated value is $130,000, accounting for eight semesters of in-state tuition, supply costs, and housing allowance at a public institution. Beyond the general recruiting power of the GI Bill, it is also a major draw for many high-aptitude enlistees. According to one study, those with cognitive abilities above the 71st percentile (as measured by the Armed Services Vocational Aptitude Battery [ASVAB]) are less likely to enlist when alternative options to finance a college education are available.22 That is, when need- or merit-based scholarships are available, many high-aptitude individuals opt for college instead of the military. On a broader scale, this suggests that if college is affordable through means other than the military, higher-quality prospective recruits may lean toward choosing college over the military, potentially depriving the military of valuable talent. A similar finding shows those with cognitive abilities at or above the 80th percentile (as measured by the ASVAB) are less likely to join the military than those between the 40th and 79th percentiles.23 These findings are especially concerning for mission-critical positions, where high scores on the ASVAB are a requirement, such as the already undermanned cyber and nuclear job specialties in the Navy.24 If the military does not address the potential impact of individuals no longer needing to enlist to receive a free college education, then recruitment levels, particularly for those with high aptitude, may be in jeopardy.

Though these laws have not been enacted, many Democrats in recent years have publicly stated their support for, or submitted bills in support of, reducing or eliminating the costs of college tuition, potentially reducing the utility of the GI Bill in recruiting. The 2022 budget proposal,25 which has since been voted down, included a measure to provide for free community college tuition, as did the America’s College Promise Act of 2021.26 Senator Bernie Sanders (I-VT), who has previously campaigned on a platform advocating for tuition-free college, submitted the College for All Act of 2021 to make college tuition-free for many Americans.27 In addition, President Joe Biden has publicly discussed reducing college loan debt, while another group of Democrats has introduced the Debt-Free College Act to reduce student loans.28 Though college tuition costs and debt remain, proposals aiming to reduce their burden have increased in number relative to past decades, making college tuition reduction or elimination increasingly likely.

Health Care

On a similar note, healthcare costs for the average civilian consumer have significantly increased over time, making TRICARE’s comprehensive coverage for Servicemembers, Reservists, retirees, and their families, with zero out-of-pocket costs, another strong recruiting and retention tool. A 2005 RAND study indicated that the monetary savings of TRICARE for one Servicemember with a family is approximately $5,000 per year versus the costs of a similar benefits package offered by a civilian employer.29 This saving is an underestimate, given that the cost of civilian health care has only increased since then.30 As with educational benefits, evidence indicates that healthcare coverage provided by the military is an important factor in the decision to join and stay in the military. One study attributed 3 percent of Army separations after a first enlistment to the implementation of the Affordable Care Act alone, suggesting that the presence of publicly available and free health care, were it to be implemented, could have an even more pronounced negative impact on military retention and recruiting.31

As with education reform, proposals and support to increase healthcare coverage and/or decrease healthcare costs are increasing. The Affordable Care Act of 2010 increased coverage for those who were uninsured and was responsible for increasing Army separations. To complement the Affordable Care Act, Senator Sanders introduced the American Health Security Act in 2011, which would grant comprehensive health coverage to all citizens with no cost sharing. More recently, Senator Sanders introduced the Medicare for All Act of 2019, and Representative Pramila Jayapal (D-WA) introduced the 2021 Medicare for All Bill.32 There are also several bills at the state level proposing the adoption of some form of single-payer health care. Again, though these bills have not passed, their level of support has increased over time, with 137 combined House and Senate sponsors of single-payer healthcare bills in 2017—more than at any other point in the previous 50 years.33 This trend suggests a single-payer health care model, which could make TRICARE a less attractive incentive to join the military, is increasingly likely.

Given the vital importance of tuition and healthcare benefits to military staffing, any threat to devalue them would require the military to develop alternative recruitment strategies and/or incentives. Although broad changes to the general civilian education and healthcare system are not likely to occur in the immediate future, their eventual enactment appears increasingly probable. Polls show that public support for tuition-free college grew from 47 percent in 2016 to 63 percent in 2019, while support for government-sponsored health care for all has increased since 2008, with many Americans supporting its implementation today.34 If college and health care were to become free, then those who contemplate military service to obtain these benefits would have a lowered incentive to serve.

One may contend that beginning to plan for such changes to healthcare and education policies is premature, but the general decrease in interest in military service, the broad scope of these changes, and the deliberate pace of government reform imply that the time to plan is now. The GI Bill funding illustrates the importance of advance planning. The GI Bill, though it serves as a recruiting incentive and retention tool, is classified as a veteran benefit and does not fall under Department of Defense (DOD) appropriations. If the GI Bill funding were dismantled, its funds would not necessarily be available for DOD to repurpose for other incentive needs as it saw fit. The same may also be true of TRICARE; if TRICARE were no longer necessary in its current form, it would not necessarily mean that its funding would be available for the military to repurpose. To be able to divert this money to other recruiting and retention incentives, DOD may need to start planning and lobbying years in advance of any potential elimination of the GI Bill and/or TRICARE.

Fairgoer performs pull-up at Washington County Fair in Greenwich, New York

Potential Recruiting Solutions

A failure to develop new tools to incentivize enlistment and retention in the military could cause decreased staffing and/or loss of technical expertise if fewer seasoned Servicemembers were willing to stay in the military without comparatively strong benefits. Even now, military recruitment is largely dependent on the civilian economy; recruiting decreases when civilian job opportunities go up, implying that many already view the military as a secondary opportunity.35 In anticipation of the growing challenges associated with maintaining staffing and experience as interest in military service declines, and particularly of a situation in which two of the most valuable recruiting incentives would lose value, we outline several potential solutions, including mandatory service, repurposing the education and healthcare funds for higher pay/bonuses, greater investment and reliance in automation, and relaxing or eliminating eligibility criteria around fitness levels and marijuana use.

Mandatory Service. Since the U.S. military became an all-volunteer force, recruiting costs have become an essential part of meeting personnel requirements. Between 1980 and 2017, the total dollars spent on recruiting increased by more than 50 percent, from $1.8 billion to $2.9 billion (in 2018 dollars), while at the same time, the number of applicants dropped by more than 50 percent, from 768,523 to 333,663.36 This trend, of a decrease in the number of applicants despite more money being spent to encourage applications, raises concerns about the expense and effectiveness of using current recruiting practices to maintain personnel requirements into the future—particularly given the widening gaps between civilian and military cultures noted. Given the necessity of meeting military personnel requirements, alternative methods of increasing service participation may be needed.

Inspired to Serve, a report submitted to the President and Congress by the National Commission on Military, National, and Public Service in 2020, reviewed challenges and potential solutions to increase participation in public service.37 Although the commission formally recommended that there be no mandatory public service, it did suggest that the Selective Service could be modified so that all young men and women would need to register for potential national service.

Given the concerns of the commission regarding the decreasing eligibility for and interest in military service, we suggest that a form of mandatory service may be necessary if current personnel requirements are maintained and recruiting challenges remain. Military recruitment losses could be minimized by the implementation of mandatory national service to begin following high school graduation. Such a program could offer the option of military service alongside other service programs (for example, volunteering with AmeriCorps, Teach for America, the Boys & Girls Clubs of America, the American Red Cross, the National Park Service, or Habitat for Humanity). The less demanding services (such as the Reserves) would require longer contracts, whereas more demanding Active-duty service would require shorter contracts to ensure a more balanced commitment between options from young adults. The main benefit of this solution would be that the military would have a larger pool from which to choose the most effective recruits. Other potential benefits include promoting national unity, providing useful skills and knowledge to younger generations, and building work experience among these Servicemembers before investing years in college education.

Some may argue against mandatory national service on the grounds that it is a violation of free will or that it may produce poor performance because it would not be a completely volunteer force and that, therefore, those who joined might not have the dedication and commitment necessary for a ready and effective force. Allowing multiple mandatory service options to choose from could reduce, though not eliminate, this concern; those who joined the military would still have chosen it over the alternatives. Although mandatory national service may seem implausible in the United States, between 2003 and 2015 at least four bills advocating for mandatory national service, sponsored by former Congressman Charles Rangel (D-NY), were put before Congress. President Barack Obama, General Stanley McChrystal, and former Senator Chris Dodd (D-CT), among others, have all expressed support for expanded community service opportunities for young people.38 The benefits to the Nation from national service could also help offset the costs of providing a college education to those who complete the service. Although mandatory national service is highly controversial, it could provide many potential benefits that extend beyond the military, including on-the-job training for youth, increased service for underserved communities, and the fostering of cooperation among people from diverse backgrounds.

Repurposing Funds. If the military and Department of Veterans Affairs no longer required funding for the GI Bill, tuition assistance, or health care, a massive surplus of funds would be available to be repurposed for modernizing incentives. Each year, about $11 billion is spent on Servicemembers’ educations through the GI Bill or tuition assistance and another $52 billion39 is spent on TRICARE, amounting to an average of approximately $48,000 spent per Servicemember per year (divided by the approximately 1.3 million Active-duty Servicemembers).40 Bonuses and raises have been strong incentives for recruitment and retention in the past, so increasing them appropriately to reflect this new surplus of funds might be an effective method to improve recruitment and retention. For instance, a 2010 study showed that a one-time bonus of $45,000 per recruit increased high-quality Army enlistments by 20 percent. Similarly, the study showed that offering a reenlistment bonus increases reenlistment probability by 8 percent and that this probability increases when larger bonuses are offered. These data suggest that the $48,000 savings per year per recruit from reapportioning education and healthcare benefits could be effectively used to improve recruiting and retention if a portion of those funds were used for bonuses, while still leaving a large remainder of funds to support other military goals. Alternatively, the education funds could be minimally changed to allow for complete tuition assistance for private education and/or medical or law schools that might not be covered by taxpayer-funded education plans. The military and government should consider repurposing these potential surplus funds into measures that are likely to increase recruitment, such as more competitive salaries, increased bonuses, and expanded educational opportunities.

Automation. The total annual expense of maintaining an Active-duty Servicemember increased by approximately 20 percent between 2002 and 2016 (after accounting for inflation), despite no real increase in pay.41 The costs per Servicemember, particularly health care and retirement, will likely continue to rise as life expectancy and healthcare costs continue to increase. The military is required to cover these costs for those injured in service and for retirees and their families. Although the military should and must continue to cover these expenses for current Servicemembers and veterans, one way to slow and eventually reverse the rising cost trend is by focusing on workforce reductions by investing more in automation. Militaries around the world have increasingly been working on developing defense automation. One study estimates that one-quarter of military personnel (for example, accountants, culinary specialists, and data transcribers) have jobs with a high probability of becoming automated over the next two decades.42 Automated vehicles are more cost-efficient than current vehicles, with the added ability to embark on dangerous missions without risking the lives of the crew. The military budget for unmanned systems and associated technologies grew more than 28 percent in the last year, and further investment in automation now could reduce the costs of staffing in the future, to say nothing of the rewards this investment would reap in the saving of lives, decrease in medical costs due to fewer combat injuries, and increase in strategic warfare options.43

Revised Fitness Criteria. Whereas each branch of the military requires its Servicemembers to meet slightly different physical fitness standards, the general idea is the same. Servicemembers are required to be below a given body mass index or waist/neck circumference, depending on their age and sex; be able to run at a certain pace; and be able to complete a certain number of pushups, sit-ups, and/or pull-ups. (Physical fitness tests are being revised at this time, and the specific activities may be changing.) These requirements have disqualified an increasing number of applicants as America’s teen obesity rate has tripled from 7 percent in 1971 to 21 percent as of 2016.44 Although physical fitness may be a necessity in some jobs, particularly among Servicemembers who deploy in combat roles, the military may need to question the relevance and recruiting problems associated with current standards when searching for applicants to fill noncombat roles, such as in health care, research, administration, or human resources. As support staff in the U.S. military outnumber combat specialists by approximately four to one, relaxed (not eliminated) standards for those applying to these roles could drastically increase the pool from which the military accesses applicants.45 At the same time, military-mandated physical training after they became Active duty could improve these individuals’ long-term health and fitness.

Revised Zero-Tolerance Marijuana Policy. Marijuana is becoming legal for recreational use in more states, even as Members of Congress introduce bills to legalize it at the Federal level, yet the military maintains a zero-tolerance policy for those who test positive for marijuana use. Simultaneously, alcohol, a drug that results in more harm to its users, remains a common part of military culture.46 By removing the zero-tolerance policy toward marijuana, the military could save money by eliminating random testing for its use; open new and promising treatment options for Servicemembers with post-traumatic stress disorder, anxiety, chronic pain, or other ailments; cease separating Servicemembers who use the drug safely; and allow otherwise qualified users to apply.47 This measure could save money while also improving health, retention, and recruiting.

We contend that the military should consider these proposed recruiting solutions for three reasons. First, even if tuition-free college and single-payer health care are not enacted soon, or are not enacted at all, the military is still facing decreased interest in joining from potential recruits. Second, the potential consequences of being caught unprepared for these changes would be much greater than the costs associated with developing contingency plans that are not put into practice. And third, preparing for such massive changes to military strategy, recruiting, and culture will take years, indicating that the time for such planning is now. We are not advocating for any plan listed here. Instead, we view it as a responsibility of our stations to open this dialogue before it is too late to develop a strategy to respond to these impending changes. Military leadership must acknowledge these possibilities and not only prepare to mitigate any negative consequences but also use these changes as an opportunity to improve the military. JFQ


1 Curtis Gilroy et al., The All-Volunteer Force and the Need for Sustained Investment in Recruiting (Arlington, VA: CNA, April 2020), available at <>.

2 Population Representation in the Military Services: Fiscal Year 2018 Summary Report (Arlington, VA: CNA, 2020), available at <>.

3 William Christeson, Amy Dawson Taggart, and Soren Messner-Zidell, Ready, Willing, and Unable to Serve (Washington, DC: Mission: Readiness, 2009), available at <>.

4 Ibid.

5 Ibid.

6 Thomas D. Snyder, Cristobal de Brey, and Sally A. Dillow, Digest of Education Statistics 2017, 53rd ed. (Washington, DC: National Center for Education Statistics, January 2019), available at <>.

7 Phillip J. Quartana et al., “Trends in Mental Health Services Utilization and Stigma in U.S. Soldiers from 2002 to 2011,” American Journal of Public Health 104, no. 9 (2014), 16711679.

8 Dror Ben-Zeev et al., “Stigma of Mental Illness and Service Use in the Military,” Journal of Mental Health 21, no. 3 (2012), 264273; Tiffany M. Greene-Shortridge, Thomas W. Britt, and Carl Andrew Castro, “The Stigma of Mental Health Problems in the Military,” Military Medicine 172, no. 2 (February 2007), 157161.

9 Meghann Myers, “Active Duty Suicides Are on the Rise, as the Pentagon Works on New Messaging and Strategy,” Military Times, September 26, 2019; “Suicide,” National Institute of Mental Health, March 2022, available at <>.

10 Carolyn B. Allard et al., “Military Sexual Trauma Research: A Proposed Agenda,” Journal of Trauma & Dissociation 12, no. 3 (April 2011), 324345; Deborah J. Bostock and James G. Daley, “Lifetime and Current Sexual Assault and Harassment Victimization Rates of Active-Duty United States Air Force Women,” Violence Against Women 13, no. 9 (September 2007), 927–944.

11 Dave Philipps, “‘This Is Unacceptable.’ Military Reports a Surge of Sexual Assaults in the Ranks,” New York Times, May 2, 2019, available at <>.

12 Gina Harkins, “Sailors Created ‘Rape List’ Aboard Navy’s 2nd Sub to Integrate Women,”, May 17, 2019, available at <>.

13 Christopher Swecker et al., Report of the Fort Hood Independent Review Committee (Washington, DC: Department of Defense, November 6, 2020), available at <>.

14 Emily Kubin and Christian von Sikorski, “The Role of (Social) Media in Political Polarization: A Systematic Review,” Annals of the International Communication Association 45, no. 3 (2021), 188206.

15 Stella M. Rouse and Ashley D. Ross, The Politics of Millennials: Political Beliefs and Policy Preferences of America’s Most Diverse Generation (Ann Arbor: University of Michigan Press, 2018).

16 James R. Yastrzemsky, “The Propensity to Serve in the Armed Forces: An Examination into the Factors Associated with Military Propensity During the Post-9/11 Era” (Ph.D. diss., University of Maryland, 2016), available at <>.

17 Jamie E. Parnes, Joey K. Smith, and Bradley T. Conner, “Reefer Madness or Much Ado About Nothing? Cannabis Legalization Outcomes Among Young Adults in the United States,” International Journal of Drug Policy 56 (June 2018), 116120.

18 Michael Hout, “Social and Economic Returns to College Education in the United States,” Annual Review of Sociology 38 (August 2012), 379–400.

19 Jennifer Ma et al., Trends in College Pricing 2015 (New York: College Board, 2015).

20 Bernard D. Rostker, Jacob A. Klerman, and Megan Zander-Cotugno, Recruiting Older Youths: Insights from a New Survey of Army Recruits (Santa Monica, CA: RAND, 2014), available at <>.

21 Chris Cate et al., National Veteran Education Success Tracker: A Report on the Academic Success of Student Veterans Using the Post-9/11 GI Bill (Washington, DC: Student Veterans of America, 2017), available at <>.

22 Andrew Barr, “Enlist or Enroll: Credit Constraints, College Aid, and the Military Enlistment Margin,” Economics of Education Review 51 (April 2016), 61–78.

23 Andrea Asoni et al., “A Mercenary Army of the Poor? Technological Change and the Demographic Composition of the Post-9/11 U.S. Military,” Journal of Strategic Studies (2020), 1–47.

24 Vice Admiral Robert Burke, U.S. Navy Chief of Naval Personnel and Deputy Chief of Naval Operations (Manpower, Personnel, Training, and Education), Testimony Before the Subcommittee on Personnel, Senate Armed Services Committee, 115th Cong., 2nd sess., February 14, 2018, available at <>.

25 “Establishing the Congressional Budget for the United States Government for Fiscal Year 2021 and Setting Forth the Appropriate Budgetary Levels for Fiscal Years 2022 Through 2030, H.Con.Res 1,” 117th Cong., 1st sess., February 3, 2021.

26 America’s College Promise Act of 2021, HR 2861, 117th Cong., 1st sess., April 28, 2021.

27 College for All Act of 2021, S. 12881, 117th Cong., 1st sess., April 21, 2021.

28 Debt-Free College Act of 2021, S. 1263, 117th Cong., 1st sess., April 21, 2021.

29 James Hosek et al., Placing a Value on the Health Care Benefit for Active-Duty Personnel (Santa Monica, CA: RAND, 2005), available at <>.

30 Samuel L. Dickman, David U. Himmelstein, and Steffie Woolhandler, “Inequality and the Health-Care System in the USA,” The Lancet 389, no. 10077 (April 2017), 14311441.

31 Michael S. Kofoed and Wyatt J. Frasier, “[Job] Locked and [Un]loaded: The Effect of the Affordable Care Act Dependency Mandate on Reenlistment in the U.S. Army,” Journal of Health Economics 65 (May 2019), 103–116.

32 American Health Security Act of 2011, S. 915, 112th Cong., 1st sess., May 9, 2011; “A Bill to Establish a Medicare-For-All National Health Insurance Program,” S. 1129, 116th Cong., 1st sess., April 10, 2019; Medicare for All Act of 2021, HR 1976, 117th Cong., 1st sess., May 18, 2021.

33 “Sponsor History of Single-Payer Legislation in Congress,” Healthcare-NOW, 2022, available at <>.

34 Lydia Saad, “Americans Buy Free Pre-K; Split on Tuition-Free College,” Gallup, May 2, 2016, available at <>; “Education,” Gallup, available at <>; Kristen Bialik, “More Americans Say Government Should Ensure Health Care Coverage,” Pew Research Center, January 13, 2017, available at <>.

35 Beth J. Asch et al., Cash Incentives and Military Enlistment, Attrition, and Reenlistment (Santa Monica, CA: RAND, 2010), available at <>.

36 Gilroy et al., The All-Volunteer Force and the Need for Sustained Investment in Recruiting.

37 Joseph J. Heck et al., Inspired to Serve: The Final Report of the National Commission on Military, National, and Public Service (Washington, DC: National Commission on Military, National, and Public Service, March 2020), available at <>.

38 “National Service Bill Gets Obama’s Signature,” NBC News, April 21, 2009, available at <>; Guinevere Nell, “What Does the Future Hold for Mandatory Public Service?” The Daily Signal, August 28, 2008, available at <>; Stanley McChrystal, “Every American Should Serve for One Year,” Time, June 20, 2017, available at <>; Holly Ramer, “Dodd: Expand Community Service for Teens,” CBS News, June 23, 2007, available at <>; Leo Shane III, “Why One Lawmaker Keeps Pushing for a New Military Draft,” Military Times, March 30, 2015, available at <>; Martin Matishak, “Rangel: Reinstate the Draft,” The Hill, March 19, 2015, available at <>.

39 Approaches to Reducing Federal Spending on Military Health Care (Washington, DC: Congressional Budget Office, 2014), available at <>.

40 The Post-9/11 GI Bill: Beneficiaries, Choices, and Cost (Washington, DC: Congressional Budget Office, 2019), available at <>.

41 United States Department of Defense Fiscal Year 2016 Budget Request: Overview (Washington, DC: Office of the Under Secretary of Defense, February 2015).

42 Sverre Kvalvik, “The Future of Military Automation and Manpower,” presentation at CRUSER TechCon 2018, Naval Postgraduate School, April 17, 2018, available at <>.

43 David Klein, “Unmanned Systems and Robotics in the FY2019 Defense Budget,” Association for Uncrewed Vehicle Systems International, August 14, 2018, available at <>.

44 Tracey Pérez Koehlmoos et al., “Child Health as a National Security Issue: Obesity and Behavioral Health Conditions Among Military Children,” Health Affairs 39, no. 10 (October 2020), 17191727; Craig M. Hales et al., Prevalence of Obesity Among Adults and Youth: United States, 2015–2016 (Atlanta: National Center for Health Services, 2017), available at <>.

45 Scott Gebicke and Samuel Magid, Lessons from Around the World: Benchmarking Performance in Defense (New York: McKinsey & Company, 2010), available at <>.

46 Rachel E. Thayer et al., “Structural Neuroimaging Correlates of Alcohol and Cannabis Use in Adolescents and Adults,” Addiction 112, no. 12 (December 2017), 21442154; Max G. Griswold et al., “Alcohol Use and Burden for 195 Countries and Territories, 19902016: A Systematic Analysis for the Global Burden of Disease Study 2016,” The Lancet 392, no. 10152 (September 22, 2018), 10151035; Jeremiah A. Schumm and Kathleen M. Chard, “Alcohol and Stress in the Military,” Alcohol Research 34, no. 4 (2012), 401; Edgar Jones and Nicola T. Fear, “Alcohol Use and Misuse Within the Military: A Review,” International Review of Psychiatry 23, no. 2 (April 2011), 166172.

47 Ana Isabel Fraguas-Sánchez and Ana Isabel Torres-Suárez, “Medical Use of Cannabinoids,” Drugs 78, no. 16 (November 2018), 16651703.