Tagged: VA healthcare
In an open letter to the Secretary of Veterans Affairs, House Speaker John Boehner has detailed a list of failings by the VA under Secretary Eric K. Shinseki’s tenure, and requested a response to a series of questions on the VA’s plans to improve performance within the next 30 days.
Congressman John Boehner (R-OH), who also heads the Republican majority in the House of Representatives, is fed up with his contituents complaining about poor performance by the Department of Veterans Affairs. He has called upon Secretary of Veterans Affairs Eric Shinseki.
Citing an ‘alarmingly high’ backlog of unprocessed claims, Boehner made the following assertions:
- The Cleveland VARO’s rating claims processing time is 334.2 days, as of February 15th, 2013.
- The current national average is 275.5 days
- The VA has already publicly announced that they had a goal of reducing the VA rating processing time to 125 days by 2015.
- The current nationwide average claim processing time is 272.5 days – an increase of 17.5 percent over the prior 13-month period.
- For the Cleveland, Ohio processing center – notable because it is within Congressman Boehner’s district, wait times have actually increased by 34 percent over the past year.
- The increase has come despite a substantial effort to modernize the Cleveland VA claims tracking and reporting system.
- The total backlog of pending compensation claims has increased from 390,000 in 2009 to more than 821,000 today.
- 71.5 percent of those claims have been pending for 125 days or more.
- The VA error rate is 86.2 percent. The Secretary has announced a goal of 98 percent error free rate. Congresssman Bohner’s office calculates that this translates to about 400,000 claims having been mishandled or wrongly adjudicated on Shinseki’s watch.
- There are currently 251,443 appeals pending, as of February 2013.
For its part, the Veterans Administration has been hit with a tsunami of claims. Nearly half of all Iraq War veterans are presenting to the VA with some issue or other. At the same time, the Viet Nam generation of veterans has entered its peak years of health care consumption. The Veterans Administration noted that it has successfully increased its throughput, processing record numbers of claims each year for the last three fiscal years – with over a million cases resolved in each of those years. Congressman Boehner, however, points out that with an error rate of 13 percent, that creates a different problem of hundreds of thousands of cases cluttering the appeals process – and veterans waiting for their promised benefits.
The VA is also struggling with some front-end problems: Only 3 percent of claims are submitted “fully developed,” according to Tommy Sowers, the VA’s Assistant Secretary of Public and Intergovernmental Affairs.
The VA has also created a blog, VAntage Point, to improve its image among veterans and the public at large.
The Veterans Administration has not been reporting reliable data to Congress regarding wait times for outpatient treatment. This was the conclusion of a recent study by the Government Accounting Office. The GAO also found that there was inconsistent implementation of certain elements of VHA’s scheduling policy that could result in increased wait times or delays in scheduling timely medical appointments.
The GAO visited several Veterans Affairs Medical Centers around the country, and found significant compliance problems with the appointment wait time reporting process. Several VAMCs did not ensure staffers completed required training on the appointment setting process.
At every center they visited, GAO inspectors found at least one staffer who was recording the patient’s desired appointment date incorrectly. Additionally, investigators found that staffers were actually able to change a record of a requested appointment date – in order to show a number that would meet the VA’s stated policy objectives. The result is a significant skewing of appointment time data.
The bottom line: As bad as the wait time numbers coming out of the VA these days looks, the reality is even worse.
In addition, the GAO found that several clinics they studied were not using the electronic wait list to schedule appointments – which created an elevated risk that some patients would “fall through the cracks.”
The GAO also cited these factors impeding VA mission success:
- An antiquated scheduling system, VistA, which is over 25 years old, slow and cumbersome.
- Gaps in scheduler staffing.
- Lack of staff dedicated to answering phones.
The recent increase in suicides among veterans has put the VA under greater scrutiny. The GAO survey did not specifically focus on mental health care facilities and appointment wait times, but described the VA scheduling problems as “pervasive.”
VHA officials have expressed an ongoing commitment to providing veterans with timely access to medical appointments and have reported continued improvements in achieving this goal,” the GAO report stated. However, it concluded, “Unreliable wait time measurement has resulted in a discrepancy between the positive wait time performance VA has reported and veterans’ actual experiences.”
Despite a massive effort to convert the Department of Veterans Affairs to a modernized, Web-based claims processing system, the VA has thus far failed to reduce wait times. In fact, they have actually made the claims process more difficult.
This was the finding of an internal investigation by the Inspector General’s office of the Department of Veterans Affairs. The IG published his report, Review of Transition to a Paperless Claims Processing Environment, earlier this month.
The VA’s goals were laudable: They intended for their massive transformation system to improve their claims processing throughput by 40 to 65 percent, while reducing their error rate. A key part of the transition was the adoption of their new Web-based automated claims processing software, VBMS.
The report faulted the VA for a failure to come up with a detailed plan for modernization or think through the system requirements. This poor planning, in combination with an incremental approach under the Agile system of software development, means that the Veterans Benefits Administration will continue to face significant problems.
Among the Inspector General’s findings:
- The Veterans Benefits Administration’s efforts to scan and digitize veterans’ claims have not been built from a detailed plan and analysis of requirements.
- Users stated that developers did not visit the pilot sites for the first time until August 2012 to understand their business needs and system functionality requirements.
- Users indicated that test scenarios were not realistic because functionality in the test environments did not replicate functionality in the production environment.
- Test cases did not process claims end-to-end within VBMS.
- While it took approximately 4 minutes to establish a claim with multiple contentions—contentions are veterans’ disabilities or health issues—in the legacy systems, it took approximately 18 minutes to establish the same claim in the VBMS pilot system.
- VBMS performance issues caused some documents to take 3 to 4 minutes or longer to open. On numerous occasions, inefficient system use of memory caused the system to crash and users had to reboot after opening multiple documents.
- VBMS-generated Veterans Claims Assistance Act letters contained errors and spacing issues and did not provide capabilities to edit or modify the documents. System users complained these letters often contained the wrong VARO addresses and VBMS did not provide the capability to make the necessary corrections.
- Ratings calculators had been deployed. However, because the calculators were not functioning properly, they were disabled and therefore not used to support disability claims determinations. A Rating Veterans Service Representative disclosed that rating an average claim in VBMS typically took 1hour in the legacy systems, but required 2 or more hours in VBMS.
- VA began scanning and digitizing veterans’ claims before it had a detailed plan and analysis of requirements for automating claims intake.
- VA proceeded with claims scanning and digitizing without a detailed plan outlining what this process would entail.
- Because a methodology was not well planned, VA encountered issues in scanning and digitizing claims folders to support the VBMS pilots. Specifically, the eFolders used to store the scanned images were disorganized and VA did not ensure proper management of hard copy claims folders.
Also, the IG’s office noted that as of September 2012, it was still not possible to complete a claim entirely using the VBMS system ‘end to end.’ This is, in part, due to the Agile approach to software development and project management, which brings the system to completion gradually, in stages.
According to the VA’s own data, average processing times actually increased at the VA claims centers designated as test sites for the VBMS rollout. The Fort Harrison facility reported an increase from 78 days to 125.6 days in the amount of time it took to process a pending disability claim during the test period, from October 2011 (pre-VBMS) to September 2012 (post VBMS). The Wichita facility reported an increase of 159.2 to 172.3 days.
Data for the other two Beta sites, Salt Lake City and Providence, RI, were not yet available for comparison, according to the report.
If you received insulin injections at the VA hospital in Buffalo, New York at any time between October 19th, 2010, and last November, get in touch with the clinic, pronto.
Hospital officials have disclosed that as many as 700 veterans may have been exposed to HIV – the virus that causes AIDS – as well as hepatitis A and B from the reuse of insulin pens.
The clinic claims that it was only the pens that were reused in this case, and not the needles themselves. But that is potentially enough to taint any insulin delivered with those pens, which were not designed for reuse.
The problem came to light when inspectors visited the hospital and found a drawer full of insulin pens that were not labeled for individual patients. Some pens are reusable, but in no case should unsterilized pens be used on more than one patient. The fact that unlabeled pens were retained and not discarded indicated that some staffers were unaware that these pens were not for use on multiple patients.
VA spokespersons indicated that as many as 716 veterans may have been exposed in this way.
The VA is setting up a hotline to deal with veteran inquiries.
Meanwhile, Senator Charles Schumer (D-NY) and Representative Brian Higgins are both calling for a top-to-bottom review of medical practices at New York VA hospitals and clinics.
They are also calling for answers about why it is that the problem went undetected for two years, and why, once the problem was discovered, it took over two months for VA officials to notify veterans or Congressional representatives.
“We must evaluate the root causes of this unthinkable error, identify who is responsible for this systematic failure, better understand if it is an isolated incident or representative of widespread problems and ensure it never happens again,” said Rep. Wiggins in a statement.
The VA is providing free blood tests to those affected to rule out any infections.
This incident is not the first in which VA medical centers have accidentally exposed patients to blood-borne pathogens through incompetence. Thousands of veterans were exposed to HIV and hepatitis when staff at VA hospitals and clinics in Miami, Fla., Augusta, Ga. and Murfreesboro, Tenn. were caught reusing unsterilized colonoscopy equipment on patient after patient. At least 10 veterans later tested positive for hepatitis as a result.
In a breath-taking display of incompetence, staffers had been sterilizing colonoscopy tubes at the end of each day, according to a VA statement, rather than after each use.
VA officials then failed to inform veterans affected – claiming they couldn’t because the records were locked away in a safe that they controlled – an assertion legislators found ‘almost impossible to believe.’
At the urging of the House Veterans Affairs Committee, the Miami VA center was so poorly run that they called for the removal of the hospital’s director, Mary Berrocal, and her deputy, Nevin Weaver. The two were finally forced out in November 2012 as a result. However, the VA isn’t much on holding executives accountable: Berrocal is still a director in the Miami VA system, and Weaver is still listed on the VA Website as the director of the VA Sunshine Healthcare Network, VISN 8 as of this writing.
John Vara, another Miami VA senior executive who was ‘admonished’ with a letter of reprimand that stays in his record for up to two years, was reassigned to the Palm Beach VA system as chief of staff for education and research.
Additionally, the New York Times reported on a “rogue” cancer unit at the Philadelphia VA Center that botched 92 of 116 prostate cancer ‘seeding’ procedures, hid the matter from investigators, and falsified records to cover the problem.
The unit also continued to seed prostate patients with radioactive particles even though the equipment measuring the radioactivity dose was broken – and the radioactivity safety unit at the hospital knew this for over a year.
That wasn’t quite the headline. The real headline is “Shorter hospital stays don’t mean worse care: study.” But they work out to the same thing.
“U.S. Veterans Affairs hospitals were able to reduce their patients’ length of stay without increasing the number of people who needed to be readmitted later on, according to a new study.
“As hospitals became more efficient there was this growing concern that we were discharging patients – as some would say – sicker and quicker,” said the study’s lead author Dr. Peter Kaboli.
“In fact, we found just the opposite,” said Kaboli, who works at the Iowa City VA Health Care System.”
The average VA hospital stay fell from 5.5 days in 2007 to 4 days in 2010. The study, published in the Annals of Internal Medicine, surveyed 4 million patient records at the Department of Veterans Affairs’ 129 hospitals nationwide from 2007-2010 to see if earlier discharges resulted in an increase in admission within 30 days.
The study shockingly found that when it came to readmissions, government health care added no value beyond the third day. More than that, the survey found that a five-day stay rather than a four-day stay was actually harmful to readmission rates: Reducing the length of stay from 5.5 days to 4 days actually reduced readmissions, from 16.5 percent in 1997 to 13.8 percent in 2010.
The survey also found that getting patients out of the VA hospital in four days rather than five and a half, on average, resulted in lower post-discharge mortality rates over the 90 days following discharge.
The sample was diverse: No specific diagnosis or medical condition accounted for more than 5 percent of the patient population. It is therefore unlikely that advances in treatment of a particular condition or disease accounted for a significant change in the numbers.
Why would patient outcomes improve with shorter hospital stays? Hospital-acquired infections, or HAI (also called nosocomial infections). Hospitals are hothouses for staph infections and other communicable diseases. Infection and reinfection accounts for a significant number of hospital readmissions within 30 days of discharge. The Center for Disease Control estimates that there are 1.7 million serious infections acquired in a hospital each year, killing almost 100,000 people per year. These infections can occur when hospital staffers do not disinfect exposed surfaces or diligently practice sound hygiene.
The Veterans Administration had, during the time of the study, also engaged in a massive, successful effort to improve hygiene at its hospitals and clinics. The effort resulted in a massive, 62 percent decrease in hospital-acquired staph infections. The initiative commenced in 2007 – the same year the study began.
13.6 percent of patients admitted who were screened for methicillin-resistant Staphylococcus aureus bacteria tested positive. This alerted VA staffers, who would isolate the patient from others and who would be extra diligent in practicing universal hygiene precautions, so as to minimize the risk of patient-to-patient and patient-to-staff-to-patient infection.
With screening at admission now commonplace, VA officials could effectively calculate how many patients acquired the infection while in the hospital. The VA estimated that there were 1.62 new infections per 1,000 patient days. The rate fell to 0.6 new infections per 1,000 patient-days. Not enough to hugely affect the VA’s readmission numbers, however.
The study also included the time period in which the VA had to inform more than 10,000 patients that they were potentially exposed to hepatitis and other infections because of faulty sanitation procedures at VA facilities in Florida, Georgia and Tennessee.
Earlier this month, the Department of Veterans Affairs announced an agreement with Indian Health Affairs that will make it easier for Native American veterans to access VA-sponsored health care.
The two organizations signed an agreement that will allow the Department of Veterans Affairs to directly reimburse IHS clinics and staff for services provided to qualifying veterans who are Native American or Native Alaskan.
Under the agreement, VA copays do not apply to treatments received from the IHS.
Until this point, veterans in very remote, rural areas had difficulty accessing VA care, because they were far from established VA hospitals and clinics. The agreement will make it possible for Native Americans to receive care from clinics already established on and near Indian reservations.
A listing of Indian Health Service medical services and resources is here.
This is not the first agreement between the IHS and the Department of Veterans Affairs. They also reached agreements in Memorandums of Understanding in 2003 and 2010. But this is the first time that IHS clinics were authorized direct reimbursement for services — essentially creating mini VA clinics out of them.
Indian officials believe that not only will treatment be accessible closer to home for these veterans, but also enable them to receive treatment in a more culturally sensitive setting and milieu, according to their 2003 Memorandum of Understanding.
Health care for military personnel and their dependents is a major line item in the Pentagon’s budget. Unless we take action to rein in expenditures, military health care costs will reach $65 billion per year – and TRICARE will cover some 9.6 million active duty troops, reservists and retirees.
And with sequestration looming, and budget cutbacks coming without a commensurate rollback in American military objectives and missions, it stands to reason that federal outlays for military health care are a tempting target for budget officials under the gun. Unless Congress intervenes, sequestration will kick in, and slash $54 billion from the Pentagon’s budget in fiscal year 2013.
It’s an easy sell to bureaucrats: Military health care expenditures don’t kill terrorists, or deter the Chinese and North Koreans from military aggression. At least not directly. It doesn’t even make for attractive recruiting posters.
But it’s not an easy sell to military families, nor to the American people. An early trial balloon proposal to increase TRICARE premiums was floated by the Obama Administration early in the President’s term. It was a political non-starter.
It is less so during a campaign year.
As it stands now, military health care programs are very much on the chopping block. Yes, military personnel programs are not subject to the 10 percent across-the-board bloodletting that other parts of the budget are subject to. So base pay and allowances won’t be immediately affected (unless Congress cuts them to avoid sequestration!)
But TRICARE doesn’t fall under the military’s personnel budget. Instead, military health care falls under the Pentagon’s operations budget. So unless officials can find enough waste, fraud and abuse in the system to offset the costs, something has to give. (And if it were that easy to find and eliminate waste, fraud and abuse, we’d already be doing it!).
Over the next five years or so, the fiscal situation confronting military planners is dire. According to reporting from the Army Times, the chief Defense comptroller – the bean-counter-in-chief at the Pentagon – we’re looking at about a $3 billion cut in military health care benefits.
Logically, the difference can be made up by reducing outlays for military health care, transferring money from elsewhere in the budget, or by increasing premiums for TRICARE benefits, or some combination of the three.
For his part, Republican presidential candidate Mitt Romney has already pledged not to raise TRICARE premiums if he is elected. He made this public commitment last week at a speech to members of the American Legion.
That sounds good to military families. But whenever a candidate rules something out, he narrows his options. As it stands now, it’s unlikely that we will find $3 billion to plug the gap from elsewhere in the Pentagon budget within the next year. A good round of base closings will help. But base closings are furiously opposed by individual Congressional representatives. Military health care expenditures, considered broadly, do not have that constituency in Congress to protect them. Previous Administrations have attempted to save money in the defense budget by closing bases – only to be shut down by Congress.
The option that’s left to Romney is to slash expenditures – most likely largely on reimbursements to TRICARE providers.
That’s going to make it a lot more difficult for military families to get care – especially if they don’t live near a major installation with a military hospital. Reserve and Guard families who are dependent on TRICARE for care, as well as those stationed in smaller communities and posts will be most severely affected. Care providers will simply cease taking in TRICARE business, as it becomes less profitable.
We see this already with Medicaid: Doctors are reimbursed at rates that barely allow them to keep their doors open. The providers still in the Medicaid business – and increasingly, Medicare – adhere to the mass-population clinic model: Long wait times to see a doctor for five minutes, and the practice of “take-a-number” medicine.
The execution problem, though, is this: Even as Romney’s proposal would make it more difficult for military members, dependents and veterans to find TRICARE providers, long-time military benefits correspondent Tom Philpott notes that Romney is pushing a proposal to offload some of the overloaded VA systems’ case load to TRICARE.
President Obama’s Department of Defense, however, under Secretary of Defense Leon Panetta and former Secretary Robert Gates – a Bush appointee originally, has already gone on record advocating an increase in health care costs for military families. Specifically, if the Obama administration has its way, some military families could see TRICARE Prime premiums increase three-fold over the next five years – from $520 per year all the way to over $2,480.
The Obama Administration’s proposals have veterans’ groups steamed: The compact we had with our troops when they were reenlisting 10, 15, 20 years ago, the argument goes, was that they would get free or extremely low-cost health care for life, if they did their 20 years with the military.
And they are right. That was the deal.
Now, a bit of soul-searching is in order. We just went through a hotly contested bailout of General Motors in 2009. One of the major obstacles to General Motors’ profitability was the huge burden of retiree health care costs. GM was still contractually obligated to pay for ‘Cadillac’ health care coverage for union workers long after they retired. Newer companies had no such obligations, and were eating GM for lunch.
The Obama Administration intervened in 2009, putting together a massive bailout package that protected the interests of the unions at the expense of GM’s bondholders and stockholders. In the end, members of unions loyal to the Obama Administration managed to have many of their interests preserved – it was the long-term non-union, salaried GM employees who took it on the chin.
At the time, the Obama Administration’s argument – and the labor unions’ – was that these health care benefits were a promise made to these workers, and that promise should be honored – precisely the opposite of the argument the Administration is making with regard to TRICARE benefits now.
Conservatives, of course, opposed the General Motors bailout, calling for the company to go through the traditional bankruptcy process. As a result of that process, the contracts with the unions would be renegotiated, either under Chapter 11 reorganization or Chapter 7 liquidation. Most or all of the more generous retirement benefits would have been eliminated to satisfy bondholders and holders of secured debt. Yes, workers were promised those health care benefits into retirement as part of the overall compensation deal. But some conservatives who now argue that our promises of free health care for life to career military should be sacrosanct had no problem whatsoever with tearing up the Cadillac health plans in Michigan. “That’s why we have Medicare” goes the argument. Indeed, opposition to the bailout – letting the company go bankrupt and tearing up the long-term agreements with union retirees was by far the more popular position, at the time.
The difference, of course, is that auto workers generally retired around the time they qualified for Medicare – and were less likely to have suffered debilitating injuries. Veterans retire in their late 30s to their 40s after 20 years. Even 30-year veterans often have a ways to go before they qualify for Medicare.
Neither side has a monopoly on goodness and light. Both sides exhibit a certain amount of hypocrisy on the matter.
My modest proposal:
- Coordinate retiree care with private sector medical care. If a retiree takes a civilian job and is eligible for a group health care plan at work, then that group plan is the first payer. TRICARE should only pick up what’s left over. We already do this with Medicare benefits.
- Do the same thing for dependents that are covered through group plans at work.
- Increase deductibles for treatment of non-service-related injuries and illnesses, especially for dependents. We can have separate deductibles for different ranks, based on ability to pay. Deductibles in TRICARE are already extremely low compared to plans available in the civilian sector – yet military families have steady paychecks and – until the personnel cuts come in earnest – have more job security than those in the private sector who are paying taxes to subsidize low premiums for military families.
- Charge a modest premium per child. This simply reflects the real costs to the military health care system in providing care to young children.
- Don’t take in married recruits. Former Commandant of the Marine Corps, General Carl E. Mundy Jr., tried to stop taking in brand new married enlistees during the last major force draw-down in 1993. He was overruled by then Secretary of Defense Les Aspin. But General Mundy was right.
Note: While we usually feature something lighthearted and entertaining on Fridays, the issue of suicide among servicemembers, and the news of an alarming increase in recent months, is of such importance that we didn’t want to wait until next week to post this story. We hope that we can return to more fun posts next Friday.
The Department of Defense announced that the number of service member suicides reached a new record in July, despite an extensive outreach program to educate military service members about how to get help for depression, how to identify other service members at risk of suicide, and training down to the boot level on how to provide buddy aid to help troops at risk.
While investigations are still underway in some deaths, the Department of Defense’s preliminary numbers indicate the number of servicemembers who took their own lives was 38 in July. That’s over 1 and a quarter every day.
Through the end of July 2012, the military reports 116 potential suicides among active duty troops (66 confirmed, with 50 still under investigation.
Among Reserve component troops (Reserve and National Guard), the Pentagon reports 12 potential suicides (9 Guardsmen and three reservists).
If current trends continue, losses from suicide will significantly outstrip last year’s total in both the active and reserve components.
Although the number of suicides among reservists remained roughly constant between June and July, the number of suicides among active duty troops more than doubled during the same time period. The military leadership is still struggling to find a satisfactory explanation.
The suicide rate also seems to have spiked with the end of formal U.S. military involvement in Iraq – and a marked decrease in OPTEMPO for the Army and Marine Corps, which now bear the brunt of the mission in Afghanistan.
While it is dangerous to infer too much from a limited data set, problems in the economy would not explain the increase in active duty suicides even as reserve component suicides remain constant: Despite an unemployment rate among military spouses of over 25 percent, the active component remains much more insulated against the weak economy than the reserve component.
According to reporting by Time, an analyst on the Army’s Suicide Prevention Task Force, Bruce Shahbaz, notes that there has been a recent demographic shift among servicemembers who choose to take their own lives: For the first time, suicides among NCOs are outpacing suicides among junior enlisted. According to Shabahz, the data suggests that the causes of the spike in suicides were more subtle than previously thought: Rather than related directly to the stress of deployments themselves and to economic pressures, suicidal behavior may be more related to difficulties in reintegrating post-deployment. While troops were going back and forth between home station and the GWOT in revolving-door fashion, families were able to mask some of the stresses – the warrior servicemember never fully reintegrated into the household.
“If you’re on the constant 12-month treadmill of deploy, reset, get ready to redeploy, deploy, soldiers and families don’t work hard to try to reintegrate, because they know that their soldier is going to be gone again,” Shahbaz says. “Issues like minor depression, anxiety and sleep disturbances – those things that are kind of related to post-traumatic stress – begin to surface after a service member has been home for more than a year, and start to reintegrate with their family…I liken it to a pot that’s on simmer – having that person stay back home and reintegrate with their family sometimes allows that pot to boil over.”
Do you need help?
If you or your loved one are at risk of suicide, call National Suicide Prevention Lifeline at 1-800-273-8255. If you are in a military family, press 1.
Mental Health and TRICARE
Good news for those in need: TRICARE covers a wide variety of mental health services for military members and their families. Stay tuned to militaryauthority.com for a more in-depth look at mental health coverage under TRICARE.
Mental Health for GWOT Veterans and the VA
The Veterans Administration has offered expanded services and access to mental health care for veterans for up to five years after discharge from the military. So if you’re no longer eligible for TRICARE, this program may work for you. Unfortunately, the VA is struggling to keep up with demand for mental health care, leading to waiting lists that are weeks long in some areas.
When the presumptive Republican presidential nominee Mitt Romney selected the Wisconsin Congressional representative to be his running mate, he sent a powerful message: Rather than select a ho-hum safe choice like Tim Pawlenty, Romney went with the leading voice for fiscal conservativism in Congress. Ryan, the head of the House Budget Committee and a senior member of the House Ways and Means Committee, is perhaps the most vocal proponent of entitlement reform and – to some extent – deficit reduction on the Hill.
He’s well known among budget and policy wonks – but the broader public probably got their first taste of him when he confronted President Obama in a “town hall” debate on the merits of the Democrats’ health reform bill last year.
Romney has never held office at the national level; his highest political office was Governor of Massachusetts. So Romney does not have a track record of military issues to look at, except as Commander in Chief of them Massachusetts National Guard.
Ryan is not a veteran. As a matter of fact, this year marks the first year since 1932 in which no one on either major party ticket had served in the U.S. armed services. On the other hand, Ryan has been in Congress for 14 years, and has voted on a number of important military appropriations and provisions, as well as use-of-force resolutions.
So what’s his record?
Well, he voted to authorize military action against Al Qaeda in 2001, as did almost everyone on both sides of the aisle that year.
He also voted to authorize the use of force against Iraq to support the UN Security Council Resolutions in 2003 – at that time tantamount to a vote to go to war against Iraq.
Ryan also voted in favor of banning the use of U.S. ground forces in Libya without first securing Congressional Approval.
Ryan opposed the repeal of the “Don’t Ask, Don’t Tell” policy – preferring instead to prohibit gays and lesbians from serving openly in the Armed Forces.
Ryan also recently came out with a budget proposal for 2013 and a spending plan for the following ten years. According to his own analysts and the Congressional Budget Office, Ryan’s plan relies on reining in spending to balance the budget by 2040, and reduce the overall national debt from 68 percent of gross domestic product in 2011 to 10 percent of GDP by 2050.
His plan, say proponents, would do so while reducing tax rates. The Ryan plan would establish just two federal tax rates: 10 percent and 25 percent, while rolling back certain deductions.
Coming up with a plan, of course, is a lot different from selling it – and Ryan got precious few Congressional representatives to sign on to it – even from his own party.
As for military spending, Ryan’s plan would hold the Pentagon budget to match inflation over the next ten years. Not quite what the Pentagon might ask for – it doesn’t have room for a lot of mission creep – but it’s still a lot more money than what many of the President’s supporters suggest.
While the military budget essentially marks time under Ryan’s proposal, all federal domestic discretionary spending would be slashed by 13 percent.
That said, Ryan has not always been a free-spender when it comes to the military and veterans. He has on at least one occasion voted for a proposal to tighten the standards required to receive medical care from the Veterans Administration. Specifically, his committee floated a proposal to cut spending on providing VA care to veterans who do not have a service-related disability and whose incomes do not make them poor. Specifically, Ryan’s floated plan would cut off Category 8 veterans – and possibly Category 7 veterans as well – from receiving care from the VA.
If this plan were adopted, it would represent a return to the status quo ante – Veterans in Categories 7 and 8 were generally not eligible for care, either, until 1996, when a Republican Congress passed the Veterans Health Care Eligibility Act of 1996, expanding their eligibility and directing the Department of Veterans Affairs to expand their number of clinics and hospitals to accommodate their new patients.
According to the Congressional Budget Office, 90 percent of Category 7 and 8 veterans have health insurance available from other sources, including employer plans and Medicare.
Ryan opposed “sequestration’s” more draconian cuts to the Pentagon, describing the Sequester as a “meat-axe” approach.
He voted against slashing funding for the Osprey.
Ryan also voted against a proposal for a mandatory period of rest and recuperation between deployments to Iraq and Afghanistan in 2007. President Bush also opposed the measure at the time. The bill exempted special operations troops and still allowed the President and Secretary of Defense to waive the requirement in response to unforeseen circumstances.
Ryan voted against a 2012 proposal to increase combat pay from $225 per month to $350.
So what do you think of the Romney/Ryan ticket? How does it compare to Obama/Biden? Do you know who you’ll be voting for this November based on what you know so far? Let us know in the comments!
“This is disgraceful!” thundered Representative Bob Filner, a Democrat representing California’s 51st district, immediately before a hearing on the tremendous delays American veterans face in receiving health care through the VA system. “This is an insult to our veterans. And you guys just recycle old programs and put new names on them!”
The VA health care system has never been a model of user-friendly efficiency. But the current backlog problems are getting insane, even by federal bureaucratic standards.
Last month, according to the Department of Veterans Affairs, there were 870,000 disability cases pending. Of those, two out of three had been pending more than 125 days. The percentage of cases taking longer than 125 days to resolve had actually increased over the previous year. In some offices, such as Oakland, California, the average claims resolution time drags on for a year.
The VA’s stated goal is to resolve all disability cases within 125 days.
Jim Strickland, the manager of a website called VAWatch.org, isn’t very impressed.
“A delay to process a claim in 125 days or less is a system failure,” he wrote on his site. “No other business on the planet would be applauding itself to set a goal of only 60% of it’s [sic] work to be a failure.”
It’s not going to be easy.
As the military draws down in strength over the coming years, hundreds of thousands of servicemembers are going to transition from the military health care system to the VA. Meanwhile, the aging baby-boomers of the Viet Nam generation are now entering their retirement years, detaching from their employer plans and entering their peak years of health care consumption.
The result is a “perfect storm” that threatens to swamp the ability of Veterans Affairs officials to process claims.
Indeed, the storm is already upon us: Allison Hickey, the VA’s undersecretary for benefits, notified Congress that there had been a huge 48 percent surge in applications at the VA over the last three years. The VA has barely been able to tread water, despite bringing new computer systems online to speed claims.
What’s behind the increase? Three factors:
A decision made two years ago to expand benefits to Viet Nam veterans who may have been affected by exposure to Agent Orange. This had a particularly profound effect on the VA’s claims processing capacity, because documenting these 40 year old claims – some 230,000 of them — was so difficult. A substantial number of VA administrators had to be assigned to process these cases – at the expense of newer claims. The VA states that it is nearing the end of processing those claims.
Second, a weak economy is driving some people to file claims for benefits who might otherwise have just toughed it out. A mild hearing loss due to military service is not devastating if you have secure employment. If you’re unemployed, it becomes tempting to file that claim for 10 to 30 percent disability. And you have time on your hands to file a claim (you’re gonna need it!).
Third, increased awareness of PTSD and traumatic brain injury, combined with aggressive post-deployment screening, increased the number of referrals to the VA system from Afghanistan and Iraq War veterans. While U.S. direct involvement in the Iraq War has come to an end, these veterans are now getting discharged and coming to VA offices in the tens of thousands for treatment of physical and psychological problems.
What has your experience with the VA been like in the last few years? Let us know in the comments below.