TCS Daily


Curing Walter Reed Syndrome; A Proposal Even Anti-War Doves Should Embrace

By Michael Cannon - March 19, 2007 12:00 AM

The scandal unfolding at Walter Reed Army Medical Center and the Veterans Health Administration (VHA) has me wondering: could we improve veterans' health benefits by eliminating the VHA?

This month, Newsweek reported the stories of Jeffrey Lucey and Jonathan Shulze, two Iraq war veterans who recently took their own lives after having difficulty obtaining mental health services from the VHA.

The VHA is supposed to provide medical, mental health, rehabilitative care to former members of the armed services. Yet it presents many of the same symptoms of other government-run health care systems, such as the Defense Health Program, which operates Walter Reed.

At the VHA, Newsweek found "a grim portrait of an overloaded bureaucracy cluttered with red tape; veterans having to wait weeks or months for mental-health care and other appointments; [and] families sliding into debt as VA case managers study disability claims over many months." Other symptoms include rapidly growing outlays, political games over funding levels, and a lack of accountability.

Everyone - right, left, and libertarian - wants our vets to be well cared for. But is a government-run system the best way to do it? Or might there be ways to provide vets better health care?

In essence, the VHA combines health and disability insurance with medical care delivery. Taxpayers bear the financial risk of veterans needing care for service-related injuries. When those injuries happen, the taxpayers cover the cost of care and the federal government delivers the care through government-owned VA hospitals.

Consider an alternative. Suppose that instead of providing those benefits itself, the federal government increased military pay enough to enable new personnel to purchase private insurance to cover service-related injuries and illnesses. (Those include illnesses that manifest themselves years later, such as mental illnesses or birth defects that result from exposure to hazardous substances.)

The pay raise would have to be enough to allow new personnel to purchase "veterans' insurance" that is at least as good as they would receive through the VHA. When they enlist or accept a commission, personnel could be required to purchase health and disability insurance that covers any service-related injuries or illness during that enlistment or commission.

Private insurers would calibrate premiums according to the risks posed by different jobs. Premiums would be higher for helicopter pilots and lower for desk jockeys. To enable everyone to purchase coverage, Congress would have to increase pay for each position according to the risk it entails, much it increases pay during combat. That would basically front-load the cost of caring for service-related injuries.

Vets who would have used the VHA would instead use their private insurance to purchase care from private facilities - not government facilities.

Privatizing both the insurance and delivery components of veterans' health benefits could have a number of benefits.

First, it would let veterans control the money. That means the system would serve them, not the politicians or the bureaucracy.

Second, it would allow vets to choose where they receive medical care and could reduce waiting times for care. Would the scandalous neglect and mistreatment of patients at Walter Reed have occurred if those same vets had the choice to go elsewhere? Patrick Feges of Sugar Land, Texas, was injured in Ramadi by a mortar. He waited 17 months for his first disability check from the VHA. A private insurer with that kind of reputation would have a hard time attracting customers.

Third, the premiums that private insurers charge would give new personnel an independent assessment of the risk posed by different military jobs.

Fourth, those risk-based premiums would increase when conflict seems imminent, in effect front-loading those war-related costs. Harvard professor Linda Bilmes estimates that caring for an anticipated 700,000 veterans of Iraq and Afghanistan will cost between $350 billion and $700 billion. Since Congress would have to increase pay enough for military personnel to insure against those costs up front, they would have an additional disincentive to start wars. The officials who make such decisions would have to plan for those costs themselves, rather than pass buck to their successors.

Some have argued that the VA should get out of medical care delivery by selling off its hospitals and giving veterans a voucher that they could use to purchase medical care wherever they like. That probably would increase the quality of care that veterans receive. But that would also leave VHA in the health and disability insurance business.

It seems to me that a better approach would be to give vouchers to all personnel currently in the system, but increase pay and let private carriers insure against service-related injuries for all new enlistments and commissions. Such a system could improve the quality of care for vets. It also would give Congress, the armed forces, and the public a lot of very useful information about the costs of foreign policy decisions.

Michael F. Cannon is director of health policy studies at the Cato Institute, and co-author of "Healthy Competition: What's Holding Back Health Care and How to Free It."


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63 Comments

How about just not outsourcing patient care to the Hailliburton spinoff that screwed up Katrina?
Same guys with the ice trucks that went nowhere at a zillino dollar per hour, chosen to run Walter Reed. Does this suggest anything at all?

Here's another hint: the idea from the outsourcing was to cut staffing at Walter Reed by more than 70 percent. Does this suggest anything?

WR syndrome
I've been watching this 'scandal' with a measure of disbelief. When I read the facts of a particular patient's dilemma I always find a disconnect with the manner in which the four services, their respective reserves and the national guard bureaus interact. Example: Normally, when you get to your ETS your pay stops. If you're in an active duty med holding company and you're in the guard, you may not get a timely extension. Result: no pay, no allowances. Med care and rehab won't cease. The problem is with personnel.
second point about the VA: I use the Houston VA as my main medical provider. It's that good.

you mean..govnmt healt care syndrom
Surely liberals(like Lemuel above) should not complain because it seems they want the entire health care system to be run by government. Why not the VA system, or would the Post Office be better at it, or perhaps the DEA? I've got it; the national teacher's union could be given a chance. But re Halliburton, are they better at oil services or should contracts be given instead to say, Toys-R-us? Or maybe the public school system could do that too. Disclaimer: I bought shares in HAL after I heard they were moving to Dubai. They are an undervalued company, with a PEG ratio of less than 1. So while american liberals complain about them, I'll make money. Great article, everybody should have private health insurance.

Once again...
LeMule misses the point of an article in order to make his obligatory, inarticulate denouncement of Bush. The problems with Walter Reed did not start with the Bush administration.

As a side note, the "screw-up" over Katrina was resided over by the local of government who had the responsibility to handle the preparations for the hurricane. I know this doesn't jive with the Democrat talking points but that is the reality.

As for the article: Great job. I fully agree that allowing the veterans to control the money, and thus their healthcare choices, is sound policy.

On a wider focus, this highlights the wonderful things we can expect if our government is stupid enough to socialize our healthcare system. They can't even manage the healthcare of our veterans much less the rest of the population.

But hey, screaming "Halliburton!" is the best way to show your intellectual deficiency. Never mind the actual article.

Denial, denial, denial
Here are the facts. In this case it wasn't government getting into healthcare, it was governent getting out of healthcare. Screaming 'socialism" just illustrates you don't know what happened here:

From the Washington Post:

The scandal over treatment of outpatients at Walter Reed Army Medical Center has focused attention on the Army's decision to privatize the facilities support workforce at the hospital, a move commanders say left the building maintenance staff undermanned.

Some Democratic lawmakers have questioned the decision to hire IAP Worldwide Services, a contractor with connections to the Bush administration and to KBR, a Halliburton subsidiary.

Last year, IAP won a $120 million contract to maintain and operate Walter Reed facilities. The decision reversed a 2004 finding by the Army that it would be more cost-effective to keep the work in-house. After IAP protested, Army auditors ruled that the cost estimates offered by in-house federal workers were too low. They had to submit a new bid, which added 23 employees and $16 million to their cost, according to the Army....

The Army selected IAP for the five-year deal in January 2006, but IAP did not take over management until last month. During that period, the number of facilities management workers at Walter Reed dropped from about 180 to 100, and the hospital found it hard to hire replacements.

Maj. Gen. George W. Weightman, who was Walter Reed's commander until he was relieved last week, testified this week that the privatization -- in combination with a decision by the Pentagon in 2005 to close Walter Reed by 2011 -- "absolutely" contributed to the problems.

http://www.washingtonpost.com/wp-dyn/content/article/2007/03/09/AR2007030902082_pf.html

Heads I win, tails you lose
The VA has been effective for decades, particularly after being strengthened by Clinton. The Walter Reed case doesn't illustrate a problem with the VA system, it' illustrates an egregioius, criminal screwup by thge Bush administration in outsourcing the opeation to political cronies.

>But re Halliburton, are they better at oil services or should contracts be given instead to say, Toys-R-us?

How about open bidding?

Non-starter
I like privatization in general, but not in this case.

Say you're a private company that sells this insurance. How do you maximize profit? You need customers so you get your premiums down to attract them. You funnel the money out as quickly as it comes in. When we get into a really nasty war, you go bankrupt. The insurance industry is always one widespread disaster away from bankruptcy.

Your ignorance is undeniable
Check out who the champions for civil service protections are and then use your amazing powers of research to find out exactly why that period of time where "facilities management workers at Walter Reed dropped from about 180 to 100" occured.

If you were truly intellectually honest you would be able to answer this question factually: What caused the year-long delay and who was behind that delay?

Then note that a great deal of complaints made by the actual veterans were in regards to the bureaucracy and red tape of the governmental system. A system that has produced nothing but complaints for decades.

But sure, the fact that the government was outsourcing the maintenance of Walter Reed is the source of the problem. And to a subsidary of Halliburton! Evil!

>"In this case it wasn't government getting into healthcare, it was governent getting out of healthcare. Screaming 'socialism" just illustrates you don't know what happened here:"

I do know that this is about facilities maintenance, not healthcare. The problem with the healthcare is the red tape and lack of access as I noted above. Once again your own words can be used to showcase your ignorance. By all means don't shut your mouth unless you wish to bite your foot.

Socialized medicine doesn't work and nether does a protected class of janitors and maintenance workers. As ususual I stand in awe of your ability to read one article, or title of an article, and pretend enlightenment. Good show!

Walter Reed
All that's nesasary is to give all members of the armed forces a goverment issued card good for medical care in the states by the doctor of their choice..Imediate care could be handled by the military doctors in country.Get rid of the V.A!

LeMule doesn't even know who runs Walter Reed
>"The VA has been effective for decades, particularly after being strengthened by Clinton."

Really? Tell me what Clinton did to strengthen the VA. Then tell me how this has anything to do with the conditions at Walter Reed since it is the DoD that runs it. The same DoD, by the way, that Clinton gutted during his time in office.

>"How about open bidding?"

Name the companies that could compete with Halliburton.

I agree, denial is your modus operandi
As usual, eric sees what his mommy/cell leader, tells him to see.

Yes, the unions thought it was a bad idea too
But you're missing the point. They were fixing something that wasn't broken before. The situation was a total sccrewup. You're blaming everyone but the people who were obviously responsible.

>Once again your own words can be used to showcase your ignorance.
Those aren't my words: those are a factual statement of the sequence of events that took place. You're using catchphrases and blaming "government" instead of focusing on the stupidity and criminal negligence of a particular adminstration, the ones now in the White House.

>As ususual I stand in awe of your ability to read one article, or title of an article, and pretend enlightenment

Even one is clearly one more than you have read on this topic, but you neverheless not just "pretend enlightenment" but are sure you are right and the facts are wrong.

There is another alternative...
Why not simply make Tri-Care Prime available to everyone currently in the VA system and eliminate the need for co-pays on anything that was tied to a service related disability?

Spending in 2006 about 31 billion, surely transfering these resources to Tri-Care would be more efficient than running an entirely seperate medical system.

Just as I thought...
You haven't yet developed a sense of intellectual honesty and have completely ignored my questions. The Unions thought it was a "bad idea"? That is all you got? Apparently "facts" are something that can be tossed aside when you find them inconvenient. But hey, we already knew that about you.

I blame the right people and/or organizations and the people to blame are those who stand in the way of privatizing veteran's healthcare and management of healthcare facilities. According to you Halliburton = Evil and Unions = Good. One has to wonder if you put any actual thought into your posts. You in no way comprehend how government bureaucracy hinders veteran's access to quality medical care and facilities.

Your dear Unions are merely interested in keeping themselves in power through increased membership.

>"Even one is clearly one more than you have read on this topic, but you neverheless not just "pretend enlightenment" but are sure you are right and the facts are wrong."

Gee. I have only managed finanical/clinical statistics and data for healthcare institutions in the US, Canada and the UK for the last 12 years. Clearly I am out of the loop as to how well the government handles your medical concerns.

Just as you thought??? You didn't think
I mean, where's your argument.

>The Unions thought it was a "bad idea"? That is all you got?

The unions did think it was a bad idea and objected, but that's not what caused the problem. Not in the view of the general in charge, not in any coherent way.

>to blame are those who stand in the way of privatizing veteran's healthcare and management of healthcare facilities. According to you Halliburton = Evil and Unions = Good.

Not at all. I simply quoted a news story on what had happened. You ignore the facts of the news story because your pre-existing idea that Halliburton is good and unions are evil. You have no facts to back up your position at all; just boats about alleged expertise.

>You in no way comprehend how government bureaucracy hinders veteran's access to quality medical care and facilities.
It was not 'government bureacracy' that caused the horrors at Walter Reed.

Zero on topic
Stop wasting everyone's time.

If you have facts, bring them
All you have is empty assertions.

>>"How about open bidding?"

Name the companies that could compete with Halliburton.

This was a spinoff company run by politically connected former Halliburton executives, and all kinds of companies could compete with them on a contract to supply services to Walter Reed.

Government Bureacracy
"It was not 'government bureacracy' that caused the horrors at Walter Reed."

The push to modernize and streamline care and facilities in the middle of a war was the driving force behind what happened, however I suspect that it was burocracy which prevented those who saw the problem from being able to quickly address and solve the problem.

In other words...
you have absolutely no idea of that which you mouth off about.

Good to know. Thanks for the confirmation.

Except it wasn't "modernizing and streamlining"
It was providing a profit center for politically connected insiders. the welfare of the patients took last place.

And it's totally of a piece with anti-government rhetoric. They don't believe in government, so anything that works is a threat. They cut funding, they staff with incompetents and then when it fails they say 'government' is the problem instead of their own malicious actions.

So you're admitting you have no facts at all:no specifics about this stituation
But you're an expert so you don't need facts. Sure.

Ummm... okay?
You just missed the part that the huge lag in the time between the signing of the contract and the actual implementation of the contract was due to Union interferrence and the governmental bureaucratic wrangling that went on because of it.

Not to mention that Halliburton has nothing to do with any of this. You are the idiot who believes that this is yet another chapter in the Halliburton - Cheney conspiracy.

You often cite Bush as being simplistic and unable to perceive complicated issues. Are you sure this isn't mere externalization? I am sure that attaching yourself to a single article, an idiotic habit of yours, seems like a solid platform from which to "debate" but it isn't and you prove that nicely. Your article didn't outline the reason for the lag in activating the contract so it surely is not important.

As usual, it is far easier to scream "Halliburton!" than to actually address the issues that relate to governmental mishandling of healthcare and health services.

I would say a market healthcare solution is far more favorable to our people in uniform than political wheeling and dealing. What do you say?

Oh yes, "Halliburton!" Case closed.

Zero on topic
You're one to talk.

Actually...
My facts come from a variety of sources and viewpoints and that is why I know so much more about this situation than you. Would you care to post your single article again? I am sure everything you need to know is there. Except for the stuff I pointed out that you feel no need to investigate.

I believe you lack what liberals call "intellectual curiousity".

I have the facts and I am an expert on the financial and clinical aspects required to provide superior medical services. My skills were developed by the market, not the idiots in untouchable government positions who lack the most basic understanding of providing those services.

Having seen, and assisted, other government run ratholes become centers of excellent medical care I can safely say, and you and your General agree with me, that the hindrance of a market solution was the cause of Walter Reed. Not Bush. Not evil Halliburton(!). Not Cheney.

Next time you reply perhaps it should be something like: Nanner-nanner-boo-boo! That seems to be the thing you are going for.

No, it's not okay
>You just missed the part that the huge lag in the time between the signing of the contract and the actual implementation of the contract was due to Union interferrence and the governmental bureaucratic wrangling that went on because of it.

You just missed the fact that the army recommended against the contract, but was overruled by political appointees.

>Not to mention that Halliburton has nothing to do with any of this. You are the idiot who believes that this is yet another chapter in the Halliburton - Cheney consp

I noted that it wasn't Halliburton, but a company run by former Halliburton executives, the same company notorious for the most expensive ice deliveries in history post Katrina.

>Your article didn't outline the reason for the lag in activating the contract so it surely is not important.

Why not bring your own source? But this is from another article, this one appearing in Army Times:

"The committee wants to learn more about 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.”

The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official.

They also found that more than 300 federal employees providing facilities management services at Walter Reed had drooped to fewer than 60 by Feb. 3, 2007, the day before IAP took over facilities management. IAP replaced the remaining 60 employees with only 50 private workers.

“The conditions that have been described at Walter Reed are disgraceful,” the letter states. “Part of our mission on the Oversight Committee is to investigate what led to the breakdown in services. It would be reprehensible if the deplorable conditions were caused or aggravated by an ideological commitment to privatize government services regardless of the costs to taxpayers and the consequences for wounded soldiers.”

http://www.armytimes.com/news/2007/03/Weightmansubpoena/

Yes, I am one to talk
I have posted facts, in the form of stories describing in detail the background and circumstances of this deal. You have offered nothing but claims about how you're an expert.

If you have facts, why not bring them, instead of just your opinions
You have offered nothing but your preconceptions. I've already posted this article from Army Times. Why not read it:

Committee Chairman Henry Waxman and subcommittee Chairman John Tierney asked Weightman to testify about an internal memo that showed privatization of services at Walter Reed could put “patient care services… at risk of mission failure.”

But Army officials refused to allow Weightman to appear before the committee after he was relieved of command.

“The Army was unable to provide a satisfactory explanation for the decision to prevent General Weightman from testifying,” committee members said in a statement today.

The committee wants to learn more about 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.”

The letter said Walter Reed also awarded a five-year, $120-million contract to IAP Worldwide Services, which is run by Al Neffgen, a former senior Halliburton official.

They also found that more than 300 federal employees providing facilities management services at Walter Reed had drooped to fewer than 60 by Feb. 3, 2007, the day before IAP took over facilities management. IAP replaced the remaining 60 employees with only 50 private workers.

“The conditions that have been described at Walter Reed are disgraceful,” the letter states. “Part of our mission on the Oversight Committee is to investigate what led to the breakdown in services. It would be reprehensible if the deplorable conditions were caused or aggravated by an ideological commitment to privatize government services regardless of the costs to taxpayers and the consequences for wounded soldiers.”

The letter said the Defense Department “systemically” tried to replace federal workers at Walter Reed with private companies for facilities management, patient care and guard duty – a process that began in 2000.

“But the push to privatize support services there accelerated under President Bush’s ‘competitive sourcing’ initiative, which was launched in 2002,” the letter states.

During the year between awarding the contract to IAP and when the company started, “skilled government workers apparently began leaving Walter Reed in droves,” the letter states. “The memorandum also indicates that officials at the highest levels of Walter Reed and the U.S. Army Medical Command were informed about the dangers of privatization, but appeared to do little to prevent them.”

http://www.armytimes.com/news/2007/03/Weightmansubpoena/

There is a strong push to make the military more cost efficient...
Except it wasn't "modernizing and streamlining"

That was the original intent, the reason funding was being diverted away from maintenance and support of vital facilities at Walter Reed was that it was deemed more efficient to merge two facilities together (Walter Reed with the National Naval Medical Center.) The problem was one of timing as well as the bureaucracy which didn't allow for a reasonable strategy to mitigate the impact of the merger on U.S. troops. The funding for an effective solution simply was not available because it had not been requested or allocated.

"It was providing a profit center for politically connected insiders. the welfare of the patients took last place."

I'm not disagreeing with you on this. Contractors make good bussiness sense (at least to me) when the military is expected to draw down or shrink in size. They are more expensive, however when the military no longer needs them the contract simply isn't renewed. The problem with this is we don't expect the military or it's mission to shrink in size anytime in the near future. Missions being performed by contractors should be taken over by less expensive government civilians and soldiers.

That was the story, but the reality was closer to old-fashioned graft
The Army used to do almost everything with its own personnel. One of the legacies of Rumsfeld was to replace this system, which was cumbersome but effective, with wholesale outsourcing and contracting.

For some functions, this makes sense. But in too many situations, the reality has been to shovel money to potential campaign contributor,in a resurrection of the old-fashioned spoils system of machine politics. The Walter Reed case shows just how hard this can be human beings.

Posted to One of Those Liberal Blogs....
I said Walter Reed is a good example of what to expect from a government run health care system (like universal HC).

Geeze, the board went crazy. You just cannot debate stuff like that on those boards.

So you posted what happens when a government facility is privatized
...as an example of what to expect from a government run health care systen?

And people noticed that there was a contradiction?

>You just cannot debate stuff like that on those boards.

It would really help if you weren't using an example that contradicted your point.

Story is still half right
One of the problems with this sort of corruption is that it's not confined to the Dems or the Repugs. One of the fatal flaws inherant in a two party system is that once two parties become corrupt, there is no one left to blow the whistle.

true that skwilinski, first worthwhile comment going down the list
The ideas in this article are worthy of discussion, but it seems very difficult to make it work in the real world. And do we really want to expose our soldiers to the crouching tiger of free market insurance companies? Can you imagine those premiums? Wow.

And you know, those soldiers are fighting for us. We elected the moron that sent them over there, its our responsibility to make sure they are taken care of. Fix the fucking system. Private contractors in a war situation are NOT more efficient than government. They are more accountable in the short term, but thats not enough.

At the very least this article makes one aware of one way the entire country is contributing to the war effort, although it doesn't count as sacrifice: our taxes pay for veteran medical care. Otherwise, its only the soldiers and their families and friends that are making any sacrifice for our country in this effort.

Our vets do receive the highest quality health care available. The problem is with the beaurocracy. Its a problem stemming from every sector and depth of the government involved with it, right on up the ladder ending at W. We lack leadership. Our leadership lacks an understanding and courage to do the right thing for our vets. Any person in the Oval Office right now would be deserving of criticism for this fiasco. The fact its W in there just makes this not very surprising. The President isn't directly culpible, but he is responsible for the org chart and the culture. You thought government worked poorly before, just let George get a hold of it... forget about it.

Curing Walter Reed Syndrome - - - -
You lost me here:

"Since Congress would have to increase pay enough for military personel to insure against those costs up front, they would have an additional disincentive to start wars".

Oh, get real. Gee, LA has just been nuked. No - let's not "START" a war, it would be just too expensive. We'll wait until the next one - perhaps we'll be able to afford it more at that time.

Wonderful!!

And that was why the civil service system was introduced...
...which the Republican anti-government propaganda is a cover for dismantling it and returning to the good old days of graft.

Bob Jones
You're the moron. Some respect bubba.

They laughed you right on out of town didn't they...
Using Walter Reed as an argument for privitized health care is like using the Titanic as an argument for larger ships.

Please clarify
Who did I disrespect, other than the people responsible for the mistreatment of our soldiers coming back from war? And what in my comments makes you think I'm a moron?

Oh wait, I did call Bush a moron. Which he is, and so is every person who voted for him in 2004. Morons for that action, not overall. I'm not unfair.

Curing Walter Reed Syndrome; A Proposal Even Anti-War Doves Should Embrace
Remember all the private nursing home scandals? The problem was that no one was checking on the quality of care.

That was the same problem at Walter Reed. The medical care itself is first class, but the physical facility used to house some outpatients was deplorable. Why? Because nobody checked on it. Not the hospital commanders, not the Army's inspectors generals, and certainly not the Washington, DC, building department.

You don't need to privatize Walter Reed (and, BTW, drive up costs to the taxpayers) to prevent this sort of thing from happening. The answer is simple: Simply have another agency check on the physical facility.

Fortunately, a newspaper exposed the deplorable conditions and created an uproar. Just like newspapers reported on those deplorable nursing homes.

Government-run facilities can be good or bad. Privately owned facilities can be good or bad.

Trust but verify -- using a third party -- would solve a lot of these problems.

Extremely good suggestion...
Whether the government is providing the service itself, or contracting it out, you need an external observer, without financial or organizational
conflicts of interest to get reliable information on what's going on. And these reports have to be public.

The facility is run by the Military
I agree that privatizing a part of a government bureaucarcy does not always work. Especially if it does not result in real accountability.

I would have to go back and see what prompted them to consider privatizing in the first place. All the liberals want to conclude that nothing was broke but we do not know that for sure.

Tri-Care
After reading the article I decided to post the very same thing that you just did. You took the wind out of my sails. I am a retired Army Master Sergeant on Tri-Care and very happy with it.

I like it as well
It's an excellent program.

I appreciate your open-mindedness
This article from Army Times (not a leftwing sournce) has some background.

http://www.armytimes.com/news/2007/03/Weightmansubpoena/

but who?
You still didn't tell us whether you want the VA system to run the whole of an American universal system, or the Post Office. Or wait a minute, maybe you will suggest the system that they have in Canada(and North Korea and Cuba that copied it).

Not as good as what we had before Tricare
Not as good as what we had before Tricare Prime, but considering the realities of the health care world it is about as good as we could hope for.

Walter Reed is scheduled to be closed
Walter Reed is scheduled to be closed an no officer there was willing to risk his career and stand up and say they needed to spend money on the outpatient quarters or to rent out a hotel to house the troops.

All those who didn't resign should be transfered to places like the Aleutians and Greenland, but not Afghanistan or Iraq because those places would might look good to their next promotion board.

Why don't you ask the Easter Bunny?
That's as much as your concerns have to do with the Walter Reed situation.

True
I'm still a little sore about the military reneging on the implied promise of healthcare for life for retirees; however I agree Tricare is the best we could hope for all things considered... and all things considered it's not that bad.

Privatizing
Sounds like there was an initiative to privatize some of the functions of the hospital before (and other areas of the defense dept) even before Bush came along but he apparently accelerated it. Could have been some cronyism going on with the awarding of this contract since the owner of the contracting firm was once with Halliburton. I agree that privatizing under these circumstances could be something less than beneficial.

When I think of privatizing I envision competative bidding for contracts and standard of performance if not not met results in the termination of the firm providing the contracted services. So in this case, IAP shold be fired and another firm brought in to provide the services. I have not seen anything indicating that this is happening but it should.

So let's say the unions were still running the place. If this happened on their watch would it be easy to fire the union workers? Not usually. Of course the question you will ask is if this would have happened at all if the union was in there. Hard to say in this case. Let's just say that I have never been real impressed with the work ethic of unionized workers be it private or public employee unions. They tend to get higher than market wages and tend to be protected if they do not meet the performance standards set by the employer. This usually breeds lazy or incompetant workers (or both) that sooner or later hurt a company's bottom line.

So I am not oppposed to privatizing some government functions as long as it done in such a way that the process is subject to normal market forces.

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