American Elephants


The Indian Health Service is Just as Bad, or Worse, than the VA by The Elephant's Child

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As long as I’m beating up the Obama Administration for their unbelievably dreadful performance on health care — at the Veterans Administration we have found needless patient suffering, fatal delays in medical treatment, and retaliation against whistleblowers — they are as well the shameful traits of the Indian Health Service.

Part of the Department of Health and Human Services, the Indian Health Service is required by treaty to deliver health care to Native Americans around the country, with more than two million depending on this federal agency. Unfortunately, it appears to be failing. Tribal members have told the Senate Committee on Indian Affairs about alarming conditions at hospitals run by the IHS. During the committee’s investigation, which began last summer, we have heard accounts of nurses unable to administer basic drugs, broken emergency-resuscitation equipment, unsanitary medical facilities, and seriously ill children being misdiagnosed. …

The situation has gotten so bad that inspectors from the Centers for Medicare and Medicaid Services have issued multiple Statements of Deficiencies over the past few years identifying four IHS hospitals in the Great Plains that are putting patients in “immediate jeopardy.” Our investigators have found evidence that the IHS, like the VA, maintains a culture of cronyism and corruption. Many staff members collect government paychecks without fear of accountability.

Tribal Leaders have contacted the Department of Health and Human Services specifically identifying underperforming supervisors and upper-level management who deserve to be fired. There is no sign that these people have been terminated. Instead employees who perform poorly are transferred to other facilities and in some cases even get raises and  promotions with work files that show no records of bad performance. Nice work if you can get it.

According to HHS, Indian Health Service funding has expanded by 43% since 2008, so more money is not a solution. What’s required seems to be a culture change at the agency from leadership in D.C. down to local hospitals. Some hospitals in the Great Plains area actually had money left over at the end of the fiscal year — but made the choice not to spend it on patient care.

When an administration consistently shows that politics and the next election trump duty and responsibility, and the Constitution is just an old tired document, those attitudes seep through the whole administration, and you get a Navy Commander surrendering boats to the Iranians because he believed that Obama’s Iran Deal was so important to the President, you get sexually-confused bathrooms, a military open to transsexuals, women in combat roles, and an administration unable to say “Islamic terrorism” because the words might offend, though it might also kill a lot of Americans.

Contrary to the hard Left who believe all things are better done and controlled  by the best and brightest in the federal government, there are few things that the federal government actually does well. There are a lot of things that must be done by a federal government, but most are better left to the states which are more directly responsible to their citizens. Health care is just one of them.

ObamaCare is slowly falling apart, Medicaid is a disaster, we have read of way too many failings of the Veterans Administration health care, and now the Indian Health Service, required by treaty to deliver health care to Native Americans around the country has more than two million depending on that service.

Free Markets, Free People and lots of competition — works every time. Presented with challenges and the opportunity to be free of meddling bureaucrats, ideas for better care pop up and little miracles happen all over.



The VA Scandal Is Caused By the Perverse Incentives of Socialized Medicine. by The Elephant's Child

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Memorial Day just calls more attention to the scandal of the Veterans Administration hospital system. Democrats are in panic mode. This is a bad one. Nancy Pelosi is trying to blame it all on Bush, the usual fall-back position. She would have it that it is all the enormous influx of young veterans wounded in Bush’s wars. Nice try, but that’s not the case. It isn’t the young guys that are dying of inattention, despite their sometimes grievous wounds, they are younger and healthier. The problem is socialized medicine.

The reason Democrats are attracted to government-run health care is that the left is always focused on intent, not results. They believe in government by experts, the best and brightest, and ever more experts to get it right — in other words, in big government. Their intent is what matters. If the results aren’t right, they will fiddle and tweak until they get it fixed.  But they intend a bright and shining success.

When you guarantee beneficiaries free treatment which is open-ended in terms of cost, more patients are apt to seek treatment for less important reasons. They have no idea of the cost—they are guaranteed care. For the government, the patients are now their responsibility and the incentive is entirely to cut costs.

Doctors and nurses may well be wonderful, and choosing to work with veterans indicates a caring intent, when they could probably do as well or better in the private sector. But for the bureaucratic staff, the incentive is to force the medical staff to cover more patients in less time, to prescribe cheaper medicines, to do less costly procedures. Success at bringing down costs results in bigger bonuses and career advancement for the bureaucrats.Some are represented by unions. The incentives for unions are to gain bigger bonuses, better retirement, and better pay, not better care for vets.  Which results in long wait lists, hidden because they are embarrassing and certainly not resulting in career advancement— or exactly what we’ve got.

Democrats don’t really understand what all the fuss is about, because they are focused on their intent. The results can be tweaked to prevent such problems.

You can see  the intent of ObamaCare being tweaked daily by the president, as he issues executive orders and rewrites the law to overcome problems. But we have had added the United States Preventative Services Task Force (USPSTF) which issues decisions on what preventative services will and will not be covered and for whom they are indicated. Got that? You don’t get to decide, it will be decided for you by a new agency filled with unaccountable bureaucrats.

The Independent Payment Advisory Board (IPAB) is tasked with cutting Medicare costs either through a reduction of services or by cutting the payments to providers. They simply don’t understand that they cannot cut payments to providers below a certain point or there will be few or only poorly qualified providers.

Whether with Medicare, Veterans Care or Medicaid, Obama and his advisers were particularly concerned with the higher costs of health care for older people. Statistically, the biggest expenses for health care are in their final years. If you can cut back on those expenses, and old people have fewer worthwhile life years ahead of them, then you are more apt to meet your budget.

And again, whenever care is free at the point of service, the more care people will demand. I wrote this in an earlier post, but this is what Obama said:

Obama did say that people might be better off taking a pain pill than getting surgery. He also said “the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out there.” Excuse me, but isn’t that what health care is for?

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The Pentagon and the Veterans Administration, and Performance Issues. by The Elephant's Child

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The Veterans Administration scandal is heating up. General Eric Shinseki appeared before the Senate Veterans Affairs Committee to give the typical bland administration response. The VA has always been committed to providing “high quality and timely” care to veterans —while noting that there were reports of “performance issues.” Well, yes.

The medical needs of veterans who have served their country honorably are falling victim to wait-list fraud in at least seven Veterans Administration facilities around the country. A VA social worker and employee representative in Chicago told CBS News that there were secret waiting lists designed to hide the fact that veterans were not receiving medical care that was timely, and sometimes no care at all.

In Phoenix close to 40 veterans may have died while waiting too long for colonoscopies and endoscopies that could have diagnosed their cancers while they were still treatable.

At the Cheyenne VA Medical Center, a Telehealth Coordinator described how patients were always listed as receiving appointments within a 14-day window no matter when the appointment was first requested nor how long the patient actually waited. At least 19 vets in Columbia S.C. and Augusta Ga., died in 2010 and 2010 waiting for appointments.

In the meantime, Private Bradley Manning, who was convicted of leaking national security secrets to the “anti-secrecy” website WikiLeaks. Manning has been diagnosed by military doctors with gender dysphoria, the sense of being a woman in a man’s body. Bradley has chosen to change his/her name legally to Chelsea, and asked for hormone therapy and to be able to live as a woman. The Pentagon is trying to help.

Pentagon press secretary Rear Admiral John Kirby said: “No decision to transfer Pvt. Manning to a civilian detention facility has been made, and any such decision will, of course, properly balance the soldier’s medical needs with our obligation to ensure Pvt. Manning remains behind bars.”

High quality and timely care, and, um. “performance issues” indeed. How about “priority issues”as well.

ADDENDUM: Sec. Of Defense Chuck Hagel has announced that they are reconsidering hormone therapy for Manning at a time when they are sharply drawing down the Army. The VA is a different department, but at least somebody realizes that this looks bad just now.

ADDENDUM II: 5/16 , According to Breitbart: Defense Secretary Chuck Hagel has formally approved the request of Pvt. Bradley Manning, convicted for leaking 750,000 classified documents to WikiLeaks, to be temporarily transferred out of military custody in order to undergo expensive hormone therapy and surgery to become a transgendered woman. Manning’s taxpayer funded request to change his name from Bradley to Chelsea was approved last month by a Kansas court. Pentagon spokesman Rear Adm. John Kirby denies the claim, saying no decision has been made.  We will get answers eventually.

In the meantime, the VA scandal is unfolding. Secretary Shinseki dramatically fired the head of hospital operations, but the gentleman was planning to retire this summer anyway. Obama has nominated someone who was in charge of another hospital where veterans died while awaiting treatment. The ability to cover up unpleasant facts is still limited.  We will get answers eventually.



Our Former Soldiers Do Not Need to Be Told that They Are a Burden to Society by The Elephant's Child

Last year, the bureaucrats at the Veterans’ Administrations National Center for Ethics in Health Care recommended a 52-page end-of-life planning document, “Your Life, Your Choices.”  It was published  first in 1997 and later promoted as the VA’s preferred living will throughout the vast network of hospitals and nursing homes in the  Veterans Administration system.   After the Bush Administration saw just how this document was treating very complex moral and health issues, the VA suspended its use.  Unfortunately, under President Obama, the VA has now returned the booklet to use.

The author is Dr. Robert Pearlman, the chief of ethics evaluation for the center, who according to the Wall Street Journal, advocated for physician -assisted suicide before the Supreme Court in 1966 in Vacco v.Quill, and who is known for  his support of health-care rationing.

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The booklet presents end-of-life-choices in a way that leads to predetermined conclusions.  A worksheet lists scenarios and asks readers to decide just when their own life would “not be worth living.”  One asks “Have you ever heard anyone say, “If I’m a vegetable, pull the plug?” There are also such scenarios as “I can no longer contribute to my family’s well being,” “I am a severe financial burden on my family” or my situation “causes severe emotional burden for my family.”

Is it the job of the government to steer vulnerable individuals to conclude that life is not worth living?  You don’t have to have official “Death Panels” to cut down on end-of-life medical costs.  If President Obama doesn’t understand  Americans rejection of his health care plans, he has only to look at the way his Veterans’ Administration is treating those in its care.

America owes a vast debt to her veterans.  We need to make sure that no veteran is ever treated as a burden, but only with the honor and care that is their due.




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