Tag Archives: Iraq War costs

The Veterans and their Administration

Veterans PopulationThe Numbers Game: Issues pertaining to the management of Veterans Administration services have special meaning to 225,933 people in Nevada, 169,255 of whom served this country during war time, and 56,678 who served during peace time.  [VA actuary]  69,190 Nevadans served during the Gulf War era, 79,281 served in Vietnam, 20,462 served in Korea, and we have about 9,444 remaining veterans from World War II. [VA actuary]  Meanwhile, 13 years of operations in Afghanistan and in Iraq are adding to these numbers.

The United States deployed 2,333,972 people to Iraq and Afghanistan between 2001 and 2011, of whom 1,353,627 have since left the forces, and 711,896 used VA health care services between FY 2002 and FY 2011. [ABC] Veterans during the period 2008 to 2011 saw deployment time increased by 28%. [Rand pdf] The Iraq operations, we were told, could last “six days, six weeks, I doubt six years.”

“We don’t talk about deployments in the specific, but we have brought a good many Guard and Reserve on active duty. Fortunately, a great many of them were volunteers. We have been able to have relatively few stop losses. There are some currently, particularly in the Army, but relatively few in the Navy and the Air Force. And it is not knowable if force will be used, but if it is to be used, it is not knowable how long that conflict would last. It could last, you know, six days, six weeks. I doubt six months.” [Rumsfeld, Aviano Air Base February 7. 2003] 

We may not want to talk of deployments, but warfare creates veterans and the longer the warfare lasts the more veterans there will be.

Estimates during the debate over initiating operations in Iraq which projected totals over $3 trillion (Stiglitz) were dismissed out of hand. Instead Lawrence Lindsay, Chair of President Bush’s Council of Economic Advisers estimated the war might cost $200 billion at the most, but during the 2002 campaign season this projection was determined to be “shockingly high,” Lindsay was fired and replaced by Mitch Daniels who argued the Iraq war would cost no more than $50 to $60 billion.  [EconMonitor]

The $60 billion figure is dwarfed by the estimated $135 billion estimated as minimally necessary to provide services to veterans.

Making the situation even more tenuous for veterans, the Sequester budget deal cut  services from other agencies (HUD, Defense, Labor) for veterans while ostensibly leaving the VA untouched — except that “administrative costs” might be cut by 2%, and what constituted an “administrative cost” remained ambiguous. [WaPo]

The Management Game:  The VA Inspector General’s office has expanded its investigation to 26 VA facilities regarding allegations of falsified records and delayed care.  One former administrator in Phoenix, AZ offered his opinion that 40 veteran may have died while waiting for care.  To date no link has been established between the delays and those deaths. [ABC]  The lack of direct linkage notwithstanding, it is certainly possible that care delayed can all to easily become care denied.  Instead of listening to carping, finger pointing, and generally distasteful politicizing of the situation at the Veterans’ Administration, here’s what I’d rather hear from our pontificating pundits and politicians:

Reducing delays and other problems within the VA system, which have long be evident, may well require a significant shift in the way in which services are perceived and administered.

#1. Future Congressional calls for war or large military operations should be accompanied by calculations projecting a reasonable TOTAL cost of the actionsincluding services and benefits for veterans. As there should be an accounting for individuals who falsified records to artificially reduce wait times, there should be an accounting for those whose minimalist estimations for the cost of operations in Iraq and Afghanistan made those actions appear “affordable.”

The failure of the VA to provide timely services is a function of staffing and facilities, infrastructure which should be considered before we launch wars in which we have an option to defer, delay, or avoid action altogether.

#2. Administration of VA services should be predicated on veterans’ needs and not dubious or inappropriate management theories.  The VA is not a commercial or manufacturing entity. Its sole function is to provide customer/client services.  In this wise, the VA perspective ought to be one in which client service is acknowledged to be labor intensive, and hiring should be adjusted accordingly.

For example, while demand for VA care services has increased by 38%, the VA has hired only 9% more medical professionals.  Public-private partnerships with local medical service providers has been applied, and more such partnerships may be one part of a larger strategy to appropriately staff the facilities.   Actions by Senate Republicans who blocked a $24 billion veterans’ health bill in February  2014 which included funding for 27 new medical facilities are unhelpful. [Reuters] [Roll Call 46 – all 41 votes blocking  S. 1982 were cast by Republican Senators]

The treatment of and for veterans should reverse the perspective that all claims are “costs” and “cost containment” is an ultimately desirable institutional goal.  If one is manufacturing widgets for WalMart this might be an acceptable perspective, but we are not talking about a price driven retail commodity — we’re speaking of veterans who have been promised a level of support services (educational, medical, and employment) which have not been delivered on a timely basis.

The much maligned Internal Revenue Service is a far more trusting agency than the VA appears to be.  When I file my return electronically the IRS assumes I am being honest. I may be audited at some point in the future, but for the latest fiscal year the assumption is that I meant what I affirmed at the end of the document — that the return is the most honest and accurate it is within my power to provide.   The VA claims process might be improved by adopting the same attitude.

Unfortunately, the VA is giving the appearance of an institution for which a claim is as much an opportunity for fraud or misuse as it might be a legitimate request for service.  This attitude could quickly spawn a multi-layered bureaucracy  devoted to weeding out any untoward claims. It’s essentially the pre-ACA attitude of health insurance corporations which sought to deny as many claims as possible in order to manipulate its medical loss ratio.  This situation might have been predicted since politicians of every imaginable stripe have loudly proclaimed their affinity for rooting out “Waste, Fraud, and Abuse.”  In the instance of the VA all this cat-calling from the bleacher seats simply serves to reinforce the “cost containment” proclivities and diminish the “service to the client” perspective.

#3 The core of the manipulation problems in the Phoenix office is said to emanate from a bonus system for “meeting the numbers.”  I’ll have to admit to a jaundiced view of bonuses.  Bonuses are what you pay employees when you don’t want to pay them up front what they are really worth. It’s close to an analogy in which the cafe owner justifies sub-minimal wages because the wait staff receives tips.

No one should be particularly surprised when people emphasize on the job what the institution/company/corporation rewards.  If the company rewards speed in delivery, speed we will get — even if a NOAA drone is delivered by FedEx to the wrong address.  If the company/agency rewards fast service, then the service will be fast, and if that can’t be done in the real world then the numbers are fudged to gain the reward and make the boss happy in the bargain.  If the disturbing consequences of the testing furor in education has taught us nothing else, it should have told us that we will get what we measure, not necessarily what we want.

How much less traumatic might the problems with the VA be if we could admit to ourselves that there are immeasurable things which are nonetheless important to the delivery of competent and complete care for veterans and their families?

#4. Technology moves faster than our fingers.  Granted that the inability of computer data systems to share information quickly and accurately is a problem, especially it seems between Department of Defense and VA systems.  At some point we need to acknowledge the hard horrible fact that older stand-alone data systems were never designed to function in a file-sharing world.  No amount of patching or plugging is going to make them compatible.

Until we accept that if we want compatible systems we have to buy them.  They are expensive, they are complicated, and they are unintelligible to most voters — however, the old retail saw holds true — we will get what we are willing to pay for.

Meanwhile there are 225,933 veterans in Nevada who deserve to receive the educational, employment, and medical services they were promised when they signed on to serve us, and who deserve more than a political outrage du jour, and a brief turn in the media limelight.

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Dear Grandkids, We’re Leaving You Some Bills

GrandparentsDear Grandchildren,

It’s March 16, 2013 and we’re all in a dither about the debt we’re passing along to you.  Yes, it’s a big one.  The lines on the charts look devastating indeed:

National debt by administration

We chose to ignore the actual debt and real deficit reduction efforts in order to focus on cutting the “size of government” in your life so you could have more “freedom.”

National Debt Presidencies But, all this said, we are leaving you some bills we sincerely hope you can pay!  In our fervor to erase the national budget deficits and reduce the level of national debt we left a few things for you to do to pick up after us, we hope you don’t mind.

The Water Bill:    We knew that as of 2009, and more information is coming on March 19, 2013, that we were running up an $11 billion per year backlog of funding to replace aging water system components.  In reality, the 2009 report wasn’t our first clue:

“The Congressional Budget Office (CBO) concluded in 2003 that “current funding from all levels of government and current revenues generated from ratepayers will not be sufficient to meet the nation’s future demand for water infrastructure.” The CBO estimated the nation’s needs for drinking water investments at between $10 billion and $20 billion over the next 20 years.” (emphasis added)

We knew that there had been a 159% increase in the demand for clean drinking water between 1950 and 2000, but we did precious little about the issue.  We moaned about the ARRA’s expenditures for water treatment, about how it would run up the Debt, so our Congress appropriated a “drop in the bucket.”

“The new federal stimulus law provides $6 billion for water projects, with $2 billion of that directed to drinking water systems. But that money is only, well, a drop in the bucket: a report released last month by the E.P.A. estimated that the nation’s drinking water systems require an investment of $334.8 billion over the next two decades, with most of the money needed to improve transmission and distribution systems.” [NYT, 2009]

We knew that the design life of concrete treatment plants would expire in 60-70 years, so the plants built in 1950 are now on their last legs.  We knew that the trunk mains were built to last from 65 to 95 years. Some of those are now aging into oblivion. [ASCE]  So we’re leaving you with the bill for $334.8 billion over the next twenty years to pay for the maintenance of a water distribution system we bragged about but didn’t really want to pay for.

The Sewer Bill:  Our 15,000 public wastewater treatment facilities serve about 225 million people in this country, but we’re still subject to about 900 billion gallons of good old raw sewage discharged every year from aging and dilapidated facilities. [NYT 2011]  We knew back in November 2002, when you were just little tykes, that the Congressional Budget Office estimated the expenditures needed for new and improved wastewater treatment would be in the range of $3.2 to $11 billion. [CBO pdf]  There was a Gap Analysis conducted by the CBO back in 2002 which had some more disheartening information:

“According to the Gap Analysis, if there is no increase in investment, there will be a roughly $6-billion gap between current annual capital expenditures for wastewater treatment ($13 billion annually) and projected spending needs. The study also estimated that if wastewater spending increases by only 3% per year, the gap would shrink by nearly 90% (to about $1 billion annually).

The CBO released its own gap analysis in 2002, in which it determined that the gap for wastewater ranges from $23 billion to $37 billion annually, depending on various financial and accounting variables.”  [ASCE]

So, when all is said and done, we dawdled around until the EPA estimated that it would cost about $390 billion over the next 20 years to repair or replace inadequate water treatment plants and other components of the systems.  We hope you don’t mind we’re leaving you this bill for $390 billion?

The Education Bill:  It’s hard to account for all the needs of our 98,917 public schools in this country. [NCES]   If we’re being honest, we haven’t really looked at the number of aging buildings, or carefully studied their functional age since the “turn of the last century,” in 1999.  We do know that children who are in poverty are also in the oldest buildings. [NCES]   Additionally, we’ve known this not-so-fun fact since the 1999 study: “While 40 percent of small schools (enrollments of less than 300) were built before 1950, 23 percent of large schools (enrollments of 1,000 or more) were built before 1950.”  Since large schools tend to be secondary, we can assume we’ve been following the time honored practice of building nice big new high schools and moving the junior high kids into the old buildings?  Then there’s the “portable building” problem — we’ve known since the Fall of 2005 that portable buildings have more problems which interfere with instruction than standard buildings. [NCES] While the issues might not be too far from the similar interferences in standard buildings — we know they exist — it was just cheaper to ignore them.  Our spending on school construction, as analyzed by the ASCE might give you some pause:

“While detailed conditions and needs numbers do not exist, we do have up-to-date numbers on spending levels. According to the American School and University’s 34th Annual Official Education Construction Report, school construction completed in 2007 (which included both new construction and renovations) totaled more than $20.2 billion. That is down from a peak of $29 billion in 2004. The downward trend is expected to continue: with $52.7 billion in funding is projected between 2008 and 2010. This represents a significant decrease from the $68.4 billion spent between 2005 and 2007.1″

If you are thinking that you might be able to kick this discussion down the road, as we did, because privatization is the solution to every public problem, please think again. First, the charter schools are public buildings in which instruction is immediately governed by groups outside the system.  Secondly, they may not be located conveniently near you, or serve the age groups of your offspring:

“In 2009–10, over half (54 percent) of charter schools were elementary schools. Secondary and combined schools accounted for 27 and 19 percent of charter schools, respectively. In that year, about 55 percent of charter schools were located in cities, 21 percent were in suburban areas, 8 percent were in towns, and 16 percent were in rural areas. [NCES]

There are studies indicating some charter schools are doing better than some public schools, but we have to be careful with our numbers.  For example, one summarization of the different levels of educational achievement (read: test scores) failed to note that charter schools youngsters tend to be from more financially secure families.  [WaPo]  However, if we’re honest, we’d tell you that we’ve not been looking too closely behind the numbers of either the cost of building or maintaining schools, or at the cost of employing qualified teachers… But, Hey, we walked to school and back uphill both ways in driving blizzards.   And, about those standardized tests — “States are likely to spend $1.9 billion to $5.3 billion between 2002 and 2008 to implement NCLB-mandated tests, according to the non-partisan Government Accounting Office (GAO),” as of 2005. [RSO]  We’re leaving you the bill for that too. Whatever it might be.

The War Bill:  We were going to have another “Splendid Little War,” the one in Iraq.  The Bush Administration and a compliant Congress authorized the expenditures as “supplemental appropriations,” meaning that we didn’t have to look at the tab we were running in real time.

Total federal spending associated with the war has reached $1.7 trillion. Future promised health and disability payments for veterans through 2053 add up to $490 billion. So, as it stands now, the Iraq War has cost $2.2 trillion, which is a far cry from the initial 2002 estimates of $50 to $60 billion. When you factor in the interest, war expenses could swell to more than $6 trillion over the next four decades. [NYDN]

So, we missed by a few dollars… but we’re leaving you with the very possible  $6 trillion bill anyway.

We might have paid for some of these items ourselves. We might even have given more consideration to the state of our bridges, dams, and public buildings.  We could have thought of the state of the air traffic system, or the highway syste, or the rail transportation system, we were leaving to you.  However, fretful as we were about these expenses and future costs, we decided that it was not in our best interests to close tax loopholes for giant multi-national energy corporations, or for yachts, or for private jets.  We decided that we “over taxed” our corporations, and rewarded them when they “repatriated” money earned overseas to the U.S.   We decided it was more important to appropriate money for airplanes that didn’t fly than to pay for G.I. benefits earned by service.  We decided it was more important to protect the interests of Wall Street than Main Street.  We decided that money earned in speculation was just as hard won as income from investments or good old fashioned hard labor.   We didn’t want to “burden” you with restrictions on financiers, or humongous banks, or on the incomes to be earned by the top 1% of the population — we wanted you to be “free,” to have “liberty,” and to say nice things about America!

We love you dearly, and want you to know that we think of you always.   Good Luck.   (PS: Hope you don’t mind we’re moving in with you.  After cuts in Social Security and the voucherization of Medicare we’re having a little financial difficulty at the moment.  Even Meals on Wheels isn’t coming anymore.  We could babysit for you now that the Headstart Program serves only a few kids in your neighborhood?)

The Gramps

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