Editore"s Note
Tilting at Windmills

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March 5, 2007
By: Kevin Drum

STILL THE BEST CARE ANYWHERE....Following the Washington Post's series on problems at Walter Reed Army Medical Center, attention has started to focus on the VA hospital system as well. Is the VA system in bad shape too? Does this go to show that government-run healthcare is inherently disastrous?

Phil Longman wrote a piece for us about the VA system a couple of years ago, so I asked him about this. Here's his answer:

Still the Best Care Anywhere
By Phillip Longman

It's great to see the Post doing investigative reporting that actually changes the national conversation and improves people's lives. But its series on the squalid conditions facing some veterans at Walter Reed Army Medical Center also has the potential to do harm unless the context of the story gets more play.

For example. True or false. Walter Reed is a VA hospital. The answer is false. The VA has nothing to do with Walter Reed, which is an Army hospital. That's why the Secretary of the Army took the fall.

Yet as the author of a Washington Monthly cover story on the VA entitled "Best Care Anywhere" (and as the author of a forthcoming book by the same title) I know all too well that many people don't get the distinction. My email box is overflowing with people wondering what I think of the VA now that it has been enveloped in scandal.

From this I conclude many Americans are taking the wrong lesson from the series. If you are left with the impression that Walter Reed is a VA hospital, then it's just a short leap to concluding that the problems exposed there are indicative of the veterans health care system as a whole. And from that point, conservatives conclude that the whole story just goes to show what happens when the government gets into the health care business, while liberals use the same VA "scandal" to bash Bush.

Look, the VA has its problems. Because the White House and Congress won't give it the funding to honor past promises to veterans, it now has to limit new enrollments to vets who have service-related illness or who can meet a strict means test. It's also having trouble ramping up to meet the needs of the unexpectedly large number of young vets diagnosed with mental illness. But despite these challenges, the fact remains that the VA enjoys the highest rate of consumer satisfaction of any American health care system, public or private.

And outside experts agree that the VA deserves this high rating from its patients. A RAND Corporation study published in the The Annals of Internal Medicine concludes that the VA outperforms all other sectors of American health care in 294 measures of quality. In awarding the VA a top prize in 2006 for innovation in government, Harvard's John F. Kennedy School of Government gushed that "While the costs of healthcare continue to soar for most Americans, the VA is reducing costs, reducing errors, and becoming the model for what modern health care management and delivery should look like."

Let's hope the press doesn't miss that "story behind the story."

Kevin Drum 3:43 PM Permalink | Trackbacks | Comments (69)

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I have heard that the VA system was a model but I also want to say I do remember hearing something about problems at the VA sometime in the last 2 or so years - most likely as part of the budget (cuts) debate.

Posted by: ET on March 5, 2007 at 4:06 PM | PERMALINK

Why can't I find anything about the "Bush Funding al Quadi-affiliated Sunnis story on this site?

Posted by: Al on March 5, 2007 at 4:10 PM | PERMALINK

One reasonable comment & then three troll spews

Don`t you people have a life ?

"...Democrats believe in checks and balances. Republicans believe in giving checks to rich people who already have large balances." - windje-firedoglake.com

Posted by: daCascadian on March 5, 2007 at 4:15 PM | PERMALINK

Wow, only four comments and three are trolls!

Obviously the distinction between the VA and Army hospitals will be deliberately obscured by the Republican noise machine (AKA "the liberal media") whenever the idea of single payer healthcare is brought up.

Speaking of Taco Bell/KFC AH, are you sure you want to leave restaurants in the hands of private industry? I mean the story about the NYC Taco Bell/KFC is proof that private enterprise will always fail to provide adequate service at a fair price. Just like Walter Reed is proof that the gub'mint can't handle health care.

Posted by: Dr. Morpheus on March 5, 2007 at 4:15 PM | PERMALINK

Your statement, American Hawk, doesn't seem to be properly to the point. Mister Longman distinguished Walter Reed from the VA hospital system, but did not try to draw distinctions among various hospitals of the VA system as your analogy would suggest.

You also phrased it rather crassly

Awkwardly, I remain dissatisfied by Mister Longman's response because, as relayed by the Center for American Progress today, the problems at Walter Reed are tied to, "systemic neglect that has nearly crippled the U.S. veterans' health system," and there have been problems at other hospitals that are part of the VA system. It seems as though there are problems with the VA system that I'm finding difficult to account for in light of your assessment.

Posted by: Paludicola on March 5, 2007 at 4:21 PM | PERMALINK

The care I have received at the VA Hospital at UCSD in La Jolla, California, is the best medical care I have ever received anywhere at any time in my life. I cannot praise that hospital and the people who staff it highly enough. That hospital is the model for healthcare that should be made available to every American citizen who chooses to join in a single-payer plan that eliminates the insurance companies and their ridiculous overhead of 250 billion dollars a year (before anyone gets so much as a band-aid) from the healthcare equation. I am not alone in my praise of the VA Hospital at UCSD, it has also been voted one of the best places to work in the San Diego area, and the smiling, positive attitudes of the staff there attest to that. What a refreshing change it is to be treated by a staff who seem happy in their jobs and genuinely glad to be of service. I am one grateful vet and regret only that all Americans do not have the option of receiving similar healthcare treatment.

Posted by: Ray Simpson on March 5, 2007 at 4:21 PM | PERMALINK

Jesus, I can't believe the nonsensical crap that trolls write here.

Please name for me, Mr. Hawk, the hospital that would accept a "voucher." I'd like to visit that hospital, because the federal govenrment would be telling it what it can charge (via such a voucher).

Then please ask the CEO of that hospital how he likes having his prices set by the government. Christ on a Pop Tart, is that really what you're advocating?

Posted by: Chocolate Thunder on March 5, 2007 at 4:24 PM | PERMALINK

It takes someone who really hates the troops like AH to come to the conclusion that handing out vouchers would be a great way to deal with the incompetence that the Bush Administration has introduced to Walter Reed.

The services manage hospitals because they are specialized in long-term trauma care and rehabilitation. Only the hospitals in cities that are most overwhelmed with crime even have the expertise to handle this kind of problem, and they are hardly in the position to treat tens of thousands of new victims. AH, as usual, has no clue what common sense means.

Of course, the other problem is that the problems at Walter Reed are connected with outpatient services managed by contractors. It's amazing how many contractors that the Bush administration has chosen have proven themselves to be totally incompetent. Why would AH want to hand off more government functions to incompetent fools who know nothing about the contracts they signed?

Posted by: freelunch on March 5, 2007 at 4:25 PM | PERMALINK

AH once again your like the two little guys on the guiness beer commercials.BRILLIANT!!Jebus why don't we just voucher the whole army.

I'll bet that Halliburton could run the war better, No pesky regulations to cover how to treat the enemy or rules of engagement. Do you ever stop with this bullshit?

Posted by: Gandalf on March 5, 2007 at 4:27 PM | PERMALINK

Christ on a Pop Tart, is that really what you're advocating?

nah, he's jest trolling.

personally I've had great experiences taking my father-in-law to the local VA hospital. bureaucratic, yes, but excellent treatment, good doctors, helpful staff. what a great benefit for a vet.

Posted by: st on March 5, 2007 at 4:29 PM | PERMALINK

Paludicola -

I thought Mr. Longman touched on the problem. The VA has decided to provide good service to the people they have the money to serve and limit the number of new enrollees. That is a problem for veterans with problems that are not directly service-related, but it beats doing a bad job on everyone just because the Republicans refuse to pay their taxes.

Posted by: freelunch on March 5, 2007 at 4:29 PM | PERMALINK

"Let's hope the press doesn't miss that "story behind the story" Oh no... the press would never miss something. Unfortunately I'm skeptical and cynical about nearly anything the press does. But give credit where it is due... the Post series on Walter Reed has been excellent. If the VA is getting a bad rap, then that fact should be touted by those who know.

Posted by: TimW on March 5, 2007 at 4:30 PM | PERMALINK

I would like to hear more about the current state of VA hospitals. It seems to me that they are having an increased burden put on them, and the questions one has to have are 1) is the funding keeping up with the increased burden, and 2) are the hospitals managing this dynamic? Obviously funding has been an issue--one discussed frequently since the beginning of the Bush presidency. We hear also that this war has a higher percentage of wounded soldiers than past wars due to advances in field medicine that permit many wounded soldiers to live who might have died in earlier wars. So one can imagine that VA hospitals are starting to have to deal with a huge influx of new patients.

Walter Reed, because it is an Army hospital dealing with wounded soldiers right from the field, is simply the first institution to be forced to deal with this influx of wounded and maimed soldiers. As time passes, these former soldiers will (and presumably now are) pass into the VA system. Is the VA system ready?

Posted by: RWB on March 5, 2007 at 4:32 PM | PERMALINK

Cue Yancey Ward declaring in his ruggedly individualistic way that he just can't beleive the government can do anything right.

Posted by: Gregory on March 5, 2007 at 4:34 PM | PERMALINK

Did Chickenshit's troll-gram get yanked?

BTW, we have to keep reiterating that Reed is not part of the VA system.

Posted by: Kenji on March 5, 2007 at 4:34 PM | PERMALINK


Consumers can avoid taco bell, with ease. It's not like soldiers can choose to go to the 'other' Walter Reeds.

I think you're missing the point. Walter Reed is an instance of an Army Hospital. Other instances are the field hospitals you see in pictures of tents near forward deployment zones, or on bases like Rammstein (though Rammstein is an AFB you get the picture).

VA Hospitals are a different breed, though, as you correctly note, they can be compared in some respects to regular civilian hospitals (on this point, you and Longman agree, though you disagree as to what conclusions can be drawn from this fact).

A problem that crops up in Walter Reed is a problem that could, on some level, crop up in any military hospital, at home or abroad, because the problem is, as I'm sure you'll admit, administrative, and Army Hospitals are part of the same administration.

Vouchers are not a solution to the military hospital question, for two reasons. First, most military hospitals are abroad, and, even just on the logistical level, voucher systems would be nearly impossible. Second the military has a strong interest in immediate access and control to any changes in a soldier's file which may affect his performance. Having a military hospital that has perfect reciprocity with a soldier's file is tantamount.

From the argument foundation provided by the Walter Reed scandal, I have no basis in making arguments about VA vouchers (though from the foundation of Longman's article, I do). However, similarly for you, there is no foundation provided by this scandal to argue about vouchers outside the armed services, and, as I have outlined, little room to argue for vouchers within the Army as well.

Posted by: the idiot on March 5, 2007 at 4:37 PM | PERMALINK

I really don't mean to in any way disparage the VA, but I am wondering if the satisfaction survey results might not have been affected by either differences in the two populations (veterans vs private health care recipients) or different expectations of what good care is from the respective health care sources. It's possible that users of private health care expect better service and thus rated their experiences lower. I'd be curious to know if any studies have been done to control for these differences.

Posted by: Royko on March 5, 2007 at 4:38 PM | PERMALINK

The VA has to be made to look bad. It's a government agency that runs more efficiently, costs less, and provides better service than comparable services in the private sector.

The VA looks like a prime candidate for privatization to conservatives; take something that works, apply conservative principles, and voila!... You now have an example of 'big government not working'...

Posted by: grape_crush on March 5, 2007 at 4:40 PM | PERMALINK

Kevin - after seeing lousy care provided by government agencies, are you SURE you want the Dems to push government-run health care ??

Kenneth -- after seeing lousy care provided by government agencies led by Republicans, are you SURE you want to push Republican-run government??

(Ignoring, of course, the fact that Democrats actually advocate not the government running health care but the government overseeing universal insurance for health care....)

Posted by: Stefan on March 5, 2007 at 4:40 PM | PERMALINK


VA quality is not measured by patient satisfaction scores alone--indeed they are just one small portion. It's measure of clinical quality process--say, was an aspirin given at arrival for a heart attack--that make up the bulk of the quality measurement, and where VA consistently outperforms the private sector.

Posted by: Chocolate Thunder on March 5, 2007 at 4:42 PM | PERMALINK

American Hawk on March 5, 2007 at 4:40 PM:

...but my comments will just be deleted by whoever the hell made the decision to create an unannounced ban on conservative commentary on this blog.

Not conservative commentary, Hawksie...Just your commentary.

Posted by: grape_crush on March 5, 2007 at 4:45 PM | PERMALINK

the VA enjoys the highest rate of consumer satisfaction of any American health care system, public or private

Yeah, if you can get in. That seems to be the thrust of a story in this morning's paper to the effect that, in the past six years, the VA system has become accessible to fewer and fewer, and its Bush-appointee boss is either indifferent, or actively engaged in diminishing its effectiveness.

Posted by: Jim Strain on March 5, 2007 at 4:48 PM | PERMALINK

I was an auditor for the VA's Office of Inspector General in the late 1990s and the situation at that time was, how shall we say, a clusterfuck. Lost medical records, unable to pay simple invoices on time, adjudication cases open for months and years at a time. And this was during a relatively peaceful time. I can just imagine how hosed it is since dipshit started waging war all over the world starting in 2001. My impression was that if a private company was run like the VA, it would be out of business in a week. I quit after a year and a half. I would rather be treated at my dog's veterinarian than at a VA hospital.

Posted by: Dancing Madly Backwards on March 5, 2007 at 4:50 PM | PERMALINK

But... you haven't been censored.

Posted by: Paludicola on March 5, 2007 at 4:52 PM | PERMALINK

The comment threads are gradually turning into dkos, where any deviation from the party line is explicitly unwelcome.

your comments aren't a "deviation from the party line", they're moronic conservatard babblings.

they own the site, they can do what they want, and finally they're showing some sense when it comes to worthless trolls such as yourself.
too bad, so sad. you'll have to resort to cutting or something else in order to get the attention you so desperately crave.

Posted by: haha on March 5, 2007 at 4:59 PM | PERMALINK

It seems that all of American Hawks posts have been removed and now my two references thereto look rather like non sequiturs.

Posted by: Paludicola on March 5, 2007 at 4:59 PM | PERMALINK

American Hawk on March 5, 2007 at 4:51 PM:

Curious that I'm being singled out. I guess the liberal ideas presented in these threads can't survive my scrutiny, so I have to be silenced. Nice.

If you approached any of the topics presented here with any sort of honest 'scrutiny', you'd be treated better. Call the whaa-ambulance, because you'll get little sympathy from me.

Or from the moderators, apparently.

Posted by: grape_crush on March 5, 2007 at 5:01 PM | PERMALINK

"I guess I'm straddling the line between steps two and three."

See under "Grandeur, Delusions of"

Posted by: Chocolate Thunder on March 5, 2007 at 5:19 PM | PERMALINK

Gandalf sarcastically writes:

I'll bet that Halliburton could run the war better, No pesky regulations to cover how to treat the enemy or rules of engagement.

Halliburton has already been traced to the Walter Reed scandal:

"We have learned that in January 2006, Walter Reed awarded a five-year $120 million contract to a company called IAP Worldwide Services for base operations support services, including facilities management," Waxman continues. "IAP is one of the companies that experienced problems delivering ice during the response to Hurricane Katrina."

Waxman notes that IAP "is led by Al Neffgen, a former senior
Halliburton official who testified before our Committee in July 2004
in defense of Halliburton's exorbitant charges for fuel delivery and
troop support in Iraq."

As with every other GWB admin screw up, this is all about stealing taxpayer money and giving it to GOP donors.

Posted by: Disputo on March 5, 2007 at 5:19 PM | PERMALINK

My, My Chickenfeathers. That's some overblown self-importance there, comparing yourself to Ghandi!

Posted by: Blue Girl, Red State (aka Global Citizen) on March 5, 2007 at 5:22 PM | PERMALINK

American Hawk on March 5, 2007 at 4:40 PM:

...but my comments will just be deleted by whoever the hell made the decision to create an unannounced ban on conservative commentary on this blog.

Not conservative commentary, Hawksie...Just your commentary.

Posted by: grape_crush on March 5, 2007 at 4:45 PM

When did this site start to censor the comments and why didn't Kevin inform us of this change? What is the criteria that is being used to find someone's comments subject to censorship and deletion?

Posted by: Chicounsel on March 5, 2007 at 5:27 PM | PERMALINK

Look, the VA has its problems. Because the White House and Congress won't give it the funding to honor past promises to veterans, it now has to limit new enrollments to vets who have service-related illness or who can meet a strict means test. It's also having trouble ramping up to meet the needs of the unexpectedly large number of young vets diagnosed with mental illness.

I presume Mr. Longman is referring to the lack of VA funding by the Republican Congress. If not, he should qualify which Congresses he refers to.

Further, what is the cause of "the unexpectedly large number of young vets diagnosed with mental illness"? Did someone estimate incorrectly? Does this point to a recruitment problem?

I can neither convict nor exonerate the VA system as it exists today without further info. I know it performed well in the 1990s at the hospital my Dad depended on as his health declined. Are the performance ratings now as good as they were then?

Posted by: Kevin Hayden on March 5, 2007 at 5:28 PM | PERMALINK

I can't speak knowledgeably about all VA hospitals, but I can say the treatment my father has received at the VA facility in Roanoke, Virginia has been top notch. His doctors, the nurses and other staff that we have dealt have been helpful, caring, and more then willing to go the extra mile.

I always go out of my way to sing their praises anytime there's a discussion of services at VA hospitals. They deserve a shout-out for their work.

Posted by: cptspalding on March 5, 2007 at 5:33 PM | PERMALINK

Comments have only been deleted in rare cases on this site. And frankly the owners of the deleted comments have always been the worst of trolls, e.g. Charlie and American Hawk.

Kevin, or whomever actually does the moderating is NOT deleting conservative postings. I welcome people like Mathew who are conservative and argue rationally for their positions.

On the other hand, pechulant children like American Hawk contribute nothing to the debate and frankly don't deserve to post.

Posted by: Dr. Morpheus on March 5, 2007 at 5:34 PM | PERMALINK

Chicounsel on March 5, 2007 at 5:27 PM:

When did this site start to censor the comments..

It's been happening for a month or two, thank gawd.

...and why didn't Kevin inform us of this change?

You didn't get the memo?

What is the criteria that is being used to find someone's comments subject to censorship and deletion?

Read the posted policy - if any - at any of the few right-wing websites that actually allow commenting. The moderation level here is probably a lot more generous than on those sites.

Posted by: grape_crush on March 5, 2007 at 5:46 PM | PERMALINK

Chocolate Thunder,

If there are other studies on clinical quality out there regarding VA services, that would certainly merit consideration, but Longman specifically cited consumer satisfaction as evidence of VA's quality, and I assume he was referring to the ACSI survey described in this WaPo story. As far as I can tell from the ACSI website, their data is solely based on consumer interviews, not on other clinical practice measurements. Now, they do seem to take consumer expectations (one of my concerns) into account, but I'd still like to see a more detailed description of their methodology or model than they provide publicly.

I'm quite sure that if the VA weren't doing a pretty good job, it would be reflected in the ACSI results, but I'm not certain that his statement that "the VA enjoys the highest rate of consumer satisfaction of any American health care system, public or private", while ostensibly true, really shows that the VA is actually providing the best care.

Posted by: Royko on March 5, 2007 at 5:54 PM | PERMALINK

Political Animal by Kevin Drum.Sound like a Non-Govermental Name or Private,And in the private world Kevin can delete anybody he wants.If you want to rant go to a goverment website and have at all day long if you like.Untill there is a law that says Kevin cannot delete Unwanted trolls from this site go cry in your mommies boosom.

Posted by: john john on March 5, 2007 at 5:58 PM | PERMALINK

I hope it's permanent change in policy. Drum's comments have been junked up with kneejerk trolls cranking out cliches for so long that it's usually a waste of time coming here. There's a potential for interesting discussion here once those guys are gone.

Chicounsel, American Hawk, and the rest of you: don't let the door hit you on your butt on the way out. Go whine to your mommies.

Posted by: John Emerson on March 5, 2007 at 6:10 PM | PERMALINK

Note to conservatives - Walter Reed is a failed experiment in privatization!

Army Times - Mar 3, 2007 - '...a letter written in September by Garrison Commander Peter Garibaldi to Weightman.

The memorandum �describes how the Army�s decision to privatize support services at Walter Reed Army Medical Center was causing an exodus of �highly skilled and experienced personnel,�� the committee�s letter states. �According to multiple sources, the decision to privatize support services at Walter Reed led to a precipitous drop in support personnel at Walter Reed.�...'

Posted by: Essjay on March 5, 2007 at 6:19 PM | PERMALINK

Is anybody else as disgusted as I am that the focus of this story is on moldy rooms and cockroaches and NOT on the fact that our soldiers are being nickeled and dimed and denied the medical care we promised them? THAT's the outrage here--but it just doesn't seem to be getting the attention it merits.

Posted by: LAS on March 5, 2007 at 6:24 PM | PERMALINK

I tend to believe the stories of quality care in the VA system. My dad, a veteran of Guadalcanal and Iwo Jima, spent the last 3 years of his life in a VA facility. The staff, several nurses in particular, were as caring as could be expected.
One of the issues is whether the VA is as efficient as it is effective. In the private sector,for example, LTC facilities (efficient ones) run around a 6% overhead rate. I don't know how the VA compares but I can hope they are as efficient as Social Security which has an extremely low overhead ratio.

Posted by: TJM on March 5, 2007 at 6:27 PM | PERMALINK

From veteransforamerica.org 2/25/07 entitled "Pentagon Has Known About Military Families Complaints of how the Wounded are Treated."

"These problems extend far beyond Walter Reed hospital. Similar disgraces have played out for outpatients recovering at Fort Stewart, Ga., and Fort Carson, Colo., according to other media reports. Steve Robinson, currently director of Veterans Affairs at Veterans for America, has been visiting soldiers at Walter Reed and at other installations across the country since the beginning of the war. He calls the situation a national failure.
Steve said the Pentagon is now diverting attention from the REAL ISSUES and focusing on mice droppings, something they can do quick damage control in hopes that the real, and much more complicated story, will go away. "They were happy to talk about mice and mold because that is something they can clean up," Robinson said.
"What we are talking about is a systemic problem where soldiers are left unattended in the barracks. They are sharing medications. They are drinking like alcoholics," and waiting for treatment, he said. "Those without families are isolated. And they are up against the largest, most complicated worker compensation claim process in the world>"

Posted by: consider wisely always on March 5, 2007 at 6:50 PM | PERMALINK

Major Hanafin's comment: this is exactly the point I was making about Military Retirees in competition with bullets and bombs for their health care coverage and related retirement benefits that civilian leaders at Bush's Pentagon are consistently attacking. Then, they have the gall to ask us to assist THEM in military recruitment. That's what they pay bonuses to military recruiters for, and our high schools and colleges in Red states are crawling with young Republicans who idolize George W. Bush and Dick Cheney's military prowess and past service just standing in line to volunteer for NEOCON wars of aggression. GET REAL!

In the past military officials have maintained that the two programs, medical care and disability decisions, are separate. But many soldiers say that is not the case. "We have met soldier after soldier after
soldier who says, 'My injury is not reflected in my Medical Evaluation Board,'" Robinson said. "They firmly believe that there is a conscious effort to screw them out of [disability benefits] they are entitled to."

At his press conference last week, General Cody only briefly mentioned the Medical Evaluation Board process when asked by a reporter, "What are the complaints you hear from the troops particularly?"
Then adding to the impression that this was to be just another COVER UP, the general quickly changed the subject."

Posted by: consider wisely always on March 5, 2007 at 6:59 PM | PERMALINK

Fort Carson has problems on many, many levels. They ostracize and isolate those returning with PTSD. One soldiers story of the mental health gauntlet at Ft. Carson can be found HERE. The soldier who is highlighted had military personnel sent to his door to inform him he was awol for missing formation because he was suicidal and going to a psychiatric facility for emergency treatment.

Posted by: Blue Girl, Red State (aka Global Citizen) on March 5, 2007 at 7:10 PM | PERMALINK

Does the American public have any idea how costly the Iraq war is in terms of brain damaged soldiers?

We tend to focus on the dead but forget the wounded, many of whom are vegetables and not exactly able to fend for themselves.

The story that needs to be told is that we basically don't give a rat's ass about what happens to our wounded.

If we did, then folks would HALT all funding NOW for the debacle in the desert.

Posted by: Tom Nicholson on March 5, 2007 at 7:15 PM | PERMALINK

Ah, Kevin.

Walter Reed is in disrepair? Oh must be Bush's fault.

Iraqis don't want democracy? Oh, must be Bushs fault.

Its raining today? Oh, must be Bushs fault.

I'm glad I'm not blinded like you people by hatred.

Posted by: egbert on March 5, 2007 at 7:26 PM | PERMALINK

Kevin, your source about VA Hospitals is 2 years old. Better check today's Wash Post, "It's Not Just Walter Reed". The may have received a 'best' rating from a recent study, but reports from patients & families tell a different story, very similar to Walter Reed. Situations there seem to be almost as bad as at WR.

I will say that when I have driven vets to the local VA Clinic & to the Haley VA Hospital in Tampa, service has been friendly, efficient, & thorough. The facilities were all but spotless. Giving credit where it is due. Across the Bay at Bay Pines, they seems very inefficient & uncaring.

And Bush is cutting their budgets again, slyly starting the cuts in 2009, after he is out of office. His rationale is to 'balance the budget' by 2012.

As far as Hawk is concerned, his abusive rants are all the reason needed to delete his crap. Every publication has the right to edit what it displays, with no exception, except for official transcripts. My advice:
Grow up. Quit the damn whining. You brought this on yourself. You make your side look ridiculous & childish.

Posted by: bob in fl on March 5, 2007 at 7:29 PM | PERMALINK

Ah, egbert...Enlisted yet?

Posted by: Blue Girl, Red State (aka Global Citizen) on March 5, 2007 at 7:39 PM | PERMALINK

I don't know if you've noticed, but we have a professional volunteer army. My hat's off to them.

Posted by: egbert on March 5, 2007 at 7:51 PM | PERMALINK


When did this site start to censor the comments and why didn't Kevin inform us of this change?

I think it might be when you pay for your subscription to The Washington Monthly.

Posted by: Edo on March 5, 2007 at 7:52 PM | PERMALINK

egbert, I did my part by doing a hitch, and my husband is a retiree.

Yes it is a professional volunteer force. It operates on volunteers and your cheerleading would indicate you should consider doing so.

Posted by: Blue Girl, Red State (aka Global Citizen) on March 5, 2007 at 8:00 PM | PERMALINK

On the way home from work today I heard a report on NPR that definitely indicated the VA hospitals are having some serious problems as well- they interviewed the father of a brain damaged marine whose anger was definitely aimed at the VA staff (http://www.npr.org/templates/story/story.php?storyId=7718565)
and although I couldn't link to it I seem to remember hearing about other similar problems at VA hospitals when NPR was doing its series on PTSD at Fort Carson. Is there any recent data showing that VA hospitals are still as good as they were when they weren't tasked with caring for recent veterens with traumatic injuries?

Posted by: yepod on March 5, 2007 at 8:30 PM | PERMALINK

yepod, in the years following WWII, the VA system was tasked with helping a huge number of injured and sick vets, my Dad included, and they did a great job. My father never tired of telling us how he wished that my Mom, sis and I could get the same level of care in the same manner. The treatment of veterans by the VA was one of the main reasons we had such a healthy middle class in the years following WWII.
As somebody already said, the VA is badly short of money because Republicans don't want to pay their share of taxes. I wouldn't have any problem with my taxes going up by 15 percent if it meant everyone could get decent care, even if there was a means test which meant I'd still have to pay for my own. That's because I love this country and my personal success is because of the greatness of this country. I don't mind giving something back, unlike our friends on the right who view taxes as being a violation of their rights.
My father, the same guy who got shot up in the China/Burma theatre, served as did all three of his brothers. They signed up the day after Pearl Harbor. And every one of them voted Democratic until the day they died because they saw the Democratic Party as being the best chance to preserve the things they fought for. None of these brave men would have wiped his shoe with Ann Coulter or Rush Limbaugh or Hannity. THEY were great Americans.

Posted by: PopeRatzo on March 5, 2007 at 8:44 PM | PERMALINK

It also minimizes the role privatization is having on the VA and the fact that this administration is committed to bringing as much of it as possible into the VA system.

Posted by: aline on March 5, 2007 at 8:46 PM | PERMALINK


A few months ago you linked to a study that demonstrated that patients were poor judges of the quality of the medical care they receive. The study showed that people were just as likely to rate poor medical care and good medical care as equally good.

Since you linked to that study, however, you have continualy used patient surveys to demonstate that people like their government provided health services.

Why? Are you just another partisan hack that will say anything to prove your point. Or worse, do actually believe it yourself?

Posted by: mark on March 5, 2007 at 9:34 PM | PERMALINK

Another vote on behalf of VA, from another satisfied customer. I'm a retired army officer—not disabled and not the usual VA patient—who ten years ago began using VA as my primary care provider through the military's Tricare system. My VA facilities were the hospital in Palo Alto, CA, and the clinic in San Jose. Can't say enough good about those folks. I've since moved from California to another state and the local VA is so overwhelmed they can't accommodate me, putting me back into the Tricare system. A world of difference. The medical folks I have now are top-notch, but they can't match VA for comprehensive care. VA has an unparalleled computer system that enables docs to access patient records in real-time from anywhere in the system; my civilian providers are envious like you can't believe.

I've been around VA much of my life. My father was 100% disabled from WW2 and he was a VA guy from 1946 until his death in 1991. They took pretty damned good care of him. They also took good care of my mother, who as his widow, was entitled to certain benefits. VA was especially helpful during the last six months of her life, aiding immensely in the care.

VA has always been a political football, with the players now in charge being a particularly bad team. Modern Republican leaders, most of whom are draft dodgers of one kind or another, seemingly have no problem with war and destruction and with placing American soldiers in harm's way. What they seem to have problems with is in cleaning up the messes they've made. That we would see problems in VA with the modern Republican Party in charge—unprincipled and unethical as it has proven to be—is no surprise. What is a surprise is that surveys still reflect military support of these people far in excess of the general population. I've reluctantly concluded that this military generation just may not be as smart as my Vietnam generation was. We learned (the hard way) to be skeptical of all politicians and to tune out flowery speeches and promises until they're backed with reality. These poor kids haven't learned that one yet, I suppose.

Military medical care is a whole 'nother issue. Top-notch in the field and in the operating room, hopelessly bureaucratic and careerist (gee, generals are careerists?) where it matters, at the resourcing levels. Politicians have something to do with that as well.

Posted by: Nixon Did It on March 5, 2007 at 10:05 PM | PERMALINK

I apologize. I haven't read the previous posts. I will go back and do so.

Just to say I posted here a few days ago about a Soldier here in the mid-West who twice reported to the VA he was feeling suicidal. Got sent home and put on a waiting list. Not here now to tell us how he feels.

You hardly get more than one chance to deal with some problems. And this is not the only case that can tragically be told.

Phillip Longman seems a little of an apologist.

Let's get real.

Now I'll go back and read.

Posted by: notthere on March 5, 2007 at 10:24 PM | PERMALINK

Oh, and I have to add, when the VA was so great was before they were asked to make any addaption to the reality of the war they were in, not the war they thought they would have. And I knew GIs in NY 20+ years ago who never got the help they probably needed.

They never adjusted. EVER.

Posted by: notthere on March 5, 2007 at 10:27 PM | PERMALINK

My Significant Other is a vet and praises the VA system to the sky. He's had a host of things treated in the past couple of years and they have, frankly, performed above and beyond any civilian facility I've personally had to use.

Posted by: arteclectic on March 5, 2007 at 10:38 PM | PERMALINK

egbert --

going to assign responsibility to ANYONE on the republican side of the aisle for what they've done the last 5 years?

No, I thought not.

As RSBG said, sign up. Do your duty.

Posted by: notthere on March 5, 2007 at 10:40 PM | PERMALINK

No one here is saying that the VA is a ghastly organization.

They have been well recognized for what they have done. I've talked with a whole number of WWII and Korean vetws who are very happy. I also talked with a whole load of VIetnam vets in the early 80s who had not had so great support for the mental side.

At the present time they are overwhelmed by a style of war the GS did not expect or predict (if we are to believe the President) and is not staffed for. They cannot be blamed for the shortfall. They are totally responsible for not speaking up and saying they were incapable of handling the flow of casualties, particularly the critical ones.

For that they have no excuse.

Posted by: notthere on March 5, 2007 at 10:49 PM | PERMALINK

I, too, sing the praises of the VA, at least since Clinton cleaned house. Their care for me has been better than any of the highly regarded HMOs I belonged to previously. But they are underfunded.

Since Bush was elected, it has been obvious that the VA staff have been more and more hard pressed to make ends meet. It must be very frustrating for them because in my experience they are 100% supportive of the vets under their care.

Posted by: frank logan on March 6, 2007 at 4:33 AM | PERMALINK

Egfart: "I'm glad I'm not blinded like you people by hatred."

Yeah, you walked in blind and only got dumber.

Posted by: Kenji on March 6, 2007 at 5:49 AM | PERMALINK

"...While money is spent without restraint for the weapons of war, the victims of war are shortchanged. Chris Adams, a reporter for McClatchy Newspapers, wrote a chilling investigative report after reviewing mountains of records from the Department of Veterans Affairs showing how people returning from the war are provided inadequate mental-health treatment...the VA "counts post-traumatic stress disorder, PTSD, the most prevalent mental health malady -- and one of the top illnesses overall -- to emerge from the wars in Iraq and Afghanistan..."
While the Busheviks talk about supporting the troops, like to wear American flags and display yellow ribbons, they are not willing to spend the money needed to care for traumatized veterans.
Chris Adams found an appalling lack of care: "Despite a decade-long effort to treat veterans at all VA clinics, nearly 100 local VA clinics provided virtually no mental-health care in 2005. Beyond that, the intensity of treatment was worsened. Today, the average veteran with psychiatric trouble gets one-third fewer visits with specialists than he would have received a decade ago."


Posted by: consider wisely always on March 6, 2007 at 6:17 AM | PERMALINK

The VA is also able to deliver prescription drugs at dramatically lower cost to patients, and I wonder if that is one big reason why it gets such high marks in customer satisfaction.

Posted by: JAG on March 6, 2007 at 8:16 AM | PERMALINK

Some distinctions in the reporting need to be made.

It appears to me that inpatient and outpatient MEDICAL services are quite good, but that the military's case management (including ancillary services) for soldiers who are in outpatient programs or assigned to medical units and awaiting disability determinations discharges are just terrible.

There also seems to be a distinction between soldiers with wounds who also have traumatic brain injuries or severe mental illnesses, and those who don't.

The military is quite right to say that managing people with TBI or SMI is extremely difficult. However, everyone saw it coming with IEDs being the weapon of choice in the Iraqi conflict, and they should have had programs in place.

Case management, some of it intensive, is a good first step. But, I mean, they should have seen it coming. It has always appeared to me that a significant part of our homeless population (and of a more functional but alienated crowd, bikers) are Vietnam vets with PTSD or other mental illnesses or brain injuries, and that conflict was thirty years ago!

Finally, there's confusion about the Walter Reed leadership and the Dept of Veteran Affairs. What are the respective responsibilities of the civilian and military leadership in this emerging scandal?

Posted by: Bruce on March 6, 2007 at 9:01 AM | PERMALINK

We are glad to have the VA clinics and hospitials, Yes there have been rats,roaches etc. But in some cases it was the individual staff member that caused more concern. Such as the Doctor that told me, this is welfare it is free and if we didn't like it go tell Clinton. We have no rights because the veteran has no place to go for care and many feel the vetern s are freeloaders. Go set in a clinic for a day and listen to were some of these guys been and what they have given. I am a proud Army brat and disabled Navy vets wife.

Posted by: Peggy Davis on March 6, 2007 at 9:56 AM | PERMALINK

Another important point (which might be upthread sorry) is that the gross failures at Walter Reed followed immediately after the outsourcing of facilities management which included a sharp decline in the number of employees managing facilities.

Thus, to the very considerable extent that it is relevant to the debate, the terrible case of Building 18 suggests that it is better for the army to do something than to contract out, because the contractor has a strong incentive to provide inadequate service.

Posted by: robert waldmann on March 6, 2007 at 10:54 PM | PERMALINK

still the best care anywhere!

maybe hyperbole is part of the problem

does the author really believe the headline "best care anywhere"

can he prove it

what does it mean?

va funding has been problematic for years

the medical treatment provided to wounded soldiers was problematic after the gulf war, the vietnam war, the korean war and even the mythical good times of wwii

the fact that the underfunded va hospital system has good marks on many variables compared to other health care instituions seems to indicate that there are serious problems in health care that are masked by similar hyperbole - the united states has the best health care

Posted by: jamzo on March 7, 2007 at 11:48 AM | PERMALINK



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