Have A Positive Thinking Thanksgiving

A Modest Proposal - The Pentagon Should Follow Boeing's Lead

 

"THE PROJECT ON GOVERNMENT OVERSIGHT By Mark Thompson

"Embarrassments like the wars in Afghanistan and Iraq, along with flubbed programs like the F-35 fighter, the Zumwalt-class destroyer, and the Army’s repeated failure to replace its Bradley Fighting Vehicles rate right up there with Boeing’s blunders."

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"Boeing, the Pentagon’s #4 contractor, was once an icon of American ingenuity and industrial prowess. But it has never recovered from the tailspin following its 1997 merger with bottom-line-obsessed McDonnell Douglas. Its new Air Force Ones and aerial tankers have hit heavy turbulence. Two of its 737 MAX airliners crashed. A fuselage panel blew off one of its jets. Safety concerns about its Starliner space capsule have left two astronauts stranded in space. Its biggest union remains on strike.

Last week, Boeing decided to pull its head out of its afterburner. The decision came as the company confirmed it had lost $2 billion on defense work over the prior three months. “I think that we're better off doing less, and doing it better, than doing more and not doing it well,” brand-new Boeing boss Kelly Ortberg said October 23. To right its flailing business, Boeing plans to shed pieces of the company, likely including some of its space programs.

The U.S. and its Department of Defense should take a lesson from Ortberg. After all, embarrassments like the wars in Afghanistan and Iraq, along with flubbed programs like the F-35 fighter, the Zumwalt-class destroyer, and the Army’s repeated failure to replace its Bradley Fighting Vehicles rate right up there with Boeing’s blunders.

The U.S. was the global colossus following World War II. While it accounted for 40% of the world’s economic output in 1960, that share has fallen to 26% today. Yet Washington still sees itself as the world cop, spending close to $1 trillion annually on its military, more than the next 10 countries combined. It has more than 170,000 troops based in 178 countries around the world and sold a record $238 billion in weapons to many of them last year.

The U.S. national-security state and U.S. national-security think tanks churn out reports every year warning that the Pentagon is underfunded and that defeat is just around the corner. They all flow from official documents from the White House (PDF) and Pentagon that insist the U.S. must be ready to defend pretty much anything everywhere at any time.

The United States is the only country in the world that designs its military to be able to depart one hemisphere, cross broad expanses of ocean and air space, and then conduct sustained, large-scale military operations upon arrival in another hemisphere,” the Congressional Research Service said in an Oct. 2 assessment (PDF) exploring the size and cost of the U.S. military. “That U.S. policymakers for the past several decades have chosen to pursue, as a key element of U.S. national strategy, a goal of preventing the emergence of regional hegemons in Eurasia does not necessarily mean this goal was a correct one for the United States to pursue, or that it would be a correct one for the United States to pursue in the future.”

Boeing’s decision to trim its flaps is rooted in humility that can mature into wisdom. The U.S. should follow suit."

POGO A MODEST PROPOSAL The Pentagon should follow Boeing’s lead

Is ‘Good Enough’ Good Enough for the Pentagon?

 

"FORBES" By William Hartung

"As each generation of weapons purchased by the Pentagon becomes more expensive and more complex, the U.S. armed forces shrink accordingly.  We need to force Washington to catch up with reality, and soon, or we will all pay a horrific price in blood and treasure."

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"Writing at Responsible Statecraft, the online magazine of my organization, the Quincy Institute, my colleague Dan Grazier of the Stimson Center summarizes the dangers of the “Defense Death Spiral,” a phenomenon first warned of by a courageous group of defense reformers during the Reagan buildup of the 1980s.

The thesis is fairly simple – as each generation of weapons purchased by the Pentagon becomes more expensive and more complex, the U.S. armed forces shrink accordingly. As Grazier points out, the U.S. armed forces have half as many combat aircraft as they did in the mid-1970s, and fewer than half as many combat ships – all on a budget that is 60% higher than it was back then, adjusted for inflation. And contrary to the official story, it’s not clear that the quality of the new generation of weaponry has made up for the reduction in quantity, as evidenced by the subpar performances of major systems like the Littoral Combat Ship and the F-35.

The Pentagon’s attempt to supply weapons to the wars in Ukraine and Gaza while acquiring equipment relevant to a possible conflict with China has laid bare the flaws of the Pentagon’s current system of developing and purchasing new weapons.

For years basic items like artillery shells have been purchased in reduced quantities in favor of spending on more expensive – and more lucrative – big ticket items. But ramping up production, or replacing munitions expended during the wars in Ukraine and Middle East conflicts, is extremely difficult to do in short order because U.S. weapons are more costly and more complex than those produced by U.S. adversaries like Russia. Even the missile wars against the Houthi rebels in Yemen put the U.S. military-industrial complex at a disadvantage, as the U.S. shoots down cheap Houthi missiles with expensive U.S. interceptors.

There are two potential solutions to the death spiral. First, build simpler weapons that are good enough for the tasks at hand, but are also cheaper, more reliable, and easier to maintain and produce. This would run contrary to decades of Pentagon practice, where more technological “sophistication” is always viewed as a positive. It should be noted that the Pentagon’s “Replicator Initiative,” which is aimed at producing large numbers of cheap, capable systems in short order, is an attempt to address the death spiral issue, but the jury is out on whether this approach will succeed. And so far these new weapons – like swarms of mini-drones – are to be produced in addition to costly current generation systems, which is good news for arms makers but terrible news for taxpayers at a time when interest on the debt is now higher than the entire, enormous, Pentagon budget. We need to spend our money more wisely across the board, and the Pentagon is a good place to start.

The second way to address the death spiral is to rein in America’s runaway military strategy, which seeks the ability to fight and win wars virtually anywhere on earth while maintaining a huge global military footprint, as well as to arm multiple allies in shooting wars. We need a more hardheaded, restrained approach to when it is in the U.S. interest to use force, or to send weapons into battle zones. For example, arming Ukraine to defend itself against a Russian invasion makes sense, but since neither side is going to win total victory on the battlefield it is also urgently important to explore diplomatic options to end the conflict. In the Middle East, on the other hand, enabling Israel’s crimes in Gaza and its escalation to Lebanon and Iran is in no one’s interest, yet U.S. weapons keep flowing uninterrupted. That has to change.

There is a reckoning on the horizon regarding the goals and costs of the U.S. military apparatus. Unfortunately, the leaders of both parties remained mired in the past, like the proverbial generals fighting the last war. But this is no longer a theoretical debate. The lives and safety of millions of people here and around the world are at stake. We need to force Washington to catch up with reality, and soon, or we will all pay a horrific price in blood and treasure."

"FORBES"- Is ‘Good Enough’ Good Enough for the Pentagon?

ABOUT WILLIAM HARTUNG

I am a Senior Research Fellow at the Quincy Institute for Responsible Statecraft.  I am the author of Prophets of War: Lockheed Martin and the Making of the Military-Industrial Complex (Nation Books, 2011) and the co-editor, with Miriam Pemberton, of Lessons from Iraq: Avoiding the N

"THE DEBT BOMB" More Spending on Interest Than On National Defense

 

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" THE PROJECT ON GOVERNMENT OVERSIGHT - THE BUNKER" By Mark Thompson

"Spending like a drunken sailor threatens national security. For the first time in U.S. history: the nation spent more money buying nothing ($950 billion in interest) than it did on its military ($826 billion)."

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"There it was October 8, buried discreetly on page 5 (PDF) of yet another eye-glazer from the Congressional Budget Office. In 2023, the nation spent $776 billion on its military — which buys something — and $710 billion in net interest on the public debt — which buys nothing. But in fiscal 2024, which ended September 30, those numbers flipped.

The Bunker has been decrying waste, fraud, and abuse in the U.S. military for nearly a half-century. But everyone’s three favorite whipping boys when it comes to Pentagon spending pale alongside the nearly trillion dollars we spent on interest last year. That’s money we paid to borrowers, so we didn’t have to make the tough decisions required to live within our means.

We have simply opted to kick this annual binge-spending, now approaching $36 trillion, down a generation or two so our kids and grandkids can foot the bill. When The Bunker arrived in D.C. to cover the Pentagon in 1979, the national debt was $805 billion. That’s just over 2% of what it is today. OK, Boomers. Good job! According to CBO, interest paid on the national debt grew by a stunning 34% ($240 billion) from 2023 to 2024 (PDF). Those are numbers that would make an F-35 blush.

Congress approves all government spending, but more than half of the annual budget goes to mandatory programs like Social Security and Medicare locked (for now) into law. The rest — so-called discretionary spending, appropriated annually — is basically split between the Pentagon and everything else the federal government does (education, transportation, justice, the environment, etc.). But as that mandatory spending — and interest on the national debt — grows, there’s less left over for the Pentagon and all that other stuff. Both categories need deep cuts to avert financial disaster.

Neither presidential candidate is riding to the rescue. Vice President Harris’s economic proposals could add as much as $8 trillion to the national debt over the coming decade, according to an October 7 assessment by the non-partisan Committee for a Responsible Federal Budget. Former President Trump’s fiscal blueprints, the group projected, could add $15 trillion.

Such profligacy eventually will do more harm to U.S. national security than any foreign foe ever could." 

POGO - The Bunker: Debt Bomb

Pulitzer Prize-winner Mark Thompson has been covering the Pentagon for more than 45 years.

The Real Versus Perceived Power Of The U.S. Presidency

A NOTE FROM THE EDITOR: 

Many of us in the military combat veteran community, who have also worked for years with the federal government, are concerned about the public view of the Office of the President. Please note George Friedman bringing reality to our expectations: 

Ken Larson

"STRATFOR GEOPOLITICAL WEEKLY" By George Friedman

"The American presidency is designed to disappoint. 

What the winner actually can deliver depends upon what other institutions, nations and reality will allow him or her.

Each candidate must promise things that are beyond their power to deliver. No candidate could expect to be elected by emphasizing how little power the office actually has and how voters should therefore expect little from him. 

So candidates promise great, transformative programs.  Though the gap between promises and realities destroys immodest candidates, from the founding fathers' point of view, it protects the republic. They distrusted government in general and the office of the president in particular.

Congress, the Supreme Court and the Federal Reserve Board all circumscribe the president's power over domestic life. This and the authority of the states greatly limit the president's power, just as the country's founders intended. To achieve anything substantial, the president must create a coalition of political interests to shape decision-making in other branches of the government. Yet at the same time — and this is the main paradox of American political culture — the presidency is seen as a decisive institution and the person holding that office is seen as being of overriding importance.

The president has somewhat more authority in foreign policy, but only marginally so. He is trapped by public opinion, congressional intrusion, and above all, by the realities of geopolitics. Thus, while during his 2000 presidential campaign George W. Bush argued vehemently against nation-building, once in office, he did just that (with precisely the consequences he had warned of on the campaign trail). And regardless of how he modeled his foreign policy during his first campaign, the 9/11 attacks defined his presidency. 

Similarly, Barack Obama campaigned on a promise to redefine America's relationship with both Europe and the Islamic world. Neither happened. It has been widely and properly noted how little Obama's foreign policy in action differed from George W. Bush's. It was not that Obama didn't intend to have a different foreign policy, but simply that what the president wants and what actually happens are very different things.

The power often ascribed to the U.S. presidency is overblown. But even so, people — including leaders — all over the world still take that power very seriously. They want to believe that someone is in control of what is happening. The thought that no one can control something as vast and complex as a country or the world is a frightening thought. Conspiracy theories offer this comfort, too, since they assume that while evil may govern the world, at least the world is governed. There is, of course, an alternative viewpoint, namely that while no one actually is in charge, the world is still predictable as long as you understand the impersonal forces guiding it. This is an uncomfortable and unacceptable notion to those who would make a difference in the world. For such people, the presidential race — like political disputes the world over — is of great significance.

Ultimately, the president does not have the power to transform U.S. foreign policy. Instead, American interests, the structure of the world and the limits of power determine foreign policy.

In the broadest sense, current U.S. foreign policy has been in place for about a century. During that period, the United States has sought to balance and rebalance the international system to contain potential threats in the Eastern Hemisphere, which has been torn by wars. The Western Hemisphere in general, and North America in particular, has not. No president could afford to risk allowing conflict to come to North America.

At one level, presidents do count: The strategy they pursue keeping the Western Hemisphere conflict-free matters. During World War I, the United States intervened after the Germans began to threaten Atlantic sea-lanes and just weeks after the fall of the czar. At this point in the war, the European system seemed about to become unbalanced, with the Germans coming to dominate it. In World War II, the United States followed a similar strategy, allowing the system in both Europe and Asia to become unbalanced before intervening. This was called isolationism, but that is a simplistic description of the strategy of relying on the balance of power to correct itself and only intervening as a last resort.

During the Cold War, the United States adopted the reverse strategy of actively maintaining the balance of power in the Eastern Hemisphere via a process of continual intervention. It should be remembered that American deaths in the Cold War were just under 100,000 (including Vietnam, Korea and lesser conflicts) versus about 116,000 U.S. deaths in World War I, showing that far from being cold, the Cold War was a violent struggle. 

The decision to maintain active balancing was a response to a perceived policy failure in World War II. The argument was that prior intervention would have prevented the collapse of the European balance, perhaps blocked Japanese adventurism, and ultimately resulted in fewer deaths than the 400,000 the United States suffered in that conflict. A consensus emerged from World War II that an "internationalist" stance of active balancing was superior to allowing nature to take its course in the hope that the system would balance itself. The Cold War was fought on this strategy.

Between 1948 and the Vietnam War, the consensus held. During the Vietnam era, however, a viewpoint emerged in the Democratic Party that the strategy of active balancing actually destabilized the Eastern Hemisphere, causing unnecessary conflict and thereby alienating other countries. This viewpoint maintained that active balancing increased the likelihood of conflict, caused anti-American coalitions to form, and most important, overstated the risk of an unbalanced system and the consequences of imbalance. Vietnam was held up as an example of excessive balancing.

The counterargument was that while active balancing might generate some conflicts, World War I and World War II showed the consequences of allowing the balance of power to take its course. This viewpoint maintained that failing to engage in active and even violent balancing with the Soviet Union would increase the possibility of conflict on the worst terms possible for the United States. Thus, even in the case of Vietnam, active balancing prevented worse outcomes. The argument between those who want the international system to balance itself and the argument of those who want the United States to actively manage the balance has raged ever since George McGovern ran against Richard Nixon in 1972.

If we carefully examine Obama's statements during the 2008 campaign and his efforts once in office, we see that he tried to move U.S. foreign policy away from active balancing in favor of allowing regional balances of power to maintain themselves. He did not move suddenly into this policy, as many of his supporters expected he would. Instead, he eased into it, simultaneously increasing U.S. efforts in Afghanistan while disengaging in other areas to the extent that the U.S. political system and global processes would allow.

Obama's efforts to transition away from active balancing of the system were seen in Europe, where he has made little attempt to stabilize the economic situation, and in the Far East, where apart from limited military repositioning there have been few changes. Syria also highlights his movement toward the strategy of relying on regional balances. The survival of Syrian President Bashar al Assad's regime would unbalance the region, creating a significant Iranian sphere of influence. Obama's strategy was not to intervene beyond providing limited covert support to the opposition, but rather to allow the regional balance to deal with the problem. Obama expected the Saudis and Turks to block the Iranians by undermining al Assad, not because the United States asks them to do so but because it is in their interest to do so.

Obama's perspective drew on that of the critics of the Cold War strategy of active balancing, who maintained that without a major Eurasian power threatening hemispheric hegemony, U.S. intervention is more likely to generate anti-American coalitions and precisely the kind of threat the United States feared when it decided to actively balance. In other words, Obama does not believe that the lessons learned from World War I and World War II apply to the current global system, and that as in Syria, the global power should leave managing the regional balance to local powers.

As I have argued from the outset, the American presidency is institutionally weak despite its enormous prestige. It is limited constitutionally, politically and ultimately by the actions of others. Had Japan not attacked the United States, it is unclear that Franklin Roosevelt would have had the freedom to do what he did. Had al Qaeda not attacked on 9/11, I suspect that George W. Bush's presidency would have been dramatically different.

The world shapes U.S. foreign policy. The more active the world, the fewer choices presidents have and the smaller those choices are. Obama sought to create a space where the United States could disengage from active balancing. Doing so fell within his constitutional powers, and was politically possible, too. But whether the international system allowed him to continue along this path should he be re-elected was open to question. Jimmy Carter had a similar vision, but the Iranian Revolution and the Soviet invasion of Afghanistan wrecked it. George W. Bush saw his opposition to nation-building wrecked by 9/11 and had his presidency crushed under the weight of the main thing he wanted to avoid.

Presidents make history, but not on their own terms. They are constrained and harried on all sides by reality. In selecting a president, it is important to remember that candidates will say what they need to say to be elected, but even when they say what they mean, they will not necessarily be able to pursue their goals. The choice to do so simply isn't up to them.

There are two fairly clear foreign policy outlooks in this election. The degree to which the winner matters, however, is unclear, though knowing the inclinations of presidential candidates regardless of their ability to pursue them has some value.

In the end, though, the U.S. presidency was designed to limit the president's ability to rule. He or She can at most guide, and frequently cannot even do that. Putting the presidency in perspective allows us to keep our debates in perspective as well."

George Friedman on The Presidency

George Friedman is a geopolitical forecaster and strategist on international affairs. He is the founder and chairman of Geopolitical Futures, an online publication that analyzes and forecasts the course of global events. Prior to founding Geopolitical Futures, Friedman was chairman of Stratfor, the private intelligence publishing and consulting firm he founded in 1996.

Time for Congress to Challenge Years of Failed Pentagon Audits

 

"THE PROJECT ON GOVERNMENT OVERSIGHT"

By Greg Williams

"DOD Financial Management has remained on the Government Accountability Office’s High Risk list for 28 years. This cannot continue. At POGO, we’ve long argued that to pit fiscal responsibility against national security is to offer a false choice."

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"Testimony of Greg Williams, Director of the Center for Defense Information
Project On Government Oversight
for the House Committee on Oversight and Accountability
Subcommittee on Government Operations and the Federal Workforce
On “Tracking Progress: 
Examining the Department of Defense’s Financial Management Practices”

Thank you Chairman Sessions, Ranking Member Mfume, and distinguished members of the Subcommittee on Government Operations and the Federal Workforce, for inviting POGO to offer this written testimony on the importance of achieving clean financial audits of all Department of Defense components.

My name is Greg Williams, and I am the Director of the Center for Defense Information at the Project On Government Oversight (POGO). We are an independent, nonpartisan watchdog group focused on promoting a more accountable, transparent, and effective federal government that also respects and safeguards constitutional principles. 

Our organization has a long history of advocating for more transparent and accountable spending from the Pentagon. When we were founded in 1981, we were the Project on Military Procurement. We worked with Defense Department whistleblowers to expose some of the shocking wastefulness of past Pentagon budgets.¹

In the more than 40 years since, POGO has continued our work bringing accountability, transparency, and reason to Pentagon spending. We’ve partnered with members of Congress and administrations from both parties on reforms to improve how the Defense Department budget is determined, apportioned, and executed. And we’ve long recognized how Congress — as appropriator of the Pentagon budget and provider of critical oversight — plays a crucial role in enacting rational defense policy. 

One important point of consensus between Democrats and Republicans and between Congress and the Pentagon is that the Department of Defense must be able to track its expenditures and assets in such a way that its effectiveness and efficiency can be measured by both the executive and legislative branches. This kind of quantitative, objective information is the necessary foundation for any serious debate on policy. Announcing the first Pentagon-wide audit in 2017, then-Comptroller of the Defense Department David L. Norquist got it right when he said, “It is important that the Congress and the American people have confidence in DoD’s management of every taxpayer dollar.”²  

At the time of that announcement, Norquist also committed to annual Pentagon audits starting in 2018, to be issued on November 15 of each year, which would allow the public to see where their Defense Department funding actually goes. Unfortunately, the Pentagon has never been able to make good on this commitment. 

In FY 2023, it failed its sixth audit in a row.³ When asked to account for their share of nearly $4 trillion in assets, 18 of 29 Pentagon components could not do so.⁴ Indeed, the problem has gotten marginally worse instead of better, with 62.1% of Pentagon components receiving a disclaimer of opinion on their FY 2023 audits (issued “when auditors were unable to obtain sufficient, appropriate evidence to provide an opinion on the financial statements”) versus 61.5% in FY 2022.⁵ The problem is longstanding: DOD Financial Management has remained on the Government Accountability Office’s High Risk list for 28 years.⁶

This cannot continue. At POGO, we’ve long argued that to pit fiscal responsibility against national security is to offer a false choice. We can have a more effective military at a lower cost, but to do so will require an intentional effort from both the Pentagon and Congress. A closer look at a few concerning Pentagon programs offers a clear example of where we’re going wrong and highlights the pressing need for acquisition reform.

• The Sentinel intercontinental ballistic missile (ICBM) program: This $141 billion program, designed to replace our current ICBMs, has seen costs soar over 81% through its program cycle. Yet even absent reliable financial data, Congress’s support for this program seems unwavering.⁷
• The Constellation frigate program: This $22 billion program is running three years behind schedule, a delay the Government Accountability Office (GAO) attributes at least in part to “the Navy’s decision to begin construction before the design was complete.”⁸ As my colleague Dylan Hedtler-Gaudette recently testified, “Agreeing to a contract for a critical program like Constellation without first having a design for that program seems like, at best, acquisition and procurement malpractice.”⁹
• The F-35 Lightning II fighter program: At an investment of nearly $2 trillion, the F-35 program has been so plagued by cost overruns, delays, and performance problems that there is not space to list them all here.¹⁰ At the same time, the Department of Defense inspector general identified the Joint Strike Fighter Program (the F-35) as one of 10 “weaknesses” in the FY 2022 audit:

The [Joint Strike Fighter, or] JSF Program Office was unable to verify the completeness and value of the JSF Program assets, and the assets were not in an accountable property system of record. Not only were the auditors unable to perform the necessary procedures to conclude on the JSF property balances, but they also could not quantify the extent of the misstatement.¹¹

If the Pentagon can’t or won’t track new, high-profile programs like the F-35, what hope is there for older, less scrutinized programs? 

In this written testimony, I propose reforms that will increase accountability and transparency in Pentagon acquisition and procurement. POGO has advocated for these reforms before, most recently before the Subcommittee on National Security, the Border, and Foreign Affairs, and we see them as a first step toward more effective defense spending.¹²  We believe that each of these reforms has merit, and taken together they would constitute significant progress toward our goal of a strong, effective military at a significantly lower cost. 

We encourage Congress and the Biden administration to take the following steps:

 Recommendations:

• Enact legislation that requires a successful Defense Department audit and imposes penalties for failure to do so. An audit is not the end-all-be-all in terms of fiscal responsibility and budgetary best practice, but it is a necessary element of a broader reform effort. The fact that the Pentagon has failed audits for successive years is emblematic of deeper, systemic financial pain points. All DOD components finally passing audits could be the catalyst that gets the Department back on solid and sustainable financial footing while spotlighting key acquisition and procurement problems.
• Congress should more frequently and more assertively conduct oversight of Pentagon spending and programming, paying particular attention to which Pentagon components have clean audits. While acquisition and procurement problems plague the Pentagon itself, Congress has a vital role to play in monitoring how defense spending and policy are being implemented on the ground. In our view, Congress has not fulfilled this role sufficiently over the years. It is time to begin more regularly asking hard questions and making hard choices through congressional oversight activities, especially for those DOD components without clean audits.
• Congress should use the “power of the purse” to operationalize necessary changes. In addition to conducting rigorous, real-time oversight, Congress has a potent tool at its disposal: funding. This tool should be used more effectively and more often to compel cooperation and change behavior when it comes to the Pentagon’s acquisition and procurement decision-making and execution, especially when major acquisitions and platforms fail to meet deadlines, exceed cost parameters, and generally over-promise and under-deliver.

It’s clear that the Defense Department is not yet equipped to pass an audit on its own — it’s time for Congress to step in and force the issue. The good news is that today, both the House and the Senate are considering bipartisan bills that would require a clean audit from the Pentagon.¹³

I want to thank you for inviting my testimony for this hearing, and for committing yourselves to bringing more accountability and transparency to Pentagon spending. The reforms suggested above are sensible, achievable steps that Congress can take to hold the Defense Department accountable and ensure that the tax dollars we dedicate to national security are actually working to keep us safe."

 PGOG - Time To Challenge Years of Failed Pentagon Audits

VA Hospitals Earn High Marks In New Federal Ratings

 

MILITARY.COM” By Patricia Kime

“A new quality assessment of U.S. hospitals by the Centers for Medicare and Medicaid Services gave nearly 58% of Department of Veterans Affairs medical centers the highest four- or five-star ratings — down 9% from 2023.

The Department also announced Tuesday that its hospitals outperformed non-VA facilities on patient satisfaction surveys, which gave 79% of VA hospitals four or five stars, compared with 40% of non-VA hospitals.”

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“The VA scores were still significantly higher than private medical centers, only 40% of which earned four or five stars. 

Despite the drop in overall scores from last year, VA Under Secretary for Health Dr. Shereef Elnahal told reporters Friday that the ratings were “great news” for veterans and the VA employees who treat them.

“We’re offering more care to more veterans than ever before, and we are exceeding on all metrics, both patient experience metrics and overall hospital quality and patient safety metrics, when we are comparing apples to apples with civilian-sector hospitals,” Elnahal said.

The Centers for Medicare and Medicaid Services, or CMS, examines hospital mortality, safety of care, readmission rates, patient experience, and timeliness and effectiveness of care to award stars on a five-point scale.

This year, 35 VA hospitals earned a five-star quality rating, one more than last year, and 15 of the 35 also earned five stars on CMS’ patient survey ratings.

“Veterans [are] able to see how VA hospitals are comparing to other options they may have in the civilian sector,” Elnahal said. “[If] they have Medicare or private health insurance, they can get care at both options. What this will allow is for them to compare, including — if they qualify for community care, as supported by VA — choices in the civilian sector.”

The new star ratings, which can be found on the Care Compare website, mark the second year the VA was included in the database by CMS, a federal agency within the Department of Health and Human Services. The agency gave star ratings to 109 VA facilities, with the remaining VA hospitals or medical centers not being rated, either because they don’t meet qualification thresholds or the level of metrics needed to assess them.

CMS does not assess specialty hospitals, ambulatory surgical centers, or some inpatient care facilities, such as psychiatric hospitals.

In addition to the 35 VA hospitals that earned five stars, 27 earned four stars, 23 earned three stars, 14 earned two stars and 10 earned one star — up from nine last year but with fluctuations on the one-star list.

Elnahal said the Veterans Health Administration considers these metrics, alongside its internal monitoring systems, when reviewing hospital performance.

“What we do is offer focused attention and support from our headquarters, national improvement office, to those medical centers scoring at the lowest levels on this scale and on our internal scale,” Elnahal said. “What this does is it highlights essentially more medical centers that maybe our internal system isn’t flagging, and ultimately allows us to get an up-to-date picture as more comprehensive of where we are on this.”

The facilities receiving the lowest ratings were the VA Southern Arizona Health Care System in Tucson; Bay Pines VA Health Care System and West Palm Beach VA Medical Center in Florida; Overton Brooks VA Medical Center in Shreveport, Louisiana; VA New Jersey Health Care System; Syracuse VA Medical Center and VA New York Harbor Health Care System in New York; VA Pittsburgh Health Care System; Providence VA Medical Center in Rhode Island; and VA Caribbean Health Care System in San Juan, Puerto Rico.

New to the one-star list were the VA medical centers in Tucson, New Jersey, Syracuse and New York Harbor Health Care. Those that received one star on last year’s list but have since increased their ratings include the James J. Peters VA Medical Center in The Bronx, New York; New Mexico VA Health Care System in Albuquerque; and the Memphis VA Medical Center, Tennessee, all of which are now two-star facilities.

A one-star rating signifies that the facilities performed well below the average for specific measurements, such as death rates for patients with heart failure, surgical complications and pneumonia; readmission rates for certain ailments; hospital-acquired infections; patient satisfaction; and more.

The data for this year’s star ratings was collected between July 2019 and March 2023, according to the VA.

According to CMS, its reviewers rated 4,658 hospitals in the U.S., and of those, just 8% received five stars. Star ratings are “limited in scope,” CMS officials said, by the data sources from which they are derived. 

Among the criticisms of the rankings from advocacy groups and industry associations such as the American Association for Physician Leadership, is that they don’t take into account the socioeconomic status of patients or the surrounding community, which may not have access to routine health care and have worse health outcomes for acute and chronic conditions.

CMS also crunches the numbers in a way that may put smaller facilities or hospitals that have a low number of cases or incidents that meet its eligibility criteria at a disadvantage when it comes to the ratings.

VA officials have noted, however, that surveys of veteran patients not only show positive response to VA services but that trust in VA health care remains high.

“Our most recent outpatient survey results show that 92% of veterans trust the care that they get in our clinics and ambulatory settings, so both inpatient and outpatient trust are at all-time highs, and we are beating the private-sector averages on inpatient trust,” Elnahal said.

In a statement released Tuesday, VA Secretary Denis McDonough said the metrics help the VA convey its message that it provides quality health services.

“We’ve made millions more veterans eligible for VA health care under the PACT Act –– and now, we want to make sure that every one of them gets timely access to the world-class care they deserve,” McDonough said. “Whenever a veteran sets foot in a VA facility, we want them to know that they are getting the very best care this nation has to offer — and we won’t ever settle for anything less.”

ABOUT THE AUTHOR:

Patricia Kime focuses on military personnel and veterans issues for Military.com, reporting on health care, military families, justice and benefits. She has covered military issues for decades, reporting on combat-related illnesses and injuries, the Defense Department and the Department of Veterans Affairs. 

 

War Veterans’ Advice On The ‘Mother’ Of All Bad Ideas – The JR-15 Children’s Assault Rifle

     "Wee 1" JR 15 Children's Assault Rifle

THE ‘WEE 1 TACTICAL’ ‘JR 15’ A FULLY FUNCTIONAL ASSAULT WEAPON, marketed for use by children and identical to the AR 15, but reduced in size and caliber.

At 2 pounds it is chambered for Long Rifle 22 Caliber Ammunition and functions in all other respects identical to the AR 15 Assault Firearm. 22 Caliber Long Rifle Ammunition can kill a human being up to a mile away.

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OUR VIEW: As  former military men and security specialists who have taken lives in combat, we assure you of the following:

If you or your child are considering a weapon of this nature or its full sized brother, and you are NOT one of the following:

1. A soldier on active duty
2. A policeman or a duly authorized security officer on duty
3. A licensed hunter of wild animals in the woods
Then consider you may become part of the problem of guns in our society today – and not part of the solution.

FURTHER:

If your child has an interest in this style of weaponry and warfare, we suggest you educate he or she on the history of this country and wars in general, as well as the role of weapons in the destruction of others lives as we are now seeing in Ukraine

If the child’s interest continues to age 18, we recommend you guide the young person to a military recruiter, where the role of a soldier is fully available through a lifestyle that includes the skilled use of weaponry in the defense of our country.

Acclimating a child to assault weapons designed for mass killing is not entertainment, recreation or sport - it is a dangerous element of real life with potential permanent consequences. 

Military Veteran Satire Writers Once Again Propose "The Department of Warfare" As A Business

CLICK IMAGE TO ENLARGE  By Tony and Friends On Rose Colored Glasses

We recommend, due to the age of this 17 year old piece, that you click on the image to enlarge. Let Tony, a winner of the “Thinking Blogger Award”, know what you think about “How war can be made FINANCIALLY profitable for the taxpayer.

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There is a prevalence of warfare in the current era. The U.S. tax payer finances military equipment/technology for our country and many others. The tax payer also donates soldiers to go in harms-way.   

Tony and his friends revisited our archives from 2007 on this subject. 

Not much has changed, other than the national debt has grown several orders of magnitude and the faces and places are different. 

With the above in mind we hereby propose, for the second time in the last 17 years, a discussion with your congressional representative a proposal to make war financially profitable for the taxpayer.

A Fiscal Crisis: The West is on the Wrong Side of Cost Curve

“REAL CLEAR DEFENSE” By Matthew Van Wagenen & Arnel P. David

“An axis of aggressors has embarked on a new strategy to defeat the West: relentless attacks with inexpensive weapons, produced at scale, to provoke a global response.

Western militaries, which cling to outdated and excessively expensive weapon systems and platforms (that take too long to develop and replenish, and regularly exceed their budgets), are being systematically bled dry”

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“In simple financial terms, the West is on the wrong side of the cost curve. Imagine the defense industry as a normal business. In economics, a cost curve illustrates the relationship between production costs and quantity. Successful businesses achieve economies of scale, reducing costs through efficiency. But the West’s defense enterprise is operating on the wrong side of this curve. Production costs are high, and output is low, pushing Western nations into diseconomies of scale.

The recent aerial attack on Israel and the war in Ukraine expose this vulnerability. Iran’s 300 plus airborne weapons that targeted Israel amounted to less than $200 million dollars whereas the Western response exceeds billions of dollars. In Ukraine, multi-million dollar weapons platforms are destroyed by uncrewed aircraft systems (UAS) that range from hundreds to thousands of dollars, and Russia’s prized Black Sea Fleet has been devastated by inexpensive maritime drones. Defense analysts estimate the cost ratio is easily 100:1.

A Call to Action

A new revolution in military spending is underway. It is a radical change in the way nations procure and integrate military capabilities.  The innovation and changes in Ukraine has been described by General Mark Milley as “the most significant fundamental change in the character of war ever recorded in history.” Consequently, this is not a military issue alone; it is a societal one. In democracies like the United States, we the people are responsible for our common defense. We cannot afford to ignore this unsustainable cost mismatch. Every defense dollar matters when there are competing demands for resources to address aging populations, health care, migration challenges, and myriad other social services.

Traditional procurement models in the West, to include the U.S. and NATO, are no longer fit for purpose. They are failing. Decades-long development cycles are obsolete in a world of rapidly evolving threats and disruptive technological change. Let’s say an adversarial nation has a four year cycle to produce a capability and, in the West, it takes ten years. In this scenario, in twenty years’ time the adversary-to-West ratio for innovation and capability development is 5:2. This all but guarantees that our adversaries will field a greater range of innovative capabilities, potentially leading to overmatch.

Rapid technological advancements are outpacing the military’s long-term development programs, rendering them obsolete as cheaper, more effective alternatives emerge. Program managers, those with the responsibility, authority, and personnel to deliver programs (e.g., ships, planes, software), lack both the incentive and the means to adapt to this fast-changing landscape. The ingrained culture of preserving existing programs stifles innovation and adaptability. It is unlikely a program manager will kill their program for the greater good.

Likewise, the political representatives of states where these programs sit will lobby heavily to keep these programs (i.e., jobs) alive irrespective of any negative strategic impact.

To overcome this, the military and the broader defense enterprise must urgently rethink their approach. Early and aggressive testing, integration, and prototyping of innovative warfare concepts are essential to gain an edge in modern conflicts. SpaceX’s rapid trial and error prototyping to develop rockets and OpenAI’s early release and testing of ChatGPT are examples of this approach to develop capability faster.  Waiting for “perfect” solutions, or clinging to lengthy development cycles, leads to unpreparedness on the ever-evolving battlefield. Keeping this approach is akin to relying on horse cavalry in the era of mechanized warfare.

A Glimmer of Hope

There is movement in the right direction. Nations like Estonia, Latvia, Lithuania, Poland, Norway, and Finland are leading the way. Their “drone wall“ initiative leverages affordable, networked sensors to safeguard their sovereignty. They will do this by keeping costs down to achieve economies of scale.

The U.S. Department of Defense is also taking steps in the right direction with its Replicator initiative. Thousands of drones have been delivered, demonstrating a shift toward rapid, warfighter-centric innovation. This could be the necessary spark to ignite essential change.

Other promising initiatives in NATO are the Defence Innovation Accelerator for the North Atlantic (DIANA) and the NATO Innovation Fund (NIF). Both complementary initiatives provide access to deep tech start-up communities, but the challenge for these programs will be transition. How do they transition capability into warfighters’ hands to be relevant going forward? As expressed above, it cannot take decades.

The Path Forward

To survive, the West must revolutionize its military procurement and production processes. We need a laser focus on swift prototyping and deployment of cutting-edge technologies. These systems must be affordable, easily updated, interoperable, and adaptable to new threats. The era of billion-dollar projects that risk obsolescence must end. A more diverse approach is not just needed, it is compulsory if we want to win wars and preserve peace.

The conflict in Ukraine serves as a stark warning. Clinging to expensive, slow-moving defense systems will leave the West vulnerable. We must out-innovate, not outspend, our adversaries. Our Alliance, made up of free and democratic nations, must unleash the creative capital present within our societies to find cost wise off-sets that can be immediately integrated into our collective defense system.

The future of warfare demands a fusion of accessible technology, rapid innovation, and scalable production. The West must adapt or face the consequences of falling behind an axis of aggressors who are united in their pursuit of strategic advantage and wish to see the West decline.”

 Real Clear Defense – Fiscal Crisis

Matthew Van Wagenen is a major general in the U.S. Army currently serving as the Deputy Chief of Staff for Operations (DCOS OPS) in the NATO Supreme Headquarters Allied Powers Europe (SHAPE).

Arnel P. David is a colonel in the U.S. Army currently serving as the director of the Strategic Initiatives Group (SIG) in the NATO Supreme Headquarters Allied Powers Europe (SHAPE).

The views and opinions expressed are those of the authors and do not reflect any entity or organization of the U.S. Government or NATO.