The Citizen and the Citizen Military – What Lies Ahead?

Military pay raises have been minimal, recruiting has been a challenge in the services. How do we acquire, train and retain what we need? Reserves and National Guard involve long term multiple deployments with no assurance of a future for those who return. 

What is the mix of technology and manpower required to fight today’s wars? The following are 3 perspectives from experts: Can YOU answer the Citizen's Question at the end of this article?

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PERSPECTIVE 1 – From a Military Man

Mark Seip a senior Navy fellow at the Atlantic Council recently noted the cultural and conception gap that exists between America and it volunteer armed forces:

“From the military side, many of us feel that we are unique to our generation in our calling; that we rose above the self-absorbed stereotype often associated with both Gen Xers and Millennials to protect our nation. We accept significant time away from our families, often subpar working conditions compared to our civilian counterparts, and average pay in relation to the skills we possess in order to wear the uniform. Moreover, as our nation’s warrior corps we assume a level of risk since time immemorial, that our occupation entails a distinct possibility of loss of life. Our service therefore requires a level of confidence and self-assurance to do our jobs and take the risks required.

Second, the widening gap is a function of exposure, both in numbers and in proximity. As Fallows points out, 2.5 million served in either Iraq or Afghanistan. To provide context, according to an NPR study 8.7 million served in some capacity in Vietnam. Furthermore, during Vietnam the majority of the generation at that time had fathers and mothers who served in some capacity either in WWII, Korea or both. Today, however, the actual number and/or the tangential family tie to the military is lower, reinforcing the distance between those in service and the rest of the nation.”

The Military/Civilian Gap 

PERSPECTIVE 2 - From a Military Contractor

Eric Prince, the former CEO of Black Water continues to insist that private security employees working for the U.S. government in warzones should be tried under the Uniform Code of Military Justice, instead of the civilian criminal justice system.

"It’s quite different for a jury that is 7,000 miles away from the warzone, looking at a split-second decision made seven years earlier in a warzone, minutes after a large car bomb goes off." Prince said he hopes the guards' convictions can be successfully appealed. "The last chapter is not written yet."

Although he quit the business, Prince still sees a future for the private security business.

"The world is a much more dangerous place, there is more radicalism, more countries that are melting down or approaching that state." At the same time, the Pentagon is under growing pressure to cut spending and the cost of the all-volunteer force keeps rising, Prince said.

"The U.S. military has mastered the most expensive way to wage war, with a heavy expensive footprint." Over the long run, the military might have to rely more on contractors, as it will become tougher to recruit service members. Prince cited recent statistics that 70 percent of the eligible population of prospective troops is unsuitable to serve in the military for various reasons such as obesity, lack of a high school education, drug use, criminal records or even excessive tattoos. In some cases, Prince said, it might make more sense to hire contractors.”

 Eric Prince on Future Wars

PERSPECTIVE 3 – From a Military Analyst

“DEFENSE ONE” Notes:

“The film “American Sniper” about legendary Navy SEAL sniper Chris Kyle broke box office records this holiday season when the picture earned a million dollars in five days on only a handful of screens. It is time we grappled with America’s actual wars and their real-time, life and death consequences, once again with as much dedication as we line up to watch them play out on the big screen.

The military [has been] fighting a war. Or wars. But we, as a country, have not. In USA Today's list of its most read articles of 2014, neither the war in Afghanistan nor the simmering fight in Iraq – to which U.S. troops [were] headed back – cleared the top 10. The same was true for Yahoo's List of its most searched stories. No Iraq or Afghanistan in sight.

It is nearly inconceivable but somehow true that in the 2013 government shutdown, death benefits for the families of those killed in action fighting for the United States also shut off.” 

Shutdown Prevents Death Benefits for Families of 4 Fallen Soldiers

Citizen's question: Could or should we reinstate the draft?

Costs Of US Wars Linger For More Than 100 Years

     Benefits To Veterans And Their Families Continue 

Long After Conflicts Are Over.

AP News:

"If history is any judge, the U.S. government will be paying for the Iraq and Afghanistan wars for the next century as service members and their families grapple with the sacrifices of combat.

An Associated Press analysis of federal payment records found that the government is still making monthly payments to relatives of Civil War veterans — 148 years after the conflict ended.

At the 10-year anniversary of the start of the Iraq War, more than $40 billion a year is going to compensate veterans and survivors from the Spanish-American War from 1898, World War I and II, the Korean War, the Vietnam War, the two Iraq campaigns and the Afghanistan conflict. And those costs are rising rapidly.

U.S. Sen. Patty Murray said such expenses should remind the nation about war's long-lasting financial toll.

"When we decide to go to war, we have to consciously be also thinking about the cost," said Murray, D-Wash., adding that her WWII veteran father's disability benefits helped feed their family.

Alan Simpson, a former Republican senator and veteran who co-chaired President Barack Obama's deficit committee in 2010, said government leaders working to limit the national debt should make sure that survivors of veterans need the money they are receiving.

"Without question, I would affluence-test all of those people," Simpson said.

With greater numbers of troops surviving combat injuries because of improvements in battlefield medicine and technology, the costs of disability payments are set to rise much higher.

The AP identified the disability and survivor benefits during an analysis of millions of federal payment records obtained under the Freedom of Information Act.

To gauge the postwar costs of each conflict, the AP looked at four compensation programs that identify recipients by war: disabled veterans; survivors of those who died on active duty or from a service-related disability; low-income wartime vets over age 65 or disabled; and low-income survivors of wartime veterans or their disabled children.

THE IRAQ WARS AND AFGHANISTAN

So far, the wars in Iraq, Afghanistan and the first Persian Gulf conflict in the early 1990s are costing about $12 billion a year to compensate those who have left military service or family members of those who have died.

Those post-service compensation costs have totaled more than $50 billion since 2003, not including expenses of medical care and other benefits provided to veterans, and are poised to grow for many years to come.

The new veterans are filing for disabilities at historic rates, with about 45 percent of those from Iraq and Afghanistan seeking compensation for injuries. Many are seeking compensation for a variety of ailments at once.

Experts see a variety of factors driving that surge, including a bad economy that's led more jobless veterans to seek the financial benefits they've earned, troops who survive wounds of war, and more awareness about head trauma and mental health.

VIETNAM WAR

It's been 40 years since the U.S. ended its involvement in the Vietnam War, and yet payments for the conflict are still rising.

Now above $22 billion annually, Vietnam compensation costs are roughly twice the size of the FBI's annual budget. And while many disabled Vietnam vets have been compensated for post-traumatic stress disorder, hearing loss or general wounds, other ailments are positioning the war to have large costs even after veterans die.

Based on an uncertain link to the defoliant Agent Orange that was used in Vietnam, federal officials approved diabetes a decade ago as an ailment that qualifies for cash compensation — and it is now the most compensated ailment for Vietnam vets.

The VA also recently included heart disease among the Vietnam medical problems that qualify, and the agency is seeing thousands of new claims for that condition. Simpson said he has a lot of concerns about the government agreeing to automatically compensate for those diseases."

Ken Larson on Hastings Veteran's Home

I have lived at the Hastings Veteran's Home for 19 years. This blog was formed by other veteran's at the home and myself in 2006 and has carried certain issues with regard to veteran's care and world events. 

I live across the road from the main building these days in a smaller unit along the river. I get my medications twice a month and take that myself. My meals, glasses, dental care and annual physicals, flu shots and the like are all part of the maintenance fee I pay from my pension. The clothing room and similar furnishings are available when I need them.  The fee I pay contributes over 90% of my social security to the operation of the facility. What remains of my monthly check is adequate for me because my needs are very simple these days.

As I got well, I realized part of my recovery required getting as far away from bureaucratic settings and authority as possible. I found over the years in the war zone and in 35 years of corporations and dealing with Washington DC that my tolerance level for it was 0 at age 60.

When Clark Dyrud was Veteran's Commissioner he and I had lunch and exchanged emails over the years since he assisted me out of Washington, but by mutual agreement we never discussed work; only family and friends from high school and our experiences in Vietnam, since he and I went through some of the same trauma during the war. I have never been seen in public with Clark on facility grounds. Now that he is retired I am sure he is relieved. He was a good services officer for over 30 years.

I meet with staff for care team reviews. They know what I do and respect me for it. I have received facility volunteer awards for my work in the community each of the years I have been here. All staff I have encountered have been professional at what they do, sincere in their motives and helpful. They have a difficult job. The population here is of vastly varying backgrounds and ages. Many are 20 years younger than I and have a lot of life ahead of them but fell on hard times, addiction, depression and other maladies veterans are particularly vulnerable to.

I have supported both Tony Rose and Louie Klemek with advice, government insights into agencies, correspondence and getting legal help. I got Tony's paperwork released from Homeland Security under the Freedom of Information Act because I know how to do it having worked government agencies in my career. I wrote a letter that resulted in Louie getting some wood working privileges back that had been taken away and a visit from a State Representative. I have done all this behind the scenes and on a personal basis with these men. I also arranged for Tony's Washington D.C. pro-bono legal help, and set up a blog for him and his cause:

http://rosecoveredglasses.blogspot.com/2008/11/navy-veteran-has-waited-2-years-for.html

I helped both men because I felt the system, from the federal level to the state level, was letting them down. They have appreciated my assistance and have told me so.

This facility to me is a room with a beautiful view of the Vermilion River, a great little small town I enjoy, fishing, photography, writing, and intellectually stimulating non-profit volunteer work in an office supplied by the county at no cost so I can help small business.

I have served over 7,000 clients through the non-profit organizations SCORE and Micro Mentor and many local businesses and small enterprises in every state in the union and its territories, receiving the SCORE National Achievement Award shown in the right margin of this site in 2010 for mentoring over 500 clients in the SCORE on-line counseling program. I have small business clients in several foreign countries. Roughly 30 % of my client base is veterans. My government contracting web site has received over 1,200,000 visits.

http://www.smalltofeds.com 

In short, the Minnesota Veteran's Home is an ingredient in Ken, reinvented in retirement and I am enjoying it very much.

GAO Says More Veterans Heading For Veterans Homes That May Not Be Ready

Image: “Columbiacare.org“

“MILITARY.COM“

“The report, released Aug. 2, found the number of veterans in VA funded nursing home care is expected to total about 44,000 by 2022.

Challenges in contracting with community nursing homes (CNHs), which provide the bulk of that care, could keep the agency from being able to meet demands."

_______________________________________________________________________

“Although the number of veterans in nursing homes is expected to rise 16% between 2017 and 2022 as veterans who served in Vietnam continue to age, the VA may not be prepared to handle the increase, according to a new report from the Government Accountability Office.

And while some of those issues may be helped by a recent VA healthcare law, known as the Mission Act, concerns remain, auditors wrote.

“While VA expects to continue placing more of the veterans needing nursing home care into CNHs, officials noted some challenges contracting with these homes,” the GAO report states. “Specifically, VA central office officials said that about 600 CNHs had decided to end their contracts with VA over the last few years for a variety of reasons. For example, officials from four of the [VA Medical Centers] we interviewed told us about CNH concerns that contract approvals can take two years, homes have difficulties meeting VA staff requirements, and VA’s payment rates were very low.”

In addition, the homes may not be able to handle the special needs some elderly veterans face, including behavioral issues or dementia, the study found.

“[VA officials] said homes may not have any of the necessary specialized equipment or trained staff, or may not have as many of these beds as needed, to meet certain veterans’ special care needs,” the report said. “VA officials told us that they are working to expand the availability of special needs care in each of the three setting.”

The VA covers the full or partial cost of nursing home care for veterans, depending on availability and the veteran’s disability rating or injuries. Veterans rated at 70 percent or higher for service-connected disabilities or those who are receiving nursing home care as the result of a service-connected disability are fully covered.

The system provides care in three types of homes. CNHs are publicly or privately owned and operated and contracted with the VA. State veterans homes are typically owned and operated under the preview of the state in which they are located. And community living centers, which often provide acute care, are owned and operated by the VA and associated with the local VA hospital.

Auditors found the VA should do a better job monitoring the quality and performance of nursing homes, an improvement that will be increasingly important as the number of veterans using the facilities increases.

VA officials contract out inspections of nursing homes, but do not regularly monitor contractors’ performance to determine whether or not inspections are being done correctly, the report said. And the way the system works with state veteran homes does not flag all quality problems, which keeps the system from tracking them.

Moreover, VA officials haven’t given VA hospital staff instructions on how to conduct on-site reviews of nursing homes without the contractor, which means they can’t hold those facilities accountable for correcting problems, the report said.

“By making enhancements to its oversight of inspections across all three settings, VA would have greater assurance that the inspections are effective in ensuring the quality of care within each setting,” the report said.

The report also recommended that VA clarify its communication on the types of nursing home care are available, giving more information on state veterans homes and how their quality compares to the other options.

VA officials generally concurred with all four recommendations. They said they plan to act on the report’s recommendation to increase oversight of inspectors while changing how issues with state veteran homes are flagged. They argued, however, that their employees don’t have the authority or oversight to inspect community nursing homes directly. They also said they would investigate whether or not it’s feasible to provide data on state veteran home quality.”

https://www.military.com/daily-news/2019/08/07/more-vets-will-be-headed-nursing-homes-and-va-may-not-be-ready-report.html

U.S. Veterans Hospitals Quality Ratings FY 2018

"U.S. DEPARTMENT OF VETERANS AFFAIRS"

"The Veterans Health Administration uses a comprehensive performance improvement tool called Strategic Analytics for Improvement and Learning (SAIL). SAIL is developed for the VA to drive internal system-wide improvement.

Many of the metrics on SAIL are not publicly reported by non-VA hospitals and health systems.  Therefore, it is not appropriate to directly compare evaluation findings derived from SAIL with results from public and private sector hospitals. "

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The metrics are organized into 9 Quality domains and one Efficiency and Capacity domain.  The Quality domains are combined to represent overall Quality.  Each VA medical center is assessed for overall Quality from two perspectives: (1) Relative Performance compared to other VA medical centers using a Star rating system from 1 to 5 and (2) Improvement compared to its own performance from the past year.  Both relative performance and size of improvement are used to guide improve efforts.

In 2018 66% (96 out of 146) of VA Medical Centers Reported on SAIL Showed Improvement Compared to Their Baseline One Year Earlier.

The table below displays relative performance in star rating in the third column and size of improvement in arrows in the fourth column that indicate whether medical center performance has improved, stayed the same or declined over the past year.

VISN	Medical Center	Relative Performance Star Rating (1 to 5)	Improvement From Baseline Scores 2017
2	Albany	3	↑↑
22	Albuquerque	2	↑
16	Alexandria	2	→
4	Altoona	4	→
17	Amarillo	4	↑↑
20	Anchorage	3	→
10	Ann Arbor	3	↑
6	Asheville	5	↑↑
7	Atlanta	1	→
7	Augusta	2	→
5	Baltimore	3	↑
2	Bath	5	↑
10	Battle Creek	2	↑↑
8	Bay Pines	3	→
5	Beckley	2	→
1	Bedford	5	→
17	Big Spring	1	↑↑
7	Birmingham	4	↑
20	Boise	3	→
1	Boston	4	→
2	Bronx	4	↑
2	Brooklyn	3	↑
2	Buffalo	4	↑↑
4	Butler	5	↓
2	Canandaigua	4	↑↑
23	Central Iowa	4	↑
7	Charleston	4	→
19	Cheyenne	2	→
12	Chicago	3	↑
10	Chillicothe	4	→
10	Cincinnati	5	↑
5	Clarksburg	4	↑↑
10	Cleveland	5	↑
4	Coatesville	5	→
15	Columbia MO	3	↑
7	Columbia SC	2	↑
10	Columbus	4	↑
1	Connecticut	5	↑
17	Dallas	2	↑
12	Danville	3	↑
10	Dayton	3	→
19	Denver	2	↑
10	Detroit	3	↑
7	Dublin	3	↑↑
6	Durham	3	↑
2	East Orange	2	↑
17	El Paso	1	↑↑
4	Erie	5	↑
23	Fargo	4	↑
16	Fayetteville AR	3	→
6	Fayetteville NC	2	→
23	Fort Meade	3	→
10	Fort Wayne	2	↑
21	Fresno	2	↑
8	Gainesville	3	↑
19	Grand Junction	4	↑
16	Gulf Coast HCS	2	→
6	Hampton	2	→
17	Harlingen	2	↑↑
12	Hines	3	↑
21	Honolulu	2	↑
23	Hot Springs	5	↑↑
16	Houston	3	→
2	Hudson Valley	3	→
5	Huntington	4	↑↑
10	Indianapolis	3	↑
23	Iowa City	3	↑
12	Iron Mountain	5	↑
16	Jackson	2	↑↑
15	Kansas City	2	↑
8	Lake City	2	→
21	Las Vegas	2	↑↑
15	Leavenworth	4	↑
4	Lebanon	5	↑
9	Lexington	4	↑
16	Little Rock	3	↑↑
22	Loma Linda	1	↑
22	Long Beach	2	→
22	Los Angeles	3	↑
9	Louisville	3	→
12	Madison	5	↑
1	Manchester	3	↑
15	Marion IL	2	↑
5	Martinsburg	2	↑
9	Memphis	1	↑
8	Miami	3	→
12	Milwaukee	3	→
23	Minneapolis	4	→
19	Montana	2	↑
7	Montgomery	1	→
9	Mountain Home	4	↑
9	Murfreesboro	2	↑
19	Muskogee	2	→
9	Nashville	2	↑
16	New Orleans	3	↑
2	New York	4	↑
12	North Chicago	4	→
1	Northampton	5	↑↑
2	Northport	3	→
19	Oklahoma City	2	↑
23	Omaha	4	→
8	Orlando	3	→
21	Palo Alto	2	→
5	Perry Point	3	↑↑
4	Philadelphia	3	↑
22	Phoenix	1	→
4	Pittsburgh	4	↑
15	Poplar Bluff	3	→
20	Portland	3	↑↑
22	Prescott	2	↑
1	Providence	3	→
20	Puget Sound	2	↑
21	Reno	3	→
6	Richmond	4	→
20	Roseburg	2	↑
21	Sacramento	3	↑↑
10	Saginaw	5	↑↑
6	Salem	5	↑
6	Salisbury	3	↑
19	Salt Lake City	3	→
17	San Antonio	3	↑↑
22	San Diego	3	→
21	San Francisco	3	↑
8	San Juan	2	→
19	Sheridan	4	↑↑
16	Shreveport	3	↑
23	Sioux Falls	4	→
20	Spokane	3	↑↑
23	St Cloud	5	↑
15	St Louis	3	↑
2	Syracuse	3	→
8	Tampa	4	→
17	Temple	3	↑
1	Togus	5	↑↑
12	Tomah	3	→
15	Topeka	3	↑
22	Tucson	1	→
7	Tuscaloosa	3	↑
20	Walla Walla	2	↑↑
5	Washington	1	→
8	West Palm	3	↑↑
20	White City	3	↑↑
1	White River	3	↑
15	Wichita	4	↑
4	Wilkes Barre	3	→
4	Wilmington	3	↑↑

*Note: Improvement From Baseline: ↑↑ - Large Improvement; ↑ - Small Improvement; →: Trivial Change; ↓: Large Decline

VA Hospital End of Year Ratings

"MILITARY TIMES"

 Veterans Affairs officials claimed improvements at 66 percent of their medical centers across the country last fiscal year, with 18 earning the highest level of excellence in the department’s internal ratings system.

But nine others remain on the VA’s list of underperforming facilities after getting the lowest possible rating. They include the embattled Washington VA Medical Center, which sits just a few miles from the White House and has seen a series of leadership shake-ups in recent years.

The VA ratings — made public in 2016 after a USA Today report on the internal scorecards — grade each of the locations on metrics like patient mortality, patient length of stay, reported accidents and patient satisfaction. Officials have said the system is used to collect best practices from high-performing facilities to use in underperforming ones.

In a statement, VA Secretary Robert Wilkie touted improvements across the 146 medical centers.

“With closer monitoring and increased medical center leadership and support, we have seen solid improvements at most of our facilities,” he said. “Even our highest performing facilities are getting better, and that is driving up our quality standards across the country.”

The number of one-star facilities dropped by six from the start of fiscal 2018 to the end. Of the nine medical centers still at that level, four were cited for significant improvements: El Paso and Big Spring in Texas, Memphis in Tennessee, and Loma Linda in California.

The five others — Washington, Phoenix and Tucson in Arizona, Montgomery in Alabama, and Atlanta in Georgia — saw no overall change.

Earlier this year, VA placed 12 medical centers on a high-risk list for “aggressive” management intervention. Of those, eight were removed from the program after showing sufficient improvement by the end of last month.

Wilkie said while he is pleased with the results thus far “there’s no doubt that there’s still plenty of work to do.”

Here are the Best and Worst VA Medical Centers

VA Will Shift Medical Records To DOD’s “In-Process” Electronic Medical Records System

Image:  Military Times

Total Investment To Date Now Projected at Nearly $10 Billion

“MILITARY TIMES”

“VA has already spent more than $1 billion in recent years in attempts to make its legacy health record systems work better with military systems.

The military’s health record system is still being put in place across that department, more than three years after the acquisition process began. The initial contract topped $4.6 billion, but has risen in cost in recent years.

Shulkin did not announce a potential price tag for the move to a commercial electronic health records system, but said that a price tag of less than $4 billion would likely be “unrealistic.”

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“Veterans Affairs administrators on Monday announced plans to shift veterans’ electronic medical records to the same system used by the Defense Department, potentially ending a decades-old problematic rift in sharing information between the two bureaucracies.

VA Secretary David Shulkin announced the decision Monday as a game-changing move, one that will pull his department into the commercial medical record sector and — he hopes — create an easier to navigate system for troops leaving the ranks.

“VA and DoD have worked together for many years to advance (electronic health records) interoperability between their many separate applications, at the cost of several hundred millions of dollars, in an attempt to create a consistent and accurate view of individual medical record information,” Shulkin said.

“While we have established interoperability between VA and DOD for key aspects of the health record … the bottom line is we still don’t have the ability to trade information seamlessly for our veteran patients. Without (improvements), VA and DoD will continue to face significant challenges if the departments remain on two different systems.”

White House officials — including President Donald Trump himself — hailed the announcement as a major step forward in making government services easier for troops and veterans.
Developing implementation plans and potential costs is expected to take three to six months.

But he did say VA leaders will skip standard contract competition processes to more quickly move ahead with Millennium software owned by Missouri-based Cerner Corp., the basis of the Pentagon’s MHS GENESIS records system.

“For the reasons of the health and protection of our veterans, I have decided that we can’t wait years, as DOD did in its EHR acquisition process, to get our next generation EHR in place,” Shulkin said.

Shulkin for months has promised to “get VA out of the software business,” indicating that the department would shift to a customized commercial-sector option for updating the health records.

The VA announcement came within minutes of Trump’s controversial proposal to privatize the nation’s air traffic control system. The president has repeatedly pledged to make government systems work more like a business, and in some cases hand over public responsibilities to the private sector.

Shulkin has worked to assure veterans groups that his efforts to rely on the private sector for expertise and some services will not mean a broader dismantling of VA, but instead will produce a more efficient and responsive agency.

He promised a system that will not only be interoperable with DOD records but also easily transferable to private-sector hospitals and physicians, as VA officials work to expand outside partnerships.

Shulkin is expected to testify before Congress on the fiscal 2018 budget request in coming weeks. As they have in past hearings, lawmakers are expected to request more information on the EHR changes then. ”

http://www.militarytimes.com/articles/va-share-dod-electronic-medical-records-decision