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VA Squalor ‘Not A Money Problem’

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A retired U.S. Marine Corps gunnery sergeant prominent veterans advocate is fuming after new revelations that the Department of Veterans Affairs Medical Center in Washington is failing to meet even the most basic medical standards.

Employees at the center are imploring new Veterans Affairs Sec. Robert Willkie to take immediate action to change practices there.  They cite rusty medical instruments and bacteria-infected water being used to sterilize equipment.

The employees also report, “Infection rates went up instead of down in veterans’ bloodstreams and in their urinary tracts. Patient satisfaction went down instead of up. Employee satisfaction tanked.”

Jessie Jane Duff served 20 years in the Marine Corps, rising to gunnery sergeant.  She is now a senior fellow at the London Center for Policy Research.

“This sounds like a third world hospital and yet it’s right at the back door of the VA headquarters itself right here in Washington, D.C.    It’s tragic.  This is one of the flagship hospitals for the VA,” said Duff, noting the facility is one of fifteen nationwide with the lowest rating.

“If it was a restaurant, it would have been shut down,” she added.  “Here is an example of basic healthcare that is being handled in such an incompetent manner.  I mean rusty instruments?  Water that you can’t even drink from?  What is going on?  Are we actually in combat?  Are we in a MASH unit?  Even then, their standards are higher.”

As a result of the VA scandal earlier this decade, funding for the department was effectively doubled.  Duff says these conditions are not due to a lack of resources.

“The VA gets the second largest bucket of money next to [the Defense Department].  So this is not a money problem.  This is a management problem.  It’s an accountability problem.  Until you’re able to bring in positive leadership with positive change. with the capability of removing those bad apples that have allowed these problems to fester, then you essentially have a status quo of business as usual,” said Duff.

Duff says legislation signed by President Trump last year does make it easier to fire the “bad apples” and also gives veterans more flexibility to find care outside of the VA system.  However, there are still problems, including veterans only getting access to private sector care if they live a certain distance from a VA facility.  Private providers are also have trouble getting reimbursed from the VA.

With the bureaucracy grinding the system to a halt and sometimes not even putting clean medical instruments into use, Duff says the American people should take a good look at the VA.

“My question to the American people is, ‘Do you see why government-run health care has never helped those that are using it?’  It sounds like an easy fix.  It sounds like a possible solution to problems, but what often happens is when you remove private enterprise from the equation, there is not a sense of responsibility,” said Duff.

She says these problems must be dealt with soon or military enlistments will drop.

“We cannot have a nation where we do not take care of those who sacrificed the most, who signed a blank check with their life or their limb for us.  That is critical.  Who will volunteer for the military if they ever see that this is the end result in their final years of life or even when they’re only thirty-something years old and need health care,” said Duff.

But what should happen now to make sure we never see similar conditions at another VA facility?  Duff says President Trump must make it clear this is unacceptable on his watch.

“This is one thing that President Trump ran on.  He stated that the VA bureaucracy was something that needed to be taken care of,” said Duff, who encourages Trump to use his Twitter account to call out those responsible.

Regardless of the public relations strategy, Duff says the problems must be solved.  She says the courage of the employees at the D.C. facility is a great first step, but meaningful change must follow.

“I admire them for speaking up and if it is being covered up, let’s crack this open.  Let’s get this exposed.  Let’s have the media go after it.

“I’ll tell you right now, President Trump is not going to tolerate veterans dying on his watch due to a lack of care run by the very system, by the very people he has now appointed.  I expect that he will be very aggressive about this,” said Duff.

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Conservatives Push ‘Better Deal for Black America’

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Black Americans can escape the cycle of failed schools, rampant poverty, and government dependence if America as a whole embraces the proven values that made our nation the envy of the world, according to a new report from the conservative Project 21 Black Leadership Network.

Entitled “Blueprint for a Better Deal for Black America,” the report offers 57 proposals in ten different policy areas that Project 21 believes would lead to a thriving U.S. and a resurgent black community.

The proposals range from taxes to criminal justice reform to relations between police and local communities, but education is central to the goal of lifting black families to stability and prosperity.

Statistics show just 38 percent of blacks earn a four-year college degree in six years, compared to 62 percent for whites, 63 percent for Asians and almost 46 percent for Hispanics.

Project 21 Co-Chair Horace Cooper says failing schools are not preparing many black students for college.

“What you’re seeing is a disproportionate number of graduates at these places can barely read the diploma that they’re given.  In 2017, six percent of black high school students who took the American College Testing exam (ACT) met the four benchmarks that were necessary for college readiness,” said Horace.

He points out only 35 percent of white students met those benchmarks, along with just under 50 percent of Asians.  Cooper that is an indictment of our public schools across the board.

“In Europe and much of Asia, they are insisting that their education system deliver for their young people.  In America, we’ve been much more interested in letting bureaucrats get cushy jobs and make sure that unions get the support that they need, rather than insisting we absolutely need our kids to be able to read the diploma that we hand them when we graduate,” said Cooper.

He says this is a crisis that must be addressed now.

“The main thing we’re trying to emphasize with this report is that there are certain strategies and policies that have the effect of hurting people who are working class and poor.  Minorities tend to be more disproportionately poor,” said Cooper.

“Our public school systems in too many inner cities are simply failing.  Black Americans are disproportionately enrolled in these failing schools,” he added.

Cooper says nothing has changed despite decades of poor results.

“Many of these cities refuse to incorporate ideas like competition, school choice, opportunities to let the faith community play a role.  And they often have a very hostile attitude about even parental involvement,” said Cooper.

And, in a toxic pattern, inner city students with a poor education see few options when they become adults.

“If you are not equipped to compete in the 21st century marketplace, you are going to suffer dramatically and you may end up feeling forced to pursue non-legal means of providing for yourself,” said Cooper, who says the other common alternative is to live off government assistance programs.

Cooper says local governments need to start threatening to decrease funding unless results improve, instead of throwing good money after bad in failing schools.

He also says America must again embrace the principles that made us the envy of the world.

“It started with the building blocks, family.  It started with faith, free markets, personal responsibility, limited government.  These attitudes, these strategies led to America’s success and they will lead to any group’s success,” said Cooper.

He says liberal intellectuals started gutting those principles and convincing millions of people to follow a different course.

“A bunch of seemingly smart people said we don’t need those things.  ‘Family?  That’s so yesterday.  We need Washington, D.C., bureaucrats to come in and dictate.  We need massive government.  Free markets can’t be trusted,'” said Cooper.

Cooper says Ronald Reagan proved twenty years later that the ethos of the 1960’s was wrong but the fight still goes on to return to the formula for American success.  Cooper is confident it’s not too late.

“If we do it again with intentionality, we can do it in America and end a lot of the poverty that we see,” said Cooper.

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The Dire Need for Civil Service Reform

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President Trump fired a major shot in the effort to enact civil service reform during his State of the Union address on Tuesday, creating what one leading workforce expert hopes will be an effort to root out the “intransigence and incompetence” from the federal workforce.

In his speech, Trump hailed the passage of legislation in 2017 that gave more authority for Veterans Affairs Secretary Dr. David Shulkin to fire people failing to perform at levels needed to provide veterans the service they deserve.  He then said that flexibility should be available to all cabinet secretaries.

“Tonight, I call on Congress to empower every cabinet secretary with the authority to reward good workers and to remove federal employees who undermine the public trust or fail the American people,” said Trump.

American Legislative Exchange Council Education and Workforce Development Task Force Director Inez Stepman studies civil service issues and detailed the problem in a Federalist column Wednesday.

Stepman says getting rid of most incompetent and uncooperative federal workers is exceedingly difficult.

“I think the average American has very little idea how difficult it actually is to fire a federal worker.  The process is usually over 300 days long.  It includes two appeals that are conducted at the same standard of proof as a civil trial.

“That means there is a discovery period.  You can call witnesses.  You can call Bob from across the cubicle and say, ‘Well, Bob says I’m doing a great job.  Why are you firing me?'” said Stepman.

She says the recent false alert for a missile attack in Hawaii is a perfect example of the problem.

“The guy who believed the drill in Hawaii and then sent out that horrible message that basically said, ‘Duck and cover, there’s a nuclear missile on the way to Hawaii,’ that guy was known to be a problem in the department for ten years.  but you can’t get rid of someone like that under our current civil service laws,” said Stepman.

It doesn’t have to be that dramatic.  Stepman says Americans are plagued by slow, subpar service on a daily basis.

“Almost anyone who’s ever tried to apply for a passport, who’s ever tried to go to the DMV, who has ever tried to go to any government outlet – since this is a problem at the state level as well – has been frustrated with how slow and incompetent government employees seem to be.  And this has a lot to do with that,” said Stepman.

Current civil service laws largely stem back to legislation passed in 1883 that was designed to make civil servants apolitical by hiring based on merit and making it very difficult to remove them by the changing of administrations.

Instead the system left Americans stuck with with too many slow and incompetent workers.  But Stepman says the impact on the functioning of our government is the bigger problem.

“It’s a deeper constitutional problem.  We have 2.8 million federal workers all over the country, but many of them in D.C.  They have very little political accountability.  They stay in office no matter who the people vote in or what policies the voters want to be enacted,” said Stepman.

The other goal of the 1883 reforms was to keep civil servants politically impartial.  Stepman says Federal Elections Commission records from 2016 prove that effort a failure too.

“Ninety-five percent of the donations over $200 that were made by federal employees went to Hillary Clinton in 2016.  It was 99 percent at the State Department.  That’s not an apolitical civil service.  That’s a civil service that has its own interests in growing government.  We’re talking about millions of people who make decisions for the American people, where the voters have absolutely no say over whether they stay or go,” said Stepman.

Stepman says we see this bias rise up against President Trump on a regular basis.

“Even in instances where you can see President Trump is trying to shake something up, often times he’s dealing with a flood of leaks.  He’s dealing with openly rebellious staff in most of his departments.

“Those people cannot be fired.  Donald Trump cannot say, ‘You are obviously trying to slow walk my policy…It’s time for you to go.  If you can’t get in line with the program the American people voted for, it’s time to get someone else.’  He can’t do that, nor can any other president.  Bill Clinton complained about the same thing,” said Stepman.

Stepman says some states are addressing the problem.  Georgia, for example, changed their hiring policy for state employees and is now seeing a big difference.

“The State of Georgia, a couple decades ago, said all their new hires would be at-will.  They couldn’t do much about the union contracts from the past, but all their new hires were going to be at-will.  Now their civil service is about 88-90 percent at-will and functioning a lot better than most other states,” said Stepman.

She says following the template of the Veterans Affairs reform bill would be a great legislative plan at the federal level.

“I think an easy first step would be to take the exact same language from that VA bill that was passed overwhelmingly with both parties and say, ‘Why is this only good for the VA?  Don’t you want the Department of Education or the Department of Energy to have the ability to cultivate a good workforce as well,” said Stepman.

Stepman expects labor unions and other interests to fight back if this idea gains legislative traction, but she says the push is now on after Trump’s speech.

“President Trump saying this as part of the State of the Union is the first major coverage this issue has received outside of super wonky circles.  So I think it’s important that we keep informing the American people about the fact that federal employees enjoy so many job protections that most Americans do not at their jobs,” said Stepman.

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Feds, Insurers Creating Fearful Doctors

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Tightfisted insurance companies and dizzying government bureaucracy are squeezing the art out of medicine, forcing doctors to use one-size-fits-all approaches with patients, and needlessly putting the lives of patients at risk, according to a patient advocate and “My Life is Worth It” Co-Founder Bob Tufts.

Tufts pitched in the major leagues, went on to become a Wall Street executive, and now teaches at Yeshiva University.  He says he never missed a day of work in 30 years before getting a series of small colds a number of years ago.  His doctor ordered tests that confirmed Tufts was suffering from multiple myeloma, a cancer of the bone marrow.

Thanks to excellent instincts by his doctor and the embrace of a novelty drug therapy including thalidomide, Tufts says he felt largely back to normal within nine months.

But he says his experience is far from normal, starting with doctors willing to do extra tests to hunt down possible ailments.

“They’re getting scared to do it because many doctors have been forced, due to the cost of electronic health records and all the government mandates into hospital systems.  And the more you’re into a system, they’ll over-regulate what the doctor can and cannot do,” said Tufts.

He says the art of medicine is lost as a result and doctors are instead practicing the science of medicine and simply treating patients based on the odds.  Tufts says if he lived in the United Kingdom or some other country with government-run care, he’s probably be dead.

“When I was diagnosed, my drug was just approved for off-label use in the United States.  It was not approved in the UK.  And frankly, for front line use it was not approved until much later,” he said.

“Considering the way my cancer was high-risk, by the time I’d have begged, borrowed or whatever to try to get this drug and maybe used other ones which were harsher, I’d probably have been dead under the [National Health Service] and [National Institute for Health and Care Excellence] system,” said Tufts.

He says anytime the government gets involved in making the rules and paying the bills, the health care priorities move farther and farther away from what’s best for the patient.

“Unfortunately, as we have more and more government use and control of health care, it becomes a budgetary issue, as we’re seeing in many of the debates going on.  The more the government controls, the more it’s on a budget line and people start thinking about what that number is on the line and look at people as little pixels on a chart, not as humans trying to fight to survive,” said Tufts.

“We create a bureaucracy and what does a bureaucracy do?  It feeds upon itself.  It creates more layers and makes it more confusing for patients and anyone who enters this Byzantine system,” said Tufts.

And Tufts sees that frustration up close.

“Let the doctors practice the art of medicine and the science of medicine as opposed to spending 50,000 a practice to fill out these forms.  It drives me crazy.  Even though I love my oncologist, of our 15 minutes together, over half is spent looking at the computer entering codes so he can be paid appropriately.  That’s nonsense and a waste of time and money,” said Tufts.

But Tufts is clear to point a major finger of blame at insurance companies who increasingly challenge their responsibility to pay for novel courses of treatment.  He says the insurers force patients to jump through cruel hoops in an effort to save money.  Again, it’s not something he’s been faced with but many of the people he helps deal with it every day.

“You found out how other people were being basically denied care by step therapy or fail first.  You are to take the older, cheaper medicine for at least 30-60 days before they would allow you to try another medication,” said Tufts.

“I had a dear friend who they did that to who had terrible neuropathy, who the insurance company made go through the hell of pain for 30 days before they gave him the meds.  What was the cost difference?  Four dollars.  Over four dollars, they made a man suffer,” said Tufts.

At other times he says insurers force patients down an unnecessary, far more expensive track.

“[They are] making people go to the hospital and having the liquid transfusions as opposed to, in my case, being able to take a pill at home.  The cost out-of-pocket of going to hospitals twice a week for a transfusion versus taking a pill every day.  Those two things really got me going and I found out I was really fortunate compared to many other cancer or rare disease patients,” said Tufts.

And Tufts says the bean counters at the insurance companies are making doctors’ lives miserable too.

“I have personally seen my oncologist get on the phone and, in my early stage of treatment, and spend 15-20 minutes arguing with an insurance company that, ‘This person needs this treatment.  This is what I recommend.  This is a standard of care,’ and having the hemming and hawing  and seeing the time wasted by my doctor basically having to beg for me to keep the care that would keep me alive,” said Tufts.

Tufts says he would like to get lawmakers in a room and “knock heads” until they agreed on solutions for the current health care system.  He also thinks doctors and patients should be helping to draft legislation and that lawmakers should not just rely on number crunchers to arrive at a final bill.

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Trump’s ‘Unfortunate Decision’ on Iran

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President Trump made an “unfortunate mistake” by re-certifying the Iran nuclear deal on Wednesday and he was pushed into a decision he didn’t want to make through the power of an entrenched government bureaucracy, according to former U.S. Ambassador to the United Nations John Bolton.

On Monday, after almost an hour of animated debate with his national security team, President Trump reluctantly declared that Iran is complying with the terms with the 2015 Joint Comprehensive Plan of Action, or JCPOA, hammered out by the Obama admnistration, Iran, and five other nations.

“It was an unfortunate decision for the administration to issue this certification,” said Bolton.  “I think the president was blindsided by the bureaucracy.”

Bolton, who served in the State Department during the first term of the George W. Bush administration, says the foreign policy bureaucracy is a powerful force in Washington.

“It was the bureaucracy on autopilot from the Obama administration.  If you don’t tell them to change direction, they just keep doing what they were doing before,” said Bolton.

But it’s not just Obama holdovers pushing the status quo.  Reports confirm that Defense Secretary James Mattis, Secretary of State Rex Tillerson, National Security Adviser H.R. McMaster, and Chairman of the Joint Chiefs of Staff Gen. Joseph Dunford all pleaded with Trump to re-certify the agreement.

Bolton says the bureaucracy has a way of winning over new cabinet members to embrace existing policy.

“The bureaucracies have a way of capturing the appointees.  Some of those (Trump officials) are still in the bureaucracy or never really left it.  It’s an art form.  People who know Washington, particularly who have watched the State Department seduce political appointees, especially Republicans and they make reasonable-sounding arguments that are simply justifications for continuing the prior policy,” said Bolton.

The Iran deal has now been re-certified twice in the first six months of the Trump administration.  Each time, the official recognition of Iranian compliance has been accompanied by a Trump administration denunciation of Iran’s human rights record and sponsoring of terrorism.

Bolton says the disconnect is jarring.

“It’s a committee camel that came out and it reflects the confusion that happens when you don’t give the president options and when you don’t allow time for a full debate.  Those mistakes will not be made again,” said Bolton, who firmly believes Trump will not certify the agreement again.

Those who applauded the decision to re-certify say abrogating the deal would create a great deal of chaos, particularly with our allies who were part of the negotiations with Iran.

Bolton doesn’t think that should be a deterrent from doing the right thing.

“If the allies are going to be upset by something, what you do is a vigorous diplomatic campaign to explain why we think the deal was a mistake, indeed why they made the same mistake we did, and why we’ve got to correct it before it’s too late,” said Bolton.

“The consequences of a bad deal are a regime of religious fanatics in Iran getting nuclear weapons,” said Bolton.

Bolton says the problems with the JCPOA are legion, starting with the painfully unclear language that he says Iran can manipulate and insist it is meeting its obligations.

“Many provisions of the deal are so badly worded, they’re so ambiguous, that a reasonable person could say, ‘The Iranians came right up to the line of their interpretation of the deal and they didn’t cross it so it’s hard to say it’s really a violation.’  That’s the argument,” said Bolton.

“That argument fails for several reasons.  First off, the fact that the agreement is badly worded is one more reason to junk it.  It shows just how poorly our negotiators, including Secretary of State John Kerry, did.  It shows the leeway that it affords Iran.  And it shows the way forward.  They’re going to press the ambiguities right to the outer limit,” said Bolton.

And he expects Iran to eventually blow right past those limits.

“If they can hide what they’re doing, they’re going to press beyond the outer limits and make it impossible to enforce the deal strictly.  That’s part of the problem.  The deal is so bad that trying to enforce it strictly is like trying to nail jello to the wall,” said Bolton, while also nothing the deal offers no inspections of Iranian nuclear sites and has no binding provisions concerning ballistic missile development.

Bolton says the bottom line is that nothing has changed as a result of this agreement.

“Iran has never abandoned its policy to get deliverable nuclear weapons.  It’s exploiting this deal.  It’s made temporary, easily-reversible concessions.  It’s cooperating with North Korea, which is getting ever closer to its own deliverable nuclear weapons capability,” said Bolton.

“We’re living in a delusion if we think this deal is slowing Iran down,” he added.

So what is the right U.S. posture?  Bolton says the U.S. bring back economic sanctions immediately and be prepared to do whatever needs to be done to prevent Iran from being able to deploy nukes.

“To be realistic, if we don’t want Iran to have deliverable nuclear weapons, if that’s really what we believe, we and Israel have to look at a military option,” said Bolton.

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Getting in the Way of Good Medicine

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Insurance companies are more frequently refusing to cover the cost of prescription drugs, even when their plans promise that they will.  This leaves patients less healthy and pharmaceutical companies stripped of incentive to innovate.  American Society for Preventive Cardiology President Dr. Seth Baum explains why this problem is getting a lot worse, why it could stifle the advancement of new medicines and how individual patients can be a vital part of the solution.

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Battling the Bureaucratic Leviathan

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Galen Institute President Grace-Marie Turner explains how government and private sector bureaucracy teamed up to drive the price of health care out of reach for tens of millions of Americans and why the Affordable Care Act only made things far worse.  Turner also discusses why she believes the new Republican plan will succeed in bringing costs down and removing Washington from the doctor-patient relationship.  Finally, she explains the factors that must be addressed to lower the cost of prescription drugs.

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