www.cnn.com/2014/05/30/politics/va-hospitals-shinseki/index.html?hpt=hp_t1

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Veterans Affairs Secretary Eric Shinseki has resigned, President Barack Obama said on Friday. Obama said he would demand accountability if problems were found at VA medical facilities, and accepted Shinseki's resignation. The two met at the White House before the President announced the the development, which came as political pressure mounted for the Cabinet officer to step down.

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It is my sincere hope that we can finally get someone in charge of the VA who has the guts to do whatever it takes to fix the department. Burn it to the ground and start over if we have to, but the VA has been broken for far too long.

"Guts" have nothing to do with it. GEN Eric Shinseki has all the guts a man could ask for - just ask ANYONE who served with him in the Army, like I had the honor to do so, several times. If "guts" were all it took to fix this problem, GEN Shinseki would have had it fixed a LONG time ago.

Unfortunately, the VA bureaucracy and piss poor management in its ranks were too just too big for one man to overcome. I don't doubt there are good people in the VA system, and that GEN Shinseki could have probably done more, but this is NOT a new problem, and no one has been able to fix it for decades. Shinseki is just another in a long line of VA Secretaries who has tried and failed to fix a VERY BIG problem when it comes to serving our veterans.

I won't say anything more about this, even though as a veteran, the son of a veteran, and the father of 2 veterans, I know all too well the red tape, the delays, the mismanagement, the antiquated systems, and the bureaucratic nightmare that the VA system can present to veterans and their families. Its NOT effective nor efficient, and it fails to serve those who sacrificed so much serving this country.

I am deeply angered and saddened by this entire mess, and am sorry that a hero like GEN Shinseki got caught up in it. He's a damn good man and an exceptional leader, and he did what he knew was the right thing to do under the circumstances: he resigned. I would expect nothing less of this great man that I served with in various assignments during my 31 years in the Army. I wish him well.

I only hope we can find the right people - not just ONE MAN - to resolve this matter and provide our veterans the care and attention they so deeply deserve. Its truly time to tear the VA system apart and start over again - for the sake of ALL who have served our great nation asking very little in return. I truly hope we can find the right people to do just that. This problem has gone on long enough. Our veterans deserve better...

Just one veteran's opinion...

Cmdt 79, I agree. No one man will fix the VA under the current rules regarding federal employees. The Sec of VA must be empowered to fire, demote, reassign with little restriction. The holder of that office does not and has never had that power. The bureaucracy simply overwhelms the secretary, regardless of who it is.

I don't know General S (wrong service) but I can't imagine any GO of any service not being able to fix the problem if he were properly empowered to do so.

Another issue which must be addressed, and I'll likely get blasted for this, is the almost unrestricted eligibility for VA medical care. Just to test the system, I filled out the online questionnaire to determine eligibility. I lied to the questions just to see how inconsequential your service could be and still qualify you for VA care.
I punched in no combat service, no service connected disability, and an annual income of 45K and, guess what, had those things been true (they are not) I would qualify with a very small co-pay. Not sure how high an income would have still qualified an applicant for care.
I don't believe we can continue to have the VA act as the primary medical care provider for any swinging Richard who serves for one tour and returns to civilian life undamaged by that service.

Of course, no politician would EVER touch that one.

Been watching all this unfold for several days. Random thoughts:

1. GEN Shinseki was a tanker, 'Heavy' guy in the Army parlance. Seems like he got cross threaded with SecDef over the Crusader FA upgrade or something like that. Meaning he was a proponent of more/better mechanized forces/vehicles and SecDef, being a former Navy Aviator, wanted 'Light' forces and air power/drones. You argue with the Boss and you lose. Forget the silliness about the black beret deal, GEN Shinseki was selling the last war (Desert Storm) and Rumsfield wasn't buying. Time will tell who was/is right.

2. Because of #1 GEN Shinseki got recruited by the Democrats in 2004 and was another, albeit quieter, version of Wesley Clark. Said some hard things and once you advance into the realm of party politics your prior honorable service becomes past/ancient history.

3. He gets the VA job as a payback for the help in 2004/2008. Just because you make it to Chief of Staff of the US Army doesn't automatically mean you know squat about the mechanics of bureaucratic healthcare delivery. VA has been a mess for a long time. Even a company commander has to walk around the motor pool sometimes just to see with his own eyes what is going on. GEN Shinseki failed to see the problem, or was told not to look. Either way, hard to defend what everyone knows now about the VA. As a lifelong military man, GEN Shenseki knows that a Commander is responsible for everything, good or bad, that his unit does. It was on his watch.

4. Eisenhower served stateside training fledgling US Army tankers at Camp Colt, PA, during WWI. Never saw combat. A few years later as a CPT he participated in a cross country convoy to ascertain how trucks/motorization of the US Army would work. Getting from PA to CA took a long time and was a priceless lesson in transportation/logistics that served him well in WWII. After seeing the German autobahns, he marveled at their utility and filed it away for future use. As President he started the Federal Interstate Highway program, which we all benefit from today. What he didn't do, however, was create a Federal Highway Construction Company. He let private contractors build it. Where I am going with this is that the VA, which should NOT be a cabinet level department, is charged with veteran benefits. Admin. They should NOT be running hospitals. America has plenty of those, located everywhere. And better, closer to the veterans where they live. If you are a retired military veteran, either by service or by medical reasons, you should be issued a 'Golden Health Care Credit Card' good anywhere for ANY medical service/need for life. Get what care is needed whenever/wherever. VA pays for it, with some reasonable claims oversight, rules known to all parties. Couple this with some SERIOUS reform of what constitutes a military 'disability'. When I retired at age 60 two years ago (RC retirement status) I was encouraged to submit stuff for a 'disability'. Pure scam, I have no PH, never got hurt while serving for ~30 years. This little racket needs fixing.

5. Sell all the VA hospitals to private medical concerns. The medical folks will transition over quickly and stay working. This could be done in 6 months and would actually fix health care for the guys who earned it. Folks won't die while waiting to be seen anymore. That is below contempt and will not be forgotten by millions of voters anytime soon.

6. Obama will never do this (Get the VA out of the health care bidness) because it would demonstrate that Obamacare is fatally flawed. It will have to await for 2016 and a new GOP President to fix this. More $ and new spear catchers at the top won't fix anything. Scrap it all and change direction. Run, clock, run.



[This message has been edited by WBBQ74 (edited 5/30/2014 5:55p).]

There needs to be hundreds to thousands of other VA employees shown the door.

Changing the man at the top will do nothing to the entrenched bureaucracy.

BQ said: When I retired at age 60 two years ago (RC retirement status) I was encouraged to submit stuff for a 'disability'. Pure scam, I have no PH, never got hurt while serving for ~30 years. This little racket needs fixing.

BINGO!

I know guys on disability for freakin sleep apnea. One for PTSD who never heard a shot fired in anger.

Make a tour of the burn ward at BAMC and if you can still ask for disability for sleep apnea, go for it.

From a guy I served with who now works cases for the VA, guidance: We'd rather grant disability for 10 who don't deserve it than deny one who does."

Admirable, I guess, but what the hell does that do to the VA's ability to provide for those who really deserve the care?

More care for those who deserve it. less for those who don't, and, there's a lot of the latter. There's half the solution right there.

Again, no politician will ever touch this issue.

Commandant79 -

I did not mean to imply that Gen Shinseki did not have the guts to do what was needed, but fact remains is he apparently did not do enough up to this point. Maybe he tried, maybe he didn't, but no matter how great a man/leader he is, we're still where we are today. These problems all existed back when I worked in Congressman John Culberson's office in 2004, and in 10 years, nothing has changed and the hole has only gotten deeper. I have seen problems firsthand with my own eyes in VA facilities.

What I meant from my comment was that we need someone to take over the VA who is willing to do whatever it takes and go as far as is needed to fix it. At this point, if it takes burning the place to the ground and starting over, then I'm all for it.

My classmates who served with Shinseki hold him in the same high regard as does General Joe.

But as said above, his department, on his watch, he's going to pay for it.

Now for the political comments: Government health care sucks. One only needs to look at the health care given to current and former military to see that. Why in Hades anyone can look at the VA and think "Obamacare is a good idea" is beyond me.

Second, General S joins a very small and exclusive club: a member of the current administration held accountable.

Still waiting for the folks responsible for IRS targeting on the Tea Party, the Fast and Furious idiots, Benghazi, etc. etc. etc. to turn in their resignations....

Ryan - I agree with you, and did not see your comment as "anti-Shinseki." I truly respect and admire that man, and would follow him into combat any time.

But WBBQ74 had it right: The first rule of command is that as the commander, YOU are responsible for everything your unit does or fails to do. Period. Shinseki was responsible, and did the responsible thing by resigning after this entire mess was brought out in the public. I expected nothing less of him. Good leaders accept responsibility and the consequences associated with their actions and the actions of their organization.

Now we'll see what the administration does to truly address this situation now that its out in the open. As mentioned by several in this thread, this is NOT a new problem, and has been a thorn in the side of veterans for decades. We need more than a new VA Secretary - we need a completely new team, from top to bottom.

In my opinion, the VA system should be staffed by both civilian and military medical staffs alike. We have MANY retired medical service GOs and senior officers who could step in, with the right civilian medical leadership, and fix this problem right away. I know that sounds simplistic, and probably overlooks a LOT of problems and issues that I couldn't even begin to understand, but its a start. ANYTHING beats what we have now. And finding qualified medical administration professionals - both retired military and civilian - to tackle this matter would not be that difficult.

Again, this is NOT an easy problem to tackle, and it won't get resolved overnight. But we need to start somewhere, and now that GEN Shinseki has resigned, its time to chart a new path that truly addresses the problems at hand and truly serves our veterans as the VA claims its supposed to do.

Again, just one veteran's opinion...

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1. GEN Shinseki was a tanker, 'Heavy' guy in the Army parlance. Seems like he got cross threaded with SecDef over the Crusader FA upgrade or something like that. Meaning he was a proponent of more/better mechanized forces/vehicles and SecDef, being a former Navy Aviator, wanted 'Light' forces and air power/drones. You argue with the Boss and you lose. Forget the silliness about the black beret deal, GEN Shinseki was selling the last war (Desert Storm) and Rumsfield wasn't buying. Time will tell who was/is right.

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If this is true, it shows how incompetent Rumsfeld really was. Rumsfeld only served active duty for 4 years and the rest of his experience was in the reserves. And he used his 4 years of non combat experience and stateside reserve experience over those that spent years of training, study and actual live experience? Now that IS pathetic if true.

I'm no fan of Rumsfeld and Shinseki was proven right when the first move that Gates did was increase the manpower (AKA the surge). Shinseki used the same formula used in Kosovo to control a civilian population with an military of occupation. It was the term "Occupation Army" that I honestly think Rumsfeld had a difficult time with. In the neocon mindset, we weren't occupiers. We were liberating a population that wanted to be liberated and would welcome us with parades and flowers.

Well, you said that time will tell who was right. Time has already shown us who was right. Rumsfeld was fired. Gates followed Shinseki's original plan. If the US followed Shinseki's and Petraus's original plans from the beginning and threw that idiot L. Paul Bremer into Abu Gharib to rot with the rest of the those who wanted to do harm to the USA, we might have not lost this war for 6 years.

Of course the real argument is whether we should have ever invaded in the first place for the WMD's that we knew weren't there, but that is a different conversation.

[This message has been edited by Irish_man (edited 5/31/2014 6:03p).]

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Seems like he got cross threaded with SecDef over the Crusader FA upgrade or something like that. Meaning he was a proponent of more/better mechanized forces/vehicles and SecDef, being a former Navy Aviator, wanted 'Light' forces and air power/drones.

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It was the Secretary of the Army, Thomas White (formerly of Enron), who got sacked for running a backdoor campaign to get Congress to restore funding to Crusader after it was cancelled by Rumsfeld. If Shinseki agreed with White he certainly was smart enough not to speak or get caught doing what White did.

Despite all the stupid things that Rumsfeld did and believed the cancellation of Crusader was definitely the right thing to do. It was a weapon system without a realistic chance of being employed against an enemy that would require its capabilities. Crusader would have grown the logistics footprint over the Paladin equipped force and been more expensive. I know it was going to put the firepower of a battery into a single tube but that's not really looking like a decisive capability against most likely threat scenarios. Like the FCS and EFV that would be cancelled in the years to come, Crusader was a more of a jobs program for certain Congressional districts than an urgent need. Crusader certainly hasn't been missed on the battlefield in Afghanistan in the first decade since it was cancelled.

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Just because you make it to Chief of Staff of the US Army doesn't automatically mean you know squat about the mechanics of bureaucratic healthcare delivery. VA has been a mess for a long time. Even a company commander has to walk around the motor pool sometimes just to see with his own eyes what is going on. GEN Shinseki failed to see the problem, or was told not to look. Either way, hard to defend what everyone knows now about the VA. As a lifelong military man, GEN Shenseki knows that a Commander is responsible for everything, good or bad, that his unit does. It was on his watch.

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I fault Shinseki for one specific management decision and it's one that many senior executives end up getting canned for doing. He picked the wrong measure of effectiveness that led to the widespread dishonesty. By basing rewards on the number of days waited for an appointment he as the senior executive in the VA created an incentive for the very people who are seeking to be rewarded to dishonestly report the numbers. Shinseki either established or continued to let hospital administrators grade their own homework.

Rather than focus on days waited for appointment a much better metric would have been customer satisfaction surveys administered to every patient AFTER their appointment by an independent contractor that did not report to hospital administrators. With all the money appropriated by Congress that the VA cannot seem to spend they could have hired some good talent to do this. Contacting every patient (or their caretaker holding power of attorney) after their appointment would yield data not only on wait time but on the quality of care, follow up treatment, and the bottom line things that make Vets angry at the VA. Shinseki ignored the voice of his customers and turned to administrators to assure him that customers should be getting happier because the magic metric was improving, or so they claimed.

The VA is no different than the rest of the federal government. They navel gaze instead of realizing that the citizens over whom they hold power are actually supposed to be served by them and not dictated to. That goes for Veterans, military, and civilians. Up until yesterday Shinseki did not demonstrate that he was willing to talk directly with customers and instead placed faith in his army of bureaucrats.

Two outstanding posts. And you are spot on with this comment:

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Crusader was a more of a jobs program for certain Congressional districts than an urgent need.

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I live in one of those Congressional districts. Got lots of media coverage when the program was cancelled.

Edit: Forgot to add, the agency I retired from also had many stupid metrics for senior managers (SES level). I worked on a big project shortly before I retired where one of those metrics was fudged beyond belief to keep an SES from looking bad. The decision was made at level above my pay grade, but my fellow peons and myself working on the project were pretty pissed about it.

[This message has been edited by NormanAg (edited 5/31/2014 10:33p).]

[This message has been edited by NormanAg (edited 5/31/2014 10:36p).]

U90 corrected the faulty memory I had on the Crusader FA program vis a vis GEN Shinseki; as usual he has it correctly described.

If in 20 years or so we wind up duking it out with the ChiComms over territory, real or financial, we might wish we had better FA systems than a ~30 year old configuration that worked OK for the last 'heavy' conflict. Time will tell and 20 years from now I will likely be someplace else. Torpedo 8 probably wished they weren't flying TBDs at Midway, too.

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If in 20 years or so we wind up duking it out with the ChiComms over territory, real or financial, we might wish we had better FA systems than a ~30 year old configuration that worked OK for the last 'heavy' conflict.

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I don't dispute that but the days of tube artillery in bore sizes larger than 105mm is numbered. The M777 is probably the last new medium howitzer we will ever buy for the US military because the MLRS systems eclipse it in range, explosive yield, and in many cases precision with the right blocks of ordnance. If preparing for a slugfest with the PLA or DPRK and given a fixed budget for artillery I would buy lots of MLRS before buying 155mm guns.

All the heavy fast firing tube artillery in the world would still be for naught without the lift capacity (maritime, air, and rail) to get it into theater and then to address the problem of getting it across rivers with bridges that won't support it. As the Crusader program bloated in budget overruns the weight was also growing to 42 tons(!!!). When that weight is laid against the road and bridge network in most of the world there are thousands of bridges that can't be crossed by a Crusader that could be crossed by towed artillery or even a GIAT Caesar which (despite the fact that it is made by the French) is a very versatile gun. The vast majority of the world is no-go for trafficability of the Crusader. By contrast, the Caesar weighs only 18 tons and the HIMARS only 12.

FWIW, I was an enthusiastic artilleryman and I am very much in favor of having a large surface fires capability. I just don't believe that tracked SP guns are the best technology available today either in performance or price.

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Time will tell who was/is right.

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WOW! Talk about complete misread on your statement!

My bad.

DP

[This message has been edited by Say Chowdah (edited 6/1/2014 4:42p).]

Anyone know of a good attorney to go after the VA? My family may have a serious claim regarding my late father.

At risk of being a shill for a classmate, when it comes to a winning litigator in a tort case you could do a lot worse than Tony Buzbee (TAMU Regent, Buzbee Leadership Center, etc.). Ask any of the K-2 fish class of '91 how intimidating he can be.

http://www.txattorneys.com/

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I don't dispute that but the days of tube artillery in bore sizes larger than 105mm is numbered. The M777 is probably the last new medium howitzer we will ever buy for the US military because the MLRS systems eclipse it in range, explosive yield, and in many cases precision with the right blocks of ordnance. If preparing for a slugfest with the PLA or DPRK and given a fixed budget for artillery I would buy lots of MLRS before buying 155mm guns.

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Well...the issues is the $41,000 per rocket unit cost.

That is a bargain compared to Excalibur, which are around double that, depending on how you calculate cost. Maybe the same at this point, since production has ramped up.

That will buy you about 40 conventional 155 rounds.

I'll throw my two cents in on this FA conversation...

-PIM is going to go a long way towards bringing Paladins into the 21st century. Seems like a good compromise between what we have and what the crusader was.

-This applies more to towed than rockets, but counter-fire threat is what made me a believer in SP artillery. The ability of Paladins to shoot and move is gonna come in handy fighting an army that can throw rds back as fast as we can.

-Last post isolated another major issue of rd cost. Rocket/Excal precision fires are more than you need in most cases with Force vs Force. PGK fuze (near-precision) is great in regards to taking a smaller degree of guidance and combining it with much cheaper conventional rds.

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-This applies more to towed than rockets, but counter-fire threat is what made me a believer in SP artillery.

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I agree but I'm more in favor of a wheeled SP than tracked. The operational mobility of wheeled SPs and the much smaller logistical tail makes them more attractive in many ways than tracked SPs. I would have preferred for the US to have bought the Caesar instead of the M777 because is has the ability to shoot and scoot i.e. 60 seconds from wheels stopped to first round out of the tube and 45 seconds after the last round is launched it is moving again. It can be made to RO/RO from a C130J which other medium towed guns cannot. If it comes to a moutaintop firebase you would still needs a towed piece than can be slung under a CH-53E or CH47.

The Caesar also has the option of a 52 caliber length tube that allows coverage of 45% more area than the standard 39 caliber length tube used on the M777 and M198.

I don't like the idea of French weapon systems but we already have one (120mm EFSS). Besides, a cynic might say that the M777 was a favor to the Brits in a quid pro quo where they bought US systems in exchange for us buying the BAE gun.

Do you guys really think the Army Mechanized/Armored Division is a dinosaur of the past?

As I understand it the VA was established first and foremost to take care of "service connected disabilities" after separation from active duty in the Armed Forces - usually for healthcare disqualification reasons.

Anything beyond "service connected" gets less priority down the chain. Obviously a higher percentage of disability also gives a vet a higher priority as well.

There are MANY veterans who served honorably for minimal periods of time - but without service connected disabilities - who, over the years have come to expect the VA to take care of all their healthcare issues... And, based on "space available" the VA will do its best to do just that...

Even in the DoD the primary active duty service member was originally the basis for healthcare. As the family unit became more PC, many facilities were sized accordingly - and, in some localities the retired population drove sizing models... Then came BRAC and CHAMPUS and then (now) TRICARE and the downsizing and outsourcing of many installations and the services provided on many installations - including healthcare - and now even BX/PX and Commissaries are in the crosshairs of the budget cutters. DoD healthcare even in heavily populated places like San Antonio, Washington area, San Francisco, etc., has been drastically cut leaving many to outsourced TRICARE and copay situations they never expected - and many often now have turned to the VA for "inexpensive care".../

Do not think for a minute that VA hasn't shared in these downsizings as well. In recent years many cases of MCP/MCA projects DoD has joined with VA in an attempt to "joint share care" under a single roof as well...

Expectations of the VA has gone far beyond the original "service connected disability" based on the good intentions of "space available" which means to many - "me and mine" and an "I earned it" attitude . And many will wait months to be seen in an attempt to get eyeglasses, hearing aides, etc as well as be seen for many other ailments. While I agree it's nice if the care is available, often it is not - at least in the short term, and the VA is roundly criticized as a result.

Most of the 58,000 (?) on waiting lists being ballyhooded in the press these last few days is for aged veterans who want to get into VA nursing homes... and there just arn't that many beds available for them so they wait for one to come available - often dying before a bed comes available - usually on a "space available" basis as most on the waiting lists are not service connected.

Sure, there is bureaucratical nonsense, and lackadaisical attitudes and staff who are "government" employed and thus less motivated than, say, the civilian sector in many respects... But, then, the modalities in a VA facility are not aimed at a quick visit for preventative health maintenance (as most young adults need) allowing physicians and providers to turn over patients at a 4-5 per hour clip either. Many of these veteran patients require extensive care and a single encounter may take an hour to resolve for the provider - especially if there are long waits between visits. Inefficient? Nope, just facts based on the level of problems most vets have when they come to the VA wishing to be addressed.

The fact is that both DoD and the VA biggest expense (besides capital $$) is Rx refills - often written by civilian doctors. Often the crowding and parking issues are related to Rx fills and refills...

One last point - most of the docs/providers in the VA are "employed on salary" (i.e. GS-12, 13, 14 and not interested in speeding up the pace since there is no $$ reward for efficiency...) - often in fact wanting to slow down after an earlier career of civilian practice and all its liability issues but not really ready to retire retire. In addition, many are foreign nationals who meet U.S. licensing standards, but do not have the wherewithal to start up their own practices. Either group is not very aggressive. And, in fact is a direct example of what Obamacare (rationed socialized medicine) will be like forevermore!!

http://www.newschannel10.com/story/25729902/longest-average-wait-times-for-va-new-patients

AAAAAAAAAAg - Air Force Aggie Architect and Hospital Administrator from Amarillo, Altus, Austin, Arabia, Africa, Seoul, Amman, Arkansas (ret). Track Letterman
"A person often meets his destiny on the road he took to avoid it." - Jean de La Fontaine

[This message has been edited by Aggie1 (edited 6/10/2014 7:51a).]

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The fact is that both DoD and the VA biggest expense (besides capital $$) is Rx refills - often written by civilian doctors. Often the crowding and parking issues are related to Rx fills and refills...

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It's strange that their biggest expense is so disconnected from the issue of appointment wait times. The medicine could have cost nothing and the appointment scandal would have still happened because as you point out there was no incentive to do it right (honestly).


http://www.forbes.com/sites/paulhsieh/2014/05/30/three-factors-that-corrupted-va-health-care/

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First, the physician shortage:

In the past three years, primary-care appointments have leapt 50 percent while the department’s staff of primary care doctors has grown by only 9 percent, according to department statistics.

Those primary care doctors are supposed to be responsible for about 1,200 patients each, but many now treat upward of 2,000…

Second, perverse incentives:

The inspector general’s report also pointed to another factor that may explain why hospital officials in Phoenix and elsewhere might have falsified wait-time data: pressures to excel in the annual performance reviews used to determine raises, bonuses, promotions and other benefits. Instituted widely 20 years ago to increase accountability for weak employees as well as reward strong ones, those reviews and their attendant benefits may have become perverse incentives for manipulating wait-time data…

Finally, a culture of dishonesty:

In Phoenix, where administrators were overwhelmed by new patients, many veterans were not logged into the official electronic waiting list, making it easier to cloak delays in providing care.

Another strategy, according to documents and interviews, was for Veterans Affairs employees to record the first date a doctor was available as the desired date requested by the veteran, even if they wanted an earlier date…

In Jackson, [whistleblower physician Dr. Phyllis] Hollenbeck reported that hospital administrators created “ghost clinics” in which veterans were assigned to nonexistent primary care clinics to make it appear that they were receiving timely care.

And in Albuquerque, an employee at the veterans center said some doctors were shocked when they received a memo a few months ago stating that 20 percent of physician “performance pay” would be doled out only to doctors who found a way to limit patient follow-up visits to an average of two a year — a tactic to reduce waiting times by persuading veterans to make fewer appointments.

“Clinic staff were instructed to enter false information into veterans’ charts because it would improve the data about clinic availability,” states a whistle-blower complaint filed by the employee, who did not want to be identified. “The reason anyone would care to do this is that clinic availability is a performance measure, and there are incentives for management to meet performance measures.”

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