POLICY: A National Disgrace By John Irvine

When the story first came out, it didn’t look like much.
Just a few problems that needed correction: a little mold here, a few repairs
there, the inevitable complaints from disgruntled patients. But two and a half
weeks after the Washington Post ran a little story by reporters Dana Priest and
Anne Hull titled “Soldiers Face Neglect, Frustration At Army’s Top Medical
“ the Walter Reed scandal has become without question the top story in the country. 

Today, Priest and Hull return with another lengthy piece examining
conditions in the military healthcare system in other parts of the country titled
Walter Reed Not an isolated case.” The two reporters say that after their initial story ran they were contacted by "literally hundreds of soldiers" from around the
country with similar stories to share. The pair writes:

Nearly 4,000
outpatients are currently in the military’s Medical Holding or Medical Holdover
companies, which oversee the wounded. Soldiers and veterans report bureaucratic
disarray similar to Walter Reed’s: indifferent, untrained staff; lost
paperwork; medical appointments that drop from the computers; and long waits
for consultations.

That appears to answer a question that many people had been wondering about. As New York Democrat Charles Schumer put it over the weekend “if it’s
this bad at the outpatient facilities at Walter Reed, how is it in the rest of the country?” On Sunday,
Schumer called for a bipartisan commission – possibly to be headed by former
secretary of state Colin Powell – to examine conditions facing returning
service men and women.

Predictably, conservative critics around the blogosphere are
pointing at the debacle as evidence that any government run healthcare system
would be a disaster. Kevin MD writes: “What’s happening at Walter Reed is small
sample of how government-run health care would turn out. Does the public understand
the implications of a nationally-run health care system?”

"Will the Bush-bashers join with free-market critics to effect real change and
help the troops who need and deserve better care? We’ll see," writes Michelle Malkin.

On THCB Eric Novack follows along in the same vein, writing: “legislators and bureaucrats have been made
aware of some of these problems for years and years. And yet, nothing
significant has changed. The missing interpretation: the absolute fundamental
inability for government-run organizations to escape convoluted, bureaucratic,
non-meritorious based hierarchies. Anyone still for VA care for all of the USA

But not everybody agrees. On the other side of the
aisle, many Democrats are arguing that privatization is to blame for the problems found at the base. Many are
pointing at an internal memo from Walter Reed garrison Commander Peter
Garibaldi to Weightman that allegedly detailed specific problems at the facility, weeks before
the Post report. (You can read the actual memo here.)

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.

The Walter Reed scandal has already provoked a massive outpouring of
commentary on editorial pages, blogs and news sites. A few more highlights:

Reporters at Salon.com are angry.They’re saying they ran
the Walter Reed story first
, way back in 2003. They’re not accusing the Post
of plagiarism. Or are they? It’s hard to

Washington Post ombudsman (shouldn’t it be ombudsperson?)
Deborah Powell has some of the back story on the reporting that broke the
Building 18 story.

But aren’t the
problems at Walter Reed the sort of thing that can happen at any large
organization if the people at the top lose touch?  I can’t help but think that
Philip Carter’s commentary “Walter Reed and the Reverse BS Filtration System,” which
ran in Slate last week, should be required reading for every business student
in the country. 

“Walter Reed’s
problems also illustrate just how bad the Army has gotten at passing
information—particularly negative information—up and down its chain of command.
Typically, subordinate units submit reports on a daily, weekly, and monthly
basis to their headquarters. At each level of command, these reports get
filtered, collated, combined, and resynthesized. Like the children’s game of
telephone, the message frequently changes in transmission. The result can be a
terribly distorted picture of reality at the higher echelons of command.”

Major problems get
renamed "obstacles," or "challenges," or some other noun
that connotes a temporary delay in forward progress, reflecting the pervasive
"can do" optimism of the military officer corps. Staff officers at
each level of command refine and insert caveats into reports to ensure they
don’t rock the boat too much. By the time information reaches a senior
commander or civilian official, it no longer reflects reality.

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11 replies »

  1. “So the scandal of WRAMC stands as a shining example of what’s wrong with privatizing health care.”
    That poses an interesting dilemma for the design of universal health care.
    Continue to permit private administration of health care facilities
    Or – convert all workers at health care facilities into government employees.
    Appears that we’ll either end up with a nation-full of Walter Reeds privately managed, or a nation-full of Walter Reeds publicly-managed.
    Sure gives me a warm feeling.

  2. Karen,
    You just demonstrated the real danger of this problem. Walter Reed is not a VA facility. It is an Army facility. The VA merely provides the coverage for some of the soldiers in question. The VA has very good facilities, some of the best in the country, and it is unfortunately being smeared because the status or condition of some of the soldiers required that they be treated at Walter Reed. Don’t let the problems of Walter Reed scare you away from the VA system.

  3. My father, now 82, served with honor under General Patton in WWII.
    After reading this, he will never go to any VA facility as long as I draw breath and a paycheck. This is not the way to reward our servicemen and women.

  4. Per Paul Krugman in yesterday’s NYT, WRAMC was privatized. And under very hinky circumstances. IAP Worldwide Services, a company run by two former Halliburton executives, received the contract after the Army reversed the results of an audit concluding that government employees could do the job more cheaply.
    So the scandal of WRAMC stands as a shining example of what’s wrong with privatizing health care.

  5. Well, this shows the fallacy of a socialized medicine system. We have the greatest health care system money can buy. If we opened veteran heath care to the free market, these guys would be able to get great health care. It’s time to let the market solve this. I say close Walter Reed altogether.

  6. Well, yesterday as I wrote the solicited comment below to the Reserve Officers Association of the United States, I thought that I should mention that when it is all said and done we will find out that the problems at Walter Reed Army Medical Center are related to contractors, just as is the issues with TRICARE, TRS, TDP and the rest of military medical care.
    I didn’t, but I am now.
    Last evening before going to bed I saw an article on the internet speaking of the issues at Walter Reed Army Medical Center. As I read it, I kept asking myself how in the name of the wide world of sports could one military member(s) do this sort of thing to another (s). It just didn’t make sense. Then the bottom line came up in the article and indeed it is the proverbial bottom line. It is contractors that are running at least the portion of Walter Reed in question! I was right! And, I’ll beat my next active duty pay check that the generals and other military officers have been screaming for months about the way these contractors are incompetently treating military members—only to be told to shut up and go color by the same esteemed representatives that are now publicly puffing their chests and screaming for action. Hypocrites ALL!
    ROA should not allow the organization to get drawn into the same bureaucratic malaise of hearings and commissions and blah blah blah (as today’s youth call it).
    Get in front of their hypocritical faces and tell them like it is– The outsourcing of the military services in this country must end! Or our esteemed representatives need to publicly announce that they don’t care if the U. S. succeeds at misdirected policy decisions anymore and would prefer to just keep making money for their buds, while they continue to get re-elected time after time after……
    I am a LIFE member of ROA and I am madder than hell! Get in their Face, ROA, and now!
    And next I am talking to NGAUS, PNGAUS, AFA, AFSA, American Legion, and VFW…………….
    To ROA:
    TRS is a god send as far as my wife and I are concerned. We are self-employed and this insurance option, while still costly saves us a lot of money in premiums over other insurance options. And the health care services that TRS provides and covers are more than adequate.
    Our biggest complaint is the huge black hole bureaucracy that is the management agency that administers this program. It is so messed up that I have to physically call them each time I go on and off active duty so that TRS can convert to TRICARE PRIME and then reconvert back to TRS after my active duty period. The TRS system cannot communicate with DEERS—TRS admits/has admitted that many times.
    The last period of active duty I came off of in Sept 2006 was a classic example of a bureaucracy from which there is no escape. I finally got that straightened out in January 2007, only after dozens of phone calls, letter writing and copying numerous other agencies, recruiting the help of my units TRICARE rep, who although is assigned this duty as an additional duty, spends most of her time working TRICARE and TDP programs for numerous Guardsmen.
    And TDP! That is surely another ugly story, including its lack of coordination with DEERS.
    Managed Health Care was a great idea and a new idea a few years ago, to get a handle on health care costs. No longer! It is a self-fulfilling bureaucracy of its own, which provides no health care value to the member and despite propaganda other wise, provides no savings to the American taxpayer. I have no doubt that if I spent some time to research the issue; I could show how the TRICARE, TDP, TRS and all other such programs are led by overpaid fat cats, who are milking the US taxpayer, prior to retiring on private beaches in a tropical paradise somewhere. I embellish, but am serious.
    I get more stress from dealing with ALL the TRICARE entities, than I do deploying in this war. In a couple more months I deploy again for 120 days (voluntarily). My wife will deserve the thank yous, Hurrahs and medals—she will have to deal with the management agencies of TRICARE. Along with dozens of other spouses in my unit who deal with the same issues all the time, with the help of 1 lonely MPF troop who does it as an additional duty, while the MPF continues to suffer manpower cuts.
    Thank you for this opportunity to vent again. I have been doing it for almost six years now. Pull the plug on managed healthcare in the US military. Bring it back to the military ( not contractors) to manage.
    Contrary to the blah blah articulated by our esteemed representatives linked at the hip to such corporations as Lockheed Martin Corp., United Concordia, etc. and others; money would be saved to fight a war, rather than buying hardware and services that have no value . President Eisenhower coined it—“The Military Industrial Complex”. It exists.
    Dave Palmer, Lt Col, PaANG

  7. Well, this shows the fallacy of a socialized medicine system. We have the greatest health care system money can buy. If we opened veteran heath care to the free market, these guys would be able to get great health care. It’s time to let the market solve this. I say close Walter Reed altogether.

  8. Maggie,
    I think you make a good point about the anecdotal nature of the Post’s report yesterday. I’d wondered about that. This seems like an example of the way the digital age has compressed the news cycle. In the old days, our would-be Woodwards and Bernsteins would have had to have spent a long time doing the legwork to follow up on their initial report. They would have had to physically pick up the phone and contact people. They would have had to have gone to god-forsaken parking garages in the middle of the night and hidden in the shadows waiting to meet mysterious sources. Today, a soldier sitting on a remote base somewhere in Oklahoma reads a copy of their Washington Post story and dashes off a quick email. Someone else at an Air Force base in North Dakota does the same thing. That speeds up the process. I’m not sure what it means, though. Is faster better? Is accuracy possible under those circumstances? I don’t know. But I have a feeling you won’t be the last person asking this question.

  9. The Regimental Surgeon of the U.S. Marines Manuel Tanguma has inquired about the use of a medical device proven to aide in the prevention of concussion in NFL players. The NFL’s concussion expert was forced to resign last week because of his concussion policy and omission of these statistics. NFL statistics confirmed in an AAOP study that warranted further study, that was never done. Dr. Tanguma has communicated with a Harvard MGH researcher about a proposed study at Walter Reed. Now we understand, why it hasn’t happened, the Red Tape of the military bureaucracy. This is a medical procedure many at Tufts University feel, would benefit the troops. Troop MTBI is at epidemic proportion, many N.E. Patriot players testify, they stopped having concussions after being fitted with this retainer like mouth guard. If anyone has a contact, please make the effort to let them know of our problem. http://www.mahercor.com

  10. The problem with all of the hoopla over WRAMC and OP medical care, is to put this into the context of all the similar hoopla in 2003 as to the BRAC recommendations as to closing Walter Reed, and combining the services medical facilities in DC. IIRC, there have been several attempts at same over the last 30+ years, all thwarted by congressional interests in the region, trying to keep status quo, and from within the military medical administrative establishment – wouldn’t want to lose any high rank prestige slots near the center of power.
    WRAMC should have been closed and the center of medical force firmly relocated to San Antonio, North Carolina, Norfolk or San Diego and TO THE ACTIVE DUTY commands and center of military population.
    The closure in Denver of Fitzsimmons Army Medical Center was the first common sense move Army MEDDAC had made in decades – 60 miles from the Academy, Fort Carson, and Peterson Field and Space Command and in need of a complete rebuild. Why maintain tertiary facilities so far from the mission???
    As to command issues – does the Army place medical admin types and nurses in command of facilities, as the Navy and USAF seem to do? If so, where do you develop and groom major facility commanders – or are they Admin types, as well?
    Separate issue, but relevant – since 2001, what has happened to the retention of surgical specialists on active duty after completion of educational commitments – it was very poor during my USAF time 1987-89. The USN O-6 neurosurgeon at Bethesda retired at 16+ years tenure due to the continued inability to operate or teach due to lack of ICU beds and OR time – no staff; called out the DOD for failure to retain any “seed corn” for further growth in the ranks.
    I am mighty proud of the excellent job so many have done for troops in theater, around the world; several relatives and sons of dear friends are with us due to their outstanding care – but it shouldn’t always have to be “despite” the upper echelons – or do we have to fight every American war that way?
    God Bless.

  11. The linked story suggesting that Walter Reed is typical of the VA system (“It’s Not Just At Walter Reed”) depends so heavily on anecdotes that it’s hard to know what to make of it. (Also, it’s worth noting that Walter Reed is not part of the VA system. The story slides from Walter Reed to the VA without making that point clear.)
    I, too, can share an anecdote. My brother-in-law, who is a Vet, recently went to the VA hospital here in New York City to get some medication and a doctor noticed his hearing aid. He inquired about my brother-in-law’s hearing problem.
    My borhter-in-law has been seeing private-sector specialists here in Manhattan (the mecca for private sector care) on a regular basis for years, and this hearing aid had remained their best solution. Unfortunately, it is at best, a half-way solution. If the room is very quiet, he can hear.
    The VA doctor explalined that a new device is availabe, and precribed it. For the first time in years, my brother-in-law can carry on a conversation in a restaurant.
    I could probably find 40 peopld with similar anecdotes. Does this mean that the VA system is excellent? No.
    But a string of studies in medical journals suggests that, despite the Bush administration’s budget cuts, overall, the VA has been providing remarkably good care. See, for example, “Creating a Culture of Quality,” Annals of Internal Medicine, 2004 and “VA Hospitals Found Best in Overall Quality, But Not Every One Measures Up,” (Health Care STrategic Management, 2005)