Wednesday, January 28, 2015

Iraq snapshot

Wednesday, January 28, 2015.  Chaos and violence continue, Reuters continues to lead the western pack in providing real news from Iraq, Ayad Allawi notes Baghdad has no plan to address the crises in the country, the VA continues to struggle to answer basic questions from the Congress, and much more.

Starting in the United States and starting with some basic questions about the VA.

"How many veterans are being seen? What are they being seen for?".

Very basic questions.

Fundamental, you could argue, to understanding what quality of care the VA is delivering.

But as the Congressional Budget Office's Matthew Goldberg explained to the House VA Subcommittee on Health this morning, in response to Chair Dan Benishek, these basic questions remain unanswered by VA year after year.

And while much has been made (here at this site and elsewhere) about VA and DoD's computers still being unable to link up and 'talk' to one another -- allowing for a seamless electronic medical record to follow a service member from active duty status to veteran's status -- Goldberg noted the reality that the computers for VBA (Veterans Benefits Administration) and VHA (Veterans Health Administration)  can't link up and talk to each other.

These were among the issues discussed in this morning's Subcommittee on Health hearing.  Benishek is the Chair and US House Rep Julia Brownley is the Ranking Member.

The witnesses appearing before the Subcommittee were the Congressional Budget Office's Matthew Goldberg, Paralyzed Veterans of America's Carl Blake, the American Legion's Louis Celli Jr. and the VA's Dr. James Tuchschmidt.

The hearing was about the quality and cost of VA health care and was set in motion by a December 2014 Congressional Budget analysis entitled [PDF format warning] "Comparing the Costs of the Veterans' Health Care System With Private-Sector Costs."

In his opening statement, the American Legion's Celli noted that "if CBO is looking for a baseline by which to estimate the cost of non-VA care, they need look no further than their own library of published reports when in June of 2014, they estimated the cost of outsourcing VA care to exceed $50 billion over 5 years, or roughly $10 billion dollars per year, just to eliminate the backlog of veterans waiting more than 30 days to see a VA doctor. One important point to keep in mind is that this $50 billion represents an additional $10 billion per year to VHA’s already existing $65 billion annual budget, and this measure was only designed to serve less than one percent of VA’s total patient population. After reducing eligibility and constricting payments not to exceed Medicare rates, and a couple of other adjustments, CBO was able to come back with a second score that trimmed about $15 billion from the figure and came in with a second estimate of $35 billion."

Subcommittee Chair Dan Benishek: Mr. Tuchschmidt do you know what the average cost for speciality care for the VA for a routine colonoscopy within the VA versus the private?

James Tuchschmidt: I-I don't have that in my head.  Uh, uhm, we can probably get that information.  Uh, I --

Subcommittee Chair Dan Benishek: I don't think you can.  See, that's the whole point of what we're doing here. We don't know what it costs to do some of the routine things in the VA because we've inquired on this in the past and that's the kind of data that we need to -- we need to have and we need to provide oversight because I agree with these other gentlemen here that VA provides care to our veterans that can't be provided in the prviate sector and yet a lot of things the VA provides can be and in those areas I think a comparison is in order so that we can provide the best speciality care for our veterans.

Pressed by Ranking Member Brownley, the VA's Tuchschmidt tried to spin, "I think that asking what is the cost of care is the wrong question to be asking."

Oh, really?  The VA is above the budget now?


I shouldn't say "now."

As Paul Giblin (Arizona Republic) reported last November, the VA "didn't track its number of unfilled medical positions until June"  and that, in November, the VA learned they had over 31,000 vacant medical positions.

The VA was unanswerable under Bully Boy Bush and it's only become more so under President Barack Obama.

Former VA Secretary Eric Shinseki's tenure (January 2009 through May 2014) was characterized by one scandal after another -- not limited to the backlog, the wait times, the doctored lists to make the wait times disappear,

Shinseki was finally forced to resign in disgrace during the spring of 2014.

Had Congress being doing their job, he could have -- and should  have -- been forced out in the fall of 2009.

The first big scandal he weathered was during that time period.  Veterans going to college on the GI Bill suddenly found themselves with tuition and cost of living expenses but with no check from the VA.

Many had to take out loans.

Many had to beg landlords to be forgiving about rent being late.

Some would still be waiting in December 2009 for their fall 2009 checks.  As a result, some veterans had to postpone Christmas for their children.

And, thing is, when Eric Shinseki took over as Secretary of the VA, he was told that the Post 9/11 GI Bill would not be able to make the college payments in a timely manner in the fall of  2009.  He knew it months ahead of time.  Neither he nor anyone else in the administration made Congress aware of the looming problem.  When the fall semester rolled around in 2009, veterans were planning on those checks.  They took out loans to cover tuition and books, they spent their own money, they did whatever they could to stay afloat and enrolled as they waited and waited on the checks that did not come.   October 14, 2009, he told the House Committee on Veterans Affairs:

Secretary Eric Shinseki: I'm looking at the certificates of eligibility, uh, being processed on 1 May and enrollments 6 July, checks having to flow through August. A very compressed time frame. And in order to do that, we essentially began as I arrived in January, uh, putting together the plan -- reviewing the plan that was there and trying to validate it. I'll be frank, when I arrived, uh, there were a number of people telling me this was simply not executable. It wasn't going to happen. Three August was going to be here before we could have everything in place. Uh, to the credit of the folks in uh VA, I, uh, I consulted an outside consultant, brought in an independent view, same kind of assessment. 'Unless you do some big things here, this is not possible.' To the credit of the folks, the good folks in VBA, they took it on and they went at it hard. We hired 530 people to do this and had to train them. We had a manual system that was computer assisted. Not very helpful but that's what they inherited. And we realized in about May that the 530 were probably a little short so we went and hired 230 more people. So in excess of 700 people were trained to use the tools that were coming together even as certificates were being executed. Uhm, we were short on the assumption of how many people it would take.

When we reported on that hearing, we became the only ones to report on the fact that Shinseki knew months ahead of time that the VA wouldn't be able to issue the checks in a timely manner.

The so-called news outlets wanted to give Eric a pass because he's such a 'good guy.'

I don't care if rainbows and candy corn flow out his ass, his job performance is what matters and he failed at it repeatedly.

A functioning press would've led the charge on that but we don't have a functioning press in the United States, we have a fawning public relations group that latches onto personalities and sells them and their 'life struggle' stories as news -- Lifetime Intimate Portraits passed off as investigative journalism.

And it wasn't just that Shinseki knew months ahead of time that veterans going to college would be screwed over in the fall of 2009.

Let's remember too what the VA did in real time: Blamed veterans.  The VA said the veterans filled out the wrong form or that their schools did.  The VA  stalled and stalled.   The VA didn't suffer.  Christmas bonuses continued at the VA.

The recent scandals were on the mind of the Subcommittee members this morning.

US House Rep Mike Coffman:  We need to know what procedures cost and we don't know that right now.  And we need transparency.  And we don't have that right now in the VA system. And we're talking about a system that --  I mean, we're talking about the quality of care -- that just excluded veterans by virtue of manipulating wait lists -- appointment wait lists, so that people could get cash bonuses.

Tucschmidt was full of nonsense and when he really didn't want to answer a question, he fell back on he wasn't sure if he understood the computer systems and accounting and thought it might date back to, gasp, the 1940s and how was simple him supposed to grasp all that?

The VA is one embarrassment after another and as they continue to play dumb in hearings and refuse to fork over information Congress requests, it's really time for Congress to start censuring them.

At today's hearing, Paralyzed Veterans of America's Carl Blake offered:

We believe that two clear conclusions can be drawn from the CBO report. First, comparing the cost of health care administered by the VA to the cost of private-sector health care is not an "apples-to-apples" comparison. In fact, the CBO points out a number of factors that suggest that trying to compare VA health care and private-sector health care is essentially a fool’s errand. I will address a number of these points in this testimony. The second observation that can be drawn from this report is that it expresses no definitive conclusion on the question of which model of health care is more cost-effective. Ironically, when this report was released, we witnessed a number of interested groups and media reports suggest the report concludes that VA health care is not more cost-effective, and by extension not higher quality than private-sector health care. However, the CBO report makes no such finding. In fact, we believe the report reaffirms in many ways the value and uniqueness of VA health care. While we appreciate the concept that the delivery of cost-effective, high quality health care should be equated across all sources of health care, such a notion ignores the many factors that make VA health care unique.

This is an issue the Ranking Member raised in her line of questioning.

Ranking Member Julia Brownley:  And then just to ask the CBO based on what was just stated, based on looking at models based on yielding the very best value and best care of our veterans understanding that, you know, we may never get to an apples to apples comparison with the private industry, is there a -- is there a study or that you could look at to look at to help inform us how -- how we are doing?  I know it's tough because we are not comparing ourselves -- in some sense, not comparing ourselves -- to anything else?  But is there a way for you to analyze what the VA just said about being cautious about strictly looking at costs -- not looking at the rest but determining the real value of what we're getting on our investment in terms of care for our veterans?

Matthew Goldberg:  Yes, let me say two things, if I may.  One is I'm heartened by Dr Tuchschmidt's  commitment to provide the kind of data that DoD provides to the oversight committees through the TRICARE report.  In the time we had, and the question from Senator Sanders was pretty narrowly focused on cost, I would agree with the sentiment in the room that the other side of the equation is to look at the quality of care and satisfaction, that would be a big study and I'm not sure that I would just divide cost by satisfaction -- I think the math is a little harder -- but I agree to get a fuller picture, you'd have to look at all of those aspects and perhaps we could do that in future studies.

Each session of Congress starts with hopes of objectives rarely achieved.

Possibly this session will prove to be productive in terms of the best interest of veterans?

One positive note, the House passed the Clay Hunt Suicide Prevention for American Veterans (SAV) Act January 12th and the Senate is supposed to vote on it Monday.

Maybe there's also hope to be found in a statement made at today's hearing?

Subcommittee Chair Dan Benishek:  Five of us are doctors, five of us are veterans and all of us share a primary goal: To create a Department of Veterans Affairs health care system that provides timely, accessible and high quality care that our veterans can be proud to call their own.  Our work will require open and ongoing communications with veterans, stakeholders and, most importantly, VA leaders. Unfortunately, it became painfully apparent last year that the Veterans Health Administration, which operates the VA health care system, was either unable or unwilling to provide basic information about the services it provides.

The American Legion notes of today's hearing:

The American Legion testified to Congress at a Jan. 28 hearing that health care provided by the Department of Veterans Affairs is more cost-effective than outsourcing it to the private sector. The Legion’s stance was in response to a December 2014 report by the Congressional Budget Office that compared VA health-care costs with those of private practitioners.
The CBO report, requested by Sen. Bernie Sanders, I-Vt., stated that VA “has provided limited data to Congress and the public about its costs and operational performance. The overarching theme of the study is clear – CBO needs more data in order to make recommendations or be able to come to any credible conclusion.”
Louis Celli, director of The American Legion’s Veterans Affairs & Rehabilitation Division, presented the Legion’s testimony before the House Committee on Veterans’ Affairs Subcommittee on Health.
Celli said much discussion over the years has suggested that veterans “might be better off if we privatized some or all of VA. The American Legion believes that this concept is shortsighted, prohibitively expensive, and fails to take into consideration the specialized care that veterans receive – and deserve – at VA.”
According to the Legion’s written testimony, most of the evidence cited in the CBO report “supports the assertion that VA is less expensive than both Medicare and private health-care solutions … The analysis indicates that VHA (Veterans Hospital Administration) represents a cost savings when comparing physician care, and pharmaceuticals, but was unable to compare ‘other medical goods and services.’”
Using a simplistic equation dividing the  9.3 million veterans  who are enrolled in the VA health care system by VHA's annual budget of $57 billion, the VA spends just over $6,000 per veteran patient

And they note that the American Legion's written statement to the Subcommittee can be found here.

Yesterday's snapshot covered the Senate Armed Services Committee hearing and Wally covered it with "The threat from the Islamic State (Wally)," Ava covered it with "Naming the prettiest and the ugliest members of the Senate Armed Services Committee (Ava)" and Kat with "Sequestration."

In the hearing, Gen John Keane stated:

This issues simply are -- and what the Arab Spring was about if you recall, it was about seeking political reforms, social justice and economic opportunity.  Nobody was demonstrating in the streets for radical Islam.  But the radical Islamists saw the Arab Spring as an opportunity and it became an accelerate for them because they saw political and social upheaval and they could take advantage of it.  So using that as a backdrop -- it drives you -- those issues are still there -- political reform, social injustice and lack of economic opportunity.  

The White House continues to fail in addressing those three key issues as they instead focus on bombings and more bombings.

Real Clear Politics notes (link is text and video) Andrea Mitchell's  comments on today's Andrea Mitchell Reports (MSNBC):

ANDREA MITCHELL, NBC NEWS: What the president proposed in the state of the union to have an authorization of the use of force will be taken up and especially with John McCain now as chair of the Senate Armed Services Committee will probably come together on the ground rules, but what is very striking... is that in the president's state of the union address, he said there's been progress in rolling back ISIS in Iraq and Syria. Perhaps there's been some progress in Iraq.
That's debatable as to whether Iraqi troops are ready to stand up, they certainly aren't ready to retake Mosul. There certainly has been no progress in Syria.

Andrea's call is a strong one (unlike the embarrassing PolitiFact).  As Mioh Song (Xinhua) noted yesterday:

Last Friday, thousands of Iraqi army, police and Shiite militias backed by Iraqi aircraft launched a major offensive with the aim of ending the presence of the extremist militants in the country's province of Diyala.
However, despite the announcement of liberating Diyala, three Shiite militiamen were killed and four wounded Monday morning when a roadside bomb struck a Shiite militia vehicle near an orchard in northeast of Maqdadiyah, a provincial police source told Xinhua on condition of anonymity.

And it's not just the US government which appears to have no plan.  Mina al-Oraibi (Asharq Al-Awsat) interviewed Iraqi Vice President Ayad Allawi at Davos last week.  Excerpt:

Q: What about the ongoing fight against ISIS? You said that the Baghdad government has no clear strategy to confront the group. Why is that?

[Allawi]: To be frank there are two dimensions [to this battle]. First, there is the military dimension to liberate these territories, and this of course is important. However, the most important dimension is mobilizing the people and guaranteeing their future. This dimension is being completely ignored, not to mention other important factors in the strategy to combat ISIS. Therefore, I believe the fight against ISIS will be protracted, while we also don’t know what will happen after ISIS is expelled from these regions, in terms of counter-terrorism laws, de-Ba’athification, and political and sectarian discrimination . . . The entire issue needs a clear strategy, and that is something that is not in place now.

All this time later and still no plan.  Not from the White House, not from Baghdad.

Some try to pretend that a national guard in Iraq is the answer and you can debate the merits of that but the reality is that such a force would require comprehensive training.  And how long would that take?  No one wants to answer that.

No plan and the costs just keep mounting.

Afghanistan, Iraq Direct War Spending To Date: $1,700,000,000,000 (and Counting)

Back to Mina al-Oraibi (Asharq Al-Awsat) interviewed Iraqi Vice President Ayad Allawi

Q: Is it possible to achieve a national reconciliation in Iraq under the current political approach?

[Allawi:] I believe that this is the last chance for Iraq to get out of this crisis. Reconciliation is a two-way process. First, we must remove the obstacles to this process, and allow reconciliation with those who must be reconciled with, reintegrating them with society. This includes the Ba’athists who have not carried out any crimes and those who took part in armed resistance against the US, particularly as such resistance is the legitimate right of any people under occupation. So we must reconcile with these parties and bring them into the political process and ensure they do not face any discrimination, marginalization or intimidation. Of course, anybody who has committed crimes must be politically excluded.
The second process must be to move away from the sectarian quota system which does not lead to state-building or strengthening the institutions of the state. However, this reform is being rejected by both Sunni and Shi’ite parties who are benefiting from this sectarian quota system. But I am certain we will not be able to defeat ISIS without real reform and turning over a new page on the past.

Alsumaria reports today on efforts of Parliament's justice and accountability commission to keep certain Sunni Iraqis out of the government.  There's no reconciliation going on.

Monday's snapshot included:

Ahmed Rasheed, Stephen Kalin and Robin Pomeroy (Reuters) report:

Sunni politicians and tribal chiefs from Iraq's eastern Diyala province accused Shi'ite militias on Monday of killing more than 70 unarmed civilians who had fled clashes with Islamic State of Iraq and Levant (ISIL) militants.

Interior Ministry spokesman Brigadier General Saad Maan denied the claims, saying ISIL was trying to undermine the reputation of Iraqi security forces.

The Minister of the Interior is a laughable joke and far from a trusted source on the topic of thugs murdering Sunnis.  As Loveday Morris (Washington Post) noted last October:

The new interior minister is Mohammed Ghabban, a little-known Shiite politician with the Badr Organization. But there is little doubt that Hadi al-Amiri, head of the party and its military wing, will wield the real power in the ministry.

The Badr militia ran notorious Shiite death squads during Iraq’s sectarian war, after infiltrating the Interior Ministry. A leaked 2009 State Department cable said sources had indicated that Amiri may have personally ordered attacks on up to 2,000 Sunnis. Amiri has denied such allegations.

 And today Ahmed Rasheed, Ned Parker and Stephen Kalin (Reuters) report what survivors of the slaughter say.  Excerpt:

The men were led a few hundred yards to a field where Abu Omar said more than a hundred others had been gathered.
For about two hours, they were forced to kneel and stare at the ground as the fighters selected their targets and led them to a spot behind a mud wall.

"They took them behind the wall. Less than a minute, then a gunshot," said Abu Omar. "All we could hear was the gunshots. We couldn't see."

It's a major report and a must-read and Reuters needs to be congratulated on the efforts they've put in on this story while other outlets have only offered what officials say.

While Reuters is reaping journalistic rewards, Big Oil wants to make big money in Iraq.  Saif Hameed, Stephen Kalin, Louise Heavens and Greg Mahlich (Reuters) report, "Royal Dutch Shell (RDSa.L) has signed a deal with Iraq worth $11 billion (7 billion pounds) to build a petrochemicals plant in the southern oil hub of Basra, Industry Minister Nasser al-Esawi said on Wednesday."

The deal comes as RT reports on a new study:

Cutting-edge research from British universities has confirmed a belief long held by conspiracy theorists, realists and hawkish neoconservatives alike: oil drives foreign intervention and war.

Foreign governments are 100 times more likely to intervene in civil wars if the troubled state is home to hydrocarbon reserves, according to a new report by academics from the universities of Warwick, Portsmouth and Essex.

Meanwhile, US House Rep Adam Schiff is again introducing a bill providing authorization for Barack Obama's actions in Iraq and Syria.  AP notes, "Schiff's bill would authorize the use of force against the Islamic State group in Iraq and Syria for three years, but prohibit the use of ground forces in a combat mission in either of the two nations."  Tewhid Bastrurk (World Bulletin) reminds, "U.S. President Barack Obama was able to begin Operation Inherent Resolve without consulting congress due to the Democratic majority in the  [Senate] Armed Services Committee (ASC) controlling, responsible for control over the Pentagon's activity, in a move which pushed the limits of his presidential power and drew unfavorable responses from both Democrat and Republican camps."

Of course, US forces already are in combat in Iraq.  We've known it since the end of 2011 thanks to then-US Ambassador to Iraq James Jeffrey's NBC interview with Ted Koppel but did the Pentagon really mean to let it slip out as well?

They did so today:

Special operations forces are very busy today, but they must also plan to confront future threats, Michael J. Dumont, the principle deputy assistant secretary of defense for special operations/low-intensity conflict said here yesterday.
Dumont spoke during the National Defense Industrial Association’s Special Operations/Low-intensity Conflict Symposium here.

  There is no shortage of threats, the deputy assistant secretary said. Special operations personnel are confronting the Islamic State of Iraq and the Levant terror group in Iraq and are planning to train Syrian moderate forces opposed to ISIL, he said.

Repeating:  "There is no shortage of threats, the deputy assistant secretary said. Special operations personnel are confronting the Islamic State of Iraq and the Levant terror group in Iraq and are planning to train Syrian moderate forces opposed to ISIL, he said."

Lastly, Margaret Griffis ( counts 585 people dead from violence in Iraq today.