Thursday, March 29, 2018

Ruptured Duck

Our old pal Phil Carter has a thoughtful (as is his wont) piece at Slate discussing the latest of "all the best people" to work for The Fraudulency Administration; the new head of the Veteran's Administration, long-time White House physician Ron Jackson.
I've been lucky. I made it out of the service with little more than some sore knees (which were, apparently, a congentital problem that my entrance physical should have caught and 4F-ed me; I saw a doc at the Portland Knee Clinic back in the Nineties who had been a draft board physio during the end of the draft years who said that he'd have rejected me out of hand) and have had employer-based (meaning, no more than normally-shitty) medical benefits my entire working life.

But I have friends who have ended up in the VA, and their care has ranged from outstanding to horrific. Apparently the just-canned VA chief spent a ton of time fighting with the GOP who, as the GOP does, want to ensure that tax money goes to pay defense contractors to gold-plate weapons (which, admittedly, is a Democratic failing, too) and not to pay for medicine for sick people, even sick soldiers (which is NOT a Democratic failing).

As Carter points out, this new Trump hire, unlike most of the Trump cabinet hires who are chosen to simply destroy the parts of their agencies they can't loot, is simply unprepared for the hellfire he's going to encounter:
"These are hard policy questions; they are made more difficult by political conflicts within the Trump administration, disagreements between the administration and Congress, and tensions across the broader veteran community as well. Shulkin battled daily with Trump’s partisans; their relations deteriorated so badly that Shulkin reportedly barred several appointees’ access to the VA’s executive suite, and the White House barred Shulkin’s access to the press. Neither the White House nor Congress nor leading veterans organizations agree on how to resolve any of the policy dilemmas facing the VA. Jackson will walk into this crossfire—and do so during a contentious midterm election year."
One of the most ridiculous conceits of the American public is the notion that governing is easy, that anyone can do it, and that any sturdy yeoman can be elected to office and simply take charge and succeed (the other is the notion that, in a public democracy "government is the problem"; in a republic the government is YOU, dummy - if it's a problem it's because you need to be better citizens...). This idiot notion explains why a lot of people voted for a real-estate shyster who promised to run the country like a business.

Well, okay, not like HIS businesses, which went bankrupt numerous times, but, like, a business-business. Or something.

But, of course, government is NOT a business, and what makes businesses successful may be ineffective, or problematic, or even criminal, when applied to governance. And what makes you a good officer, or a good doctor, may not make you a good administrator of a huge, complex, medical and social welfare organization.

Not that our current Chief Executive would know that. Or care; it's all about the brand, baby; it's all about raking in the bucks for the Trump Organization. THAT's the only organization set up to profit from our present regime.

As we're all discovering.


  1. bring back Shinseki. The VA scandal back four years ago, although under his watch, was actually the fault of Congressional strangulation of the VA budget.

    Furthermore, VA medical centers IMHO need some political oversight. Not by another organization, but by elected officials of the state and congressional district where those facilities are located. My former sister-in-law, may she rest in peace, worked 40 years as a candy striper in the VA Hospital in Canandigua NY emptying bedpans, changing sheets, dressing patients. She said the hospital had a visit by Senator Clinton, at least annually and who did a walk-around on the wards and the kitchen, personally talked to patients, and had her staff eyeball admissions and hospital staff credentials. And then personally talk to the VA Secretary on any action needed. The 2014 VA scandal was primarily at the VA hospital in Phoenix. Guess who the Senators of AZ were in 2014? McCain must have been too busy in Syria with the FSA jihadis or flying with his buds Lindsey G and Joe L (the real Three Amigos), so didn't have time to visit.

    1. It won't happened under the current regime, but yes, bring back Shinseki.

      I started doing VA appeals after COVA got up and running, and the resistance from the adjudication branch was astonishing. At one point, COVA had to issue a Marbury v. Madison style decision, telling the VA that it was required to follow decisions of the court. The VARO's had taken the position that they were not bound by decisions from COVA.

      Up to and during this era, it was not unusual for a simple SC claim to take five years.

      Shinseki kicked some butt, and by the time he left the adjudication branch was paying attention, and moving appeals quickly. A straight forward reopen claim could be done in 90 days.

      The Phoenix VA tale has attained urban legend status. Up there with returning VN vets being spit upon, and vaccinations causing autism.

      There were problems at Phoenix, but they were blown far out of proportion by a fake news organization (CVA - Concerned Veterans of America) funded by the Kochies:

      And the mainstream media gobbled up the reports from CVA without fact checking or questioning, and gleefully repeated them.

      FWIW my experience with VA healthcare here in Louisville has been excellent.

  2. I won't pretend to know how to best run the VA complex. From everything I read it looks like an Augean stable.

    I do know this; the way NOT to run it is the way we run our private-insurance-and-fee-for-service civil medical system. I'm a post-bacc college grad with 40-something years of navigating bureaucracies and dealing with my employer's insurer requires immense time, patience,band persistence, and is usually somewhere between mildly frustrating to hair-tearingly infuriating. How a war-damaged 22-year-old with a 12th-grade education fares is a nightmare.

    No question that oversight is key.

  3. Chief,
    Today i go to the VA for my yearly glasses.they are made in china and ALWYS break after a few months use.
    The funny part is that i don't remember serving in the chinese army.
    The drugs are not always made in the US of A.
    lifers who are grads of the service academies should be barred from this post as they are organizational assets with little regard to the vets.
    I've stopped writing about VA problems because it does no good.
    My Senator(nelson) has written me off and doesn't bother to solve my service problems.
    if u add up my service connected items it adds up to 170 sc.
    and i get the run around with little regard for anything.
    Example-the release of info office WILL NOT print out my list of SC conditions.
    so why are they there?
    i'll bet if i had bone spurs they'd send me to the experts.
    jim hruska

    1. What's weird about the VA, jim, is that the care I got at Womack and Tripler AMCs was generally pretty good. The AMEDD system doesn't seem to have the problems you describe, generally speaking. Tho there are still trouble spots; I remember hating Ft. Lewis not just because it was always cold and rainy but because we had guys get messed up w poor care at Madigan. So YMMV.

      Now Tricare...don't get me started.

      I am always baffled at why the VA always seems to have problems with the same stuff the RA medical system has got wired.

      But this poor squid; with zero bureaucratic experience he's probably gonna get eaten alive.

  4. Jim -

    Sorry to hear about your VA problems. Have you tried taking them to a local VFW chapter or American Legion? The larger chapters typically have a 'Service Officer' whose job it is to help out any and all vets, members or not, with VA problems.

    If that doesn't work maybe you should take it to Little Marco instead of Nelson as Marco probably has more clout. Maybe not with Corporal Bone Spurs, but with the Senate Committee overseeing the VA, considering the current political triumvirate in Washington. Or take it to your Congressional House Member instead of your Senator. Those House guys are hungrier and respond more to constituent requests, they wanna grow up to be Senators.

    By the way, my non-VA glasses are made in China also. I could get Italian-made if I wanted to pay the big bucks. My optician tells me there are no American-made glasses available on the market.

    And most of the drugs sold by my local pharmacy are non-US. Same for the TriCare mail order drugs.

    And there are no ring-knockers posting here. I fess up to being a lifer myself but the only service academy I ever saw the inside of was the NCO Academy at Pendleton.

  5. Walter -

    I understand that CVA pulled the rug out from under Shulkin also.

    What beef does the Koch family have with the VA anyway? I thought they were in oil and chemicals? Are they now investing in health insurance with an eye towards the veterans market if they can get the VA to go knockers up? Or is it just their 'crush-ALL-government-programs' attitude? I guess those vultures were not satisfied with Captain Spankee's tax cut for billionaires and need more.

    1. Mike, the Koch brothers have decided that the VA is a successful example of socialized medicine and they are determined to stamp it out. The latest effort is privatization.

  6. Chief,
    a visit for glasses should be easy.
    the dr. who was a canadian citizen 24 yo woman didn't send the prescription to the provider hence as long wait and i had to backtrack the process. then samo with the eye prescriptions.
    i believe the VA head was relieved over privitization battles.For years upon years i had massage therapy for my cervical spine injuries. now i'm under Choice program and THEY WILL NOT FUND this item. they are contractors so they don't budge because they profit by denying us benefits.
    THE VA WILL BE PRIVITIZED because its another way to screw every day citizens. all govt has morphed into white collar crime.
    i've been thru three congressmen and one senator and as a lifr mrmber of DAV i've worked thru them, but its a sad day when a va patients advocate won't do anything but tell you -we can't do that. we should rather why we can do it.
    it's all a huge swindle.
    the choice program is the first step.
    jim hruska

    1. So, here's the thing, Jim; we don't live in Zimbabwe or Burma where governments HAVE, by the nature of the system, to be a massive swindle. The papers that set up our government make it pretty clear that We the People are supposed to be the Boss. If enough of us start voting against these swindlers, they're gone.

      I mean, that was supposed to be Trump, right? He'd "shake things up", he'd"drain the swamp". Except any of us who had been familiar with him knew he was a swampy grifter who would just sink comfortably into the swamp.

      But the anger that got lefties out for Bernie and righties out for Trump is real. If we can quit letting ourselves getting spun up over abortion, weed, guns, and immigration maybe we could dial in a FFE on the moneymen who are making bank off US by buying our government and get a better government; someone(s) who really WILL kick the cash out of politics and drain that swamp.

  7. Jim -

    Get a different advocate and keep plugging. As my old Dad used to say, "If you can't fight city hall, you can still keep shitting on their front steps".

    If the VA privatizes, which I oppose, my opinion is that all vets regardless of age should go on medicare. Plus Uncle Sam should provide absolutely free coverage for service connected maladies at the best medical centers of excellence in the country plus travel and per diem costs. But the should still keep certain VA medical centers open that specialize in veteran specific issues. i.e. PTSD, multiple amputees, burn centers etc.

    And what about the other non-medical benefits: GI Bill, national cemeteries, burial benefits, disability compensation, transition assistance, education & training? Don't privatize those! Although I note some VA programs are already in corporate hands: GI home loans and SGLI/VGLI insurance programs.

  8. to all,
    if i wolf on the dva then to should i praise if earned.
    after 20 some years of waiting 6 weeks for my new glasses this has changed.
    yesterday both pairs arrived in the mail.
    these are contractors who do the glass concession.

  9. Glad that went well Jim. You can thank Former DVA Secretary David Shulkin's reforms for the better service. There is major anxiety among veterans groups that the reform efforts are now going to slow down. Or be scrapped in order to privatize everything and give the Health Insurance corporations a huge windfall of profits. A percentage of that of course will be diverted to the politicians that allowed it to happen.

    What is going to happen now to Shulkin's Electronic Health Record reforms that will use the same software as DOD health records?

    1. I was lucky to have my mustering out physical done by a wise doctor, a full bird Navy Captain. He advised me to register with the VA the day after I was discharged, and to turn over to the VA a copy of my DOD medical records. I did and never had a problem since. I know many vets who never got that advice, or perhaps they did and ignored it because they just wanted to go home asap to be a civilian again. They paid for it later when they tried to register with the VA and it took forever. It was not always the fault of the VA. Some vets never kept a copy of their DD214. Plus just a few years ago there was the red-tape nightmare in trying to retrieve records from the various military services. The VA and the miltary records centers did NOT speak the same lingo. Some of those same issues impacted the appeals process which can used to take years. Is that still the case under the 2017 Veterans Appeals Improvement and Modernization Act? Probably not yet fully implemented is my guess.

  10. Good post over at SST on the VA experience by one of the saner guest posters:

    He mentions that Virginia has VSR's (Veterans State Representatives) paid for by the state, one of whom helped him through the process. I know Oregon and Washington also provide that service. Not sure about the other 47?

  11. Thanks Pluto -

    What is next for the Kochs? Will they go after military hospitals and clinics that are also a form of socialized medicine?