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“The Comforting Feeling Of Rolling Heads”: It May Make You Feel Better, But Will The Issue Be Solved?

Since the firing of Health and Human Services Director Katherine Sebelius you no longer hear as much about repealing the Affordable Care Act (although certain candidates, most recently Scott Brown, continue to bring it up). But when her head rolled a lot of people seemed to feel better. Now the call is for the head of Veterans Affairs Secretary Eric Shinseki, after dozens of stories cited deaths allegedly related to delayed care for veterans at many of the nation’s 1700 veterans hospitals and treatment centers. If he is let go people may feel better. But will the issue be solved?

The so-called secret lists of veterans waiting for care is troubling, but if it is true then the system as a whole needs an overhaul. This has been apparent for some time and was previously highlighted by the conditions at Walter Reed Hospital and the delay in computerizing records. But these things most likely won’t follow merely by firing the secretary. And although Congress is calling for another investigation, at the same time recent budget proposals by the GOP reduce money for veterans, including cutting health benefits for veterans.

VA hospitals and clinics served 8.76 million veterans last year. In 2008, 37 percent of veterans sought treatment for PTSD and depression. But it is thought that at least half of all veterans suffer from these. Those who report PTSD usually also suffer from many other conditions, some of which do not manifest themselves until more than 5 years after service.

The VA is a huge bureaucracy which serves as the largest single health care system in the country. Along with men and women who served in Iraq and Afghanistan, it still serves veterans of World War II, Korea and Vietnam. Today’s veterans survive injuries that would have quickly killed veterans of earlier wars, including burns, amputations and traumatic brain injuries. And in the past ten years the numbers of vets seeking care has increased exponentially due to our most recent wars, with almost half of those veterans seeking disability compensation for their injuries.

For some perspective: In 2010 the Office of Inspector General for the Department of Health and Human Services reported that bad care contributed to 180,000 deaths of patients in Medicare alone. As many as 440,000 people nationwide suffer from some sort of preventable harm which could have contributed to their death. And that is in our civilian hospitals. Medical error is the third leading cause of death in the US.

Average wait time in hospital emergency rooms has risen. It can take two to four weeks to get an appointment with a specialist (In 2009 people waited an average of 20 days. In 2010 fifty percent of our population felt they could have avoided a trip to the ER if they had been able to get an appointment with their regular doctor People without insurance have received little or no care until recent changes with the implantation of the ACA. Before the passage of the ACA, as many as 45,000 uninsured died each year.

In many small towns, including Savannah, Georgia, waiting times to see a mental health specialist can be at least a month for a psychologist and three to six months for a psychiatrist. At the local VA clinic in Savannah, veterans wait no more than three weeks, and often less, for mental health care and walk-ins who are in crisis are treated immediately.

According to the Associated Press yesterday, a recent report indicated that the department’s internal watchdog found no evidence that delays have caused patient deaths. President Obama has appointed deputy White House chief of staff to review VA policies and procedures.

Further inquiries will be held and outrage will continue to mount until something concrete is done. This is not a new issue. But firing Shinseki is like providing palliative care for end-of-life patients: the patient will be more comfortable but he will still die. Any investigation into the VA has to result in major changes to the system as a whole which will not be possible if the problem is “solved” by yet another head rolling.

 

By: Lisa Solod, Washington Monthly Political Animal, May 17, 2014

May 18, 2014 Posted by | Health Care, Veterans | , , , , , , | Leave a comment

“Are Guns A Public Health Issue?”: Let Us Count The Ways…

Is calling guns a public health issue a political statement? That’s become the underlying issue in the nomination of the White House’s pick for surgeon general, Vivek Murthy. In 2012, Murthy sent out a tweet: “Tired of politicians playing politics w/ guns, putting lives at risk b/c they’re scared of NRA. Guns are a health care issue.” The NRA got Senators to hurl the words back at him during a confirmation hearing, and seems to have convinced not just Republicans but some Democrats to vote against him. Now nobody is talking about bringing his nomination to the floor.

Let’s leave aside the issue of whether a Tweet should be the grounds for an opposition campaign, and of whether Murthy, best known for running an advocacy organization to support Obamacare’s launch, is the most qualified person for the job. If the question at hand is whether it’s partisan to believe that gun violence should be under the purview of the nation’s top doctor, it seems the answer is no. As Lucia Graves at National Journal chronicled last week, Ronald Reagan and George H.W. Bush’s surgeon generals, C. Everett Koop and Louis W. Sullivan, have professed the same view as Murthy without ruffling feathers. “Promoting reasonable gun policies does not make [public health professionals] ‘antigun’ any more than the Insurance Institute for Highway Safety is ‘anticar,’” wrote David Hemenway of the Harvard School of Public Health in his 2004 book Private Guns, Public Health.

Gun violence impacts health in all kinds of ways. There are the more obvious ones, like death and injury. As Olga Khazan pointed out at The Atlantic, suicide rates are higher in states where gun ownership is more common. In 2010, 19,392 people took their own lives with guns, while “justifiable homicides”—self-defense shootings that may have saved a life—numbered only 230. Over two-thirds of homicides and over half of successful suicides involve the use of a gun, and accidental gun deaths average about two a day. The U.S. spends $2 billion a year on medical care for victims of gun injuries; one out of three people hospitalized after shootings is uninsured, according to The Huffington Post.

Then there are the less obvious health effects of gun violence: Lead in the ground from ammunition. Loss of hearing from gunshots. Widespread PTSD that effects everyone from shooters, to victims, to bystanders. “Gun violence traumatizes whole communities,” Hemenway told me. This creates a cycle: “People with PTSD in inner cities often don’t have good access to mental health care, and it makes them more likely to be aggressive.”

Public health experts have a list of possible solutions that fall outside the most fractious debates over firearms. Stephen Teret, a public health expert at Johns Hopkins University, has pushed for the engineering of “smart guns,” which could only be fired by their owners: No more weapons finding their way into the black market, or becoming deadly playthings in the hands of children. (The NRA has fought the new technology.) Teret’s idea would address both intentional and accidental gun hazards, but there are lots of ways to approach the latter—from mandated child safety locks, to features that would make it more obvious if a weapon was loaded.

Hemenway also suggested changing the culture around some aspects of gun use, as a sustained campaign did for drunk driving in the 20th century. “One of the social norms should be that it’s your responsibility, if you’re a gun owner, to make sure your gun is not stolen,” he said.

The power of the surgeon general lies mostly in the ability to shape public conversation, and to do so he or she needs to maintain a high degree of trust, on both ends of the political spectrum. But sometimes advocating for public health means wading into controversial issues, like AIDS or smoking, because people’s lives are at stake. That means a surgeon general must be ready and willing to speak out on all kinds of hazards, even ones with powerful constituencies behind them. Those can include carcinogens from cigarettes, poisons from pollution, and, yes, bullets from guns.

 

By: Nora Caplan-Bricker, The New Republic, April 3, 2014

April 4, 2014 Posted by | Gun Violence, Guns, Public Health | , , , , , , | 2 Comments

“The Vets We Reject And Ignore”: Leave No Fallen Comrade Behind Applies At Home And To All Veterans, Regardless Of “Bad Paper”

Today, we honor the nation’s 22 million veterans, including more than 2.5 million who served in Iraq, Afghanistan and other fronts in the war against Al Qaeda. But we are turning our backs on hundreds of thousands of veterans who were discharged “under conditions other than honorable” and so do not qualify as veterans under federal law.

Their discharges, which include overly broad categories encompassing everything from administrative discharges for minor misconduct to dishonorable discharges following a court-martial, nevertheless make them ineligible for the health care, employment, housing and education benefits offered by the Department of Veterans Affairs.

Because of the “bad paper” they carry in the form of their discharge certificates, many of these veterans struggle upon leaving the military. And when they falter, the burden for supporting them falls heavily on their local communities because federal agencies cannot, by law, help them.

No federal agency publishes the numbers of bad paper discharges. But historical studies suggest that at least several hundred thousand veterans fall into this category. Approximately 260,000 of the 8.7 million Vietnam-era veterans were pushed out of the service with bad paper. More recently, according to documents separately obtained by the Colorado Springs Gazette, the Army discharged 76,165 soldiers between 2006 and 2012 with bad paper. Of these recent Army discharges, only one in seven were kicked out following a criminal conviction for a serious offense. The rest were discharged for smaller breaches of military discipline like missing duty or abusing alcohol or drugs. For many of them, their misconduct was likely related to the stresses of war.

Instead of showing compassion for these troops who were carrying the invisible wounds of war, their commanders kicked them out. These troops’ getting pushed out under such circumstances would be enough of a blow, but these commanders compounded the injury by giving them bad paper, instead of merely administratively separating them from the service.

While assessing the needs of veterans in the Western United States, my research team met with community leaders and nonprofit agency staff members in seven cities with the largest populations of veterans, and interviewed others in outlying cities and rural areas as well. Across these communities, veterans with bad paper were believed to be significantly overrepresented in the at-risk veterans populations. All too frequently these veterans become part of the nation’s chronically homeless or incarcerated populations.

When they end up in distress or on the streets, their communities must bear this burden alone.

We have a moral obligation to those who serve, especially those who serve us in combat. At times, the military must discharge those who can’t perform or conform. However, commanders should exercise far greater discretion and compassion in trimming the ranks. Bad discharges indelibly mark veterans as damaged goods and cost society a great deal too.

Congress should also allow the V.A. to more broadly provide mental health care, homelessness support and other forms of crisis intervention to veterans with bad paper. The V.A. has case-by-case authority to do so now, but that does not help veterans with bad paper who have acute needs. A more compassionate policy would not diminish the military’s ability to maintain discipline, nor would it cheapen the valor of those who have served honorably.

The military has a process to fix bad paper, but that process takes too much time, and veterans often need legal help to prevail in an incredibly bureaucratic and difficult process.

The story of John Shepherd Jr., who earned a Bronze Star for valor in Vietnam but was kicked out after disobeying an order to return to combat after developing severe post-traumatic stress disorder, shows how difficult these cases can be. Mr. Shepherd went without V.A. support for 40 years until a team of students and lawyers at Yale Law School helped him correct his record this month.

Excellent programs exist to help veterans in such cases, but they deserve more resources. Small investments in pro bono legal services can help unlock a lifetime of access to the V.A. and help the neediest veterans with bad paper move on with their lives.

Finally, the veterans community should do more to lift up those veterans who have been discharged with bad paper, particularly in those cases where combat experience lies at the heart of the bad discharge. The American military ethos calls on all of us to leave no fallen comrade behind. That applies at home, too, and to all veterans, regardless of whether they carry bad paper.

By: Phillip Carter, Op-Ed Contributor, Opinion Pages, The New York Times, November 10, 2013

November 11, 2013 Posted by | Veterans | , , , , , , , , | 1 Comment

   

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