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May 20, 2009

Comments

Thanks for this, Eric.

A recent U.S. News & World Report cover story, "Cheating and Shortchanging," claims the Pentagon deliberately underrates disabilities in order to reduce the compensation payments to veterans.

It is rather interesting to compare and contrast:

Personnel at all levels, including headquarters and unit personnel that GAO interviewed after they returned from Afghanistan or who were in Afghanistan in November 2008, expressed a need for more personnel to perform CERP program management and oversight functions. Due to a lack of personnel, key duties such as performing headquarters staff assistance visits to help units improve contracting procedures and visiting sites to monitor project status and contractor performance were either not performed or inconsistently performed.

It never fails to amaze me that they don't even bother to hide it anymore.

18th century (German) soldier song:
When we are discharged
Whereto do we turn?
Health is lost and strength is gone
In the end it will be said
A(nother) bird without a nest
Hey, Old One take the beggar's bag
(for) you have been a soldier too

To praise the 'heroes' but to abandon them once not needed anymore is an old dishonorable tradition (cue Kipling)

"the Pentagon deliberately underrates disabilities in order to reduce the compensation payments to veterans"

It's even worse than that: the VA actually neglects to properly annotate patient records so that levels of disability look less severe than they really are.

I've got a friend that's wrestling with the VA over this right now. The VA is basically staffed with unaccountable and practically unfireable GS personnel that are incentivized (by bonus, even) to maximize the number of patients they see, while minimizing expense (which roughly translates to quality of care). I don't know if this is in general, or if this is an isolated case, but he can't even have analysis (MRI, for example) done at his own expense, and have the results added to his record.

His suggestion is to have the VA staffed more by military, who at least have some amount of accountability, as well as possibly some empathy.

There's more. I wish I could persuade him to write about it, other than writing to various Senators and General Shinseki.

"To our collective and deep shame..." may rank as the understatement of the week. It always astounds me (although I suppose it shouldn't any more) that those politicians who proclaim their support for the troops the most loudly apparently compete with those who proclaim their empathy for those needing medical care -- with both sides doing their utmost to avoid spending any money on our veterans who have been damaged in combat.

COIN doctrine for dummies (which is what the COINdinistas think we are)
1. Resettle populations behind checkpoints, monitor all comings and goings
2. Pay local goons to crack heads behind the checkpoints
3. If things still get hot, mass-arrest the usual suspects it all blows over

That's "easy" in an urbanized environment. A vast, desolate moonscape full of transhumant pastoralists? Good f'ing luck.

We're gonna have a lot more like Tanner, God help him.

I would like to read an essay that compares the VAs performance caring for soldiers with the coming national health system. It would be interesting to see what is being done to insure that the coming national system will not be "stretched and overburdened" or engage in "deliberately underrat[ing] disabilities in order to reduce the compensation payments to [patients]." Will "officials instead blame a system that is complicated, outdated and ambiguous"?

I'm sure this new program will be run more professionally than the VA program.

// The VA is basically staffed with unaccountable and practically unfireable GS personnel //

I believe this statement is generally true. My father had physician privileges at a VA hospital until recently and he has a million stories of how he couldn't get GS nurses to do anything. There were non-GS temporary nurses who would actually work. He likes to say the GS nurses were all laying the ground work for disability retirements.

But this won't happen in the coming national health system. It will be run alot more professionally than the VA program.

Excellent post, Eric. As you rightly note, there are long-term consequences for disabled US veterans (and the US as a nation) as a result of how these strategies are being employed. And that's not even taking into consideration the unspeakable toll for those on whose behalf we've shouldered the burden.

http://www.wsu.edu:8080/~wldciv/world_civ_reader/world_civ_reader_2/kipling.html

(Fncking Typepad stripping fncking HTML -- any update on moving to a blog platform that, y'know, DOESN'T lick erupting hemorrhoids?

Also, if there's any justice in the universe, a certain insufferable, unrelenting troll will finally receive a nutsack full of splinters from so vigorously and shamelessly humping their unvarnished hobbyhorse. Bored. Now.)

Two questions for d'd'd'dave:

1) Where can I find the proposal that would put "GS nurses" into the general US healthcare system?

2) Where can I find YOUR proposal to replace the government-run VA system with some kind of free-market alternative?

--TP

"...the coming national health system"

Please link to the proposed bill you are referring to.

"It will be run alot more professionally than the VA program."

There is no such "national health system" proposed that offers government-run health service. You're making that up out of whole cloth. If you're not, link to the proposed bill.

"Alot" isn't a word, btw.

Excellent post Eric. I could quibble on some points – but it would be dumb because your overall point is right on.

Thank you.

OTOH – the VA as a model for universal health care would seem to take a hit here…

OCSteve, to repeat what Gary said before, in terms of actual proposals how is the VA being taken as a model. Oh and BTW, in terms of long term care, the VA is probably one of the best systems in the country. Were they are overloaded and why the floater of having private insurance pay for some services made sense is in the case of returning wounded veterans.

//"Alot" isn't a word, btw.//

If it conveyed the intended meaning then it is in fact a word. We both know it conveyed the meaning.

"If it conveyed the intended meaning then it is in fact a word."

Don't ever try to get work as a copyeditor.

matttbastard

//Also, if there's any justice in the universe, a certain insufferable, unrelenting troll will finally receive a nutsack full of splinters from so vigorously and shamelessly humping their unvarnished hobbyhorse. Bored. Now.//

Because you come here to have comfortable conversation with people who share your attitudes, biases, and philosophy. How d'd'd'dare this interloper disturb the reverie. After all, you paid good money to read and comment on this site.

//Don't ever try to get work as a copyeditor.//

I started my journalism career at the top - editor of the school paper. I soon realized that reporters were people who watched the people who were actually doing worthwhile things. They were folks who wanted to do those things but couldn't. Copy editors were stiff people who had paid attention in grammer class and were either too shy or too prissy to go into the field as reporters. If you could qualify for other things then you wouldn't be doing those jobs.

You can rest assured that I will never try to get work as a copyeditor. I would certainly hire you to do it though. Your ability with english is excellent and your wide general knowledge would also be an asset.

I'll keep you in mind and call you if something comes up.

"How d'd'd'dare this interloper disturb the reverie."

I expect that most people here like being intelligently disagreed with, with arguments that are supported by facts.

You might try doing a better job of doing that, rather than substituting the voices in your head for citations.

How about citing that bill proposing "the coming national health system" that'll use government-employee nurses?

People are interested in having conversations connected to reality.

Introducing blatant falsehoods that can't be supported tends to undermine the notion that someone is posting in good faith.

So, try either supporting your claim, or consider that some people might entertain the thought that you are either consciously lying (in a really stupid way, since it's not exactly difficult to fact-check what bills are or aren't proposed), or that you simply don't care about making truthful claims.

Dare to support your claim, or dare to admit you're making it up.

>>America's severely wounded veterans are
>>enduring humiliating financial hardships of
>>epic proportions. Home evictions, utility
>>shutoffs, car repossessions and foreclosures
>>are commonplace

Welcome to America. How is this different than what is being experienced by the rest of the lower, working, and middle classes?

The injury and fatality rates are higher for a logger than a soldier. Do we hold it against the logger that they didn't choose to make a living by engaging in foreign invasions and immoral wars of choice?

Why?

The VA has had its ups and downs. In the 80s and into the early 90s, it was a horror story. Once Clinton put competent people in charge, it got better. See this piece by Longman

http://www.washingtonmonthly.com/features/2005/0501.longman.html

I can readily believe that things are starting to slide again. Their budgets were based on a declining veteran population of WW2 and Vietnam vets. I believe the increase from Iraq and Afghanistan was unexpected, as were the nature of the injuries.

On a personal note, I have received treatment in both VA facilities and private hospitals and definitely prefer the VA. They also have one of the better electronic health record systems around.

"Dare to support your claim, or dare to admit you're making it up."

That's like asking one of those mimes who used to "perform" by pretending they're trapped in a glass box to present evidence that there is, in fact, a glass box around them. "Look! My palms are flat up against it," they would cry (if they were not, in fact, mimes), "what more do you want?!"

--TP

"Introducing blatant falsehoods that can't be supported tends to undermine the notion that someone is posting in good faith."

so does a long history of not making good faith arguments.

good thing libs are tolerant folks.

Nice attempt by d'd'd'dave to cover another of his many grammar issues by exercising some sort of power relationship, contemptuously dismissing copy editing as sissy work done by priggish wallflowers, then cheerfully offering to find such work for Gary. Is your ego really that fragile, dave?

Mr Farber

You say //You might try doing a better job of doing that, rather than substituting the voices in your head for citations.//

I said //The VA is basically staffed with unaccountable and practically unfireable GS personnel...But this won't happen in the coming national health system. It will be run alot more professionally than the VA program.//

The voice in your head somehow twisted this into //"the coming national health system" that'll use government-employee nurses?//

You said //Introducing blatant falsehoods that can't be supported tends to undermine the notion that someone is posting in good faith.//

in response to this //I'm sure this new program will be run more professionally than the VA program.// and //But this won't happen in the coming national health system. It will be run alot more professionally than the VA program.//

You say //Dare to support your claim, or dare to admit you're making it up.//

Okay, I admit it. I made up the part about the coming system being operated more professionally than the VA program.

"If you could qualify for other things then you wouldn't be doing those jobs."

Funny, all those people I know who have chosen to work as copyeditors for decades because they love their jobs, and love being highly respected in the publishing industry, and sought after by the best writers there are, don't agree.

It's obvious you don't actually know any copyeditors.

It's an extremely demanding job that requires the finest eye possible for every little detail, and calls for an absolute devotion to precise wording, and a fanatical devotion to ascertaining what is and isn't fact.

I can see why it wouldn't interest you.

"...who had paid attention in grammer class...."

It helps no end in writing well. Writing is the art of expressing thinking in clear, coherent, and pungent fashion. If you're interesting in presenting ideas in a convincing and compelling way, knowing how to write well is essential.

If you're not interested in such things, you won't care much. I can see why you might not care.

How about citing that bill proposing "the coming national health system" that'll use government-employee nurses? How's that coming along?

GHBT.

(Gary has been trolled).

One of the more common occurrences on teh innerwebs.

Reminds me of the veterans of Vietnam...just modern day.

Gary: "I expect that most people here like being intelligently disagreed with, with arguments that are supported by facts.

"You might try doing a better job of doing that, rather than substituting the voices in your head for citations."

Yes, that. Is not the 'dissent' that disturbs, d'd'd'dave; is the utter banality of your reflexive, inconsequential contributions that still somehow seem to undeservedly garner dubious attention from people who should know better (present company included). You distract and derail, draw attention away from important matters and onto the contrarian strawman du jour (and, of course, yourself) and generally appear to comment in something less than a good-faith capacity.

Look, I don't give a toss what ideological position you claim to represent, nor social strata or cohort.

Trolling is trolling, and it's fncking boring, whether said troll rocks the colours of Hayek or Hegel.

Hence my boredom.

"The voice in your head somehow twisted this into //"the coming national health system" that'll use government-employee nurses?//"

Your words are the ones I quoted.

Let's quote you at greater length: "I would like to read an essay that compares the VAs performance caring for soldiers with the coming national health system."

"It would be interesting to see what is being done to insure that the coming national system...."

The VA system is a "government-run" system; it supplies health care using government employees as doctors and nurses.

It's your comparison. If you want to now try denying that you asserted that there's a "coming national system" that will use government employees, then everyone who can read will see that you'd be denying what you wrote.

You wrote: "Will 'officials instead blame a system that is complicated, outdated and ambiguous'?"

If you'd like to deny that you were asserting that this "coming national system" will be a government-run, using government employees, system, hey, go for it. I'm sure that'll build your credibility.

You wrote: "I'm sure this new program will be run more professionally than the VA program."

You write there of a government-run program/"system." That's the plain meaning of your words. You're not so incoherent as to have meant something else, and if there's a shred of honesty in you, you won't deny that that's what you wrote, and that that's what you meant.

"Okay, I admit it."

You still can't admit that you simply made up an unsupportable claim, can you?

If you want to disagree with any of the proposals being considered in Congress and by the administration as regards health care, you're perfectly free to. But you're not entitled to make up false claims about non-existent proposals.

Easier though that is then bothering to argue with actual proposals, to be sure.

Reminds me of the veterans of Trafalgar and Thermopylae. Although just because it's an old problem I don't at all mean to imply that it's not a grave one.

now_what: I have my doubts there. I'm not certain that pasting a "kick me" sign to your head counts as skillful trolling when you then get kicked.

Part of the issue here is the TBI. Having seen the VA neurologists talk about this, the pattern of injuries has changed. Gone are the bullet holes leading to obvious limb disfigurement or paralysis from piercing injury. Instead, these guys get blown up half a dozen times in twelve months. Each time they are knocked out but back at work in a few days.

The cumulative effect is more akin to boxing in the bad old days with dementia, epilepsy and frontal lobe behavioral issues predominating. These are crippling but any system of percentage disability rating scale designed for mutilation and paralysis is going to under-rate that disability.

matttbastard: Trolling is trolling, and it's fncking boring, whether said troll rocks the colours of Hayek or Hegel.

True, but nitpickery on a blog thread about a typo like "Alot" is also a troll, and a very stupid one.

The neglect and outright abandonment of veterans by an overstretched and underfunded healthcare service (when Bush/Cheney went to war without bothering to invest in additional support services for the injured survivors) is an appalling thing.

D'd'd'dave attempted to derail the discussion by trying to claim a national health care service would be a bad thing because it would be just like VA and he apparently misreads Eric's post to be saying VA is intrinsically a bad thing: he successfully derailed by not pressing the spacebar when typing "A lot" and then responding when the error got trolled.

It is, in fact, a rule in professional mailing lists for copyeditors and technical writers (both sets of people being anguished automatic proofreaders) that one does not attempt to apply professional standards of proofreading or copyediting to comments on a mailing list - nor to comments on a blog. Minor typos that do not affect understanding may, and should, be ignored.

The failure to account for the current deluge of wounded veterans - and the deluge yet to come - is but one example of this peculiar myopia.

Well said.

There is a huge discrepancy between benefits for veterans and those for active duty, it's even worse than the linked article describes. A troop who makes it safely through 20 years gets much better benefits as a retiree than the veteran who lost his health for his country.

Active duty compensation is made up of base pay plus housing and cost of living allowances. The allowances are usually about as much as the base pay. Only base pay is taxed, so even though the yearly overall income might be $60,000, the troop only pays taxes on $30,000 of that, or whatever his base pay comes too. This effectively boosts his income.

But disabled veterans don't get allowances anymore. So if they're getting 50% disability (and it's true that the military deliberately underrates injuries ratings), their income has dropped by WAY more than 50% - more like 70 or 80%. And this at a time when they're unable to find work due to their medical issues. At least disability benefits aren't taxed. But I think that means the benefit income doesn't count towards Social Security, thus contributing towards lower future income.

Active duty members get health care for themselves and their families, and the active duty system is better than the VA. Veterans only get health care for themselves, spouses and children aren't covered. This is a huge burden.

I'm not sure about this but I also think that veterans aren't eligible to shop on base so they don't have access to tax-free shopping like active duty and retirees do.

Tragically, when the veterans could most use the benefits that they had as active duty, they are cut off. And they deserve it most.

Eric, you are right that things are only going to get much worse - either for the veterans or for the national debt - if the wars continue. Keep in mind that most of these veterans are in their late teens and early 20s so we will be responsible for their care for decades.

Much as I hate to interrupt another great day of troll-feeding here at ObWi, I'd like to see a little more discussion of now_what's comment above.

The stories are indeed tragic. But to suggest that there's some kind of extra-super-mega-tragicness at work here because the victims are veterans? I'm not so sure.

I was referring to now_what's comment at 10:31 PM. I put in the link, to no avail.

"tens of thousands of wounded veterans... will swell the ranks of an already unwieldy throng that, due to its size, is being neglected, under-served and dishonored"

This strikes me as being a cop out for the duty the congress and the VA have towards the veterans. That's why I actually find it insulting when it is assumed that we can't handle this burden.

"Welcome to America. How is this different than what is being experienced by the rest of the lower, working, and middle classes?"

The difference is that these men and women are losing their jobs and incomes because of injuries suffered while serving this country in the armed forces. Thus, their condition is different. They served, and as a direct result of their service, they are not able to hold jobs and are being crushed by medical bills/forced care of a spouse.

It's not that they're suffering financially from failure to find a job. Period. That is, indeed, America.


"This strikes me as being a cop out for the duty the congress and the VA have towards the veterans. That's why I actually find it insulting when it is assumed that we can't handle this burden."

Sure, if taken in a vacuum. But if you read the rest of this post, it's clear that I do not mean to exonerate Congress and the VA. Or the President for that matter.

I've heard it said that traditional warrior cultures are contemptuous of their wounded. The motto seems to be 'Return with your shield or on it.'

There's a logical reason for this, but it's not a nice one.

up to 50 percent or more

Sneaking of copy-editing...

"Reminds me of the veterans of Trafalgar and Thermopylae. Although just because it's an old problem I don't at all mean to imply that it's not a grave one."

There were Thermopylae veterans?
I think the most notorios example were the British sailors that defeated the Spanish Armada. They were ordered to stay (unpaid) on their ships until diseases etc. had eliminated the problem of having to pay them. Henry V. on the other hand made special laws against frauds that claimed to be wounded or crippled veterans of Agincourt in order to get preferred treatment.

"There were Thermopylae veterans?"

I almost made a comment on this last night, but there were, of course, veterans on the Persian side. I don't know anything about the health care they received as such, though, myself.

I don't know anything special about the health care given vets of Trafalgar, as such, either, although British Navy sailors of the time did have an old age and sickness benefit, if I recall correctly.

>> They served, and as a direct result of their
>> service, they are not able to hold jobs and
>> are being crushed by medical bills/forced
>> care of a spouse.

That isn't any different than what working class people experience.

A truck driver injured in Iraq who can't work anymore isn't any worse off than a truck driver injured in Idaho who can't work anymore. Sure, they may be able to get disability, after waiting for 5 months to be eligible and another 3 for the application to be processed. By then they've been foreclosed on. And they are only going to see disability replace a small percentage of their income.

Should we take care of the sick and weak? Yes, because they are humans - not because they are soldiers.

Your post implies that soldiers are a separate class of citizens, more deserving than civilians. That type of glorification of the military will not end well. It's the same type of attitude that lets leaders get away with horribly immoral acts in the name of "defense".

"There were Thermopylae veterans?"

Of course there were, and not just Persian ones. From Wikipedia (http://en.wikipedia.org/wiki/Battle_of_Thermopylae) (not your best source, but it's one that's online, and they have this part right I believe):

"Aware that they were being outflanked, Leonidas dismissed the bulk of the Greek army, and remained to guard the rear with 300 Spartans, 700 Thespians, 400 Thebans and perhaps a few hundred others, the vast majority of whom were killed."

So, yes, quite a few veterans.

"Don't ever try to get work as a copyeditor."

"copyeditor" is a word?

;>

"That isn't any different than what working class people experience.

A truck driver injured in Iraq who can't work anymore isn't any worse off than a truck driver injured in Idaho who can't work anymore."

No, not worse off, but injured while performing different activities. I mean, likewise, the injured Iraqi vet isn't any different than the man injured cliff diving on vacation in Mexico. Both sustained the same injuries.

But there is a differentiation because the soldier was injured in the course of serving in the armed forces of the country, and thus deserves care for those injuries.

"Your post implies that soldiers are a separate class of citizens, more deserving than civilians."

That is certainly not the intention. But a firefighter injured in the line of duty, a police officer or a soldier are deserving of a certain level of support from the government for which they were serving.

Single payer health.

Eliminate the VA. I have only walked out of a private hospitals twice for poor performance. VA probably half of the time. Quality of care is not an issue, it is uniformly terrible. There is a "study" that keeps being cited as saying the VA is great, cost efficient, excellent care, however all of those studies lead back to one company that plays for pay. Always gives excellent ratings for excellent contract pay. Can't find a single survey that didn't find the company or government surveyed that wasn't found to be in the highest rankings. One of their surveys found Phoenix to be the best run city in the world.

Get the French government to survey VA health care, then tell me how good they are.

In fact, contract with the French to run the US health system. The French that I have known and the foreigners that have been treated over there swear by it.

"'copyeditor' is a word?"

Yes. Quite.

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