David Weigel | March 5, 2007
The Washington Post reports on more veterans reporting crappy medical care in their far-flung hospitals, all the information tumbling forth in the wake of the Walter Reed scandal.
Across the country, some military quarters for wounded outpatients are in bad shape, according to interviews, Government Accountability Office reports and transcripts of congressional testimony. The mold, mice and rot of Walter Reed's Building 18 compose a familiar scenario for many soldiers back from Iraq or Afghanistan who were shipped to their home posts for treatment. Nearly 4,000 outpatients are currently in the military's Medical Holding or Medical Holdover companies, which oversee the wounded. Soldiers and veterans report bureaucratic disarray similar to Walter Reed's: indifferent, untrained staff; lost paperwork; medical appointments that drop from the computers; and long waits for consultations.
Sandy Karen was horrified when her 21-year-old son was discharged from the Naval Medical Center in San Diego a few months ago and told to report to the outpatient barracks, only to find the room swarming with fruit flies, trash overflowing and a syringe on the table. "The staff sergeant says, 'Here are your linens' to my son, who can't even stand up," said Karen, of Brookeville, Md. "This kid has an open wound, and I'm going to put him in a room with fruit flies?" She took her son to a hotel instead.
It provides more context to this Raw Story report, which claims that Walter Reed's problems can be partially traced back to a half-assed privatization.
A five-year, $120 million contract awarded to a firm run by a former executive from Halliburton – a multi-national corporation where Vice President Dick Cheney once served as CEO – will be probed at a Subcommittee on National Security and Foreign Affairs hearing scheduled for Monday.
...
"We have learned that in January 2006, Walter Reed awarded a five-year $120 million contract to a company called IAP Worldwide Services for base operations support services, including facilities management," Waxman continues. "IAP is one of the companies that experienced problems delivering ice during the response to Hurricane Katrina."
It was only a year or so ago that congresspeople were outraged, outraged that Walter Reed might be closed. Too bad they worked over the symbolism of the facility without checking out the conditions inside. Still, the important issue here is whether the government knows how to contract out services without making an incredible hash out of everything. Jim Henley:
Basically, if it’s a situation where the service has many buyers and the new private entity will have to sell to them, presume in favor of privatization. But if the new arrangement would have a private corporation selling to one buyer, the government, presume that the “prvatized” situation would suck much, much worse than good old fashioned bureaucracy.
This seems completely true.
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Huh? I don't see how having more buyers helps. What's needed is more service providers. You know, competition.
Still, the important issue here is whether the government
knows how to contract out services without making an incredible
hash out of everything.
I understand the dilemma, but I personally am always in favor of
incredible hash.
The lesson: if the government does something and it turns out
poorly, it proves that they need to privatize.
If the government privatizes and it turns out poorly, it proves
that the government doesn't know how to properly privatize.
Can someone tell me why the government even provides stateside
care to the wounded? I mean care, not insurance. Wouldn't it be
cheaper just to have the government send them to hospitals and act
as an insurance company? Would the cost of transporting the wounded
be that much worse?
I can understand the military getting involved in treatment for
kinds of injuries that are rare in civilian life, but is treating
battlefield trauma that much different than treating car crash
trauma?
Basically, if it's a situation where the service has many
buyers and the new private entity will have to sell to them,
presume in favor of privatization.
This depends on whether the "many buyers" act independently of each
other. If they are able to engage is parallel behavior and tacit
co-operation, then the difference between one buyer and many buyers
is one of form, rather than substance, and the benefits that we
expect to see from competition will not be realized in fact.
Do the employment contracts of those employed by the military
require that wounded soldiers be given long-term care? Maybe the
best solution is to cut that benefit. This is sort of akin to the
healthcare benefits in the auto industry making that sector less
competitive. The military would be more cost effective is they do
not go overboard on medical benefits.
Ok, so you're going to stop providing health benefits to
soldiers long-term....
Good Lord. Given the low pay of a soldier, the risk involved, the
one-sidedness of any contract ("we can do anything we want to you,
break any promise we made, and you can't say boo") and NOW you want
to remove the possibility of taking care of these people when they
get back to the US with quasi-permanent disabilities?
Yeah, that'll show how much we "support the troops."
It's statements like that which are why Libertarianism will never
be considered more than a fringe doctrine by the bulk of the US
populace.
If we privatize Army healthcare, where will the people who graduate in the bottom half of their med school class find employment?
"The military would be more cost effective is they do not go
overboard on medical benefits."
I don't like a military draft for a lot of reasons, but I wouldn't
mind conscription into a chain gang for people who actually believe
such nonsense.
I don't like a military draft for a lot of reasons, but I
wouldn't mind conscription into a chain gang for people who
actually believe such nonsense.
Well, I don't think long term medical care for people who were
conscripted into the military should be cut. However, for
volunteers, caveat emptor is probably the preferred rule
from a libertarian perspective. If the volunteers wanted guaranteed
benefits, then they should have made sure that was in the contract
before signing. If the US military would not put that in, then they
did not have to sign and could have worked in the private sector
instead.
We shouldn't forget that African American soldiers get much better medical treatment than their civilian counterparts. They probably eat better, too.
I'm certainly not against providing long term permanent care to
servicemen and vets, but it would probably be cheaper and more
effective to just have the government pay for private care outside
of some privatization contract. Just put the soldiers in regular
hospitals. It also might make it possible to put them in a place
convenient for family visits.
I mean the VA has always been a basket case, and it might be better
to eliminate most of its functions in favor of using the private
sector.
"Does Privatization Hurt the Troops?"
Whose side are you on?
"This seems completely true."
What does that mean?
The problem is that "privatization" is sold as a way to get
something for nothing. The car is expensive and it is underfunded.
The sollution to this is always to "privatize". This does two
things, it makes Congress feel good because they can pretend that
they have done something about the problem without spending any
money that could otherwise be used for useful things, like pork and
it allows them to reward political chronies with fat government
contracts. What is not to love?
Of course, the soldiers are screwed because privatization, while a
good thing in some cases, is not a magic wand and won't produce
money and assets where there were none before. The soldiers end up
with crappy care from a private provider rather than the
government.
The Army needs to be held responsible for this. At the same time,
Congress has oversight and spending authority. How long before
anyone ever holds them accountable for underfunding and deliquent
oversight?
Ok, so you're going to stop providing health benefits to soldiers long-term...
I had to turn off my Dave W filter to actually see what you were
babbling about.
You're two very diverse trolls: a ranting conspiracist loon and
someone who keeps going on about how he's sympathetic to
libertarianism but can't ever manage to express anything but
disgust at any libertarian ideas actually voiced. It's downright
heartwarming seeing you guys work together.
I can understand the military getting involved in treatment for kinds of injuries that are rare in civilian life, but is treating battlefield trauma that much different than treating car crash trauma?
One difference is that the military trauma centers often get to use
all sorts of new, innovative treatments that are denied to
civilians. From peripheral
nerve blocks that allow major surgery to be conducted on
appendages without traditional anaesthesia, to new compounds that
can be injected into broken bones to speed healing, they have all
the cool stuff that would help out the rest of us, but which is
inevitably a "few years" from civilian deployment.
For those reasons, if I were a soldier, I would prefer to be
treated in a government trauma center rather than a private one
that's tied up by the FDA...
-Fenevad
I keep seeing references about filters to keep some people's comments out of the list. How do you do this?
Anyone who has served in the U.S. military already knows that
military medical sucks, has always sucked, and will always
suck.
That fact that it is being reported on is the only thing that is
NEW.
You're two very diverse trolls: a ranting conspiracist loon
and someone who keeps going on about how he's sympathetic to
libertarianism but can't ever manage to express anything but
disgust at any libertarian ideas actually voiced. It's downright
heartwarming seeing you guys work together.
I am proposing that government benefits be cut.
That is a libertarian idea for obvious reasons.
The problem is not that I never propose a libertarian idea. rather,
the problem is that when I do propose a libertarian idea, as I do
on this thread, then you fail to recognize it and credit it as
such.
This is not the first time I have made the libertraian suggestion
of cutting back on the military here. I am not sure whether those
previous comments have been deleted or allowed to remain, but I
swear this is not the 1st time.
FFF,
Presumably you would want military trauma cases in a specialized
military hospital. The injuries that hit servicemen are quite
different than the types of injuries suffered by the general
public. Having specialized hostpitals would likely reduce total
cost.
I wouldn't say that its a particularly libertarian idea to cut care for soldiers given that libertarianism is comfortable with a military being used to defend the country, to defend our life, liberty, and property. In order to ensure a supply of suitable recruits, providing long term care may be necessary. It is certainly better than supplying a rum ration to drunks to get them to join.
"Presumably you would want military trauma cases in a
specialized military hospital. The injuries that hit servicemen are
quite different than the types of injuries suffered by the general
public. Having specialized hostpitals would likely reduce total
cost."
The military sends its doctors to be trained in inner-ciy trauma
centers during peace time. It is the only place you get to see a
lot of bullet wounds. So, I am not sure that is true. A bullet
wound is a bullet wound and being burned is the same whether it
comes from an IED or an explosion at a natural gas plant.
Dave W,
Sending people to war and then telling them we won't provide them
medical care because it "wasn't in the contract" is not
libertarian, it is just cruel inhumane and stupid.
Sorry to feed the troll.
How different are war injuries than general injuries, at least after the immediate emergency stage? I mean, a lost leg is a lost leg, isn't it. But yes, if military hospitals are better at providing care for injured servicemen, I'm for that.
I wouldn't say that its a particularly libertarian idea to
cut care for soldiers given that libertarianism is comfortable with
a military being used to I wouldn't say that its a particularly
libertarian idea to cut care for soldiers given that libertarianism
is comfortable with a military being used to defend the country, to
defend our life, liberty, and property. In order to ensure a supply
of suitable recruits, providing long term care may be necessary. In
order to ensure a supply of suitable recruits, providing long term
care may be necessary.
On the other hand, lifetime care for volunteers helps the
government wage wars that are not neccessary (or even particularly
helpful) with defending the country, and defending our lives,
liberty, and property.
In the case of these unneccessary wars, the spending of my taxes
dollars on government benefits is not just repellant for the same
reason that spending my tax dollars on government benefits is
always repellant. It is repellant for the further reason that it is
part of what makes it possible for the government to bring an
unneccessary, wasteful war in the first place.
Besides, private charity is a better way for volunteers to get long
term medical care. Priate, voluntary charity is quite efficient,
and wounded volunteers would be sure to bring out plenty of this
money if called on to do so.
In theory, privatization makes sense; in practice, it rarely
yields either increased efficiency or cost savings because of the
method by which the government contracts out for required services.
Program managers prefer "best value" cost / technical trade-off
award criteria permitting them to pay a cost premium where the
added bang-for-buck warrants paying a higher price. That makes
sense in theory. However, too often in practice the only constraint
in the award decision is whether there are sufficient funds
available to pay for the higher priced offer, evaluators are more
comfortable with incumbents (better the devil you know...), cost /
technical tradeoff analysis is superficial, cost and price analysis
is almost nonexistent and the contracting community's focus is
almost entirely on contract award, not contract
administration.
I could write a book on this subject. In fact, it would be a
shorter book if it focused on what works in government contracting.
Meanwhile, the privatization process conceals the continued growth
of government -- the number of actual federal employees is constant
or shrinking, which would be a good thing but for the fact that the
missions continue to expand and are thus performed by contracted
personnel. Smoke and mirrors.
My point was less about the specific injuries and more to do
with the mix of injuries. Normal hospitals do deal with burns and
amputees. However, and I am speaking ex rectum currently, there is
a higher proportion of certain injuries in military situations than
everyday life.
There are civilian equivalents. Think of burn clinics. You can get
treated for burns at a regular hospital, but you'll get much better
care at a burn clinic due to specialized facilities and staff
expertise.
D.A. Ridgely,
Your book contracting failures would be pretty damn long. How about
a whole chapter on the "small business set aside". No you can't buy
that new computer for $800 from Best Buy and get it today, you must
bid it out and get it six months from now for $1,500 from mom and
pop computer store.
Blogimi Dei is on the money. I've seen the former Long Beach
Naval Hospital where they gave my buddy, Ray, Metamucil instead of
cancer surgery. I've been in Balboa Hospital in San Diego. The VA
hospital told us that grandpa had senile dementia but when we sent
him to FHP (a fargin' managed care operation fer gawd's sake) he
came home sane in just a few days and was fine for the rest of his
life.
I always thought it was such irony that the military, who is
charged with defending a free nation, is run like a socialist
workers paradise. Everybody gets the same pay, same medical
benefits, same housing, unless your married, then it's each
according to his needs. People rarely get promoted on merit, they
tell you when to eat, sleep, piss, & get a haircut. And btw
Private, if This Man's Marine Corps wanted you to think we would
have issued you a got dam brain.
Man, I can see the liberals using this as an argument against
privatization. And that is crap.
FinFangFoom,
There are a lot of cases, which, though not unique to military are
a lot more common in to soldiers in this war, than in civilian
life
egsamples I can think of:
PTSD - Is actually really common (anecdotally).
Mental problems from the brain being subject to blast
pressures.
physical injuries from blasts.
There are probably a few others that I am not thinking of.
Still I am sure that in a free market hospitals would meet this
need. Doctors could pool experience and information.
I think that the initial surgury that many get in Germany would be
ok to be from a miltary, and then troops could go home and pick
their hospital for follow on care. And troopers would, and could
travel to any part of the country where hospitals created a good
name for themselves.
I've seen the former Long Beach Naval Hospital where they
gave my buddy, Ray, Metamucil instead of cancer surgery.
Was his cancer related to his military service?
Warren: one of the rules of thumb in economics is that a
"monopsyny," a market with a single buyer, will eventually create
an equal and opposite "monopoly," a market with a single seller.
Despite occasional attempts to spread the work around to various
firms, the US defense industry has steadily consolidated since
World War Two.
DA Ridgely has the right of it. "Privatization" has become the
mantra of the Republican Party and it carries with it everything
that's gone wrong with the Republicans: outright dishonesty about
"shrinking government," open corruption in the contracting process,
and voodoo economics in assuming that all the inefficiencies of
government accumulate not in the idea of taking on another
responsibility, nor in the political process that leads to
lowest-common-denominator policy, nor in the inept planning and
overoptimistic assumptions they use to establish the budget, but
solely in the actual delivery of the service.
Hell, at the employee level, the whole government is already made
up of "private contractors." Apparently, the cure for Congress'
inability to task or discipline government employees is to hire
outsiders that are even more unaccountable to do the same work.
Ah, well, John, it wouldn't be about only small business
set-asides, but would have to include small disadvantaged business
set-asides (i.e., unconstitutional Section 8(a) awards), hub-zone
preferences, the Buy American Act (as modified by NAFTA, the Trade
Agreements Act and the Balance of Payments Act), required small
business subcontracting programs, the Service Contract Act with DoL
wage rate determinations, Davis-Bacon, and blah, blah, blah.
Oh, and back to the thread topic for a moment, it typically takes
something like the uproar over Walter Reed's problems before any
serious thought is given to exercising the options on a base
operations services contract or any contract including
option years, for that matter. More typically, such option exercise
decisions are purely pro forma because the requiring activity would
prefer suffering merely poor performance and / or paying a higher
than market price than the much more painful prospect of another
competition.
Not to mention that soldiers who come home with disabilities, brain injuries, lives shattered have to navigate through the most insulting bureacracy you can imagine. Trying to get benefits from the military is a process heavily stacked against the soldiers.
How about giving the soldiers a pizza if they heal quicker? From Dominos - that's the fundie-owned one, so it's like faith based n all, too.
DA - re: your second paragraph...
you stated it much more elegantly than I could have, but I've seen
this kind of thing when I worked for the community college district
here in Maricopa County. It wasn't until a project had almost
completely collapsed that a re-bid was ever done, if even then. I
shudder to think about the amounts of money that was wasted
there.
I keep seeing references about filters to keep some people's
comments out of the list. How do you do this?
Side note to Dee Watz: No, I am not doing anything to avoid the
filter. Good luck w/ that.
"Hell, at the employee level, the whole government is already
made up of "private contractors." Apparently, the cure for
Congress' inability to task or discipline government employees is
to hire outsiders that are even more unaccountable to do the same
work."
The fact that the entire Democratic party is a wholely owned
susidiary of the public sector unions may have something to do with
that fact. The complete inability to fire or dicipline or expect
any work out of a government employee after the one year
probationary period drives a lot of the move towards using
contractors. If you don't like the employee a contractor sends, you
make one phone call and a new guy shows up the next day. If you
don't like a GS employee, get ready to start documenting every
wrong thing they do in writing over the next six months to a year,
followed by detailed counseling sessions and written reprimands,
followed by a long grevience process and probably law suit after
you do take action against them.
Don't need no stinkin' congressional inquiries. Ask the student nurses that learn/practice in VA hospitals. Ever wonder why there are no young nurses or doctors in VA facilities.?
"The problem is that 'privatization' is sold as a way to get
something for nothing. The car is expensive and it is underfunded.
The solution to this is always to 'privatize.' This does two
things, it makes Congress feel good because they can pretend that
they have done something about the problem without spending any
money that could otherwise be used for useful things, like pork and
it allows them to reward political chronies with fat government
contracts. What is not to love? Of course, the soldiers are screwed
because privatization, while a good thing in some cases, is not a
magic wand and won't produce money and assets where there were none
before. The soldiers end up with crappy care from a private
provider rather than the government." - John
The word "privatize" means something very different in DoD-speak
and Congress-speak. It essentially means that more jobs are cut
from the active duty sector but end up being performed by federal
employees. (Only in Washington can hiring more federal employees be
considered "privatization!)
DoD is going to continue to take beatings like this until it learns
that "do more with less" is a recipe for gradual and escalating
failure when it comes to an organization that isn't designed to
make a profit by creating things, but to destroy things that belong
to the enemy. Taking out a second loan with a higher interest rate
than the initial loan payment costs doesn't change lower how much
the initial car loan costs and actually increases the amount you
have to pay.
Civilian corporate culture simply doesn't EVER have to address most
of the issues that the DoD does. They're completely different
entities, and trying to run one by the rules of the other just
leads to ignominious failures.
"In theory, privatization makes sense; in practice, it rarely
yields either increased efficiency or cost savings because of the
method by which the government contracts out for required services.
… the privatization process conceals the continued growth of
government -- the number of actual federal employees is constant or
shrinking, which would be a good thing but for the fact that the
missions continue to expand and are thus performed by contracted
personnel. Smoke and mirrors." - D.A. Ridgely
Exactly! The more the DoD cuts back on active duty personnel, the
more it hires GS civilians to take over the work that active duty
personnel USED to do. While GS salaries and benefits are actually
higher than most of their active duty counterparts, because their
salaries come from a "different pot of money" it makes DoD appear
to be downsizing and saving money on personnel when in reality it
is just using other federal pots of money to fund larger and larger
portions of its manpower bill. Smoke and mirrors is a painfully
accurate description of this insane policy.
Despite what guys like Ken Schultz (or whatever name he posts under
these days) believes, firing the organization's head is NOT
necessarily a good solution. As much as I believe that there should
be accountability, the trend is to fire whoever is at the top of
the chain doesn't really benefit the organization. That's because
there's ALWAYS a fall guy by virtue of assignment or appointment,
even if he had no ability to fix anything or any culpability for
what is wrong. (Abu Ghraib comes immediately to mind - no
organization's leader has the ability to stop people from doing the
wrong thing on the ground. It's like firing the CEO of Wal-Mart
because the Wal-Mart greeter punched a customer despite corporate
policy to give them a smile, greet them and give the kids Wal-Mart
stickers.)
Unfortunately, everyone wants to fire the guy holding the bag when
the music stops - even if he's done a better job than anyone else
in recent memory and a better job than most people could have done.
Firing the lead guy, unless he's committed actual misconduct or
made actual mistakes that lead to the problem (like the former head
of FEMA during Katrina), doesn't fix anything. It just satiates the
public's anger for a little while, obscuring the initial issue long
enough for the buck to be passed again at a later date.
Frankly, I think Rumsfeld has had more positive influence on the
DoD than any other SecDef - even MacNamara, who drug them screaming
and kicking towards putting actual ORGANIZATION into the
organization. But guys like Ken Schultz wanted the guy's head -
because scape-goating is easier than admitting that no one can
control EVERYTHING. Of course, being the next possible scape-goat
in the job just ensures that the new guy has to focus on fixing the
one pin-point issue to the detriment of figuring out how the
organization actually should be functioning.
Government contractors != privatization. If it were truly private, it wouldn't involve the Government at all.
Granted, I haven't covered every word of every post, but it
seems to me that everyone has missed the chance to point out that
this scheme is *NOT* privatization.
The government (read: you and I) foots the bill. The G.I.'s have no
choice for their healthcare. So, tell me, how is that privatized?
Just b/c it's run by a group that doesn't have a room in Congress
doesn't mean it's "private."
The fact that the government can farm out contracts of
ANY sort is damning proof that the government is
too large in the first place. Since the consumers have no choice,
b/c the power of purchase has been taken away due to the Gov't
contract, they are forced into accepting what they've been given.
As a friend puts it: "It would be like having a private company
contracted to run the same Government school system where people
are still forced to attend their local school."
Can we please stop referring to Government
handouts to buddy companies, lobbyists, lowest bidders, Vice
Presidential liasons, etc. as "privatization"?? It's tacitly
false.
John: I guarantee it's a lot easier to fire a civil servant (or
at least reassign him) than it is to pull a corporation's contract
out from under it. In the end, given the "monopsyny-monopoly"
relationship, you find yourself having to go back to the contractor
you just fired because they're the only ones that can do the
work.
The USG has a long history of becoming a prisoner of its
contractors. Fine: you can fire a seventy-thousand-dollar-a-year
employee you don't like. That's nice, but it doesn't reimburse you
for the hundreds of millions in padded bills the contractor sent
before getting his pet politicians to fire the auditors.
As sr2 pointed out, true "privatization" takes tax money off the
table. Anything else is just a shell game in which money disappears
into a politically connected black hole.
The Walter Reed scandal is a travesty.
However, it's the poster child for what would probably occur in
many places around the US under a single-payer health care system.
I've said before, at best single payer would look like Wal-Mart; at
worst, like the VA. I really wish this realization would dawn in
more heads...
Hey! its good for a growing economy....and the economy IS
growing and that's all that matters
...mission accomplished.
I keep seeing references about filters to keep some people's comments out of the list. How do you do this?
You can find a Greasemonkey-based filter (for Firefox) here. Installation details
are a bit further down the thread.
Why does privatization hate America?
And I guess it depends on which soldiers you're privatizing, and
which branch you put them in. If you take a colonel in the Air
Force and make him a private in the Marines, I'd say his chances of
getting hurt go way up after privatization. But if you take a 2nd
lieutenant on his first tour in Iraq and make him a private in the
marines, he's not only not much more likely to get nailed by an
IED, but he's much LESS likely to be fragged by his own men.
Was his cancer related to his military service?
No, but he was a 25 year vet and was entitled to medical as part of
his retirement.
Sweet! That is a hard deal to snag in the private sector these days. Did he see much combat in The Gulf War?
The biggest problem is the bureaucracy that is set up to deny
the claims of soldiers. They force the soldiers to prove things
that the Army should have in its records, and are experts in
denying the obvious.
Would a private insurance company do any better? Given that such a
high % of healthcare dollars goes to passing the cost to someone
else, I can't imagine the GIs would do much better under a private
system.
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