Janet's Conner

This Blog tell the Truth and will never not tell the Truth. Impeach Bush

Saturday, May 20, 2006


In 2001 the President appointed a Task Force to examine veterans health care. Among the recommendations was that a mechanism should be found to remove funding for those programs from the annual appropriations process and that an assured funding model be established. The President ignored the recommendations of his own Task Force and, in January 2003 instituted "temporary" measures to exclude some "high income" (above $27,000 or in some cases less, per year for a family of four) from veterans' medical benefits. Based on this policy, more than 600,000 veterans were denied health care, some 262,000 in 2005 alone.

The President rejected this recommendation by his own task force and embarked upon a policy of under-funding, deception and incompetence that has denied veterans the health care they deserve and have earned. This paper will detail the many ways the Bush Administration has broken faith with American's veterans. A subsequent paper will offer suggestions to correct this unacceptable situation.


Of the 24 + million American military veterans, the Department of Veterans Affairs (VA) estimates that in FY2006 over 7.5 million will be enrolled in VA medical care programs and 5.4 million individual veterans will be treated. That represents a 48% increase in enrollments, a 28% increase in patient load and a 42% increase in appropriated funding (not including inflation, user fees and third-party collections) since FY2002, the first Bush administration budget. But this apparent increase in spending does not account for medical cost inflation that, at a modest 5% per year, makes the apparent increase vanish. Even these numbers were only reached because the Congress doubled the increases requested in the Bush budgets.


The deceptive use of numbers is best illustrated in the FY2007 budget submission. The Bush Administration touts its $3.5B FY2007 increase as the largest percentage increase in history. But this increase is all smoke and mirrors. Deduct mandatory salary and other increases ($1.2B), requested in user fees and co-payments, rejected by Congress the past four years ($800M), overstated third-party collections ($500M) and phantom "management savings" ($1.08M) and the increase disappears.


A scathing General Accountability Office (GAO) report (GOA-06-359R, dated February 6, 2006) shows how deceptive the "management savings" estimates are. The report stated that the VA had no methodology to determine or track any such savings. The GAO also alleged that the VA overestimated third-party collections. Indeed, the GAO contends that the methodology of the VA was to determine the level of funding needed, compare it to the level of funding the administration was willing to provide and then bridge the gap by claiming "management savings" and increases in user fees and third-party payments. When these fail to materialize, programs and services must be cut to meet the shortfall.


The Bush five-year (FY2007-2011) budget projections call for accelerated under funding of the VA. After the increase in FY2007, the plan calls for the VA spending "to decline" through by $2.7B through 2010 before rising a paltry $200M in 2011. The Congressional Budget office estimates that this results in an $8.6B short fall over this period. There is also the specter of the recommendations of the Veterans Disability Benefits Commission that will be made public later this yer. There is an expectation that its recommendations will call for significant reductions in disabled veterans' benefits.


The Administration estimates a 145,000 decline in treatment patients from FY2006 to FY2007. How can this be? The answer is that this is the number of patients estimated to be unable to afford increased enrollment fees and prescription drug co-payments and will therefore be forced to drop out of the VA system! Congress has not approved these user fee increases. The VA routinely uses faulty estimates to reduce budget requests. For example, in the summer of 2005, after months of denial and deception, the VA was forced to admit that it faced a $1.0B shortfall in the current fiscal year. This shortfall was based on faulty estimates based on 2002 (pre-war) projections. As noted above, faulty estimates characterized both "management savings" and third-party payments. As will be seen below, the mental health toll from the war in Afghanastan and the invasion and occupation of Iraq were also underestimated---or misrepresented.


In addition to the denial of service to over 600,000 veterans, other services have been delayed or denied. VA data show that the number of new (mostly Iraq and Afghanastan) veterans who are wanting to schedule their first VA appointment has increased from 15,211 to 30,475 between April 2005 and April 2006. This marks the second year this waiting line has doubled. The number of staff at VA regional benefits offices has declined from 7,053 at the end of FY2002 to 6,880 at the beginning of this fiscal year. The FY2007 budget is to add 130, almost reaching the level of 5 years ago. Largely because of the current conflicts, nearly 50,000 more claims were filed in 2005 than 2002. Backlogs have increased and more veterans are waiting more than six months for a decision on their claims. As of January 21, 2006 more than 500,000 claimants were waiting a decision including 368,000 who were seeking a decision on disability. In addition, some 151,000 veterans were awaiting decisions on their appeals.


Mental Health care, especially Post-traumatic Stress Disorder (PTSD) is a particular problem. Of the 140,000 + returning veterans who sought VA treatment, approximately 3 in 10 were diagnosed with mental health problems and half of those were diagnosed with PTSD. According to the VA's own national advisory board on PTSD in a report released in February 2006:

"The VA cannot meet the ongoing needs of veterans of past deployments while also reaching out to new combat veterans of [Iraq and Afghanastan] and their families within current resources and current models of treatment."

The report also found that a returning war veteran suffering with emotional maladies now has to wait an average of 60 days before he or she can even be evaluated for diagnosis, let alone treated. 42% of VA primary care clinics had no mental-health staff members and 53% of those that did only had one. 82% of new patients needed to be in the most intensive PTSD treatment programs, the VA report found, but 40% of those programs were already so full that they could only take a few more patients; 20% said they were too full to take any at all. In one case the VA hospital saw mental health demand grow from 9 in FY2004 to 58 in FY2005 and to 72 "in the first quarter" of FY2006. And for various reasons of shame or fear, nearly two-thirds of returning veterans who screened for mental health problems are not receiving treatment. With 1.3 million service men and women now having served in the war zones, there is a mental health hurricane coming and the administration is as unprepared as it was for "Katrina."


In addition to being unprepared for the PTSD crisis, the VA has questioned the prevalence of PTSD dagnosis, including launching abortive plans to review thousands of previous PTSD awards. There is a long sad history of the VA and the Pentagon ignoring and denying veterans health problems. It took years to get compensation for veterans exposed to nuclear tests in the 1950's and Agent Orange in Vietnam. The VA did not acknowledge PTSD until 1985, long after it became an accepted mental health diagnosis. Today the Pentagon and the VA are downplaying the effects of the use of depleted uranium in the Gulf War and the current conditions despite persistent and widespread reports by reputable, independent researchers and health professionals of the health hazards.


In addition to creative accounting to overstate the resources being given to the VA health care system, the VA continues to underestimate future demand. In addition to increases from the current conflicts, the demand on VA resources is growing from older veterans. Some of this is due to aging, some to the emergence of past problems such as Agent Orange and DU, and some from being no longer able to afford health insurance. The longer the Bush Administration and congress continue to avoid the reality of the situation, the more veterans will be short-changed and the more difficult it will be to correct their mistakes by a future administration that understands that "support the troops" is a hollow phrase unless it is accompanied by support for their needs when they become veterans. IT MAY WELL BE THAT THE CRISIS IN VETERANS' HEALTH CARE, LIKE IRAQ AND THE BUDGET CRISIS WILL HAVE TO AWAIT A NEW ADMINISTRATION OR A NEW CONGRESS.

Source: Tom Manatos
Advisor to the Leader
House Democratic Leader Nancy Pelosi
May 2006


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