Republican blank checks and crisis after crisis

As news of the $700 billion bailout requested by the Bush administration is consuming the news, pundits take over the topic pushing for their candidate in the presidential election, we need to take a look at what's missing from all of these discussions.

For the last 7 years, Bush has demanded blank checks for Iraq and Afghanistan. When he didn't get it, he made sure the American people didn't hear how essential it was to have oversight of tax payer funding, opting to say it was unpatriotic and against the troops to even ask for accountability. While the Democrats fought, albeit timidly, the Republicans demanded affording Bush anything he wanted with no strings attached.

This mess is not just about the lack of oversight on financial institutions, but on every part of the way government has been operating for the last seven years.

Now we know there was another $13 billion that was either stolen or wasted in Iraq.

$13 Billion in Iraq Aid Wasted Or Stolen, Ex-Investigator Says
By Dana Hedgpeth
Washington Post Staff Writer
Tuesday, September 23, 2008; Page A19

A former Iraqi official estimated yesterday that more than $13 billion meant for reconstruction projects in Iraq was wasted or stolen through elaborate fraud schemes.

Salam Adhoob, a former chief investigator for Iraq's Commission on Public Integrity, told the Senate Democratic Policy Committee, an arm of the Democratic caucus, that an Iraqi auditing bureau "could not properly account for" the money.

While many of the projects audited "were not needed -- and many were never built," he said, "this very real fact remains: Billions of American dollars that paid for these projects are now gone."

He said a report that went to Iraqi Prime Minister Nouri al-Maliki and other top Iraqi officials was never published because "nobody cares" about investigating such cases. Many investigators, he said, feared for their safety because 32 of his co-workers have been murdered.

Adhoob said he reported the abuses to the U.S. Special Inspector General for Iraq Reconstruction, an agency charged by Congress with helping to root out cases of waste, fraud and abuse in the nearly $50 billion U.S. reconstruction effort. SIGIR spokeswoman Kristine Belisle said her agency continues to "actively follow up" on Adhoob's information, but she would not discuss ongoing investigations.
go here for more

http://www.washingtonpost.com/wp-dyn/
content/article/2008/09/22/AR2008092202053.html?hpid=topnews

$13 Billion? Ever think of what that money could have paid for if anyone was watching out for it? We've all heard the horror stories about troops coming back from Iraq and Afghanistan wounded but not being treated by the VA, turned away, provided with limited access to appointments along with having their claims tied up for years. We've all heard how the VA had been trying to reduce the payments to PTSD veterans. We also heard how Dr. Katz and Norma Perez had the attitude that if they ignore the problem, deny the problem, alter the diagnosis they could save a lot of money.

While CSPAN was covering what was going on in Washington, the media was ignoring it. Nicholson was not only operating in a budget that had produced shortfalls, he returned funds. This produced this outcome.

Snapshot of How VA Budget Shortfall is Hurting Veterans’

Access to Safe and Timely Care across the Nation



The VA claims that by shifting funds dedicated to replace old equipment and conduct maintenance the department can address its budget shortfall and meet veterans’ demand for timely, high–quality health care. The following snapshots from across the nation reflect the stark reality of the budget shortfall on veterans’ access to safe, high quality care.



The 3 surgical operating rooms at the White River Junction VAMC in Vermont had to be closed on June 27 because the heating, ventilation, and air conditioning system was broken and had not been repaired due to the siphoning of maintenance funds to cover the budget shortfall.


The VAMC in San Antonio could not provide a paraplegic veteran with a special machine to help clean a chronic wound because the facility did not have the equipment dollars.


The VAMC in Lebanon, Pennsylvania, closed its Geriatric Evaluation and Management Unit which does extensive case management to help elderly veterans increase their functioning and remain at home.


The Community Based Outpatient Clinics (CBOCs) needed to meet veterans’ increased demand for care in the North Florida/South Georgia VA Healthcare System have been delayed due to fiscal constraints. The Gainesville facility has made progress in reducing its wait lists, but as of April there were nearly 700 service-connected veterans waiting for more than 30 days for an appointment.


VA Medical Centers in VISN 16, which includes Arkansas, Oklahoma, Mississippi and Louisiana and part of Texas, have stopped scheduling appointments for many veterans who are eligible for care, pending available resources.


Even though the VA Palo Alto, California, Health Care System has used $3 million in capital funds for operating needs, as of March 1 more than 1,000 new patients had to wait more than 30 days for a primary care appointment. A third of these new patients had to wait more than 3 months. More than 5,000 patients had to wait more than 30 days for a specialty care appointment. Roughly 1,400 had to wait more than 3 months.


The replacement of the fire alarm system at the Loma Linda VAMC in California won’t be done this year because the facility is using most of its capital funds to cover operating expenses.


The White River Junction VAMC in Vermont struggling with a $525,000 shortfall in its prosthetics budget.


Because the FY 2005 budget is inadequate, the facility has not been allowed to hire 3 additional mental health care staff and 3 additional Registered Nurses for the ICU. Nurses in the ICU have been forced to work double shifts, which this Committee has found to be an unsafe patient practice.



Even though the San Diego VAMC expects to exceed its goal in medical care cost collections, it will divert $3.5 million of non-recurring maintenance funds to partially cover operating expenses, and has delayed filling 131 vacant positions for 3 months. The facility has a waiting list for patients of 750 veterans.


Because the Iowa City VAMC had to shift maintenance funds and equipment funds to cover a FY 2004 million shortfall of $3.2 million in medical care expenses in FY 2004, the facility is facing severe infrastructure problems and a larger shortfall of $6.8 million in FY 2005 that puts patient care and safety at risk. The facility wanted to spend $950,000 in non-recurring maintenance funds last year to prevent a mechanical failure of the electrical switcher, which would close the facility, but was required to use those funds to cover a budget shortfall in medical care last year. As a result in FY 2005, the VA must divert $1.5 million of medical care funds to maintain the key electrical switchgear for the hospital.


Recently, a motor failed on a hospital bed, which the VA planned to replace but couldn’t because of the shortfall, causing a fire with the patient on the bed. Fortunately the patient was able to get out of the bed safely, but the facility was forced to expend $700,000 of medical care dollars to replace all the beds, which thanks to the diligence of VA staff lasted 7 years beyond their life expectancy. The facility could not use capital funds to replace the very old beds because the money had already been siphoned off to cover medical care.



To bring the shortfall down to $6.2 million the facility has delayed hiring staff for 4 months. The deliberate short staffing of nurses on the psychiatric ward – as a means to correct the budget shortfall -- has forced the VA to cut the beds available for treatment in half.



As a result of cost cutting measures to make up for the shortfall in FY 2005, the Portland, Oregon, VAMC is delaying all non-emergent surgery by at least six months. For example, veterans in need of knee replacement surgery won’t be treated because of the budget shortfall.


Since FY 2002, the Portland VAMC has had to use its equipment and non-recurring maintenance funds to cover medical care expenses. For FY 2005 the facility needed $13 million for medical and clinical equipment but only received $2 million.



The facility is reducing staff as a cost-cutting measure and is now short at least 150 hospital staff, including nurses, physicians, and social workers. As a result of budget cuts for staffing, the VA has cut the number of medical beds available to care for veterans.



Veterans in need of outpatient psychiatric treatment at the Portland facility are on a waiting list because of the budget shortfall.



The Biloxi, Mississippi, VAMC has diverted maintenance dollars to meet operating expenses for the past two years but the facility will not be able to balance its budget without reducing staffing levels at a time when the Gulf Coast Veterans Health Care System has approximately 100 new veterans seeking enrollment each week.


Fifty percent of all the veterans receiving home health care through the San Antonio VAMC will now have to fend for themselves. This cost-cutting measure means that some 250 veterans, including those with spinal cord injuries, will no longer be provided this care.


The VA Connecticut Healthcare System is facing a major budgetary challenge of sending veterans to non-VA facilities for hospitalizations because the VA has a shortage of beds to care for veterans and staff.


Due to the budget shortfall, the VA facility in Bay Pines, Florida, has been forced to put veterans who have a service-connected illness or disability rating of less than 50% on a waiting list for primary care appointments. As of late April, some 7,000 veterans will be waiting longer than 30 days for a primary care appointment.




Prepared by the Democratic staff of the House Veterans’ Affairs Committee

http://veterans.house.gov/democratic/budget/snapshot6-29-05.htm

This was almost 4 years into the occupation of Afghanistan and over two years of the occupation of Iraq. Two combat operations ongoing, producing more wounded only added to the burden of the ageing population of veterans just as outreach work regarding PTSD was penetrating the veterans minds supporting them in seeking help for what they had been carrying inside of them since they came home from wars.

It got worse.

Budget Shortfalls and Outsourcing Remain Serious Threats to VA Employees and Veterans
Friday September 29, 2006




DEPARTMENT OF VETERANS AFFAIRS

Introduction

Budget shortfalls and outsourcing remain serious threats to VA employees and veterans.

AFGE’s 150,000 members who work at the Department of Veterans Affairs (VA) are deeply committed to providing veterans with the health care, benefits and other services they need. They are honored to contribute to a health care system that is recognized as “the true future in American health care” (New York Times) and to work in hospitals viewed as “models of top-notch care” (U.S. News and World Report). They took great pride when Secretary R. James Nicholson praised VA’s “heroic staff” for their role in Hurricane Katrina and Rita rescues. Many AFGE members at the VA are veterans themselves, and they work closely with veterans groups at the national and local levels to ensure veteran access to quality health care and benefits.

So why are VA employees and veterans getting mixed signals? Year after year, the Administration proposes inadequate funding for health care in the face of growing demand. The Administration keeps trying to balance the VA budget on the backs of veterans through co-pays and enrollment fees. The Administration pressures the VA to outsource jobs to private contractors even though contracting out wastes taxpayer dollars and diminishes health care.

The twin threats of underfunding and wasteful outsourcing result in a vicious cycle: Staffing shortages cause burnout among overworked employees who end up leaving, hiring freezes lead to costly contracting out, failure to repair and upgrade VA laundry facilities leads to contracting out of laundry services, and long waiting lists lead to delayed care that worsens health problems, so that treatment becomes more costly.

Congress should enact an assured funding formula for VHA’s budget.
The Flawed Fiscal Year 2006 budget process
In 2005, the problems with the current VA budget process made national headlines. Mid-year, the VA acknowledged a billion dollar shortfall in health care funding, caused in part by the use of outdated projections of the number of soldiers returning from Iraq and Afghanistan. Throughout the summer of 2005, the House and Senate debated how much supplemental Fiscal Year (FY) 2006 funding was needed to close the shortfall before reaching an agreement in late August.
While the FY 2006 appropriations approved by Congress in November increased VA medical dollars above the President’s request, the increase was more than a million dollars short of the amount veterans groups projected was needed.
President’s FY 2007 Budget Request – Not much, not much new

Under the new proposed budget, VA funding would increase by $2.6 billion up front. However, over five years, funding would steadily decline and reduce purchasing power by over $10 billion below the 2006 funding level. The White House proposes to double drug co-pays and institute annual enrollment fees for Priority 7 and 8 veterans – a budget gimmick rejected by Congress for the past three years. There are no additional funds for state nursing homes and the major construction budget would be cut significantly by one-third. Other recycled gimmicks include claims of management efficiencies that cannot be proven and overly optimistic assumptions about third party insurance collections.

On the front lines, budget shortfalls harm patients and worker morale

Across the country, VISNs and hospitals are experiencing significant shortfalls. Their funding is both inadequate and unreliable. This flawed funding process produces many harmful effects:


Denial of care to over 260,000 Priority 7 and 8 Veterans
Growing waiting lists, e.g. over 12,000 veterans were on VISN 16’s electronic waiting list (EWL) for over 30 days in fall 2005
Hiring freezes when facilities are facing hundreds of vacancies
Pressure and/or requirement to work prolonged overtime
Delayed facility construction and repairs, causing veterans to travel longer distances to get care
Delays in equipment repair, requiring costly contracted services
Closing of nursing units and other inpatient units
Delayed CAT scans and MRIs, requiring costly outsourcing of tests
Inability to staff new medical units
Delays in surgery


AFGE supports the Assured Funding for Veterans Health Care Act of 2005 (H.R. 515), sponsored by Representative Lane Evans (D-IL). H.R. 515 would require that annual VA health care funding be based on the number of enrollees and medical and hospital inflation.

Congress should retain the statutory ban on spending VA medical dollars for outsourcing studies.


The current spending ban protects VA medical dollars from privatization reviews that take jobs away from veterans, hurt health care quality and waste taxpayer dollars.

38 USC 8110(a)(5), the federal law that prohibits the use of Veterans Health Administration (VHA) funds for outsourcing studies, was enacted in 1982 with bipartisan support. The ban applies to OMB A-76 studies and other cost comparisons. Proponents were concerned that outsourcing would hurt health care and would not end up being cost effective. Bipartisan concerns remain today. The VA’s track record in contracting out laundries over the past few years is poor; contracted laundries fail to produce savings and in some cases, cost more than VA laundries. In addition, the VA does not adequately track dollars spent on outsourcing studies.

Not a complete ban: Outsourcing with VHA funds is still permitted on a case-by-case basis where the VA is unable to provide needed specialized services or where veterans would have to travel too far to get services. The spending ban only covers VHA funds: The VA may use Veterans Benefit Administration (VBA), National Cemetery Administration (NCA) and departmental-wide construction and administration funds. In addition, Congress can make separate appropriations for these studies, apart from the VHA budget.

Cost of contracted out medical care: Unfortunately, years of budget shortfalls have accelerated this type of outsourcing as a stopgap solution to hiring freezes and growing waiting lists. Contracted out medical care is expensive, e.g. contract nurses can cost more than twice as much as in-house nurses. Contracted care often lacks the consistent level of quality and patient safety provided by VA-trained health professionals. In September 2005, Senators Daniel K. Akaka (D-HI) and Ken Salazar (D-CO) asked GAO to investigate the VA’s growing practice of contracting out registered nurses.

True cost of contracting out: In 2002, OMB compiled a list of VHA jobs for cost comparison studies, should appropriations become available. Laundry and food service jobs are at the top of the list. Veterans hold the majority of these low-wage jobs. These jobs are used to help disabled veterans learn new jobs skills and return to employment and self-sufficiency, thus reducing their dependency on VA benefits. Minorities and women are disproportionately hurt when the VA contracts out these jobs. In addition, contracted and consolidated laundries require additional transportation costs, are not as reliable as services provided on-site and may increase hospital infection rates. Consolidated and contract food services incur similar hidden dollar and quality costs.

Congress should ensure that any cost comparisons are conducted through a fair competitive process and with strict financial oversight.


In 2005, Senate VA Committee Chairman Larry E. Craig proposed to repeal the current spending ban. An amendment to strike the proposal (and keep the spending ban in place) received bipartisan support and lost by only one vote. Later in the year, Senators Craig and Akaka reached an agreement to keep the spending ban in place and instead, conduct a two-year pilot project to study contracting out (moving VA jobs to the private sector), contracting in (moving contractor work back to the VA) and VA’s Business Process Reengineering (BPR) initiative (discussed below). This compromise awaits House action.

If this pilot project is enacted, or if outsourcing studies are conducted with other permissible funds, the cost comparisons should be truly competitive and comply with existing requirements under A-76 and the government-wide “right-to-compete” provisions in the Transportation-Treasury bill. In addition, as the pilot project would require, contractors should not get a competitive advantage if they fail to provide the equivalent level of health coverage as the federal government.

According to a recent GAO report, VA lacks the accounting structure to adequately track funds and labor used to conduct cost comparison studies. Appropriators should require regular reporting and vigilant oversight to ensure that funds are properly tracked.

Business Process Reengineering: Congress should increase oversight of the BPR process to ensure that employees are afforded a meaningful role and to evaluate claims of management efficiency savings.


Background: Management Analysis/Business Process Reengineering, a VA initiative launched in August 2005, (MA/BPR or BPR) is an approach that the VA has adopted to improve the efficiency of support functions such as laundries and food service. DVA has stated that unlike A-76 cost comparisons, BPR “cannot result in competition with the private sector.”

Management has stated that employees from the function to be studied will play a key role in the process. However, the AFGE VA Council’s July 2005 request to be involved in the BPR implementation was denied. The Council was not included in the recently formed BPR Steering Committees for food service and laundries. To date, we have not heard of any participation in BPR by laundry or food service employees.

Even though BPR does not involve public-private cost comparisons, AFGE is concerned that BPR will encourage reorganizations and consolidations that threaten VA services and jobs. Over the years, the VA has consolidated and closed numerous laundries and food service facilities in the name of efficiency, and too often, subsequently hired contractors to perform these services.

Congress should require more transparency in the BPR process so that claims of management efficiency savings can be evaluated. Despite repeated claims that laundry outsourcing is cost effective, VA’s own report revealed that laundries privatized several years ago produced no savings or actually cost more than in-house laundries. The need for verification of these claims was highlighted by a recent critical GAO report that found that VA lacked adequate support for its recent claims of management efficiency savings, and furthermore, lacked a methodology for even making savings assumptions or developing savings goals.


Physicians Pay: AFGE and rank-and-file providers should be included in compensation panels and key groups implementing the new pay law.
The Department of Veterans Affairs Health Care Personnel Enhancement Act of 2004 (P.L. 108-445) was signed into law in December 2004 and took effect on January 8, 2006. The law establishes a new pay system for physicians and dentists, and authorizes alternative work schedules for nurses.

AFGE played an active role in the legislative process, but was excluded from the steering committee and other bodies that addressed critical issues such as pay ranges. Since the effective date, union representatives and rank-and-file physicians and dentists have not been adequately included in compensation panels (despite requirements in the statute), trainings or policy-setting meetings. We also have concerns about the availability of funds for pay raises, management’s willingness to provide appropriate pay increases, the impact on part-time providers and the choice of surveys used to set local pay.

The VA should address AFGE’s concerns about the new leave rule.


Effective January 6, 2006, the VA revised the handbook rule that required physicians, dentists, podiatrists and optometrists to take leave on weekends, while reducing leave accrual by 4 days. In addition, it capped carryover leave to 86 days and froze excess leave until termination of employment. Providers were not given any advance notice of the new carryover rule so that they could use their excess leave instead. Providers with excess leave should be grandfathered in under the new rule and/or be allowed to use their leave within a reasonable period of time. The VA should maintain a dialogue with AFGE over other concerns that may arise over the leave rule in the future.

AFGE urges Congress to address health care work staffing shortages.


Budget shortfalls have exacerbated understaffing of nurses, other health care workers and support employees such as housekeeping and maintenance workers. There is growing evidence of a link between staffing, quality of patient care and patient outcomes. In addition, poor working conditions increase turnover, in turn worsening the shortage.

VA health care workers and VA management should have the right to negotiate safer staffing levels.


Currently, staffing levels in hospitals are driven by budgets, not by health care policy. Under current law, VA management and representatives of front-line health care workers are prohibited from bargaining over staffing levels, staff-to-patient ratios, patient panel size or ways to improve direct patient care.

All VA health care employees who are required to work a Saturday shift should receive Saturday premium pay.


Congress passed a law in 2003 that expanded the eligibility of VA employees for Saturday premium pay. To date, VA has not finalized the list of employees who will be eligible for premium pay on the basis of providing direct patient care. The VA should not arbitrarily exclude certain groups of workers.

AFGE urges Congress to pass mandatory overtime legislation.


Budget shortfalls have exacerbated the use of mandatory overtime. When nurses are pressured or required to work double shifts, patients are placed at risk. Burnout and greater staffing shortages are likely to occur. The Safe Nursing and Patient Care Act of 2005 [H.R. 791, introduced by Representatives Pete Stark (D-CA) and Steve LaTourette (R-OH) / S. 351 introduced by Senator Edward Kennedy (D-MA)], would prohibit mandatory overtime in hospitals, except in cases of formally declared emergencies or where nurses felt it was safe to do so.

The Veterans Benefits Administration needs additional staff and training to meet a growing and more complex caseload.


Between 2002 and 2005, the number of new compensation claims filed increased by 50,000. At the same time, staff levels dropped slightly. The number of multiple and complex claims is rising.

To better handle growing caseloads, DVA should:

Develop more accurate projections of future demand for claims processing that take into consideration veteran populations and changes in law and policy.
Ensure that staff receives comprehensive training.
Improve coordination between production and training standards set at the national level and those set locally.
Allow employee input into decisions regarding productivity and training.


Conclusion: AFGE urges Congressional and/or Departmental action in the following areas:

Assured funding formula for the VA health care budget.


Retain the spending ban on using VHA funds for cost comparisons.
All cost comparisons should be conducted through a fair competitive process and with financial oversight; moreover, cost comparisons should be conducted with an eye towards bringing contractor work back in-house.


The BPR initiative should include input from front line workers and veterans, and should be required to substantiate claims of management efficiencies.
AFGE and front line providers should have input into physician pay changes through compensation panels and other key groups.


The VA should address AFGE’s concerns over the leave freeze and other changes in the new physicians leave rule.
AFGE and management should be allowed to negotiate over staffing.


Saturday premium pay should be given to all VHA employees who work Saturday shifts.
Congress should pass mandatory overtime legislation.


VBA needs adequate staffing and resources to handle projected caseloads.

http://www.afge.org/index.cfm?page=Veteransaffairs&Fuse=Content&ContentID=760

While Democrats and a few Republicans were trying to fix the problem, were the veterans in this country paying attention to what was causing all the problems they were facing? Were they paying attention to who was behind all of it? Were they paying attention to other veterans not getting what they needed across the nation?

Between the major service organizations memberships in the millions, it's puzzling how few veterans in this country pay attention to the most pressing issue involving them. While they fought the nation's battles, they ignore the fact they then have to fight another battle against the government to have their needs taken care of. Far too many will receive the benefits and treatments they need then feel no need to insure other veterans receive what they also deserved and earned. They do not feel the need to fight for the others, vote for candidates who show up to make a speech without checking their record on their votes and allow the suffering these same people inflicted on the veterans. What is behind all of this? Are they part of the "I got mine and the rest are on their own club?

While it's true the veterans in this country are a minority group, what is not taken into account within their numbers are the additional families and friends of veterans all across this nation. Their numbers are powerful but they refuse to use the magnitude of their power to its full advantage.

We've all heard the speeches by ranking members of the service organizations as they embrace some candidates appearing to make a speech just as we've heard them welcome warmly President Bush when he was running for his second term but when the applauds end and speech is over, veterans standing there were still standing alone.

It's time for the veterans in this country woke up to the fact that what the government does, what the politicians are willing to allow directly affects them. Too many veterans in this nation have accepted the notion that the Republicans are the ones who take care of them instead of noticing that they do not. They are the ones who stand in the way of bills being passed, of funds being increased and accountability.

Democrats want to take care of people and then business. Republicans want to take care of businesses. It's time for the Republicans to makes sure the veterans in this nation were their business and stop ignoring them until they need their votes.

This is exactly what John McCain has been doing since he was first elected. He's voted against veterans at almost every opportunity he's had to prove he is worthy of their support. He's not the only one. McCain has also been against accountability at the same time billions of our money has been wasted like the $13 billion in the above report. It is time to check his record seriously to know for sure if you really believe he's earned your support instead of just taking that support for granted then forgetting all about you. Check the record of every politician running for re-election and the plans of those who are running for the first time. Understand fully who you are supporting because most of the times you've voted against your best interests.

Senior Chaplain Kathie Costos
Namguardianangel@aol.com
www.Namguardianangel.org
www.Woundedtimes.blogspot.com
"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive veterans of early wars were treated and appreciated by our nation." - George Washington