Saturday, March 07, 2015

Iraq snapshot

Saturday, March 7, 2015.  Chaos and violence continue, Canada suffers a loss in Iraq, Stephen Harper is a Chicken Hawk in hiding, Gen Martin Dempsey apparently previously worked for Dionne Warwick's Psychic Network, the VA shows up at a budget hearing unprepared and leaning on the work of others, and much more.

February 26th, the Senate Veterans Affairs Committee heard from the VA led by Secretary Robert McDonald, we covered part of the hearing in Thursday's snapshot.  McDonald is in his seventh month on the job.  He replaced Eric Shinseki who resigned in disgrace.  As Ranking Member Richard Blumenthal told McDonald in the hearing, "That has been one of the downfalls of the VA to this point, the lack of reliable truthful information.  It was the downfall of your predecessor."

It was noted throughout the hearing and it sort of left a question mark hanging over whatever limited information the VA was able to provide in the hearing.  Blumenthal is the Ranking Member and Senator Johnny Isakson is the Chair.  The hearing was about the VA's budget request and the first panel was composed of VA employees led by McDonald.  The others were Dr. Carolyn Clancy, well known fabulist Allison Hickey, Ronald Walters, Stephen Warren and Helen Tierney.

Senator Patty Murray is a long serving member of the Committee and is a former Chair of the Committee.  She and Senator Dean Heller sponsored the Women Veterans Access to Quality Care Act of 2015.

Senator Patty Murray:  Secretary McDonald, as you know and as you said in your opening statement, the population of women veterans is increasing dramatically, it's doubled since 2001. I was really pleased to work with Senator Heller to introduce the Women's Veterans Access to Quality Care Act to make sure that the VA does have the services and the facilities to meet the needs of women veterans.  One of the key positions of that bill is requiring obstetrics and gynecology to be available at every medical center.  I wanted to ask you what resources and staff -- including support staff -- will you need to meet that requirement?

Secretary Robert McDonald: Thank you, Senator Murray.  We've very much in favor of that -- of that approach.  We're in the process of putting, uh, women's clinics all over the country.  We have a new one here in Washington, D.C. and I'd like to invite the members of the Committee to visit it.  Uhm, it's in our Washington, D.C. facility, it's a women's clinic.  Uh, as you know, I've been out to about 12 medical schools, talked to deans.  I'm -- We're hiring.  And we need to hire more gynecologists --

Senator Patty Murray:  Do you -- Do you know how many you would need to --

Secretary Robert McDonald:  Exact number --

Senator Patty Murray (Con't):  -- to do this?

Secretary Robert McDonald:  I don't have an exact number.  I can tell you that in the past -- the past nine months or so, we've hired about 8,000 people.  Of that, about 1,000 are doctors.  But I don't have how many of that are, uh, gynecologists --

Senator Patty Murray:  Okay, if you can get --

Senator Robert McDonald (Con't):  -- with that --

Senator Patty Murray (Con't): -- that for me and get back with me on that.  

And this is what frustrates me regarding the hearings.

McDonald doesn't have basic information?

He's got a team siting with him at the table and they don't have the information.

Forget not know -- they should know it -- but they're not able to flip through their paperwork in front of them and pull out the figure?

And the team McDonald has sitting behind him at the hearing can't whisper the information to him?

Because, throughout the hearing, the people behind him were feeding him figures and statistics.

When they don't feed on that, when no one at the table volunteers, it doesn't look like people just do not know, it plays like they don't want to share the information.

As Ranking Member Blumenthal and others noted throughout the hearing, Shinseki himself complained, when resigning, that he was not given accurate information from those in the VA reporting to him.

So you'd assume McDonald would be focusing on nailing down information.

If you're aware that approximately 8,000 people have been hired and 1,000 are doctors, knowing how many are OB-GYNs should not be a mystery.

Though he didn't supply a number, with 1,000 being doctors.

There are 152 VA medical centers and if we add in VA outpatient clinics, we're left with nearly 1,000 facilities.  (We could also add in the nursing home care units and domiciliaries.)

So there is an issue of a serious lack of gynecologists at VA medical facilities and if only 1,000 doctors were hired, you probably didn't fulfill the needs.

The hearing was February 26th.  The Women Veterans Access to Quality Care Act of 2015 was read and referred to Committee on February 12th.

14 days later, you're not prepared to discuss it?  You don't anticipate discussing it?

Let's go back:

Senator Patty Murray:  One of the key positions of that bill is requiring obstetrics and gynecology to be available at every medical center.  I wanted to ask you what resources and staff -- including support staff -- will you need to meet that requirement?

Secretary Robert McDonald: Thank you, Senator Murray.  We've very much in favor of that -- of that approach.  We're in the process of putting, uh, women's clinics all over the country.  We have a new one here in Washington, D.C. and I'd like to invite the members of the Committee to visit it.  Uhm, it's in our Washington, D.C. facility, it's a women's clinic.  Uh, as you know, I've been out to about 12 medical schools, talked to deans.  I'm -- We're hiring.  And we need to hire more gynecologists --

Senator Patty Murray:  Do you -- Do you know how many you would need to --

Secretary Robert McDonald:  Exact number --

Senator Patty Murray (Con't):  -- to do this?

Secretary Robert McDonald:  I don't have an exact number. 

The VA was present to argue for the budget and what the budget needs are.

The failure to be prepared to address this issue goes to the continued lack of respect for the needs of women veterans.

Senator Patty Murray:  And I also just wanted to bring up the VA's policy, up-to-date -- It is way past time to VA's policies up-to-date with modern medicine and allow the VA to provide better fertility treatment -- including in vitro fertilization for seriously injured veterans who want to start a family.  This is a high priority for me.  I think it is a high priority for our veterans and I want to work with you to get that done so I'll be talking to you more on that.

Senator Robert McDonald:  Working on it.

Senator Patty Murray:  Okay, I want to hear from you.  What are you doing to work on this?

Dr Carolyn Clancy: So my staff briefed me recently on how many women might be eligible and what would be the specific --

Senator Patty Murray:  Well it's women and men. 

Dr. Carolyn Clancy:  -- medical requirements.  Yes.  Uh, also compared what the Dept of Defense covers versus what we cover.  Or, actually, don't.  At the moment.  So, uhm, I sent them back with some more questions.  So we'll be happy to follow up with you.  

Senator Patty Murray:  I'll submit some questions on this but I think this is absolutely critical for our men and women who serve overseas, lose their capability and we have to make sure they can start a family so I will be focused on this.  

Again, the lack of respect for women veterans.

An issue the VA has failed on is referred to, by a medical doctor -- no less, as an issue for women.

Murray corrected her because Murray's worked on this issue repeatedly. She has spoken to many couple's effected by the issue.  She has Chaired hearings on this issue.

She is informed.

And she's done the work to be.

Why hasn't Clancy?

Check her official bio and ask yourself why she is so ignorant of this basic medical issue.

And, please note, this ignorance is after, she maintains, "my staff briefed me on this issue."

And let's note again, as Senator Murray has highlighted for several years now, the Defense Dept provides coverage for this to service members.  It's the VA that's failing to do so.

Senator Patty Murray:  I also wanted to talk to you about the legislation that I introduced last year to expand the caregivers support systems to VA, to all eras of veterans.  I'm going to be introducing that again this year and I want to be sure we're all working together to strengthen that program so that it will be ready to take on the additional workload.  VA's budget request says that in Fiscal Year 2015 you cannot hire any new caregiver support coordinators to help with overwhelming demand and I hear already at some facilities that providers refuse to help with doing initial evaluations or home visits.  And to me that is just unacceptable. I wanted to ask what you were doing to bring in more caregvier support coordinators?

Secretary Robert McDonald: Let me start and then I'll ask Carolyn to comment. We're very much in favor of improving our care-caregiver operation.  In fact, in the last week, I met with, uh, Senator Dole of The Elizabeth Dole Foundation.

Senator Patty Murray:  We're working very closely.

Secretary Robert McDonald:  We're working closely with her.  Uh, what we've agreed to do, I want to set up a special advisory committee for the Secretary on caregivers.  We don't have that and I think we would benefit from having that.  Number two -- working with her, incidentally, working with her foundation.  Secondly, is, uhm, we're talking about having a caregiver summit. Uh, something where we could get everybody together and, uh --

Senator Patty Murray:  For all eras? Or just --

Secretary Robert McDonald:  All eras.  Because-because, again, post 9/11 is not enough.

Senator Patty Muray:  Yeah.

Secretary Robert McDonald:  So we want to work together with you on this.

Senator Patty Murray:  Okay.  Well I want to stay in touch with you on that and keep me up-to-date on what they are doing. 

A basic question was asked:  What are you doing to bring in more caregiver support coordinators?

And the answer?

We're talking to Elizabeth Dole's foundation and we plan to have a summit at some point.

That's what you're doing?

After all the hearings on caregivers, that's what you point to as 'action'?  Farming out your work to Elizabeth Dole's foundation and talk of a summit?

Senator Patty Murray: And, finally, I want to talk to you about a home state issue -- the Spokane Emergency Room.  They have seen a dramatic cutback in operations simply because of staffing problems.  I have to tell you as the daughter of a WWII veteran this is unacceptable to me.  It is a very serious problem for veterans in that area and we've got to get it back to a full time operation.  I wanted to ask you today, when will the emergency room at the Spokane VA start operating 24 hours again?

Dr. Carolyn Clancy: So, Senator, we have had significant recruiting problems.  We had originally hoped to open it to 24/7 in April and it's now looking like that's going to get pushed back a few months until I met with some colleagues from the American Legion just a couple of days ago at their meeting this week and they have actually been out speaking to some of the other hospitals in town who may be able to help us out.  The other area where I think we need help recruiting emergency physicians is, uh, a legislative, uh, change that would allow us to accomodate what many people who go into emergency medicine want which is greater flexibility for hours than the current federal HR policies allow.

Senator Patty Murray:  So are you looking at every option because -- 

Dr. Carolyn Clancy:  Yes.

Senator Patty Murray (Con't):  -- we've heard recruiting forever. Temporary providers, bringing in doctors from other facilities, absolutely everything because this is a critical need in that community. 

Dr. Carolyn Clancy:  No, I would agree with you.  And we are looking at all options, yes.

Senator Patty Murray:  Okay and I want to follow up on you with that.  Let me know when and how and when we're going to see that open again.  Thank you. 

Robert McDonald has had many mis-steps since becoming VA Secretary.  And maybe that distracts from the above nonsense.

As Murray noted "we've heard recruiting forever."

The excuse has gotten more than a little old.

In addition, it's shameful that the E.R. would not be open full time but I find it more shameful that the needed work on the issue is done by the American Legion and not by the VA who is paid to do that work.

Good for the American Legion, They are a strong advocate and defender of veterans.

But why is the Legion able to do the work and the VA isn't?

The VA comes into a budget hearing, doesn't know the basics and repeatedly points to the foundations and VSOs as the answer -- in a budget hearing requesting funding.

'Fund us because of all the work that the VSOs and foundations do!'

McDonald's chief selling point was that he knew how to run things.  Seven months into his tenure, that has yet to be demonstrated.

In Iraq, Mahmud Saleh (AFP) reports, "Iraqi forces faced tough resistance from jihadist fighters around Tikrit Saturday, but the top US military officer said ahead of a Baghdad visit that victory was only a matter of time."  The officer is Gen Martin Dempsey, Chair of the Joint Chiefs of Staff.   You'd think US military brass, having so often gotten predictions on Iraq wrong, would hesitate before consulting their crystal balls yet again.

Even more so since the US military is shut out of this Tehran-Baghdad assault on Tikrit.  Hassan Hassan (The Observer) feels things may be less clear cut than Dempsey's predicting:

But there are ominous signs that the campaign faces many perils and there are fears that its impact may unleash fresh waves of sectarian conflict, as well as long-term rebalancing of political forces in the region.
The campaign, which entered it’s second week on Sunday, is the first serious attempt to dislodge Isis from a Sunni area it has governed since the group’s military blitz in Iraq last June. Despite the American-led air strikes since the summer, the militant group has faced little pressure inside what can be described as its heartlands, such as Mosul, Falluja, Raqqa and Deir Ezzor. The offensive in Tikrit is therefore a critical development that will be monitored closely and nervously by almost everyone involved in the conflict. It is also the first major effort led by pro-government forces without consulting the United States and members of the international coalition. That latter fact leaves many question marks about the campaign. The Iraqi government portrays it as a national effort, led by the security forces and including thousands of Sunni tribal fighters. It also claims that Tikrit is all but empty of civilians.

But these claims are not entirely accurate. Hashd al-Shaabi, the umbrella organisation for Iranian-backed Shia militias, put together in the wake of Isis’s takeover of Mosul in June to serve as a de facto replacement for the army in the fight against the terror group, is leading the offensive. Any Sunni forces participating, notwithstanding their numbers, take a back seat at best.

You'd also think predictions would be put on hold considering the claim Press TV reported earlier this week, "According to provincial officials, Iraqi forces are expected to reach Tikrit late on Friday."

They're supposedly still outside.

Dempsey did offer other things.  Missy Ryan (Washington Post) notes:

“The important thing about this operation in Tikrit in my view is less about how the military aspect of it goes and more about what follows,” he told reporters ahead of a visit to Iraq, where he will meet with the Shiite-led government. “Because if the Sunni population is then allowed to continue to live its life the way it wants to, and can come back to their homes . . . then I think we’re in a really good place.”  
"But if what follows the Tikrit operation is not that, if there’s no reconstruction that follows it, if there’s no inclusivity that follows it, if there’s the movement of populations out of their homeland that follows it, then I think we’ve got a challenge in the campaign.”

It's already a condemned operation.  Iraqi forces and Shi'ite militia were captured on camera this week executing an 11-year-old Sunni boy.  An unarmed child.

Dempsey's full of crap -- probably had his mouth pressed Barack's anus too long.

The US is backing the slaughter of children.

There is no high ground to scramble to.

As for what follows a 'liberation' of Tikrit, Abdulrahman al-Rashed (Al Arabiya) offers a Sunni perspective

The Americans should realize that they have become part of the region’s repugnant sectarianism, fighting alongside Alawites in Syria and Shiites in Iraq, while negotiating with Shiite Iran on the nuclear issue. All three scenarios are against Sunnis, or at least this is how it seems. The Americans have put themselves in an unprecedented, terrible trap.
We hoped, and are still hoping, that the United States will participate in isolating Assad, the Syrian regime and its sectarianism, and support the moderate opposition that includes all religions and ethnic groups. We hoped that Washington would refrain from supporting the government in Baghdad unless it agreed to become representative of all Iraqis.

Widening the sectarian wars in the region will not serve the West. Al-Qaeda, ISIS, Al-Nusra, Hezbollah, Asaib Ahl al-Haq and others are nothing but the outcome of such blind fighting. The West should help promote moderate civilian institutions against religious hardliners, not support the latter to achieve victories in wars against temporary opponents.

While the US government -- including Dempsey -- lie, Grand Ayatollah Ali al-Sistani at least expresses concern.  Human Rights Watch's Kenneth Roth Tweets:

  • Across Iraq, Margaret Griffis ( counts 143 dead and 47 injured on Friday.

    And the violence includes a death.

    The State Dept's Brett McGurk Tweets:

    We mourn with & send our deepest condolences to our Canadian partners after the loss of SGT Doiron in northern Iraq.
    24 retweets 9 favorites

    Do you mourn, Brett?

    Because (a) you enabled Nouri al-Maliki.  You saw him as your ticket to power.  You almost succeeded in becoming Ambassador to Iraq.  Now you do the work but don't get the title.

    Fitting for someone who saw Baghdad as a whore house and couldn't keep it in his pants.

    Maybe Brett is mourning . . . if death turns turns him on.

    Otherwise, it's just hollow empty words.

    Stephen Harper is the prime minister of Canada.  He promised it would just be training -- that's all Canadian forces would be engaged in.

    Barack's made similar promises.

    Will Brett "mourn" if or when a US service member is killed in the latest wave of the never-ending Iraq War?

    Sgt Andrew Joseph Doiron.  Brett "mourns" so hard he can't even include the first name of the fallen.

    If there's anything more shameful than Brett, maybe it's Stephen Harper.  While Defence Minister Jason Kenney did make an on camera statement, Harper still hasn't released a statement.

    Grasp that Harper can grand stand and preen about sending Canadian forces into Iraq, he just goes AWOL, runs like a coward and hides when it's time to face citizens and explain his 'peaceful' operation resulted in death.

    That's how a War Hawk becomes a Chicken Hawk.

    Support war, demand it.  I'll disagree with you on that.  But I'll lose any remaining respect for you when you don't have the maturity to step forward when it's time to own consequences of your actions.

    Stephen Harper is a Chicken Hawk.

    Somebody should tell him that but they'd have to figure out what closet he was cowering in first.

    missy ryan

    Friday, March 06, 2015

    Who got trapped in Afghanistan?

    The violence continues in Iraq.  Alsumaria notes a bombing outside Falluja left 5 Iraqi soldiers dead and four injured, 3 corpses were discovered dumped in an orchard outside of Baquba, 4 Iraqi soldiers were killed in a house bombing outside of Tikrit, 4 Iraqi forces were killed and twenty-eight injured in a battle outside of Tikrit, a Baghdad roadside bombing killed 1 person and 1 corpse was discovered dumped in the streets of Baghdad.

    As the Tikrit offensive continues, Joshua Keating (Slate) notes:

    Washington seems a bit unsure of how to feel about that. U.S. officials say the Iraqis did not ask for U.S. support in the Tikrit operation, but military commanders say they were aware of the operation to retake Saddam Hussein’s hometown in advance, even if they didn’t coordinate it. As one official told the Wall Street Journal, “any geography taken from ISIL is a good thing.”

    Still, the increasing influence of Iran in Baghdad, and the fact that Iranian-backed Shiite militias are taking the lead in the fight against ISIS while the U.S. continues to debate the readiness of the official Iraqi army, cannot be good for the American push for Iraqi unity.

    We should probably note now that a few in the administration having been bragging around DC about how this is really a brilliant stroke and it will keep Iran trapped in Iraq like, they insist, happened to the Soviet Union with Afghanistan.

    The idiots making that boast seem unable or unwilling to note how that actually worked out in the long run: the never-ending US - Afghanistan war for example -- a strange oversight considering US troops are still fighting in Afghanistan.

    In the long run, who got trapped in Afghanistan?

    It would appear it was much more than just the Soviet Union.

    At least they have legal cover.  The US troops in Iraq today really do not.  Michael Ratner (Center for Constitutional Rights) has a column at MSNBC on the Barack's requested Authorization for the Use of Military Force:

    Generally, if you’re sincere in asking for permission to do something, you don’t ask more than six months after you start that something. But that’s the case with the AUMF against ISIS, which authorizes a war Obama actually started waging in August of last year. Six months ago, however, the president didn’t have a Republican majority in both chambers of Congress – a Republican majority seemingly hell-bent on continuing a legacy of never-ending U.S. involvement in the Middle East.

    The truth is, we’re already at war. By asking for the authorization to use military force in such a manner, the White House is acting as if the AUMF against ISIS is a mere technicality, some paperwork they didn’t get to on time but finished eventually. But in reality, the consequences could be much darker, because if Congress approves the AUMF as it stands, this president—and those who come after him—will be able to wage a war unlimited by geographical distances, with no defined enemy or length.

    On last week's  Law and Disorder Radio,  Michael and co-host Heidi Boghosian, discussed the AUMF and you can refer to the program's website to stream that discussion or you can read a transcript of the bulk of the discussion in the February 23rd snapshot.

    The following community sites -- plus Jody Watley, and Dissident Voice --  updated:


  • The e-mail address for this site is

    law and disorder radio
    michael s. smith
    heidi boghosian
    michael ratner

    Thursday, March 05, 2015

    Iraq snapshot

    Thursday, March 5, 2015.  Chaos and violence continue, while allegedly saluting women Iraq's prime minister makes two insulting remarks about women, residents of Tikrit flee, Nimrud is attacked by the Islamic State, the US Senate Veterans Affairs Committee wonders where the money is for research, and much more.

    "The Choice Act has been shocking underutilized," declared Senator Richard Blumenthal at last Thursday's Senate Veterans Affairs Committee hearing.  Blumenthal is the Ranking Member, Senator Johnny Isakson is the Chair.  The hearing was about the VA's budget request and the first panel was composed of VA employees led by Secretary of the VA Robert McDonald.  The others were Dr. Carolyn Clancy, well known fabulist Allison Hickey, Ronald Walters, Stephen Warren and Helen Tierney.

    Ranking Member Richard Blumenthal:  As I outlined earlier, Secretary McDonald, the choice card program basically seems not to be working.  I think you and I, in our conversations, have talked about the potential reasons that it is so underutilized a small fraction of the veterans who are eligible to use it in practical terms are doing so.  The 40 mile rule may be a cause.

    Before we go further, let's all get on the same page.  The House Veterans Affairs Committee offers the following highlights of The Veterans Access, Choice and Accountability Act of 2014:

    To improve access to and quality of care for veterans, the law:
    • Requires VA to offer an authorization to receive non-VA care to any veteran who is enrolled in the VA health care system as of August 1, 2014, or who is a newly discharged combat veteran if such veteran is unable to secure an appointment at a VA medical facility within 30 days (or a future published goal established by VA) or resides more than 40 miles from the nearest VA medical facility, with certain exceptions.
      • Requires VA to provide a Veterans Choice Card to eligible veterans to facilitate care provided by non-VA providers.
      • Provides $10 billion for the newly-established “Veterans Choice Fund” to cover the costs of this increased access to non-VA care. Choice program authority would end when funds are exhausted or three years after enactment, whichever occurs first.
    • Requires an independent assessment of VA medical care and establish a Congressional Commission on Care to evaluate access to care throughout the VA health care system.
    • Extends the ARCH (Access Received Closer to Home) pilot program for two years.
    • Extends for three years a pilot program to provide rehabilitation, quality of life, and community integration services to veterans with complex-mild to severe traumatic brain injury.
    • Improves the delivery of care to veterans who have experienced military sexual trauma as well as care for Native Hawaiian and Native American veterans.

    To expand VA’s internal capacity to provide timely care to veterans, the bill would:
    • Provides $5 billion to VA to increase access to care through the hiring of physicians and other medical staff and by improving VA’s physical infrastructure.
    • Authorizes 27 major medical facility leases in 18 states and Puerto Rico.

    To provide real accountability for incompetent or corrupt senior managers, the law:
    • Authorizes VA to fire or demote Senior Executive Service (SES) employees and Title 38 SES equivalent employees for poor performance or misconduct.
      • Provides an expedited and limited appeal process for employees disciplined under this authority. Appeals would go to a Merit Systems Protection Board administrative judge, who would have 21 days to decide on the appeal. If a decision is not reached within that 21-day period, then VA’s decision to remove or demote the executive is final.
      • Prohibits SES employees from receiving pay, bonuses and benefits during the appeal process.
    • Reduces funding for bonuses available to VA employees by $40 million each year through FY 2024.

    To improve education benefits for veterans and dependents, the law:
    • Requires public colleges to provide in-state tuition to veterans and eligible dependents in order for the school to remain eligible to receive G.I. Bill education payments.
    • Expands the Sgt. Fry Scholarship Program to provide full Post 9/11 G.I. Bill benefits to spouses of servicemembers who died in the line of duty after 9/11.

    According to the Congressional Budget Office, the bill would result in net spending of roughly $10 billion from 2014 - 2024, making it less expensive than previous VA reform packages passed by the House and Senate.

    Along with backlog claims issues, the VA has suffered from the scandal of not delivering timely care and inventing a system not to fix that but to hide it.  The simplest explanation is that the VA kept two sets of books on appointments -- the false one had veterans receiving timely care when they called in to schedule appointments, the reality version -- which was hidden from Congress --documented the lengthy wait times.

    As a result of veterans being denied timely care -- and the health problems and, yes, deaths that resulted from these actions led to the passage of the 2014 act.

    It was hoped that this measure allowing veterans living "more than 40 miles from the nearest VA medical facility" to utilize a non-VA facility and doctor would allow for more timely health care.

    To be clear, veterans can utilize that and could before the bill -- minus the 40 miles clause.  But to do so they had to get a written referral from a VA doctor and present that at whatever appointment/consultation with a non-VA doctor.  This clause in the act was supposed to simplify this process.

    But that did not happen.

    Today, Tom Philpott (Stars and Stripes) noted Senate VA Committee Chair Johnny Isakson is calling for the 40-mile aspect to be loosened:

      As we reported here several times last year, the law is more restrictive than early Capitol Hill tweets had indicated.  For each episode of care, regional VA healthcare managers still must authorize outside care, and VA usually will direct patients into a contracted network of health care providers.
    Meanwhile, the 40-mile rule narrows eligibility to use cards in two ways.  First, the law uses “geodesic” or as-the-crow-flies distance to determine if a veteran lives more than 40 miles from VA care.  This denies access to private sector care to many vets who reside within 40 miles of VA care if one uses a map and ruler.  Actual drives for care can be much longer.
    Second, the 40-mile rule applies to the nearest VA health facility, not nearest VA facility providing needed care. So veterans who reside within 40 miles of a VA clinic that can’t treat their conditions still aren’t eligible to use the Choice Card.  Those are two problems that need fixing, Isakson said.
    “We need to make sure that if [VA] health care within 40 miles of the veteran doesn’t provide chemotherapy or doesn’t provide a heart transplant or doesn’t provide a specialty the veteran needs, they get to exercise the 40-mile rule because the health care they need is not available,” said Isakson.

    “We also need to be certain we look at how long it takes to drive there…This straight-line application is crazy,” Isakson said.  “It needs to be the time [or mileage] from leaving the garage of the veteran to pulling into the parking lot of the Veterans Administration.”

    I understand why the act was passed, I understand the reasoning behind it -- and I actually support that.  But I'm confused to this day of why the lawmakers seem unaware of what was already available.

    Veterans had to jump through hoops -- whether they were VA, TRICARE or CHAMPVA to get those referrals unless their VA primary care doctor was a good one.  (A sign of a good one?  They retroactively authorize it if you're on vacation and have to see a non-VA doctor out of your area.  Which they can do but only very few will.)  (If your visit is not authorized -- prior to the appointment or retroactively -- you are responsible for the cost of the visit, your veterans plan is not covering it.)

    It appears the hope was that by the wording of the 40 miles, it would be easier for the veterans to receive the referral for care.  I think it was stupid to rely on the same system that was already a problem -- VA doctors -- to give the same referrals.

    I'm glad Isakson wants to reform it and I agree with his comments but more needs to be done.  The easiest thing would be to have some sort of clearance that took place online and by phone (because everyone doesn't have a computer -- shocking though that is to America's so-called 'creative class').  So a veteran would log on or dial in and enter their address -- already on file with the VA -- and request a referral for a visit to a non-VA facility.  The computer or phone system would know that the address was X number of miles from the nearest VA and if was 40 or more a referral would automatically be sent out to the veteran.

    The thinking seems to have been that by putting it into law the VA doctors would be less hesitant about providing the referrals.  But the problem was more the issue of accessing the doctors and getting the referral -- the time involved for both -- and this was time while you were waiting for treatment.  The system should have been automated.

    If the doctors are part of the reason for the delay -- and they are and that's chiefly because of the time involved -- then the solution was to automate the process.

    Senator Patty Murray serves on the Committee (and is a former Chair of the Committee).  We'll note her remarks in the hearing in the next snapshot.  But she submitted a written statement for the record and from that we'll note these remarks, "A budget is a statement of our values and priorities. And as the daughter of a World War II veteran, I believe making sure our country keeps the promises we've made to our nation's heroes should be at the top of our list of priorities, all of the time. Taking care of our veterans when they come home is a fundamental part of who we are as a nation. It is part of the cost of going to war. And making sure the VA has the tools and resources it needs to provide care and support our veterans is critical."

    And Murray knows what she's talking about the budget request "is a statement of our values and priorities."

    And that's why the current budget request is so disturbing in so many ways.

    Ranking Member Richard Blumenthal:  Finally, [.  . .] the issue of medical research, particularly into mental health, my understanding is that there has been no requested increase for that research.  Am I correct?

    Helen Tierney:  For mental health, I'll have to check.  But overall the research budget goes up $33 million in our [20]16 [Fiscal Year budget] request.

    Ranking Member Richard Blumenthal: Well for the VA's National Center for Post-Traumatic Stress Disorder -- which, as we all know, is the signature wound of these 13 years of war -- the funding is stagnant.  For centers like the Health Care System Medical Center Campus at West Haven --  which is doing enormously promising and critically important work -- to leave this funding stagnant in my view is, again, unacceptable. 

    Helen Tierney: So, yes, sir, and I think Dr. Clancy can better address this.  When we ran the model we are finding that we're having less very seriously injured people in the war coming back and our costs are stabilizing in that area but  our --

    Senator Richard Blumenthal:  Well, if I may say, with all due respect your injuries may be stabilizing because you're not recognizing -- 

    Helen Tierney: Thank you.

    Senator Richard Blumenthal (Con't):  -- and not acknowledging their existence.  The military itself says that 30 to 50% of our returning and separating men and women suffer from these invisible wounds of war.  This passed, new law, Clay Hunt SAV Act, recognizing the importance of providing mental health care, the research into how to treat it is even more important -- or at least as important as providing funds for the treatment because we're now using pharmaceutical drugs that are actually counter productive according to the experts in this area.  So may I suggest respectfully that the research funds be increased for this purpose.

    First, why is it that the Congress is always more concerned that the VA isn't asking for enough money -- always more concerned about that possibility than is the VA itself?

    It's a question worth considering.

    The budget request does represent priorities and the VA did not look good in that exchange.  Not only did the VA fail to make a needed request but Tierney -- the VA's Chief Financial Officer -- showing up at a hearing on the budget request and being unable to answer what the requested amount for research on mental issues was?

    That's setting aside her questionable remarks and questionable wording.

    People are not less wounded.

    Medical care -- including in the combat theater -- has progressed to allow service members who would have died from injuries in previous wars to survive very severe wounds.

    It's sad that Tierney used the wording that she did.

    It's sad that so many VA officials seems to have problems speaking of veterans in an appropriate manner.

    Moving over to Iraq, Ticia Verveer notes:

  • Agatha Christie was a British writer who dominated the mystery genre with novels built around characters such as Miss Marple, Hercule Poirot and Tommy and Tuppence Beresford.  In the 1979 film Agatha, Academy Award winner Vanessa Redgrave portaryed the author.

    In 2011, Laura Allsop (CNN) reported:

    Now, 3,000-year-old ivory artifacts recovered by Mallowan between 1949 and 1963 from the ancient city of Nimrud, in what is now Iraq, and likely cleaned by his famous wife using cotton wool buds and face cream, go on display Monday at the British Museum in London.
    Nimrud was a city in the Assyrian kingdom, which flourished between 900-612 B.C.. The ivories found by Mallowan and his team were originally made in what is now Syria and Lebanon and brought to Assyria as looted treasures.
    John Curtis, keeper of the Middle East collections at the British Museum says they make up "the finest collection of ancient carved ivories that have ever been found at an archaeological excavation" and are in good condition, possibly because of Christie's efforts.

    "Face cream in fact is quite a good thing to clean (artifacts) with. Obviously conservators now wouldn't use that but I don't think it's done (the pieces) any harm," he continued, adding that in fact it was quite resourceful of Christie to think of applying her Innoxa face cream to the fragile, dirty pieces.

    Nimrud is back in the news today.  The Washington Post's Liz Sly Tweets:

    Having scored a hit video by smashing up Mosul Museum (inc.some copies) ISIS turns to the ancient city of Nimrod

    As with the assault on the Mosul Museum, the above is getting non-stop jawboning.

    Yesterday's execution of an 11-year-old boy by Iraqi's military and Shi'ite militias?

    They can't be bothered.

    But the endless jawboning over what did or didn't happen in Nimrud will continue.


    Just as the assault on Tikrit continues.

    Isabel Coles (Reuters) reports that countless residents of Tikrit are fleeing.  AFP goes with the United Nations figure of 28,000 fleeing.  Margaret Griffis ( notes:

    Tens of thousands of people are fleeing the greater Tikrit area ahead of military operations. Many of those refugees, however, are stranded at checkpoints that lead towards Samarra. Relief supplies are being deployed to help them. Others are being kept in the area to serve as human shields for the militants.

    The refugees not only fear combat, but they are also suspicious of Shi’ite militiamen, who are accused of war crimes in other areas of Iraq. P.M. Abadi cautioned the militiamen that they must respect civil rights, and those who don’t will be punished. Meanwhile, Turkish Prime Minister Ahmet Davutoğlu said that the cities should be rescued by their own people, because the presence of Shi’ite militias could re-ignite sectarian war. 

    The assault is led by Iran.  Robert Burns (AP) observes, "Iran's growing influence in Iraq is setting off alarm bells, and nowhere is the problem starker than in the high-stakes battle for Tikrit."  The editorial board of the Washington Post offers:

    While any reduction in the Islamic State has benefits, the Tikrit operation raises multiple red flags. The United States was excluded by the Iraqi government of Haider al-Abadi; meanwhile, Iran has dispatched its own ground forces, artillery and drones. The assistance is being overseen by a notorious general, Qassem Suleimani, who previously supervised attacks on U.S. forces in Iraq.

    Iran's Foreign Minister Javad Zarif spoke with Christiane Amanpour (CNN, link is text and video) about many topics today -- including Iraq:

    AMANPOUR: Can I move on to Iraq -- a great focus right now on the town of Tikrit, where Iraqi forces, other militias, and crucially Iranian forces are engaged in trying to push ISIS back. I would like to play for you a little bit of a soundbite from the Chairman of the Joint Chiefs of Staff to Congress, regarding Iran's involvement. General Martin Dempsey says, quote: "This is the most overt conduct of Iranian support in the form of artillery and other things. Frankly, [it] will only be a problem if it results in sectarianism. If they perform in a credible way, rid the city of Tikrit and turn it back to its inhabitants, then in the main, it would have been a positive thing in terms of countering ISIL's campaign." How do you respond to what the General said, and how involved is, for instance, General Soleimani of the Quds Force of the Revolutionary Guard?

    ZARIF: Well we do not have forces on the ground in Iraq. We have always had advisors helping the Iraqi government and the Iraqi army. We were the first to come to the assistance of the Iraqis, both in Baghdad as well as in Irbil, when the ISIS started moving in in massive numbers last summer. So we've been there, we've been assisting the Iraqi people, everybody knows that without our assistance, things would have been different in Iraq. We are in Iraq in terms of advisors and other support, but without military personnel on the ground, fighting forces on the ground, as you say, boots on the ground, in order to help this very serious global fight against these extremist and terrorist groups. We hope that this could unite Iraqis, because -- and all peoples of the region -- because in spite of the short-sighted attempts in the past, now everybody has come to the conclusion that these extremist forces are a threat to everybody. They cannot be contained in Syria or in Iraq, or in only several countries in this region. This is a global threat. You see the implications in Europe, you see the fact that they are recruiting from Europe. So this is a global problem, it requires global cooperation and global work. We are there, we have been there, we have been on the right side. We recognised this threat from its initial inception. And we have been warning the international community about short-sighted policies, of playing politics with this very serious danger. And we continue to do that and we are on the side of the Iraqis. So we hope that this fight -- which is not just a military fight, it's a comprehensive fight, it should be a comprehensive fight against extremism -- could be moved forward. It is very difficult to win this fight so early on in this process, but we hope that with international cooperation, with blocking financial assistance to these groups, with blocking recruitment of these groups, with blocking easy safe havens for these groups, with blocking access from the territory of various, of our neighbours, the variety of our neighbours from their territory to provide new recruits for these groups -- all of these should come together in order to reach a useful and hopefully a positive and constructive conclusion in this very serious international fight.

    AMANPOUR: Mr Zarif, you say you only have advisors. Obviously General Soleimani is one of the most effective active military commanders that your country has. Do you believe -- and he is there on the frontlines, directing the Tikrit battle -- do you believe that they are making progress and Tikrit will be liberated by ISIL -- from ISIL?

    ZARIF: Well this is a job that the Iraqis are doing, and they are doing with great sacrifice and great vigour. And I hope that they can succeed in this battle, as well as in the bigger war against ISIL and terrorism in Iraq and in Syria. But more than just winning one battle, it requires a concerted global campaign, a campaign that must be multi-faceted and must engage all participants and not just a few.

    US military brass has made unconvincing statements where they act (a) as if there's no consultation with Iran and (b) that maybe some good could happen from it.

    The statements are weak and unconvincing.  There may be a reason for that.  Yaakov Levi (Israel National News) notes:

    Iraqi sources told the London-based Arabic-language newspaper Al-Sharq al-Awsat Thursday that the US and Iran have been cooperating in fighting ISIS forces in Iraq. The sources said that US and Iranian forces have “come to an understanding” on the deployment of forces to retake the city of Tikrit in the Salah-a-Din district from ISIS.

    The sources said that Iran has sought to be in charge of the military operation to conquer Tikrit. Iraqi officials have been reluctant to ask for US air forces to bomb ISIS targets, possibly because they are seeking to defer to Iranian forces. There are numerous Iranian advisors in Iraq, led by Kassam Suleimani, the head of the Al-Quds Brigades of the Revolutionary Guards, the sources said.

    Meanwhile, we can't afford dumb assery.  In a story dated March 5th, Jason Ditz scribbles:

    Defense Secretary Ash Carter confirmed today that the US is “concerned” by Iran’s involvement, which Sen. John McCain (R – AZ) termed as Iran “basically taking over the fight.”

    I'm sitting there and thinking, "Huh?"

    Because it's March 4th.

    We covered the "concerned" in our report on that day's hearing.

    And I'm thinking "Huh" because that's a distortion of what was stated.  We don't have time for dumb assery.  If you don't know what you're writing about, find a topic you can contribute to.

    From the March 4th snapshot, this is the exchange being misreported:

    Chair John McCain: Today in Tikrit, Secretary Carter, the Shi'ite militia with the Iranian Revolutionary Guard leader -- among others -- and Iranian air is now attacking Tikrit -- the hometown of Saddam Hussein, as we recall.  And the majority of that effort with a couple of thousand of Iraqis are being undertaken by the Shia militia. The same militia that we fought against in the surge.  The same militia that according to estimates manufactured the IEDs which are -- which directly resulted in the deaths of some thousand or two young Americans.  Are-are you concerned that Iran is basically taking over the fight and, according to the Wall St. Journal this morning, we are observing that operation.  Does that ring an alarm bell with you, Mr. Secretary?

    Secretary Ash Carter:  It-it-it does.  It does.  Our approach to, uh, combating ISIL in Iraq is to work with the Iraqi security forces and a, uh, multi-sectarian government that takes a multi-sectarian approach to defeating ISIL and retaking its own territory.  Sectarianism is what brought us to the point where we are.  And so I do look at it with concern.  We're watching it very closely.  The, uh, Shi'ite militias involved also the Iraqi forces involved -- some Sunni forces involved. Uh-uh, I would note that there have -- Some Sunni tribal leaders in Tikrit -- and this is important -- have signaled their support for this offensive.  And if that's true, it's good news because that suggests that this is not purely a Shi'ite on Sunni thing. But this is the problem that brought Iraq low.  So I am -- So I am looking at it with great concern.

    Chair John McCain: And of course we -- There's well documented human rights violations -- significant -- by Shi'ite militias on Sunni as we all know.

    Quit misrepresenting what people say.

    I really don't see the value in dumb assery.

    "Sectarianism" is what Ash Carter looked at with "concern."

    In fairness to Ditz, his link goes to Robert Burns.  But when people chop up statements, anyone with a brain should question what was said that it couldn't be quoted in full.

    I don't have time for dumb assery.

    Criticism of Iran's involvement (leadership) with the Tikrit assault is also coming from withint he region.  Richard Spencer (Telegraph of London) reports:

     Saudi Arabia became the second key American ally in the Middle East to demand President Barack Obama change tack towards Iran on Thursday, as it called for US-led coalition "boots on the ground" to fight Isil.
    Prince Saud al-Faisal, the Saudi foreign minister, told John Kerry, the US secretary of state, that he risked allowing Iran to "take over Iraq", echoing Israel's recent concerns over the White House's policy toward Tehran. 

    And Jim Michaels (USA Today) speaks to the prime minister of another regional player, Turkey's Ahmet Davutoglu who states, "All these cities, Sunni-populated areas, should be liberated by the inhabitants of those cities.  If Shiite militias come in, then there will be sectarian war."

    Haider al-Abadi is Iraq's Prime Minister.  And he's quite taken with himself.

    On International Women's Day, PM Al-Abadi stresses commitment to increase representation of women in senior positions
    47 retweets 33 favorites

    How wonderful.  Except . . .

    PM Al-Abadi met with Baghdad's new mayor Dr. Thikra Alwash and discussed plans to rejuvenate the capital its services
    33 retweets50 favorites

    That's the Mayor of Baghdad.  A woman.

    And that speech he's congratulating himself for?

    All Iraq News reports he stated he was pressured to appoint a woman to be mayor of Baghdad.  He didn't want her.  (He was told by US officials that Iraq's black eye on women's rights since the 2003 invasion was hurting Congressional support.)

    And that's not even getting into his offensive remark that women have a role to play on the battlefield:  encouraging men to fight.

    Women in Iraq have been fighting and defending Iraq since before the 2003 invasion.

    Women since have fought in many roles.  The Kurdish Peshmerga, for example, has women fighters.  The Sunnis have offered DOI -- Daughters of Iraq -- the female counterpart to Sons of Iraq.  The DOI was paid less than SOI but didn't have an easier job.  Female suicide bombers meant the 'new' (post-invasion) police were forced to (again) hire women (men aren't allowed to search women).

    So his remarks were really insulting.

    Women's role is to encourage men to fight and the only woman he's appointed (have we looked at his Cabinet) was the Mayor of Baghdad whom he stated, on this day of observance for the rights of women, that he only appointed because he was pressured into doing so.

    the telegraph of london
    richard spencer