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“The Battle for VA Healthcare and Its Funding”

VA healthcare has its faults; but, it still is one of the more successful examples of publicly funded healthcare even while hampered by a lack of funding to provide more capacity in strategic places for new Iraq and Afghanistan veterans and aging Vietnam veterans like myself. Libertarian Pete Hegseth, a veteran of Afghanistan and Iraq and the CVA, both sponsored by the Koch Brothers, are hawking a dismantling of the VA hospitals in favor of higher cost and less result-oriented commercial healthcare and their own ideological interests. invisible hand

The history of the VA has always included struggles with ideological, political, and commercial (healthcare providers, pharma and hospital supply) interests. In the seventies, activists went as far as to stage scenes (Life Magazine picture depicting care for Vietnam veterans) to make the care look worst than what it was. For commercial interests, it is all about selling more services, healthcare procedures, and pharma as compared to the evidence based treatments received at the VA. For the Kochs, Libertarians, and Pete; it is all about a Randian ideology, an ideology which Ayn Rand could not live up to and forsook to accept Social Security and Medicare.

As you may remember the Koch Brothers are also buying their way on to college campuses such as Western Carolina University by funding Centers for Free Enterprise A Slippery Slope Indeed. The selling of Public Choice and Libertarian ideology under the guise of Economics courses is paramount and they staff these centers accordingly by selecting those who view it favorably. The centers are not a free range of salt water and fresh water economics or intellect as one might find at typical universities. The American Legion and other VSOs have shown similar support for the dismantling of VA Healthcare the same as the Western Carolina University administration showing support for the Free Enterprise Centers. The VSOs have bought into the Koch funded CVA push to do so in favor of commercial healthcare and giving veterans healthcare vouchers.

Together they have orchestrated an attack on the VA by claiming 40 veterans in Phoenix , AZ had died while waiting for their appointments. I did not pick the claim of 40; but, I believe it is time to debunk it and challenge subsequent claims based upon the lack of integrity and truth in the original claim. What was reported to the public by CNN and other news media sources as a failure of the VA to take care of the 40 veterans in critical need by keeping them waiting for care is not true. Yes, there is a longer wait for new patients and first time visits; but, it is not to the extent stated. The Koch Brothers, Pete, and their “web of affiliates have succeeded in manufacturing a ‘scandal’ at the VA as part of a larger campaign to delegitimize publicly provided health care” in favor of the commercial healthcare industry. The exaggeration fed scandal forced the dismissal of Shinseki besides creating another taxpayer-funded commission to investigate the alleged abuses by the VA. “The Best Care Anywhere; Why VA Health Care Would Work Better For Everyone” author Phillip Longman was appointed to this commission. He will need all of the support he can get from veterans who oppose this move by ideological and healthcare industry interests to dismantle VA healthcare.

Former Wall Street Journalist Alicia Mundy (author of Dispensing with the Truth: The Victims, the Drug Companies, and the Dramatic Story Behind the Battle Over Fen-phen) gives a different story of what took place at the VA “The VA isn’t Broken Yet,” The Washington Monthly. Her article and two other articles report on the latest findings and paint a dismal picture of Koch Brothers and the healthcare industry attempts to dismantle the VA using innuendo and exaggerations.

While the allegations of deaths were not proven, the declared accusation of increased deaths resulting from wait times did raise concerns about how effectively the VA was with their care of Veterans. Of course, we all know how effective the overly funded commercial healthcare system is with the care of its patients. If you can afford it you will get every pill, procedure, and practice known to mankind regardless of effectiveness. This is not to say there are not good institutions or professionals; but to say commercial healthcare and wait times are both far better than the VA is simply not true. Indeed, it is the opposite. The overriding interest of those advocating the dismantling of the VA in favor of commercial healthcare is in securing it’s funding for commercial healthcare rather than improving the care for veterans.

One month into his presidency, President Obama appointed former General Eric Shinseki with no opposition in Congress to his appointment as the head the VA. Shinseki immediately set to work transforming a VA burdened by returning Iraq and Afghanistan veterans, a lack of needed capacity in places where needed (Phoenix and Tampa), and funding which did not keep up with the influx of new patients. The Bush administration had failed to close costly unneeded facilities (5 million square feet @ $53 million annually) and add capacity in other places (Phoenix and Tampa) as recommended by the CARES report besides increase the funding necessary to meet the onslaught of new vets. The CARES report listed what facilities needed to be improved and modernized, projected the future demands on VA services through 2022 in each geographic area the VA serves, compared them again to existing infrastructure, and made recommendations on how to meet the future needs of veterans. It was largely ignored as it too needed funding.

Instead of helping to care for all veterans, President Bush had also reversed the decision of former President Clinton to allow all veterans to use the VA and again installed the “proof of need” format for VA care. In other words if you were exposed to Agent Orange, drank bad water at LeJeune, were exposed to radiation from depleted Uranium artillery shells, or indigent; you again had to prove your ailment was military related or provide proof of being indigent. This can be difficult to do and it takes time. Again, presidential enforced bureaucracy ruled at the VA. It could again raise its ugly head with the wrong administration in place.

What about those news broadcasted wait times and other things Shinecki was accused of by Pete, the Koch Brothers, and the CVA? The VA under Shinseki reduced the number of homeless vets by ~25%, reduced the backlog of unprocessed veteran disability claims resulting from increased numbers of new and wounded Iraq and Afghanistan vets by 84 percent, and helped convince Congress to take in Vietnam veterans with chronic illnesses associated with exposure to Agent Orange making them automatically eligible for VA care.” As accused by the Koch Brothers, Pete, the CVA, and the silly news media, this was the man and the General who allowed veterans to wait for appointments and care only to die in the chow line of the VA while side stepping? But wait, there is more:

Under Shinseki, the VA built teams of healthcare providers whose responsibility was the care of its patients. Specific teams of PCPs, nurses, social workers, pharmacists, and health technicians were assigned to manage and coordinate the needs of each patient. This methodology overcomes the fragmentation of care, which can be seen in commercial healthcare today, and was described in Phillip Longman’s “The Best Care Anywhere.” I am taken care of by the VA Blue Team of healthcare providers.

Mental health professionals and substance abuse specialists were integrated into each team and this care excelled beyond that provided by commercial healthcare as it applied proven, evidence based therapy and methodology for mental illness. Insurance companies, Medicare, and Medicaid will not pay for this type of “body and mind” care by commercial healthcare. It is crucial to have it available for veterans as 25% of veterans suffer from chronic mental illness and 16% are addicted.

One study, “The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans” touched upon the differences in the success rate of VA care as compared to commercial healthcare.

” In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.”

Furthermore the study concludes the ‘findings demonstrate the significant advantages accruing from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.'”

Hey, but what about those overly long wait times broadcasted by the news media and pitched by Pete and the CVA which caused the deaths of so many veterans as stated by them? After all, the team methodology and evidence-based physical and mental care put in place by Shinseki does strain the VA capability to set prompt appointments for new veterans coming into the system for the first time. Then too the need for primary care doctors outstrips the supply of them by ~7500 in 2010 and the shortage is estimated to more than double by 2020. This shortage as well as the amount of team care given does place a strain on the VA capability to supply care to new vets. Unlike commercial healthcare, the VA put in place performance measurements which are available to the public. Commercial healthcare does not make its performance measures available beyond the advertisements seen on TV. “Across facilities, veterans waited an average of six and half days from their preferred date of care to their actually seeing a primary care doctor. In comparison, a private survey taken by the consulting firm Merritt Hawkins showed that in fifteen major medical markets across the country, non-VA patients seeking a first-time appointment with a family practice doctor had to wait an average of 19.5 days.”

For the first half of fiscal year 2015 starting October 2014 through March 2015 using the most recent data available from the Assessment B (Health Care Capabilities) Page 190 wait time study, the average number of days “Veterans waited for new patient appointments was approximately six and a half days from the preferred date for primary care, six and a half days from the preferred date for specialty care, and three and a half days from the preferred date for mental health” care as taken from page 190 of the same report.

Indeed, Figure 4-14 shows >93% of all veterans completed their appointments within 30 days. Again to compare, the average wait time for new veteran patient appointments is six and 1/2 days from the preferred date while the average wait time for non-veterans using commercial healthcare as experienced in 15 markets for first time visits is 19.5 days from the preferred date or three times longer.

invisible hand

And those 40 deaths caused by too long of a wait time? As taken another report, Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System, revealed, six and not forty veterans had died experiencing ‘clinically significant delays’ while on waiting lists to see a VA doctor. In each of these six cases, the IG concluded “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.” But for some reason those wishing to dismantle the VA can conclude such. Maybe they have a different source of information? They do not and this gets to the root of the issue. Why would someone make up such stories and the media report on them without adequate research when the end result would potentially cause so many veterans to lose their coverage and surrender to a must worse situation with commercial healthcare? News and especially catastrophic news sells and news today is lazy and lacks integrity. For everyone else concerned, it is the money involved or the VA funding.

My own experience with the VA has been good and that with major US hospitals and commercial doctors has shown similar if not greater wait times. God knows, I have been in enough hospitals since 2012 advocating on my own treatment. If you do not know, ask questions and do not be so ready to accept what is told to you because the person is a doctor. They do make mistakes like being given blood thinners when you have a blood disorder. As Alicia Mundy put it succinctly “while the VA has an assortment of serious problems, it continues to outperform the rest of the U.S. health sector on nearly every metric of quality—a fact that ought to raise fundamental questions about the wisdom of outsourcing VA care to private providers.”

I am not on board with this take over of VA Healthcare by commercial interests as supported by moneyed ideological and political influences. I would urge veterans to speak up as what you are going to get will not match what you have. Once your voucher is spent, game over.

References:

“THe VA Isn’t Broken Yet Alicia Mundy, Washington Monthly

Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System

” Assessment B (Health Care Capabilities)” Rand Study on Wait Times 2014/2015

” Comparison of Quality of Care in VA and Non-VA Settings: A Systematic Review”

“Changes in Suicide Mortality for Veterans and Nonveterans by Gender and History of VHA Service Use, 2000–2010”

“Department of Veterans Affairs to Realign Its Capital Assets”

“Documents Show the VA Debacle Began Under George W. Bush”

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Hey Ho Hey Ho These Caucuses Have To Go

Update: It appears that I may have been completely confused. Never mind. BillB wrote in comments that the numbers from Alaska refer to delegates to the state convention which will chose the delegates to the national convention. I do see the numbers under the heading “votes” on various sites, but I think that is a web site rigidity/error. Sorry for my silly post.

caucuses

I have removed the old graphics which confused me. The one above is picking on RealClear politics from pure spite.

The low turnout at some Democratic caucuses in some of the further flung parts of the USA is really absurd. Each participant has an insanely gigantic weight in delegate selection.

So far, the preferences of 399 caucus participants have been reported. is widely reported that Bernie Sanders is projected to win the Alaska Democratic Caucus. The vote totals

They are choosing 16 delegates (of whom 9 have been chosen so far and are pledged to Sanders) . When all report, the ratio of voters to elected delegates will be more than 25 to 1, but it will be insanely low.

It will definitely not be a record.

In American Samoa 237 caucus participants assigned 11 delegates so less than 22 voters per delegate.

update III: This site claims

The South Pacific island chain held its caucus Tuesday.

Clinton won 73 percent of 223 votes cast to earn four of the six delegates at stake. Bernie Sanders picked up two delegates.

but I fear they might have been as confused as I recently was.
end update:

Now those 237 Samoans are not represented in Congress or the Electoral College, so I don’t mind how many delegates they elect. But it is silly to put the responsibility to express the opinions of a territory with over 58,000 inhabitants on the 237 who are willing to endure the boring hassle of caucusing.

(By the way the state of Alaska has 710,231 inhabitants 2 senators and one reprehensible representative (but at least it’s not Wyoming pop 586,107) while the non state of Washington DC has 672,228 inhabitants 0 Senators and 1 non voting representative. )

update: well they’ve finished tabulating the results. Turns out the 16 delegates were chosen by 439 voters so less than 27.5 voters per delegate. Alaska’s new motto is “More Alaskans than Samoans voted”.

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Why did Donald Trump Propose Huge Tax Cuts for the Rich ?

Trump is running as a bombastic billionaire progressive. His argument (to the extent that he has one) is that he is already rich so he doesn’t have to serve the rich. However, he also officially promised the yugest tax cut of all the candidates. I think this makes no political sense. Obviously he wants to cut his own taxes — he is rich selfish and greedy — but you aren’t supposed say your are out for yourself alone out loud.

Notably, Trump never mentions his campaign’s official proposal. He talks about raising taxes on some rich people. Jonathan Chait is puzzled

rump … barely differs from Ted Cruz in the specific proposals … . Trump has attracted the support of the majority of Republican voters who favor higher taxes on the rich, but Trump himself would reduce them.

Clicking the link to a Rand survey I found this figure

trumptax

So why did he propose cutting his own taxes ? Other Republicans can’t attack him for this very unpopular proposal, but, if he is the nominee, the Democratic candidate surely will.

The only explanation I can think of goes as follows: Trump wanted a detailed serious looking policy proposal (one including numbers) and the only serious looking policy proposal his staff could generate was a huge tax cut for rich people. The usual Republican wonk shortage was exacerbated by the fact that no semi serious Republican was willing to have anything to do with them.

I think this shows that he really has no ideas except for 1) cut taxes 2) negotiate great deals 3) make Mexico pay for a wall 4) remove lines around the states and 5) Trump is Great.

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Millennials like socialism — until they get jobs. Or until a pollster tells them that it would mean tax increases but doesn’t tell them, for example, that the tax increases would replace healthcare insurance premiums and out-of-pocket medical expenses. And doesn’t tell them that “more government services” means something other than, say, trash collection twice a week instead of once a week.

Okay, so the title of a Washington Post op-ed piece today by research fellow and director of polling at the Cato Institute Emily Ekins is “Millennials like socialism — until they get jobs.”  She knows that this is do because a recent Reason-Rupe poll—that’s libertarian magazine Reason, and some polling organization they hired—found that:

When tax rates are not explicit, millennials say they’d prefer larger government offering more services (54 percent) to smaller government offering fewer services (43 percent). However when larger government offering more services is described as requiring high taxes, support flips and 57 percent of millennials opt for smaller government with fewer services and low taxes, while 41 percent prefer large government.

Ah, yes; the ole, reliable, generic smaller-government-with-fewer-services-vs.-larger-government-with-more-services polling gimmick. Because of course everyone absolutely definitely, completely understands what the generic “services” are.  Like, say, trash pickup twice a week rather than once a week?

The survey was, by this writer’s undoubtedly accurate account, prompted by a recent Gallup survey that, to quote Ekins, found that an astounding 69 percent of millennials say they’d be willing to vote for a ‘socialist’ candidate for president — among their parents’ generation, only a third would do so.”  Spilling the beans about the motive for the Reason survey, she continues, “Indeed, national polls and exit polls reveal about 70 to 80 percent of young Democrats are casting their ballots for presidential candidate Bernie Sanders, who calls himself a ‘democratic socialist’.”

Uh-oh.  And that was before Bloomberg released a poll yesterday showing Sanders’s support with a 1-point lead over Clinton nationally, with almost no undecideds: Sanders has 49% to Clinton’s 48%.

Ekins writes:

Millennials are the only age group in America in which a majority views socialism favorably. A national Reason-Rupe survey found that 53 percent of Americans under 30 have a favorable view of socialism compared with less than a third of those over 30. …

Yet millennials tend to reject the actual definition of socialism — government ownership of the means of production, or government running businesses. Only 32 percent of millennials favor “an economy managed by the government,” while, similar to older generations, 64 percent prefer a free-market economy. And as millennials age and begin to earn more, their socialistic ideals seem to slip away.

I dunno.  Ekins continues:

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MI Pushing the 85th Percentile “Again”

Michigan has had an issue fixing its roads and for the last two years the Republican controlled Legislature and the Republican Governor have not been able to decide or agree on what the solution might be. I believe what has been decided was an increase in gas taxes, some money from the imaginary general fund which also contains the Medicaid expansion money, and an inflation factor (my idea) in the gas tax law going into the future. It solves 50% of what is needed to fix the deteriorating Michigan infrastructure.

It is pretty well known and proven, vehicles are more efficient at lower speeds. If you get out on highways 96, 696, 75, 275, etc.; you would wonder if such were true or not, especially when gasoline was $3+/gallon and TBTOTF (too big, too often, too fast) dinosaurs were out there cruising at 80-85MPH in 70MPH zones. Mind you, I am not a left lane hog and usually run the right lane and move to the center to pass at my 70-75mph speed. Even then, you will find someone who wishes to get up-close and personal at 2 car lengths behind you to where you can not see their headlights anymore. Its like, what gives? Oh, I could go faster; but, what is the point? I may arrive a second sooner if lucky.

I had an interesting discussion with some of the proponents of the 85th percentile in setting speed limits on highways. Their points vary; but much of this goes back to a sixties study by Dave Solomon who suggested the 85th percentile as the right speed limit to set. If 85% of the drivers are going 70MPH, then this is the speed limit even if it is 65MPH (never seen this applied backwards yet). They go on to cite various supporting anecdotal factors such as people going too slow cause most of the accidents, the police become the enforcers and we begin to resent them so we should not make it such, my friends should not be made criminals for speeding, etc. It is unique how many excuses are made to increase speed and go faster. Except the proponents of going fast conflate the issue and only present one issue as a cause of accidents. The proponents cite accident reports of people claiming they were doing the speed limit when they were involved in an accident with someone going slower. Is this good data? Well maybe, if it was recorded on a radar; but more than likely, this was a report by the driver of the car supposedly doing the speed limit. What driver would report doing 80MPH to the police? Going too slow is an issue as well as going too fast or what one might call “speed variation” which encompasses both factors.

Advocates of the 85th Percentile approach argue the 85th usually brings about a reduction in the need for enforcement and reduces crash risk by narrowing variation among vehicle speeds. Studies have shown the speeds do not remain within that narrow range for long and speeds have continued increasing beyond the newly set limit. The 85th Percentile is not a stationary point and is akin to a moving target and requiring a new 85th percentile target when people begin to exceed the now old 85th. There have been changes upwards before in Michigan and still the need for more speed increases. They will burn more gasoline in the end and fill the state coffers with revenues from it. There is a hint of libertarianism here or “I want to do what I want to do, its my right!”

Lets call it what it is; “Don’t impede my right to do as I want to do and do not force me to pay more in gasoline taxes.”

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The ACTUAL Likely Reason That Clinton Won Ohio by 15 Points: Blue-Collar Whites Voted in Large Numbers for Kasich Against Trump. (This matters. Maybe a lot.)

Okay, so Paul Krugman blogged yesterday that the Clinton campaign’s numbers guru, Joel Benenson, claims that Clinton lopsidedly won the Ohio primary because:

Ohioans took a hard look at Senator Sanders’ claims, and rejected them. Despite his attempt to portray Hillary as an ardent free­trader, Hillary voted against the Central America Free Trade Agreement (CAFTA), the only multi­national trade agreement that ever came before her in the U.S. Senate.

Krugman mocks it, saying:

The rules of the game require, of course, both that he be totally positive about his candidate and that he profess a certainty about the meaning of every victory that I’m fairly sure he does not, in fact, possess. The truth is that nobody can be sure exactly why Ohio was so different from Michigan. … I very much doubt that many Ohioans knew about Clinton’s anti­CAFTA vote, or even what CAFTA was.

Clinton voted against CAFTA.  Krugman goes on to say that he was surprised back then when he read it to learn that CAFTA wasn’t a true trade agreement at all in the usual sense; it dealt mostly with intellectual property rights, especially with pharmaceutical companies’ patents. Like TPP.  He concludes by characterizing Clinton as a senator as cautious about trade deals and in selective opposition to them.

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Canadian Content

Not the same one, but had the same effect on Toronto, ON, that this one did on Deadwood, SD Saint Joseph, MO.

ETA: Yes, I conflated Billy the Kid and Jesse James. Here’s an extra video in apology:

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Ryan’s Hope ?

Ross Douthat and Stand Collender wonder why Paul Ryan is acting like a fan of Ayn Rand.

Douthat notes

Repeatedly Harwood presses him on whether the party needs to change to address the concerns of the blue-collar Republicans who are voting for Trump. And every time, as The Week’s James Pethokoukis pointed out afterward, Ryan simply returns to a 1980s-era message: cut spending, cut taxes, open markets, and all will be well.

He neglects to add that the sun rises in the East. Ryan is an absolutely rigid small government supply sider ideologue. He has never managed to hide this (and rarely tried).

But Douthat is sure that he is a reformicon in his heart and just froze when asked because Trump’s rise has caused him to panic (I am not exaggerating ” the tendency is to freeze, like mice under a hawk’s shadow, and hope that stillness alone can save you from the talons.

For an unfortunate case study, in this year of Donald Trump’s rebellion against the Republican Party as we’ve known it, look no further than the speaker of the House of Representatives, Paul Ryan.”)

I complain after the jump.

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