Friday, March 17, 2023

Iraq snapshot

Friday, March 17, 2023.  A major hearing in the Senate this week and not seeing any coverage of it -- one discussing wasted money and harm to veterans.  We also go over a just-published piece of nonsense on the Iraq War by an Iraq War cheerleader.

Let's start with EHRM.  That's the Electronic Health Record Modernization.  It's been supposed to happen since back in the day when Bully Boy Bush occupied the White House.  It's still not happened.  Our focus on this issue is veterans.  The point of the EHRM with regards to veterans is to ensure that they have the healthcare that they need and to ensure that, if they are disabled or challenged, their disability ratings is correct.  

They start as service members with one record.  Then, when they are out of the service, they are veterans.  Paper records have been a nightmare.  They're asked, as veterans, to document something that happened while they were in the service.  And, no, it does not automatically transfer over.  The EHRM, for veterans, was supposed to create a record that would start when they enlisted and that would follow them in the service and when they became veterans after.

Disability ratings especially are impacted.  Veterans are left fighting with the VA over their disability rating because the proof is not there or the VA won't recognize it or -- None of this should be happening.  They were promised care and they need to get the care they were promised.  If they were injured while serving, that's even a deeper debt that the government owes them.  


US House Rep Matthew Rosendale Sr. took a break from taking photos with US-Nazi Greyson Arnold and White supremacist Ryan Sanchez to introduce HR 608 on January 27th.  The bill, which has been referred to subcommittee, would "Terminate the Electronic Health Record Modernization Program of the Dept of Veteran Affairs."  


In a press release at the end of January, his office noted:

“The Oracle Cerner electronic health record program is deeply flawed – causing issues for medical staff and posing significant patient safety risks,” said Rep. Rosendale. “We cannot continue to further implement this inadequate system at the expense of billions of dollars in government funding. We must hold the VA to the high standard of care promised to our veterans and be good stewards of taxpayer dollars.”


The Department of Veterans Affairs has implemented the Oracle Cerner electronic health record (EHR) system at five of 171 medical centers since 2018, expending roughly $5 billion. Last year, an independent life cycle cost estimate found that the cost to implement the system had more than doubled, from $16.1 billion over ten years to between $33.6 and $38.9 billion over 13 years. Additionally, VA acknowledges that the new system has created unacceptable levels of productivity losses, patient safety risks, and staff burnout at these five small and medium-sized facilities.


Let's drop back to September 24, 2008 when Senator Daniel Akaka was Chair of the Senate Veterans Affairs Committee and introduced that day's hearing by noting:


Good morning, aloha, and welcome to all of you to today's hearing on the state of health information sharing between the Departments of Veterans Affairs and Defense. This is historic. I will tell you that Veterans Affairs and also the Department of Defense have been talking to each other, have been working together, and here is another area that we are getting to where we are working together. And so, this is why I said historic. Even in the waning days of this Congressional session, we must continue to strive to improve care for servicemembers and veterans. An essential ingredient to reaching that goal is the sharing of personal health care information between the two Departments. The merits of Electronic Health Records are well documented. While VA is considered to be a leader in using Electronic Health Records, much work remains before the two Departments can achieve the ultimate goal--the goal of sharing medical information in real time. Until this goal is reached, military and VA medical practitioners simply will not have access to the most accurate personal medical information on their patients. Technology is not necessarily the problem. The technology exists, as we will see today. Indeed, the Electronic Health Record systems of the two Departments are each remarkable in their own right. The biggest challenge is the development of common standards so the two systems can talk to each other easily and in real time. DOD and VA have been working toward achieving interoperable systems for over a decade at a rate that can charitably be described as glacially slow. Only recently has there been significant progress. It appears that, for the first time, there is the needed commitment for full data sharing of electronic medical information; and the results of that commitment are visible. I encourage the Departments to continue to work together in order to extend the progress we have already observed. When VA and DOD finally have the ability to fully exchange medical information in real time, the best interests of servicemembers and veterans will be served.


Wednesday, the Senate Veterans Affairs Committee held a hearing on EHRM -- another hearing.   We're still waiting on the data bases of VA and DoD to be able to speak to one another.  Let's revisit some of the ways we ended up here.



Key moments took place in the history of this long process back when Eric Shinseki was the Secretary of the VA.  Congress was -- as usual -- asking what the delay was.  No real delay, Shinseki insisted.  Let's drop back to the snapshot for May 30, 2014 which noted that the inept Eric Shinseki was resigning as VA Secretary:


 Shinseki, at the start of his tenure as VA Secretary, was tasked with determining whether or not his computer system would change -- one had to.  DoD and VA were supposed to offer a seamless transition for those going from service member to veteran.  How?  They'd do it with electronic records.  But the two systems couldn't communicate -- this was all determined before Barack Obama was sworn in for his first term as President of the United States.  So one of the two would have to change.

Shinseki chose not to.  He also sat on this issue that Congress poured billions of dollars into.  He's been Secretary of the VA since 2009.  This was supposed to have been handled immediately.  Robert Gates told him to do what he wanted and the Pentagon would adapt.  Then Leon Panetta became Secretary of Defense.  He told Shinseki that whatever Gates had already approved was fine.  And still nothing.  Then Chuck Hagel becomes Secretary of Defense.

Something finally happens.

Hagel's not shedding any tears today over Shinseki's departure. Not after Shinseki tried to blame him to Congress.

April 11, 2013, Shinseki appeared before the House Veterans Affairs Committee which was irritated by the budget request coming to them late and not coming to them in full because, as they pointed out, what the administration submitted did not include all the costs -- even if you set aside issues of discretionary spending, the VA 'budget' request was a joke.  Ranking Member Mike Michaud noted the money that was being poured into the VA -- others did as well but he's the one who asked for a status on the electronic health record.  And this is where Shinseki chose to lie.  There was no progress, he admitted, but that was because Chuck Hagel hadn't added any input.

What the hell was that?  It's so high school cafeteria.  Did he think it wouldn't get back to Hagel that the House Veterans Affairs Committee was vocal about the fact that there was no progress on this issue despite the funds provided for it in 2009, 2010, 2011, 2012 and now 2013?

It had nothing to do with Chuck Hagel.  Good for Hagel that he wasn't going to stay under the bus.  He complained to Barack who had a sit-down with Hagel and Shinseki to ensure that a decision was made and there was no 'confusion' about the status.

If you're not getting what a little bitch move Shinseki pulled before Congress, grasp that Hagel was confirmed as Secretary of Defense on February 26, 2013.  Not two months later, Shisenski was blaming a multi-year delay to starting the program on Hagel.

 

Things like that happened over and over while Shinseki was VA Secretary.  And the press looked the other way over and over.  There was the veteran who felt he was at the end of his rope and called the suicide hotline only to be ratted out by Shinseki's son-in-law.  It was one thing after another -- including the scandal with veterans not getting their fall tuition checks on time -- some had to wait until the following January.  

Eric Shinseki took over the VA in January 2009.  When he did, he was immediately informed that one of the signature pieces of legislation, the Post-9/11 GI Bill, was in trouble.  While it was due to be implemented in the fall of 2009, Shinseki was told in January of 2009, the VA couldn't handle it, checks were not going to be going out.  That's when you inform Congress there's a problem.  He didn't.  He hired an outside contractor to examine the system and the results were the same: When the program was rolled out in the fall, many veterans would suffer because the system was inadequate.

Did Shinseki inform Congress then?

No.

He stayed silent.  And nothing was said as fall rolled around.  Then a few problems emerged, a few veterans weren't getting their checks.  These semester checks would cover tuition, rents, etc.  And a few were having problems.  The VA immediately blamed the veterans and the educational institutions.  Their mouthpiece on the House Veterans Affairs Committee, Corinne Brown, announced she'd been watching MSNBC at three in the morning and it was time for these institutions to get their act together.

It wasn't the colleges.

And as a few veterans turned to many, finally in October, Eric Shinseki revealed that he'd always known there was a problem.  He revealed that October 14, 2009 when he appeared before the House Veterans Affairs Committee. The press didn't care to report that revelation.  Even those reporters who were present ignored it.  For months after that, veterans continued to suffer.  Some families had to postpone Christmas because all the money was being used to cover bills as a result of their still waiting on checks they should have received in August and September.


There was the deliberate mis-classifying of veterans with Post-Traumatic Stress -- wrongly classified to 'save money' as Senator Patty Murray discovered with regards to Madigan Army Medical Center.



Finally, the scandal on wait times forced Shinseki to resign in disgrace but find any outlet that adds up all the scandals and provides that reality.


You can even read the CRAPAPEDIA entry on Shinseki and be left with the impression that Shinseki did a wonderful job -- that no one was calling for his head on a platter when members of both Houses of Congress were calling for him to resign, when VSOs were calling for him to resign.  And he was forced to resign and he he resigned in disgrace.  Senators like Al Franken and John McCain were calling for him to step down or be fired,  then-US House Rep Tammy Duckworth was telling the press that it was time for him to go.  The American Legion called for Shinseki to resign. In real time, Senator Patty Murray noted, "There are serious problems at the VA that won't be solved simply by replacing the Secretary, but I am hopeful that this leadership change will spark structural, cultural, and personnel changes, from the top of the organization to the bottom, to make sure our veterans are getting the care and support they expect and deserve."

With all that in mind, let's turn to this week's hearing.  Senator Jon Tester is the Chair of the Senate Committee and Senator Jerry Moran is the Ranking Member.  The Committee held from the VA's action director over the EHRM Integration Office Neil C. Evans (who was accompanied by Dr Shereef Elnahal, Kurt DelBene and Michael Parrish), the Government Accountability Office's Caro Harris and Oracle Global Industries Vice President Mike Sicilia.


Sicilia spent his time talking up Oracle Global Industries, "As a result of our initial efforts since June 2022, system performance has improved, with the most severe type of outages down 67 percent. Oracle delivered ahead of schedule critical enhancements for VA’s pharmacy system and implemented fixes to address scheduling and numerous other issues. We have brought on additional capability to improve training. Much additional work is in-process currently."  Are you impressed?  Me neither.  And the fact that Oracle took over the contracted company back in June doesn't really matter to me.  When are they going to complete the project?



He testified that an integrated, electronic record -- traveling from DoD to VA -- would allow for "better health outcomes," "improved medical treatment," "increased access to care" and "less administrative burden."  Yes, it would.  And we've known all of that for years now, decades.  This is not news nor is it a new discovery.


As Jon Tester declared in his opening statement, "We need to know exactly where the hell we're at, where we're going, what it's going to cost, and when we can look for a timely delivery of a thing that we've been talking about here for 20 years."  His frustration was understandable and only increased during the hearing.  He asked the VA's Michael Parrish about the contract with Oracle -- the new one (the previous contract was for five years and is due to expire May 16th) -- that they are negotiating currently and whether it would "be more favorable to the American taxpayer?"  Parrish replied, "That's absolutely the plan."

The plan.

It's really a yes or no.  But Parrish couldn't deliver that and Tester had to be the one talking about "the bottom line."  "How much money are we going to have to spend to make sure this program works and that veterans get the healthcare that they've earned?"  Ranking Member Moran would note during his questioning, "I think my question is worthy of a yes or no answer" in response to the evasion he was being given by the VA witnesses


Oracle wasn't any more forthcoming.  Senator Sherrod Brown, "I just don't see the benefit from your system.  Veterans are frustrated by delays in their care.  The contract is coming up for renewal in May of this year, without significant changes to the terms of any new contract, why should we support it?  What benefits are you providing?"

Good questions, no solid answers.

This impacts veterans and their families and, as Senator Kevin Cramer noted, "Every year, approximately 200,000 men and women leave US military service and return to life as civilians -- a process known as the military to civilian transition."  That's a lot of people and that's a lot of family members of the veteran.

A lot of people are being impacted and it's a negative impact.  Senator Patty Murray spoke of a constituent who did not get their cancer diagnosis in a timely manner as a result of this.  Let's note that section of the hearing.


Senator Patty Murray: We are almost five years into the CHR contract and, from the very start, before the original Cerner contract was even agreed to by the Trump administration, I have been raising concerns from my constituents in Spokane and in Walla Walla and I believe that I have been very patient and reasonable in pressing the VA and Oracle Cerner to get this system to work the way it should.  Now I have heard from providers who are now burnt out trying to navigate this broken interface on top of what has already been an incredible trying time for healthcare workers.  And I have heard directly from my constituents who have received a late cancer diagnosis just because of the flaws in the system and everything in between.  None of this is okay.  And something that concerns me deeply is that we have not heard a lot about how those voices -- that on the ground perspective -- will be taken into account when we determine the future of this program. VA is now in the decision making process about whether to renew this contract.  This is a key moment   So, Dr. Elnahal, I need to know who is representing the front line experience from eastern Washington who's been using this system and how exactly is the patient and provider experience represented in that decision making.

Dr. Shereef Elnahal:  I think it's a really important question, Senator, and we focus squarely on that in this spring effort in collaboration with the program.  We built a governance structure that takes the views of end users into consideration in the first instance.  The most important input we have is the input we have from front line clinicians like Dr Evans who are telling us about the problems that need to be fixed, that need the veteran care.  That cascades up into different levels of governance, our clinical counsels that ultimately make decisions on the changes we need to be able to meet --

Senator Patty Murray: So it isn't the users who have been facing these challenges over and over again?

Dr. Shereef Elnahal: Yes, our governance now includes users from the five sites where it exists and leaders who are advising on what changes need to be made based on their input.


Senator Patty Murray: Okay, I'd like to see that chart.

Dr. Shereef Elnahal:  Absolutely, Senator.

Senator Patty Murray:  Mr. Sicilia, Mann-Grandstaff  has been dealing with serious and even life threatening issues for over two years now -- since the roll out of the HR -- and many of the IG reports have further confirmed what I have been hearing on the ground over and over.  There are problems in the system with suicide flags, with unknown cues, pharmacy issues.  And I know that Oracle has begun working on some of those fixes but we are still talking about the same problems two years later and that is just so unacceptable.  The stakes are really -- they couldn't be any higher.  So just tell me, why is it taking so long to update this system when we've been telling you the problems and, you know, from the ground up two years ago and we're still getting 'Well we're going to have a fix for this.'


Mike Sicilia: Uhm, thank you for the question, Senator.  To my knowledge, the unknown queue issue has  been addressed.  I committed to this-this panel in July that we would deliver a fir -- a fix on this by August 1, 2022.  We did that. It is deployed now.  On average, there is one order a day that shows up per site in the unknown queue.  I think the last time we spoke here, we were up to about 1500 a week of orders in the unknown queue.  So, uhm, if that is still a problem, uhm, that is in fact news to me and I'm happy to come back to you in writing if the are repetition -- additional -- problems but I have not heard those.  In terms of pharmacy, uh, the last time we spoke the-the estimate was that it would take three years to address the pharmacy's issues.  My response to that was that when that kind of estimate was given the real answer is nobody knows.  So the first thing we did after that hearing in July, was broke that down in the smaller -- smaller subsets.  We delivered in, uhm, February those -- the top three fixes for pharmacy.  The fourth fix -- number four on the priority list in April to the VA as, uhm, Dr Evans just mentioned.  We have heard some positive feedback from sites about the those-those-those pharmacy fixes.  As far as behavioral -- behavioral health, uhm, flags -- behavioral health flags are now, uh, in the system and are -- will continue to be added to all modules of the system, uh, on schedule in-in April.  As well, the opioid advisory tool that has been deployed has flagged over 1600 just at the five sites that are live -- has flagged over 1600 potential opioid prescriptions that would have been made, uh, to patients that perhaps should not have received, uh, opioids.  So I think a lot of the issues that have been reported, uh, have been addressed.  I'm disappointed to hear that that news has not made it to you and that, uh, certainly we will make sure that we will respond in writing with --

Senator Patty Murray:  I would like to see that in writing.  Mr. Chairman, before I finish my time, I just want to say as Chair of the Appropriations Committee and Chair of the Military Construction and Veterans Affairs Subcommittee and a long time member of this Committee, I take my oversight responsibility pretty darn serious.  And despite how much funding has been provided, this system is by no means living up to our promise to care for our veterans.  The continued patient safety risks are totally unacceptable.  So I want to be candid here because, at the end of the day, what I care about is getting this right for our veterans.  And I do not believe that more money is what is going to solve this problem.  And I'm not sure it makes sense, Mr. Chairman, to continue to fully fund the budget request for this system until I can see that this system is working and not putting our veterans in harms way.  That responsibility is on both the VA and Oracle Cerner -- and both entities need to step up.


This weekend, the Iraq War hits the 20 year mark.  US troops are still in Iraq.  









20 years and has anything been learned?

THE NATION magazine, let's look there.  They've just published a piece on Iraq an hour ago.  So we should applaud, right?  It's the 20th anniversary and they finally remember Iraq.  And since they're as full of crap as corporate media, they don't go with someone who was right for the column, they farm it out to a writer who cheered the Iraq War on.  He was at THE NEW REPUBLIC at the time.  And THE NEW REPUBLIC nearly went under as the American left walked away from them because they pimped the Iraq War.  

It's Spencer Ackerman, if you were wondering.  And there's some worth praising in the article.  To his credit, Spencer is aware of some events that took place in Iraq after 2008.  Don't expect him to admit he was wrong for cheerleading the Iraq War  -- in fact, you won't even find the admission that he cheered on the Iraq War.  He's whining in the article about how lessons haven't been learned, how people have amnesia (he's also pimping the proxy-war on Russia) and yet he's the one forgetting to take accountability.  

What's worse, and most people won't catch this, is he's still lying.

In 2008, he lied and whored non-stop to get Barack Obama the Democratic Party's presidential nomination.

If you're talking about Iraq and how US troops remain in Iraq, you might need to cover Barack -- unless, of course, you can pin it all on Joe Biden which is what Spencer does.


In 2011, a fractious Iraqi parliament declined to extend legal protections to the remaining US forces, prompting Obama to recall the troops. Many in US national security circles decried the withdrawal as a failure of Obama’s diplomacy rather than as a verdict on the viability of a US presence from Iraqi leaders willing to work with Washington. When the Islamic State conquered Mosul in 2014, the blame in Washington went to the withdrawal, not the war that created ISIS’s parent entity, Al Qaeda in Iraq.

The horrors of ISIS preempted any discussion of how the original US aggression, compounded by the routine brutalities of occupation, generated enemies worse than its initial ones. US policy-makers considered the central error to be not the invasion but the departure. The efficacy of the Iraqi and Syrian Kurdish-led ground forces in dislodging ISIS reinforced a preference for proxy war—a perennial imperial strategy—over large-scale US combat. That preference is perhaps the dominant lesson of Iraq drawn by the US foreign policy establishment.

By 2021, President Joe Biden, who had been one of the most important Democratic validators of the invasion, had secured a residual force without a clearly defined mission. Roughly 2,500 US troops are deployed in Iraq, with 900 more in Syria. Ostensibly, they’re a backstop against an ISIS resurgence, but in practice, they’re targets for Iranian proxies. Biden, his Republican critics, and the security institutions all regard this as more responsible than ending an imperial misadventure. Doing so ensures they can persist in a delusion central to their hegemonic project: that the world is a grenade and America the pin.


 That's just garbage.  There are people who are not old enough to remember that period and that period was also poorly covered by the media.

Let's deal with the 'withdrawal.'  It was not a withdrawal, it was a drawdown.  The US Defense Dept called it a "drawdown" because that's what it was.  Ted Koppel established this in the immediate weeks before the drawdown on both NPR and NBC.  

As for the failed agreement,  Nouri wanted more troops in Iraq, not the number Barack was offering.  And that's why some criticize him in terms of 'deal making.'  I know this from Leon Panetta who I've known for years (and who was Secretary of Defense at the time).  I know this from public hearings on Iraq -- ones Spencer never covered.  And a public hearing that the corporate press and the panhandle press (just repeating the corporate press because heaven forbid they themselves attend a Congressional hearing) turned into "John McCain was mean to Leon Panetta!"  The hearing was on Iraq.  Democrats were being very clear about the number of US troops that would still be in Iraq (and the thousands being shifted to Kuwait).  But, looking back, it really does seem that the corporate press was trying to distract the American people from the realities of the hearing with their report of "John went bitchy!"

ADDED for those e-mailing the public account that no such hearing ever took place:  It was an important hearing, on the future of the US in Iraq.  It mattered, what was discussed mattered.  Senator Kay Hagan, for example, made important points (to the witnesses Leon Panetta and Gen Martin Ddmpsey), about how the 'withdrawal' was a drawdown and how some of the US troops 'leaving' Iraq were going to Kuwait and would continue to cross the border back and forth.  There was so much worth noting in that hearing.  In fact, we covered it -- community wide -- in the following:  the November 15, 2011 "Iraq snapshot," the November 16th, 2011 "Iraq snapshot," November 17, 2011 "Iraq snapshot," Ava's "Scott Brown questions Panetta and Dempsey (Ava)," Wally's "The costs (Wally)," Kat's "Who wanted what?" and THIRD's "Gen Dempsey talks '10 enduring' US bases in Iraq."    That's all covering one hearing because it was that important.



We have to note Spencer earlier in the article:

Bush’s escalation, the 2007–8 troop surge, never produced the promised political reconciliation among Iraqis. Instead, it entrenched Prime Minister Nouri al-Maliki, who persecuted the disempowered Iraqi Sunnis. 


I do not have time for all that is wrong with those two sentences (the first one, for example, fails to note that a military will never be responsible for "political reconciliation" because the US military isn't trained for that).  But Nouri became entrenched, did he?

Who made Nouri entrenched?  

Barack Obama.

But Spencer is never going to tell the truth about that.

In 2010, Iraqis went to the polls and voted.  And eight months and several days later, Nouri gets a second term as prime minister.

So Iraqis backed him, right?

No.

The prime minister should have been Ayad Allawi.  That was the choice.  Iraqiya was a brand new political coalition and it surprised many (not all of us) by winning.  

It certainly surprised NPR and their whore who went on the air before the votes were even counted, less than 48 hours before the polls closed, to announce Nouri had won a second term.  No.

The people didn't support Nouri and State of Law.  It was a huge upset.  

They went with Iraqiya.  This is not a minor detail.  Iraq might be better off right now if Barack had done the right thing.

But instead of doing the right thing, when Nouri refused to step down for months and months and months, Barack had the US negotiate The Erbil Agreement (Joe was the chief supervisor of it).  It was a contract with the major political parties.   They signed on to give Nouri a second term (as the US wanted) in exchange for other things.  Iraqiya was supposed to get a newly created security post with independence (it never happened) and the Kurds would get the referendum that was supposed to take place in Nouri's first term but never did -- to this day it hasn't taken place.

The US refused to support the Iraqi people.  The Erbil Agreement overturned the votes and gave Nouri the second term.  Barack called Ayad Allawi personally to get him back in Parliament and swore that The Erbil Agreement had the full backing of the US government and would be enforced.

No.  It wouldn't.

Nouri used it to get the second term and then refused to honor it.  And that was the end of that.

The Iraqi people were left with someone they had tried to vote out of office.  The Iraqi politicians -- and cleric Moqtada al-Sadr -- tried to make Nouri follow it by threatening to remove him from office.  Joe Biden pressured Jalal Talabani to end that (Jalal did).  And Nouri gets worse and worse and that's what give rise to ISIS.  It's Nouri's persecution of the Sunnis.  


You want to talk honestly about Iraq, talk about telling people that this is a new Iraq and their vote matters and then overturning their votes with a legal contract.  Talk about telling them that they have a democracy (one that they didn't ask for) and then stripping them of their votes.  

Iraqiya was inclusive.  That's why people supported it.  It was Shi'ite and Sunni, men and women.  It was inclusive.  It was about a national identity, not sects.  

I can't predict the future but that does seem much more promising for Iraq -- for any country -- than a second term by Nouri who we already knew had brought back the secret prisons and torture chambers, who was disappearing Sunnis.  

What lesson was learned from the Iraq War?  The media learned that they could lie and get away with it.  So they continue to lie today and publish an Iraq War cheerleader.


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