Saturday, March 03, 2012

More reasons to hate ObamaCare






Yesterday snapshot noted Wednesday's Senate Veterans Affairs Committee hearing where the VA appeared as witnesses. Senator Patty Murray is the Chair of the Committee, Richard Burr is the Ranking Member. The topic was the White House's budget request for VA in Fiscal Year 2013. Many topics were raised in relation to the budget. We'll note this exchange initiated by the former Chair of the Senate Veterans Affairs Commitee, Senator Daniel Akaka.
Senator Daniel Akaka: General Shinseki, as you know, we often face challenges in treating our veterans who live in many rural and remote areas. This is especially true in places like Alaska and Hawaii where you just can't get to some places by jumping in a car and driving there. I know you're working on an MOU [Memorandum Of Understanding] with the Indians to find solutions to help provide services to our Native American veterans and I commend you and all of you involved in these efforts. Mr. Secretary can I get your commitment to possible ways of working with the Native Hawaiian health care systems and the Native American veterans systems that provide services for Native Hawaiian veterans who live in many of the rural parts of the state of Hawaii.
Secretary Eric Shinseki: Senator, you have my assurance that, uh, we will do our utmost to provide for any of our veterans wherever they live -- the most rural and remote areas, the same access and quality to health care and services as we provide to someone living in a more urban area. There is a challenge to that but we are not insensitive to that challenge and we're working hard to provide VA provided services and where we can't to make arrangements -- if quality services exist in those areas marking arrangements for veterans to be able to participate in those local opportunities. We are, I think you know, working and have been for some time on signing an MOU with Indian Health Service so that wherever they have facilities and we have vested interests that a veteran -- an eligible veteran -- going to an Indian Health Service facility will be covered by VA's payments. We're in stages of trying to bring that MOU to conclusion. We intend to do that. And where tribes approach us prior to the signing of the MOU and want to establish, from Tribal Nation with VA, a direct relationship because they have a medical facility and would like us to provide the same coverage, we're willing to do that. But that would be on a case-by-case basis.
Senator Daniel Akaka: Thank you. Secretary Shinseki, staffing shortages continue to be a problem although there's been some progress. But some clinics are seeing staffing levels below 50% causing excessive waiting time for veterans that need care. I understand this is an issue you've been working on. As you know the number of veterans needing services is growing yearly and it shows that you have been making progress. Can you provide an update on the Department's progress to address staffing levels?
Dr. Robert Petzel: Uh, Mr. Secretary, thank you; Senator Akaka, thank you for the question. The -- uh -- We've addressed mental -- We've talked about mental health earlier and the efforts we're making to try and assess whether there's adequate staffing there. I think you're probably talking about primary care, which is our largest out patient clinic operation. We treat 5 -- 4.2 million veterans in our primary care system and it accounts for the lion's share of our budget expenditures. We assessed staffing three years ago when we began to implement a Patient Aligned Care team or PAC program and have done it again recently. And we're finding that we're now able to bring up the support staffing and the physician staffing to reasonable levels associated with the standards around the country. I would like to take off record -- offline -- any information you have about specific places where there's a 50% vacancy rate. I'm not aware that we have this around the country. So I would be delighted to meet and talk with your staff and find out where these areas might be so that we can address them specifically.
Senator Daniel Akaka: My time has expired but, Secretary Shinseki, as we face budget constraints, we must all work to improve our efficiency and redouble efforts to look for ways to get the most from our budgeted resources. My question to you is can you talk about any steps you are taking to improve the acquisition process at VA and any efficiencies you've been able to realize in this area?
Secretary Eric Shinseki: Senator, I would tell you that, uh, we have been working for several years now on restructuring our acquisition business practices. Three years ago, acquisition was spread throughout the organization. Now it's consolidated in two centers. One comes directly under Dr. Petzel and that's where all medical acquistions -- gloves, masks, aprons -- we ought to be able to leverage that into a bulk purchase and get a good price on those kinds of things. For everything we have an Office of Acqusition, Logistics and Construction and we have a director who heads both offices then come up to my level to the deputy secretary as part of our monthly oversight review process.
When I think of veterans in "rural" areas, I think of them in southern states or in Michigan which is densley populated in and around Detroit but much more sparsely populated throughout the rest of the state. I also think of Alaska, Montana and other states. I never consider Hawaii rural but of course it is. "Remote and rural" really drives that home. Senator Akaka's word choice really drove the point home. He also asked about staffing and a community member (Troy) had asked if the empty medical positions at VA were raised by any senator when discussing the budget on Wednesday? Ranking Member Richard Burr raised that issue.

Ranking Member Richard Burr: Since the Chair just asked about mental health, let me just ask if my information is correct. In December, VA polled their facilities and they found that there were 15,000 open mental health positions. Is that accurate? Dr. Petzel?

Secretary Eric Shinseki: Let me turn to Dr. Petzel.

Dr. Robert Petzel: Uh, could you repeat that number, Senator Burr.
Ranking Member Richard Burr: In December of 2011, the VA polled their facilites and found there were 15,000 mental health slots that were unfilled meaning --

Dr. Robert Petzel: Our of 20,500, that's true.

There were many important questions raised in the hearing. On Iraqi violence, Mohammad Akef Jamal (Gulf News) raises an interesting one today about the February 23rd attacks across Iraq, "The spokesman of the Ministry of Interior announced that the ministry possesses grave and important information regarding the blasts. He then proceeded to threaten all those who have carried out the terrorist operations -- but if the ministry was truly in possession of information, why are the culprits still at large? " Don't expect it to get answered anytime soon but it is an important question. AKE's John Drake appeared Wedensday on New Zealand's Radio Live (link is audio) to dicuss the ongoing violence. Excerpt:
James Coleman: John Drake is an Iraq intelligence analyst at AKE Intelligence -- an organization offering research and analysis on security risks around the globe. He joins us from London. John, good evening to you.
John Drake: Good evening and good morning.
James Coleman: So Baghdad is the focus of much of the violence. What has triggered the increase in aggression in the capitol?
John Drake: Well it's the focal point of all the main political organizations in Iraq. It's the seat of government, it's where a lot of the Iraqi and international media are based. So by conducting attacks in Baghdad, it often gives the militant groups additional attention, it raises the profile of their activies. It generates an audience for whatever political agenda they're trying to push. That's one of the main reasons. It's also, wherever you get a large amount of people in a large urban area that is often where you will get the great concentration of violence. Larger cities tend to see more crimes. It's often very similar when it comes to terrorism as well.
James Coleman :Mosul's been unusually quiet. Is there any indications that militants are looking elsewhere?
John Drake: That could be the case. Mosul is normally one of the most violent parts of the country. Over the course of last year, it saw an average of about one to two attacks a day. Over the last few weeks, it's been down to about two or three attacks a week. Now while the Iraqi authorities did indicate this was maybe due to some of their recent counter-insurgency operations in the city, the operations that they've been initiating haven't been more intense than normal and they haven't really been netting more militants than normal either. So there are two concerns. One is that militants may be looking across the border to Syria. They may be crossing the border to sell weaponry or even equipment and medicine or anything that they could put on the black market to raise finances for their operation. They may also be sending fighter across the border into Syria to engage in unrest and revolution there. They may be trying to infilitrate the main opposition organizations to Syrian President Basher Assad. They may be responsible for conducting some of the recent terrorist attacks in the country. However after the attacks -- the series of attacks in central Iraq a few days ago, it's obvious that they haven't all gone across the border. There's still a lot of them still in Iraq and looking to conduct attacks in the center of the country.

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