ACADEMIC CULTURE IN AMERICA: CHAPTER I

 Is Education a culture of its own?

   Def: CULTURE [1]

   : the beliefs, customs, arts, etc., of a particular society, group, place, or time

   : a particular society that has its own beliefs, ways of life, art, etc.

   : a way of thinking, behaving, or working that exists in a place or organization           (such as a business)

Let’s have a look…

Could education be considered its own culture? I’m inclined to answer “yes” to that question. The fact is our public education system is available to all who qualify. That is a sizeable number of participants and Public Education may indeed be the largest segment of this Country’s culture/society.

I, for one, lose sleep wondering and imagining where our Public Education system is going. For some of us who remember the past six decades, our public school system ran under Federal protocols that had no problem producing doctors, lawyers, scientists, engineers, and the like. Were there inequities from State to State? Yes, there were some “off the rails” interpretations of Federal guidelines.

Starting in 2000, it didn’t take long, and by 2005 our Federal Congress started seriously trying to fix something that wasn’t broken. Mismanaged and frayed around the edges, yes, but not broken. In true fashion, Congress did not make this fix a priority all on their own. As in life, so it is in politics. Money rules the day. So, just follow the money to identify the “players”. Keep in mind that this was about the time that “corporations” started taking over control of our Federal Prison system, too. By 2005, they had their greedy little eyes drawn on the education system. So, for the sake of their corporations, privatizing every damn Federal Institution was on the table to be taken over by the private sector (The Department of Veterans Affairs being the most prominent on the list).

I usually don’t focus on empirical numbers; it makes my head hurt. However, when I started perusing the numbers on our education system, I had no option than to pay attention. Let’s look at a few of these numbers as they are pertinent to a disappearing part of our overall culture.

How many public schools:

There are 130,930 K-12 schools in the U.S., according to 2017-18 data from the National Center for Education Statistics (NCES). Here’s how they break down:

All: 130,930

Elementary schools: 87,498

Secondary schools: 26,727

Combined schools: 15,804

Other: 9

Traditional public schools: 91,276 (2017-18, Source)

Public charter schools: 7,427 (2018-19, Source)

Private schools: 32,461 (2017-18, Source)

There are 13,551 regular school districts in the U.S. (2017-18, Source)

How many students attend public schools?

In America’s public schools, there are over 50.6 million students, based on federal projections for the fall of 2021.

How many students attend charter schools?

According to data from three years earlier, almost 3.3 million public school students, or 6.5 percent of all public-school students, attend charter schools.

How many students attend private schools? What are the religious affiliations of those schools?

In total, 5,719,990 students attend private schools, according to NCES 2017 data.

37.4% of those in Catholic schools

24.4% in nonsectarian (non-religious) schools

15.2% in un-affiliated religious schools

12.0% in conservative Christian schools

11.1% in other religiously affiliated schools

Note: numbers may not add to 100 due to rounding.

How many students are home schooled?

There are an estimated 1,755,233 homeschooled students. That’s 3.23 percent of all students, according to NCES 2019 data. After doubling between 1999 and 2012, the number of homeschooled students in the United States appears to have leveled off. So, who are the nation’s homeschoolers? This overview of homeschooling includes more information on the topic. [2]

Have we already gone.......

From This……............To This?

The “Center for Media & Democracy” (CMD) has taken up the cause of exposing the wonderful folks who are bringing us to the end of Public Education. I recall the days when “Charter Schools” were all the rage, and listening to the call that this was going to be the saving grace for our Nation’s education system. Well, looks like they are finally getting their cake and eating it, too. The CMD has launched a project called “OutsourcingAmericaExposed.org”. They’ve come up with an initial accounting of twelve corporations that have made serious inroads on the take-over of our Public Schools. It is not lost that, coincidently, our State and Federal prison system is being taken over in a similar fashion.

 “No, a little “consulting” firm called K12, Inc. has nothing to do with mountains in Nepal. They have everything to do with little Johnny’s kindergarten through twelfth grade education. The corporate classroom is where our children and grandchildren are headed to be educated exactly how the owners of this Country see fit. Only one small glitch so far. They haven’t been experiencing much success.

With only ¼ of their schools making the grade, they are struggling to meet even the least strenuous State and Federal criteria. What these grifters do extremely well is get paid. One of these grifters took in a cool $19 million for 2013 (according to their 10-k report). The same report boasts of $848.2 million in gross income for 2013 with $730.8 million coming from their “managed public schools”. You may ask, “Where the Hell do they get this kind of money?” The answer isn’t going to surprise you, but it sure as Hell better concern you. This money comes from diverted educational funds allocated by the U.S. Congress. Yup! Your tax dollars are funding this supposedly capitalistic venture in educating our youth.”

According to a release by the Center for Media and   Democracy, there are twelve major players, so far, making “phatt” money off the spoils of Federal taxation. When was the last time you ran into a teacher who was making $19 million, and whose company investors were the likes of Mike Milken and Wall St. investment firms?...........................  I didn’t think so! [3]

By looking at the sheer numbers involved and the definition of “culture”, our public education system certainly can be considered a culture. The big difference here is that most cultures this large take many hundreds of years to change their core principles and lifestyle. We seem to be doing it in mere decades. It’s simply wonderful how quickly life moves along, when it’s packed with enough greenbacks!

If children can’t learn the way we teach,

maybe we should teach the way they learn.

References:

[1] https://https://www.merriam-webster.com/dictionary/culture

[2] https://www.edweek.org/leadership/education-statistics-facts-about-american- schools/2019/01

[3] https://en.wikipedia.org/wiki/Center_for_Media_and_Democracy

 

SECOND LARGEST BUDGET...WORST PERFORMANCE

 NOT ALL THE BAD GUYS ARE IN JAIL

STEEPED IN CORRUPTION FROM THE START

A Veterans Administration Medical Center – Northport, NY

the land purchase & occupation:

1925

Construction1926-1927

First occupants

1928

@@@

The Observer
The Northport VA Medical Center

May 29, 2020

Teresa Reid is curator for the Northport Historical

Society, author of the book Northport, and a

columnist for The Observer.

Northport VA Medical Center

Shortly after WWI, it became apparent to Congress that the returning veterans were not able to obtain the proper medical and psychological treatment they needed and deserved. To rectify this situation, President Harding established the US Veterans Bureau in 1921, which assigned Public Health Service hospitals to the new agency’s control. 

Under the supervision of Brigadier General Frank T. Hines, a committee was formed to choose a site in the New York area for a new modern and specialized health care facility. In 1925, the committee, after scouting hundreds of locations in the tri-state area chose the small, picturesque village of Northport. 

Residents, having learned plan to purchase 522 acres of farmland in the Middleville area, rallied together in protest. Public hearings were held where citizens voiced their concerns about another such hospital, like the one in King’s Park and Islip, coming to Suffolk County. The people in attendance thought land values would decrease, businesses would suffer, and traffic would stress the small unpaved roads. A resolution was drawn up and sent to the NY Representatives. Two weeks later, a delegation from Northport led by Mr. R. B. Jones, went to Washington DC and appeared before the Federal Board of Hospitalization. Among the list of disputes: the land was too expensive. Why had the Federal Government paid $350 an acre, double the going rate? 

The property once owned by Rinaldo Sammis (hence Rinaldo Road), was then owned by Mrs. Inez Todd Hodges. Just before the land purchase though, the land became the property of rich and powerful copper industrialist Ryan ^[1], who had made a fortune during the war. It seems that, for reasons unknown, Mrs. Hodges was in debt to Mr. Ryan for over $100,000. They struck a deal. He would sell the land for her to pay off her debt and anything over the debt amount, would be extended to her. Ryan sold the property to the government at the inflated price, perhaps because of powerful friends doing a favor, Mrs. Hodges never saw a dime, and Northport resident’s concerns fell on deaf ears.

Construction began in August of 1926. The plan of the Medical Center is based on the standard set plan developed by the Veterans Bureau in Washington DC for all such facilities in the U.S. Between 1920 and 1946, the Bureau built 50 Veterans’ hospitals across the country, constituting the most ambitious and most advanced health care delivery system in the world at the time.

The original Medical Center in Northport was built for $3,386,518. The 956-bed facility offered a campus-like setting with beautiful landscaping, out-door recreational facilities and paved roadways. The exterior design was approved at the highest level of the VA in Washington but reflected the historical nature of Northport Village. Thus, the style selected, Georgian Colonial home, is unique among the VA system. 

The first patients were admitted on April 16, 1928 with Doctor George F. Brewster as the Medical Officer in Charge and the Center soon became a source of pride for Northport.

Patients received the most current treatments and therapies of the time, there were no bars on the windows, there was a swimming pool, large porches, and community dining rooms. All the cooking was done with electricity in the large kitchen. A large recreation room seated 1,000 patients, contained a stage, scenery, and dressing rooms. The Center was equipped with x-ray machines, a research lab, and an operating room. Dental care was also offered. It became its own little community, with farms, a fire department, general store, mechanic shop and its own baseball team, the “Wildcats.”

Patients were kept busy with occupational and agricultural therapeutic programs, such as carpentry, textile making, painting and farming. They ate the fresh vegetables they grew, including potatoes. They also had “chores” taking care of gardens or working in the stables. Chickens, pigs and sheep were raised for research purposes. Many of these programs lasted until the 1960s.

During WWII, many activities were curtailed due to fuel shortages, however the hospital maintained a “Victory Garden.” Many employees joined the armed services and as a result military personnel were assigned to fill the vacancies. One of the enlisted men assigned to the hospital was actor Sidney Poitier. After the war the hospital’s ecumenical chapel was built as a gift from the readers of the New York Journal American.

In the 1950s, Northport’s hospital was one of the first psychiatric hospitals to treat patients with newly discovered drugs and was pioneering programs like group therapy and community out-placement, earning them an award for its accomplishments. After the Korean and Vietnam Wars the increasing number of veterans forced the Medical Center to expand, providing general medical and surgical care. Many new buildings were constructed, and the farm-setting community atmosphere changed dramatically, however, patient care was always their number one goal. 

In the decades that followed, the Northport Veterans Medical Center has had to continually adapt to change as it finds itself doing once again during the Covid-19 Pandemic. On March 27th the VA released its Covid-19 response plan and announced its “Fourth Mission”, a plan to help the U.S. combat the virus. 

Reference(s):

[1] - John Dennis Ryan (October 10, 1864 – February 11, 1933) was an  

         American industrialist and copper mining magnate. He served as

         President of the Anaconda Copper Mining Company and was a founder

         of the Montana Power Company.

LINK:   https://teresareid.com/f/the-northport-va-medical-center

United States Third Generation Veterans Hospitals, 1946-1958

Investigation into Veterans Administration Practices, 1945 The condition of these Veterans Administration facilities led to a public demand that returning veterans deserved only the best, modern facilities, and not the old-fashioned hospitals of the past. In early 1945, Albert Deutsch, a journalist with a particular interest in the care of the mentally ill, published a series of articles in the New York City newspaper PM that criticized the medical care provided by the Veterans Administration. Deutsch conducted a survey of multiple VA facilities and interviewed VA staff including General Hines, lower-level employees, doctors, and members of veterans’ groups. Deutsch identified multiple problems within the Veterans Administration, including a “medieval attitude towards medicine” that discouraged young doctors from joining the VA, limited medical research, a massive bureaucratic system that restricted the time doctors spent with patients, and “undue kowtowing” to political pressures. ⁶⁰ While Deutsch acknowledged that the Veterans Administration likely did not suffer from the same corruption that had triggered the scandal that led to the Hines appointment in 1923, he condemned the administrator’s ability to provide the necessary medical care for the veteran population. At one point, Deutsch suggested Hines must adhere to the tenets of Christian Science, a faith reliant on prayer over medicine for healing, as it could be the “only logical explanation for his otherwise incomprehensible antagonism to medicine.” Hines responded he was Episcopalian.⁶¹ Deutsch identified multiple ways to fix these problems. Suggestions included creating a VA medical corps independent within the Veterans Administration, constructing new hospitals in urban areas near medical schools, forging connections with medical schools to ensure the Veterans Administration’s doctors were aware of the latest research and medical innovations, allowing young doctors to intern at Veterans Administration hospitals, convincing the American Medical Association to permit the VA’s doctors to join, hiring African-American doctors and nurses, and “break[ing] down the isolationist tradition in the VA system.”⁶² These charges and calls for an investigation were echoed in other publications, including the Journal of the American Medical Association, Cosmopolitan magazine, and the New York Times, which claimed “more attention has been devoted to the construction of monumental hospital buildings than to the standards of care within them.”⁶³ The New York Times summarized the complaints alleged “brutal treatment, unwarranted overcrowding, neglect, improper care, poor food, bad sanitation, and inferior medical care.”⁶⁴ The Veterans Administration responded with denials, but acknowledged there may be isolated incidents that were the result of issues with under staffing rather than a systemic problem.

References:

60 Alfred Deutsch, “Vets’ Setup Needs Revamping Now to Avert Scandal,” PM, January 7, 1945, 6.

61 Alfred Deutsch, “Program for Vets: Remove Hines,” PM, March 14, 1945, 8.

62 Deutsch, “Vets Setup,” 6; Alfred Deutsch, “Hospitals Should be Freed from Medical Isolationism,” PM, March 15, 1945, 5; Alfred Deutsch, “’Paper Work Doctors’ in Vet Hospitals Should be Freed to Relieve Shortage,” PM, March 16, 1945, 9.

63 Leo Egan, “Veteran Hospitals Widely Criticized,” New York Times, May 16, 1945.

64 Leo Egan, “Veterans Critical of their Hospitals,” New York Times, May 17, 1945.

reference:   United States Third Generation Veterans Hospitals, 1946-1958 (penndot.gov)

AND, ON, AND ON, AND ON………...”AD INFINITUM”.

Considering what has happened over the past twenty years, It appears absolutely nothing has changed: not the direction of the Hospital; not the upkeep of the buildings & grounds; not the treatment of employees; not the management of outside contractors; not the treatment of medical students and interns; and above all, not the treatment of Veterans.

1] May, 2016

Northport VA Hospital Forced to Shut Down Operating Rooms

By Kristina Rebelo

{!! Guess what? It did happen, again. Luckily their portable A/C units, which had been rented (about $30,000 per month). This was a much shorter outage due to their previous experiences.}

2] September/2016

Deaths, Fraud Allegations and an Inquiry into the Long Island Veterans Hospital 

3] April, 2018

Schumer: Northport VA needs $15M in emergency repairs

By Sara-Megan Walsh

“Standing in front of Northport Veterans Medical Center’s shuttered homeless shelter on Monday morning, U.S. Sen. Charles Schumer (D-NY) said the center requires $15 million in emergency repairs to its heating and air-conditioning systems. Or, it faces the possibility of closing more buildings and its operating rooms again this summer.  

4] June, 2019

Head of Long Island VA hospital quits after year on the job

“The VA hospital has been without a full director since Scott Guermonprez left abruptly…”           

The list of all things anti-Veteran and anti-employee is enormous. Even a long time researcher would be overwhelmed by uncovering the scabs at the Northport VAMC over the 100 years of its existence.

 

 

DO THE RICH EVER GO TO JAIL

 NOTE: I have embellished this article with a few pictures from my file.

That's what I'm talking about!

DO THE RICH EVER GO TO JAIL

NOTE: I have embellished this article with a few pictures from my files.

 It has been thirteen years since our Nation’s financiers brought us to our knees by concocting a plan to get rich with a “sub-prime” mortgage scheme. Collectively, they stole Billions from us and our economy. They came very close to tipping the entire world upside down financially to the tune of Trillions of dollars. Companies like AIG, Goldman Sachs, Lehman Brothers, JP Morgan Chase, Bank of America and Morgan Stanley turned out to be the bad actors involved in the sub-prime mortgage-backed securities.

Only one of the top executives in these, and other, companies that cooked up and cashed in on the phony financial boom has ever been convicted…ever! And, he was simply the low-hanging fruit. All these years, and no one except Bernie Madoff, 17.179 billion, has been indicted, tried, and marched off to the slammer. $14.418 billion was recovered leaving almost 3 billion just floating around the universe. On April 14, 2021 Has anyone ever questioned why this happened?

“Why Isn't Wall Street in Jail?“⁽¹⁾

A good question............

Matt Taibbi, author of the book "Griftopia” (which I recommend) and Rolling Stone reporter writes:

 Financial crooks brought down the world's economy — but the feds are doing more to protect them than to prosecute them. Over drinks at a bar on a dreary, snowy night in Washington this past month, a former Senate investigator laughed as he polished off his beer. “Everything’s f@#ked up, and nobody goes to jail," he said. "That's your whole story right there. Hell, you don't even have to write the rest of it. Just write that. “I put down my notebook. “Just that? “That’s right," he said, signaling to the waitress for the check. "Everything's f@#ked up, and nobody goes to jail. You can end the piece right there. “Nobody goes to jail”. This is the mantra of the financial-crisis era, one that saw virtually every major bank and financial company on Wall Street embroiled in obscene criminal scandals that impoverished millions and collectively destroyed hundreds of billions, in fact, trillions of dollars of the world's wealth — and nobody went to jail. Nobody, that is, except Bernie Madoff, a flamboyant and pathological celebrity con artist, whose victims happened to be other rich and famous people. The rest of them, all of them, got off. Not a single executive who ran the companies that cooked up and cashed in on the phony financial boom — an industry-wide scam that involved the mass sale of mismarked, fraudulent mortgage-backed securities — has ever been convicted.

Their names by now are familiar to even the most casual Middle American news consumer: companies like AIG, Goldman Sachs, Lehman Brothers, JP Morgan Chase, Bank of America and Morgan Stanley. Most of these firms were directly involved in elaborate fraud and theft. Lehman Brothers hid billions in loans from its investors. Bank of America lied about billions in bonuses. Goldman Sachs failed to tell clients how it put together the born-to-lose toxic mortgage deals it was selling. What's more, many of these companies had corporate chieftains whose actions cost investors billions — from AIG derivatives chief Joe Cassano, who assured investors they would not lose even "one dollar" just months before his unit imploded, to the $263 million in compensation that former Lehman chief Dick "The Gorilla" Fuld conveniently failed to disclose. Yet not one of them has faced time behind bars. Instead, federal regulators and prosecutors have let the banks and finance companies that tried to burn the world economy to the ground get off with carefully orchestrated settlements — whitewash jobs that involve the firms paying pathetically small fines without even being required to admit wrongdoing.

To add insult to injury, the people who actually committed the crimes almost never pay the fines themselves; banks caught defrauding their shareholders often use shareholder money to foot the tab of justice. "If the allegations in these settlements are true," says Jed Rakoff, a federal judge in the Southern District of New York, "its management buying its way off cheap, from the pockets of their victims. To understand the significance of this, one has to think carefully about the efficacy of fines as a punishment for a defendant pool that includes the richest people on earth — people who simply get their companies to pay their fines for them. Conversely, one has to consider the powerful deterrent to further wrongdoing that the state is missing by not introducing this particular class of people to the experience of incarceration. "You put Lloyd Blankfein in pound-me-in-the-ass prison for one six-month term, and all this bullshit would stop, all over Wall Street," says a former congressional aide. "That's all it would take. Just once."

But that hasn't happened. Because the entire system set up to monitor and regulate Wall Street is f@#ked up. Just ask the people who tried to do the right thing. Taibbi concludes his article: All of this paints a disturbing picture of a closed and corrupt system, a timeless circle of friends that virtually guarantees a collegial approach to the policing of high finance. Even before the corruption starts, the state is crippled by economic reality: Since law enforcement on Wall Street requires serious intellectual firepower, the banks seize a huge advantage from the start by hiring away the top talent. Budde, the former Lehman lawyer, says it's well known that all the best legal minds go to the big corporate law firms, while the "bottom 20 percent go to the SEC." Which makes it tough for the agency to track devious legal machinations, like the scheme to hide $263 million of Dick Fuld's compensation. ‘It’s such a mismatch, it's not even funny," Budde says. But even beyond that, the system is skewed by the irrepressible pull of riches and power. If talent rises in the SEC or the Justice Department, it sooner, or later, jumps ship for those fat NBA contracts. Or, conversely, graduates of the big corporate firms take sabbaticals from their rich lifestyles to slum it in government service for a year or two.

Many of those appointments are inevitably handpicked by lifelong stooges for Wall Street like Chuck Schumer, who has accepted $14.6 million in campaign contributions from Goldman Sachs, Morgan Stanley and other major players in the finance industry, along with their corporate lawyers.

                                                 

                                                  MITCH AND THE BITCH

As for President Obama, what is there to be said? Goldman Sachs was his number-one private campaign contributor. He put a Citigroup executive in charge of his economic transition team, and he just named an executive of JP Morgan Chase, the proud owner of $7.7 million in Chase stock, his new chief of staff. "The betrayal that this represents by Obama to everybody is just — we're not ready to believe it," says Budde, a classmate of the president from their Columbia days. "He's really fuc@#king us over like that? Really? That's really a JP Morgan guy, really? Which is not to say that the Obama era has meant an end to law enforcement.

On the contrary: In the past few years, the administration has allocated massive amounts of federal resources to catching wrongdoers — of a certain type. Last year, the government deported 393,000 people, at a cost of $5 billion. Since 2007, felony immigration prosecutions along the Mexican border have surged 77 percent; non-felony prosecutions by 259 percent. In Ohio last month, a single mother was caught lying about where she lived to put her kids into a better school district; the judge in the case tried to sentence her to 10 days in jail for fraud, declaring that letting her go free would "demean the seriousness" of the offenses.

So, there you have it. Illegal immigrants: 393,000. Lying moms: one. Bankers: zero. The math makes sense only because the politics are so obvious. You want to win elections; you bang on the jail-able class. You build prisons and fill them with people for selling dime bags and stealing CD players. But for stealing a billion dollars? For fraud that puts a million people into foreclosure? Pass. It's not a crime. Prison is too harsh. Get them to say they're sorry, and move on.  Oh, wait — let's not even make them say they're sorry. That's too mean; let's just give them a piece of paper with a government stamp on it, officially clearing them of the need to apologize, and make them pay a fine instead. But don't make them pay it out of their own pockets, and don't ask them to give back the money they stole. In fact, let them profit from their collective crimes, to the tune of a record $135 billion in pay and benefits last year. What's next? Taxpayer-funded massages for every Wall Street executive guilty of fraud? The mental stumbling block, for most Americans, is that financial crimes don't feel real; you don't see the culprits waving guns in Liquor stores or dragging coeds into bushes. But these frauds are worse than common robberies. 

They're crimes of intellectual choice, made by people who are already rich and who have every conceivable social advantage, acting on a simple, cynical calculation: Let's steal whatever we can, then dare the victims to find the juice to reclaim their money through a captive bureaucracy.

They're attacking the very definition of properly — which, after all, depends in part on a legal system that defends everyone's claims of ownership equally. When that definition becomes tenuous or conditional — when the state simply gives up on the notion of justice — this whole American Dream thing recedes even further from reality. You can read the rest of Taibbi's article in the latest Rolling Stone magazine.

When I read articles and e-mails like the following, I get truly worried about the direction this Nation is going in. Our Economy refuses to cooperate with our hopes and dreams: food costs are on the rise, fuel costs are set to go through the roof, "real" unemployment still hovers around 18%, State Governments are trying to tackle their fiscal shortfalls, people we elect to represent us don't, and I get the distinct feeling that apathy is giving way to rage all across this Country. Unlike the Nations in Northern Africa and the Middle East, the United States has an "armed" populace, and a Constitution that allows for that. With the "Dog Days of Summer" fast approaching, I sincerely hope my prediction of civil unrest does not come to fruition.

Blog Comment: And, none of these robber barons get more than a slap on the wrist.  I have to ask the same question Matt Taibi does; “Why hasn’t anyone gone to jail?”

This article appears in the March 3, 2011 issue of Rolling Stone.

Why Isn't Wall Street in Jail? - Rolling Stone – BY: Matt Taibbi, Contributing Editor, Rolling Stone

Commission Defends Integrating VA Care and Outside Doctors

POSTED BY: TOM PHILPOTT, SEPTEMBER 8, 2016

PREDICTION:

By the second quarter of 2017, The VA Health Administration (VHA) will be well on its way toward “privatization". The Commission on Care was chartered by Congress. Most of our elected Officials and many prominent private citizens are fully behind this movement. They have very quietly made extraordinary progress toward their goal of enriching the private health systems with the money they will receive from the Federal Government for enrolling Veterans. I had to read this twice to make sure I wasn't missing something extremely important to Veterans; Mental Health Care. The 'Commission on Care' report to Congress does not address this at all. There is a way to remedy the problems inside the Department of Veterans Affairs. It seems that no one involved in this has any desire to do the right thing for Veterans. It's going to be a dark day for our Nation's Veteran population when this report morphs into Law and practice.

Military Update: Commission on Care leaders defended their tough diagnosis and 18-point treatment plan for what ails the VA Healthcare system, including their controversial push to let veterans begin to choose their own primary care doctors from new, integrated networks of VA and private-sector physicians.

Answering critics who say they went too far or not far enough in proposing to transform the Veterans Health Administration (VHA) over the next 20 years, Commission Chair Nancy Schlichting, Chief

                                                                              

Executive Officer of the Henry Ford Health System in Detroit, and Vice Chair Dr. Delos “Toby” Cosgrove, CEO of worldwide Cleveland Clinic hospitals, warned the House Veterans Affairs Committee on Wednesday that VHA is rife with weaknesses. TheThe many “glaring problems,” said Schlichting, include under staffing,aging facilities, obsolete information technology, flawed operating processes, supply chain weaknesses and health outcomes that vary across VHA, all of which “threaten the long-term viability of the system.” Yet VHA’s ability to transform is most hampered by “lack of leadership continuity and strategic focus,” and “a culture of fear and risk aversion,” she said.

By having only two of 15 Commissioners from the Congressionally chartered panel testify allowed committee members to focus on what a majority of industry health experts recommend, rather than complaints of Veterans’ service groups defending the status quo or the unpopular notion of dismantling the VHA system as backed by the billionaire Koch brothers.

But Rep. Jeff Miller (R-Fla.), the Committee Chair who will retire in January, added his own list of VHA weaknesses that have been the focus of House Committee hearings and press releases: “persistent access failures, noncompliance with federal prompt pay laws, lack of accountability, a bloated and self-preserving bureaucracy, and billions of taxpayer dollars lost to financial mismanagement of construction projects, IT programs, bonuses for poor performing employees.” The list, Miller said, is “legion and growing.”

But, Miller on one issue joined with the Obama administration and most Veteran service organizations. He opposes the Commission’s call to establish a new layer of VHA oversight — a Board of Directors comprised of health industry experts who would have authority to direct VHA transformation, set long-term health care strategy and ensure both are carried out by a VA Under Secretary of Health who would be appointed for five-year fixed terms.

“Outsourcing the crucial role of a Cabinet Secretary to an independent board…neither elected nor accountable to the American people would be irresponsible and inappropriate, not to mention unconstitutional,” Miller said.

 Miller and Rep. Mark Takano (Calif.), the Committee’s ranking Democrat, agreed with many Commission recommendations and noted that VA Secretary, Robert McDonald, said many already were being implemented as part of his ambitious MyVA reforms announced last year.

But, Takano, on behalf Veterans’ groups, criticized the Commission’s call to integrate VA medical staff with networks of screened private care physicians, to allow enrolled Veterans to choose their own primary care doctors, and to allow their providers in turn to manage all care including referrals to specialists on VA staffs or approved outside networks.

The worry, Takano said, is that too many Veterans will choose private sector care, driving up VA costs and jeopardizing “the viability of unique VA health services” to treat spinal cord injuries, polytrauma cases, amputee care, blindness or traumatic brain injuries. Why didn’t the Commission recommend that its expanded “choice” model be tested initially to determine the impact on VA budgets and programs, he asked.

Commissioners did discuss a phased approach to include testing, Schlichting said, and that is reasonable considering the complexity of implementing these reforms.

“It’s important to balance this question of choice — making sure access is really available within every market across the country — with the issue of how we’re trying to also control those networks to better serve Veterans,” the commission chair said. “Finding that balance is really important.”

Schlichting recalled heated commission debates over how and why to expand patient choice using the private sector. In the end a consensus of commissioners believe they have hit a “sweet spot” for expanding choice by preserving VA system strengths while also allowing access to outside providers carefully screened to provide quality and Veteran-centric care.

The commission would allow VA-enrolled Veterans to pick a private care provider even when a doctor was available inside VA. What data did the commission rely on to decide that would be okay, Takano wanted to know.

“If you begin to the think of the VHA care system in the way we did,” Schlichting said, then “it’s not a question of VA versus provider-in-the-community. It’s one system that should be operating in a much more integrated way. And every provider within that VHA care system then would be able to provide access for Veterans. It’s a different mindset than today.”

She bristled at a charge from Rep. Doug Lamborn (R-Colo.) that the commission missed a chance to truly transform Veterans’ health care by rejecting the vision of two dissenting commissioners who wanted VA care more fully privatized and the VHA bureaucracy largely dismantled.

Neither of those commissioners, Schlichting said, “has ever implemented a major change in a health system as Dr. Cosgrove and I have. I think we recognize the transformative aspects of what we’re proposing.”

If Congress embraces recommendations from a majority of commissioners, she said, it would begin a “process that will take many, many years to complete, recognizing the complexities of both facilities and staffing issues and leadership [and] IT interoperability…And to say that what we’re proposing is not transformative I think is just untrue.”

Cosgrove, a former Air Force surgeon, emphasized that a first step toward transforming VA health care must be replacing a woefully outdated electronic health records system with an off-the-shelf commercial system that allow providers and patients to schedule their own appointments.

He and Schlichting also stressed that VHA can’t be transformed without an Undersecretary for Health who sticks around, and the backing of some sort of oversight team of experts to demand adherence to sustained progress. Congressional oversight, they argued, just isn’t enough.

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