Archive for the ‘Medical’ Category

Mr. McDonald,

Congratulations on your nomination to lead the Department of Veterans Affairs. As a good citizen you have agreed to take on one of the most demanding and important jobs in Washington.

As a veteran yourself you can appreciate how shaken veterans and their families are by the scandals and corruption that has been exposed throughout the Veterans Administration. I know you will agree that we owe our veterans the best care and we have failed to deliver.

Given the scale of the challenge, I hope you will not mind if, as someone who has spent nearly five decades in politics and government and has seen scores of cabinet secretaries come and go, I share a few thoughts on the position to which you’ve been nominated.

Should the Senate confirm you to this post, you will take command of the VA at the most troubled time in its history. The reports of corruption, incompetence, and corruption to hide incompetence have drawn the nation’s outrage and caused your predecessor to resign. How might you succeed at reform where so many others before you have failed?

Given your lifetime spent in business, probably you are familiar with W. Edwards Deming’s famous “Red Bead Experiment.” Deming used to carry around a bin full of red beads and white beads mixed together. He would describe to audiences his intention to gather up just the white beads, and then he would blindly plunge a scoop into the bin. To his ostensible frustration, the scoop would always emerge with a mix of both kinds of beads. Feigning disbelief, he would appoint a new person to wield the scoop. Invariably, he or she would fail as well. Then Deming would proceed to the next candidate, and so on.

The point of the Deming demonstration was to illustrate that a systems problem couldn’t be solved with new people, new slogans, and new speeches. When the system is broken, the personalities don’t matter. People will fail one after the next until the system is changed.

The range and scale of the misconduct at the VA shows that the corruption there, like the doomed attempt to isolate white beads, is not just a problem of personalities but more importantly of systems, and it goes to the very core of the bureaucracy. I have attached a map we have developed at Gingrich Productions which shows 55 VA sites with major problems. We are certain this number will grow as more parts of the VA are investigated and audited.

When you have that many places in trouble simultaneously you are not dealing with a few bad apples, a failure of a few leaders, or a need for better inspections. With that many places simultaneously in trouble, you have a system and a culture that have been corrupted and are collapsing.

The agency’s own audit found that 70 percent of VA medical facilities were using improper scheduling practices to hide long wait times by falsifying data. The wait times persist despite (or more likely because of) the fact that VA doctors see less than half as many patients as doctors in the private sector.

This is a department that has 40 percent more employees and costs 90 percent more money than it did in 2006. Operating rooms close at 3:00 pm so the union cleaning staff can leave by 5:00. Officials get bonuses no matter what their performance, apparently (though 100 percent of them were given “fully successful” performance reviews or better last year–a remarkable achievement in light of the agency’s widespread mismanagement).

It takes 175 days to transfer a veteran’s medical records from the Department of Defense to the VA. The DoD and the VA spent $1.3 billion and four years trying to build software to solve this issue before announcing in February that they had given up.

Failure this thorough points to a system–the giant, fossilized bureaucracy–that is hopelessly broken and must be replaced rather than repaired. Unfortunately, the entrenched bureaucrats, the unions, and the President, along with many others in Congress who are ideologically committed to a failed model of delivering health care, all oppose the systemic changes that could actually work.

Mr. McDonald, you are about to become the next guy holding the scoop at the VA. The prison guards of the past might write legislation to give you a bigger scoop, and then they will call the problem solved. Your job, as the new champion of our nation’s veterans, will be to focus the public’s outrage and to marshal support for real change.

Opportunities to force the kind of transformation the VA needs come along once or twice in a generation. It would be a tragic mistake if, after the enormous human pain that led to your appointment, you allowed the moment to pass.

What would systemic change look like? It would begin with enforcing the right metrics, with measuring success not by how well the Department serves the bureaucrats but by how well it serves our veterans. This would mean insisting the VA meet the standards our veterans are accustomed to as consumers in every other aspect of their lives–the world where services work and are increasingly digital, mobile, virtual, and personal.

The VA is a long way from that today, and to get there it will have to become a radically different agency with many fewer bureaucrats operating under a new set of assumptions. The fight to change the VA will be big. But the ramifications could extend well beyond your single department. The whole federal bureaucracy is broken, swollen into an unrestrained fourth branch of government. If you can harness public support to transform the current VA into a system based on choice, accountability, and efficiency, you could be setting the pattern for replacing the entire bureaucratic state with a government for the modern world.

It would be a fitting conclusion to a century plagued by bureaucracy if the renewal of American governance were to begin at the VA, a department which exemplified the system’s worst tendencies from the start. Charles Forbes, the first person to hold the position to which you have been nominated, stole tens of thousands of dollars from the bureau after World War I, as did many of his cronies. The corruption is not new, but nearly 100 years of it is enough.

I hope you will be the Secretary with the courage to demand the fundamental change our veterans need. The American people will be with you, even if many in Washington are not.


Newt Gingrich


From LBEB:

Progress: it is the reason why the majority of us are in the gym every week. However you measure progress, whether you want bigger lifts, bigger muscles, less bodyfat or a faster 400m split, progress is what keeps us training day in and day out. Disregard the individuals that are going to the gym to “maintain”, that is just an excuse to not work hard. But, what if everything you put into your training doesn’t amount to a hill of beans? Here are 10 things that can indicate whether or not your programming & training is being spent wisely.

1. You don’t understand the difference between difficult and useful.
Just because something is hard to do, does not mean it is useful, or will do anything to progress your lifting career. I could spend 3 months mastering a strict muscle up, but will that really help me as a Strongman? Spend your time wisely, time is finite.

2. You aren’t eating enough carbs.
If I had a nickel for every time we added carbs in to someone’s diet improved their lifts, I would have more nickels than you. Carbs are not your enemy, stagnation is. Steak and broccoli is not eating big, so for the love of progress, put a potato on the barbie.

3. You ask everyone on the internet for advice, and listen to all of it/none of it.
Either way you end this equation, you are going to lose. If you try to follow everyone’s cues and tips, you will go nowhere, because everyone on the internet has different opinions about the “right” way to do things, which may not apply to you at all. If you listen to none of it, you are wasting everyone’s time, especially yours. Pick someone’s advice that you trust, put on your blinders, and follow their orders.

4. You think a supplement will make up for calories. No supplement is going to replace the calories you need to get bigger and stronger, if it comes in a pill, it has little or no calories in it. Pills and powders don’t get you big on their own, that’s why it is called a supplement, not a replacement.

5. You want to get better at everything, and you want it to happen yesterday. Arguably, a lot of us are guilty of this. However, the line that separates those who want to be good and those who want to become good is the ability to break goals into smaller pieces, and accomplish them in segments. World records aren’t built in a day.


6. You view training gear as non-primal/cheating. I am going to let you in on a secret: if you are reading this article while connected to the internet, you are about as far removed from a primal state as you can be, why should your training be any different? I am not afraid to venture a guess that I am stronger than my cave dwelling ancestors, because I am not afraid to use proper assistance gear when lifting. Belts, straps, chalk, and wrist wraps are your friend, if you think that is cheating, you should start walking barefoot to work and start living in the nearest redwood forest.

7. You aren’t recording your lifts. Unless you are doing bodybuilding movements, you probably don’t need to watch yourself in a mirror while lifting. However, recording your lifts and watching them after is an excellent way to study your movements and learn how to improve them next time. If you think good athletes don’t record and post their videos, you are in for a rude awakening.

8. You are afraid to compete. I can personally attest to this, because I was once afraid to compete. Sometimes failing at a competition is exactly what you need, in order to do better the next time. I have yet to work with someone who, after their first competition, did not have a fire lit under their ass to compete again ASAP.

9. You think bench/squat/deadlift is all you need to do to be a good lifter. This may be true for those first starting out, but as you progress, you will see that it is simply not true. By not adding in supplementary bodybuilding movements, your weaknesses will still be your weaknesses as you get stronger. Suns Out, Guns Out.

10. You don’t know how to detach. What if I told you that there was a whole world out there, full of people and places that have no idea about lifting, or care about it? Sometimes getting out of the “community” for a short period of time is exactly what you need to get your mind right. Familiarity breeds contempt, and all too often we get extremely familiar with our lifestyles. Take some time off and hit lifting with renewed vigor.

From Alanna Casey at LBEB

“I can’t deadlift, I have a bad back.”
“I can’t squat, I have bad knees.”
“I can’t ‘insert exercise here’, I have an ‘insert excuse here’.”

We all get injuries, we all could make excuses. Some are actually legitimate, but the majority are just that: excuses. Unfortunately, body pains are part of the world of lifting heavy things, especially back pain. But, you don’t have to accept the pain. Instead, you can do things to mitigate back pain or eliminate it all together.

I will start with the disclaimer that if you have persistent, unmanageable pain, symptoms of nerve damage (numbness/tingling), or loss of bladder control then get to a doctor ASAP. I have struggled with back pain for years. Ever since I started deadlifting/squatting over twice my body weight I have had to manage back pain, especially lower back pain. Many of my world class powerlifting/strongman friends suffer from back pain as well. Even my friends who participate in crossfit have back pain.

There are many different causes of back pain. Within the strength community the most common are muscle strains, nerve impingement, disk degeneration and muscle imbalances. My personal back pain is from muscle imbalances which led to muscle tightening in my lower right side, which led to nerve impingement. It took me about 10 doctor’s visits and 3 years to figure that out,but I finally got it! Yay. I would first recommend seeing a doctor about your particular issue but, given my issues I’d like to offer some advice on how to alleviate your pains.

1. Stretch
I hate stretching! Its sooo boring: it takes foreevver, it’s uncomfortable and most importantly, I cannot feel myself immediately getting bigger/stronger when I’m doing it. Yes, I understand stretching sucks. But it’s immeasurably important. At a minimum, I recommend stretching your shoulders, back, and hamstrings prior to any lifting workout. See the below illustration for some simple back stretches.

Stretching is important to your next PR attempt. Here’s why. Stretching will improve flexibility and increase your range of motion (especially important on squat). Stretching will lengthen tight muscles that are pulling your body away from their optimal and balances position (correct posture). Stretching also can decrease your chance on injury by preparing them for work. AND stretching after you train could possibly decrease muscle soreness by increases blood and nutrient supply to muscles which helps to clear and distribute lactic acid build up.


2. Take note of your posture
As you are sitting at your computer at work, or driving your car, watching tv, or sitting on the bleachers cheering on your kid during her soccer game, take note of your posture. Is your spine aligned or are you slouching over? If you’re slouching, correct it. Is your head at neutral or are you constantly looking up or down? As you sit do you have equal pressure on both cheeks or are you favoring one side?

I found that I had a tendency to lean to the right when sitting. This meant that my left side was constantly getting a stretch but that my right side was tense and constricted. This contributed to my back pain. I now make a conscious effort to correct my posture, no matter where I am.

3. Use proper form on squats
Yes, I’m talking about squats NOT deadlift! A lot of people end up hurting their back while squatting (or trying to squat). Women especially seem to have this problem for some reason. I am referring to the tendency to lean forward when squatting (see figure below). Many people (myself included) make the mistake of allowing their back to fall forward on the squat. When this happens the lower back has to work 1000% harder and in a 3D plane instead of a 2D one. Some people call this “clamming.” When you squat, you want your upper body as erect as possible. When you feel yourself leaning forward, your lower back has to try and compensate to keep you from toppling forward. Essentially, you end up doing a good morning while squatting. If you can keep your back straight up and down, your lower back will not be overworked.


But, in order to do that you must have enough flexibility in your hips and hamstrings, ESPECIALLY your hamstrings. During my last training cycle I stretched my hamstrings about 5-6 times a day for ten minutes (my doctor recommended 10 times a day but 5-6 was the best I actually did). I would also stretch my hips after each deadlift and squat session. One really good way to stretch your hips is to stand directly in front of a wall, get your legs into your squat stance, spread your arms onto the wall, parallel to the floor, and then squat. Concentrate on keeping your hips open and knees out; it’s the only way you will be successful.

4. Work your lower back muscles
Your back hurting (alone) is no reason not to train your lower back. My doctor recommended that I perform isometric (static, non-moving) back exercises, with lesser weight, as opposed to full range of motion exercises. Some great exercises for lower back are:
– Barbell row
– Standing or seated good mornings (I prefer seated)
– Back extension (great exercise to make isometric)
– Reverse glute ham raises

5. Get a good spotter
If you know that your back might be an issue, having a good spotter for heavy exercises is a must. Brief your spotter on exactly how you want him/her to assist you. Tell him what you will say if you need assistance and exactly what you expect him/her to do. I see a lot of people “spotting” on squat but, if their partner actually needed help, I’m not sure they would know how to properly assist.

If I am spotting someone on the squat, I squat directly behind and with my partner. I put my arms under their arms by their lats. If he/she needed help I would place my hands on or under his/her chest and squat the weight up using my legs. As you spot someone on the squat you want the lifter to be able to maintain form.

If you start to experience extreme discomfort in the middle of a lift, you want someone there (who is capable) to help you out to avoid injury. If you don’t have a spotter at least use a safety rack.

5. Know when you call it quits
There is a fine line between discomfort and pain. When pushing yourself in any exercise you will be uncomfortable. But, if you feel sharp pain, I recommend you stop your exercise. About once a month I will end a session early because my back is in sharp pain following an exercise. When this happens “pushing through it” will only cause greater damage. If you feel pain during any workout I suggest you stop that movement and either dramatically correct/change your form OR drastically lighten the weight OR start a cool down complete with stretching. It’s important not to let your ego get the best of you in this situation. Do what is best for YOU every day. Just because your lifting partner is doing a certain exercise or weight, doesn’t mean you have to do it. Exercise your brain as well as your muscles.

6. Deep tissue massage
I invest in a deep tissue massage about once every 4-8 weeks. If I had the funds I would do it every single week. Deep tissue massages help to release toxins from your muscles and help to prevent scar tissue from forming after muscle tears/strains. Deep tissue massage can also break up and eliminate scar tissue from previous injuries. If your deep tissue massage is an enjoyable and relaxing experience then your massage therapist isn’t doing it correctly. A true deep tissue massage will be quite painful as muscle knots are broken up. Be sure to drink lots and lots of water following a message.

7. Strengthen your core
Back pain may be caused by an imbalance between your lower back and your abdominals. Strengthening your abs will help correct this imbalance. I recommend training abs 1-2 a week, especially women.

8. Ice
I recommend icing your back for 20 minutes prior to going to sleep. Just make sure you don’t fall asleep with a bag of ice on your back and wake in a puddle! Icing will reduce inflammation and ultimately decrease your pain.

9. Osteopath vs Chiropractor
If you do all these things and still have back pain I would recommend and MRI. If the pain isn’t caused by a herniated disc, you might have a nerve pinched. In this case a Doctor of Osteopathic Medicine (D.O. or DO) would be able to best help you. Unlike a chiropractor, an osteopathic physician is a doctor. I have found that osteopaths are more likely to offer a more permanent solution to pain rather than short term pain relief. My osteopath realigned my spin and corrected the nerve impingent. I had been to a chiropractor many times before and he offered a 60 second massage, 60 seconds of hip stretching, and 10 minutes of a TENS unit (electrical stimulation). That did offer me relief but it only last a day or so. When I go to the osteopath my relief lasts a month or so, big difference.

I hope this article helps you to manage your back pain. Remember, pain doesn’t mean you shouldn’t use a particular muscle group, just that some sort of correction needs to be made and attention given.

You’re welcome.

– Rob

True story. I spoke with an Army veteran who had a below-the-knee amputation recently, and he had this to say via text message about his experience with the Veterans Administration (VA).

“I’m 8 weeks past amputation and the VA won’t even listen to the prosthesis they referred me out too!”

“After talking to Hanger orthotic every veteran that needs a prosthetic is getting delayed some guys 4-6 months after amputation.”

We have a term for this in the military, and it’s called UNSAT (short for unsatisfactory).

Mr. President, there’s a reason the tree at the VA is not producing any fruit – it’s dying and incapable. During my service in the Special Operations community, I learned a tremendous amount about good and bad leadership, and I can tell you that if an organization is plagued by long-term problems, it’s not the people in the organization that are the problem, it’s their leadership.

Shinseki doesn’t have much to be proud of during his time at the helm of the Veterans Administration (VA) since being appointed by President Obama in 2009. His list of accomplishments include an internal investigation by the Inspector General (IG) that found his organization guilty of millions of dollars in fraud, waste and abuse (off-site meetings and federal acquisition bribery), and more recently, we’re starting to get eyewitness accounts of massive veteran record purges.

“If these allegations prove to be true, it is dishonorable, it is disgraceful, and I will not tolerate it, period,” said Obama

The situation has been bad for years, and the Veterans Administration has become more like the movie “Hunger Games,” with Shinseki and his inner circle eating and drinking themselves fat in the “Capital” city, while millions of veterans go without proper help, medicated into submission, and purged of all things important.

I’m glad that this topic has finally caught fire in the mainstream media and DC – although the writers on this site have been covering the VA debacle since long before it became trendy in politics or the media.

The solution is a simple one, Mr. President: Shinseki and his top staff need to go. Until the Secretary and his leadership are held accountable, we’ll continue to see the problem get worse for veterans everywhere. Time to lead by example or have one made out of you by American veterans.


From CBS MIAMI – When asked why he would risk his job and speak publicly, Detective Thomas Fiore considered the question carefully before answering.

“People are dying,” he finally said, “and there are so many things that are going on there that people need to know about.”

Fiore, a criminal investigator for the VA police department in South Florida, contacted CBS4 News hoping to shed light on what he considers a culture of cover-ups and bureaucratic neglect. Among his charges: Drug dealing on the hospital grounds is a daily occurrence.

“Anything from your standard prescription drugs like OxyContin, Vicodin, Percocet, and of course marijuana, cocaine, heroin, I’ve come across them all,” he explained.

Even inside the hospital, he says he was stopped from doing his job – investigating reports of missing drugs from the VA pharmacy. When the amount of a particular drug inside the pharmacy doesn’t match the amount that the pharmacy is supposed to have, a report, known as a “discrepancy report” is generated. Normally it was his job to investigate the reports to determine if they were the result of harmless mistakes or criminal activity. But all that changed, he said, about two years ago.

“I was instructed that I was to stop conducting investigations pertaining to controlled substance discrepancies,” he recalled.

He said he was personally told to stop investigating them by the hospital’s chief of staff, Dr. Vincent DeGennaro.

“I have no idea why,” he said. “He’s the chief of staff he doesn’t have to tell me why.”

DeGennaro declined our request for an interview. A spokesman for the VA wrote CBS4 News: “The Miami VA is required to monitor all controlled substances and resolve inventory discrepancies within 72 hours. Any unresolved discrepancies are reported to the Miami VA Healthcare System Director and Controlled Substance Coordinator, VA OIG, DEA and VA Police for independent investigation.”

Fiore said he decided to contact CBS4 News following our report last month on the death of Nicholas Cutter, a 27-year-old Iraq War veteran with PTSD who died from a cocaine overdose inside the Miami VA’s drug rehab center.

Fiore said it was well-known that Cutter was someone who not only abused cocaine but also smuggled it into the hospital. He said he reported it to his superiors in the weeks before Cutter’s death last year but no action was taken. Fiore said he was amazed the staff continued to give him passes to leave the building.

“He would have been number one on my list of people I would want to stay at the facility, not just for his safety but for the safety of all the other veterans that are in the medical center,” he said.

When Cutter’s body was found on June 1st, Fiore said the staff inside the rehab center failed to immediately call him. Cutter’s room should have been considered a crime scene. Instead, the staff bagged up the body and cleaned the room. He said he only learned about the death two days later.

“I was very shocked to be honest with you that I wasn’t called,” he said.

Fiore claims the way the hospital handled Cutter’s death was typical of the way they try to handle most problems. He said they prefer to keep things as quiet as possible rather than fix the problem.

Referring to drug dealing on the hospital grounds, Fiore said, “It’s been a problem for a while, for a very long while.” But administrators refuse to address it.

Fiore said the dealing usually takes place near the front entrance to the hospital, where patients and other gather to smoke. Patients will sometimes sell portions of the prescriptions they just filled. Other individuals will bring illegal drugs onto the grounds to sell. He said he has seen individuals in the drug treatment program time their smoke breaks so they can do downstairs and meet their dealers.

The VA police, who are all sworn federal law enforcement officers, can do little to stop it. The handful of VA police officers who patrol the hospital grounds are easy to spot since they are always in uniform and are well-known to patients.

“The patients know us, they see us every day,” Fiore said. “So I had brought up a plan to bring in somebody from a different facility where these patients don’t know them and basically go undercover into this [drug rehab] program or into this area at least and try to give us some good leads, so we can try to eliminate or reduce the amount of drugs that are coming in there.”

He said it wasn’t simply a matter of trying to make arrests. He said his goal was “to protect the patients.”

Fiore said he even found someone with undercover experience who was ready to do it. He said he presented his plans to his superiors, but never heard back from them.

“I’m still waiting,” he said. “And it’s been a couple of years now.”

A spokesman for the VA said he is not aware of any “significant findings concerning illegal drugs at the Miami VA Healthcare System.”

Fiore said another reason drug dealing became a problem was the lack of working surveillance cameras inside and around the hospital. The lack of security cameras was an issue the Inspector General raised in its report earlier this year into Cutter’s death. They said the cameras had not been working for at least six months prior to Cutter’s overdose.

In fact, Fiore said, the cameras have not worked for at least four years. In 2010 he was assigned the responsibility of conducting a “vulnerability assessment” of the VA facilities in South Florida. He noted the problem with the cameras back then. As a result of his report, he said the Miami VA was allocated money to improve security. He said he believes the amount was somewhere between $2.5 million and $3.5 million.

But he doesn’t know what happened to the money.

“I can tell you it wasn’t spent on cameras or any of the other recommendations that were made in that assessment,” he said, “because they still have yet to be corrected.”

Fiore said in addition to ignoring the drug problem at the hospital, he also believes the hospital fails to address allegations of patient abuse.

“I know that I’ve seen patient abuse in the nursing home,” he said. “I’ve seen patients with just full black and blues, I’ve seen patients with hand marks on their chest; the hand mark doesn’t match theirs. It’s obvious that it is somebody else’s hand mark.”

He said rather than deal with these issues as criminal matters, the hospital handles them administratively. “A lot of times to make the problem go away they just take that individual staff member, they pick them up and they relocate them to a whole different area” of the hospital, Fiore said.

Asked if he agreed with the idea of handling patient abuse cases administratively, Fiore said: “I think any time somebody gets hit, especially an older person who can’t defend themselves, there should be a law enforcement investigation.”

A spokesman for the VA wrote to CBS4 News saying that all cases of patient abuse are taken seriously and staff members are often moved to other parts of the hospital while the investigation is conducted.

A final area of concern for Fiore is theft.

“Theft is rampant,” he said.

He estimates there are millions of dollars in theft every year from the Miami VA, everything from computers to medical equipment.

“We’re talking government property, we’re talking about things the taxpayers are buying,” he said. “I can’t begin to explain to you how retaliation works within just the Miami VA. They don’t like people who air their dirty laundry.”

He said he hopes his comments will encourage more congressional oversight.

“As a veteran myself,” Fiore said, “I’ll be honest with you I’m just sickened that they would allow this type of stuff to happen to people that have fought for this country.”

This is one Veteran Hospital in one state. I know the VA hospital in Tallahassee isn’t exactly a state-of-the-art facility. From my recent posts about Veteran Affair hospitals, I remember a map about current wait times from across the nation. Many of the major cities in the US have major wait times from overwhelming bureaucracy. I’d be interested to see what the VA police from these facilities, or any facilities, had to say about what goes on during daily life.

Will anybody ever cut through the administrative bulshit and get to the root problems of the Department of Veteran Affairs?

– Rob

The usual Washington dance around a failed bureaucracy has begun. The media reports enough scandals and failures that hearings have to be held.

The head of the department, in this case Secretary Shinseki, after avoiding the cameras as long as possible, appears at the hearing to announce his anger at the revelations. “Any allegation, any adverse incident like this makes me mad as hell,” he said.
The White House promptly defends its appointee. Appearing on CNN’s The Lead yesterday, White House Chief of Staff Denis McDonough told Jake Tapper that Shinseki “holds himself accountable to his men and women.”

This stonewalling just increased public and media frustration at the apparent lack of accountability. ABC’s Jon Karl reminded White House Press Secretary Jay Carney today that “veterans have actually died.” Tapper demanded of McDonough, “How many dead veterans do you need?”
They weren’t just asking rhetorical questions. The VA has already admitted that 23 veterans have died across the country from bureaucratic problems and the news media has alleged substantially more deaths than the VA has admitted.

Meanwhile the prison guards of the old order, led by Senate Veterans Affairs Committee Chairman Bernie Sanders, rally to oppose change by asserting that satisfaction with Veterans Administration services is actually very high.

The White House, having supported Shinseki (who today “accepted the resignation” of an under secretary responsible for health), decided to cover its bets by appointing a White House Deputy Chief of Staff to review the VA. President Obama announced he wanted the system scrutinized despite his Chief of Staff having just vigorously defended the Secretary. Shinseki promptly expressed his support for the White House intervention.

Next, in an effort to slow everything down, Shinseki said the VA’s Inspector General had asked him not to share details with the Congress until his investigations were complete which could take months or even longer.

All of this is a familiar gotcha dance with some members of Congress allied with a media which in this case, at least, is demanding more information, and other members allied with the bureaucracy trying to slow everything down until the media and the public forget the issue and move on to something else.

What our veterans need is something profoundly different from Congress.

The real question has to be, ” What is the best system for veteran services that we can provide in the 21st century?” If we simply start with the capacity of the smartphone we can begin to imagine a dramatically more powerful, more effective and more convenient Veterans Services System.

Former Hewlett-Packard CEO Carly Fiorina has suggested very insightfully that the 21st century will have four dominant characteristics: our lives will increasingly be digital, mobile, virtual and personal.

If you look at your own smart phone you can see what she is talking about. Congressman Mike Burgess, for instance, has eight different medical apps on his smart phone (as he is also a doctor). After talking with him, I added an EKG attachment to my iPhone just to see how if it would work. It performed perfectly, analyzed the data, and emailed the results to my doctor. The whole attachment cost less than $100. (Having the test performed once at a doctor’s office typically costs more.)

These capabilities will only get more advanced and will rapidly fall in price. A system the size of the VA could deploy them to serve hundreds of thousands of veterans at much lower cost.

In addition to using technology to create a new system for veterans, we could also make services drastically better by allowing veterans to be seen at civilian health facilities. Tricare dependents have the option to see civilian physicians in the Tricare Network when they are not close to military facilities or there are no available appointments. The VA could rapidly eliminate its backlog if it offered veterans the same opportunity if they couldn’t book an appointment at the VA within 14 days.

We can’t allow our vets to be prisoners of an incompetent bureaucracy. We need to replace the failed system with a modern Veterans Services System that is built around defending the health of our veterans, not the health of the bureaucracy.

While Congress is focused on finding the truth about what was happening to our veterans, many of us are also focused on developing this totally new approach to VA to ensure these problems never happen again. There are some immediate reforms that Congress should enact. In particular, House Veterans Affairs Committee Chairman Jeff Miller has introduced the 2014 VA Management Accountability Act that will make it easier to fire people for poor performance.

“VA’s widespread and systemic lack of accountability is exacerbating all of its most pressing problems,” he said, “including the department’s stubborn disability benefits backlog and a mounting toll of at least 31 recent preventable veteran deaths at VA medical centers across the country.”

Senator Marco Rubio has offered a companion bill that would also help eliminate red tape “to give the VA secretary authorities similar to those members of Congress have to fire employees from their staffs.”

Congressman Dan Benishek’s Demanding Accountability for Veterans Act would put a system in place to ensure VA administrators respond appropriately to IG reports.

Senator John Thune has proposed legislation that would require the VA’s Inspector General Office to report wait times directly to Congress.

These bills are the beginning of getting the VA bureaucracy under control. Now it is time to think through the replacement.

From Newt Gingrich

In the current nationwide series of Veterans Administration scandals, the real focus has to be on rethinking the system that is failing to serve our veterans and their families.

I strongly favor Secretary Eric Shinseki resigning or being fired. He has clearly failed to lead and manage this vast bureaucracy. There are too many problems in too many places for him to remain as Secretary. No one should believe, however, that simply replacing the Secretary with a new person will solve the Veterans Administration’s problems.

Scapegoating one or even a team of senior leaders will produce only marginal results and ultimately be drowned out by an enormous bureaucracy.

The real challenges in developing a 21st century Veterans Administration are challenges of systemic reform that go far beyond any single person or even a new senior leadership team.

The VA is a classic example of the principle Edwards Deming, the father of the quality movement, was trying to communicate with his red bead experiment. Deming had a bin full of mixed red and white beads. The goal was for workers to obtain only white beads, but he required them to scoop a random assortment blindly from the bin. Of course, they always came up with red beads as well as white beads. The experiment illustrated the point that organizations fail when the systems are bad, even if the workers are willing.

Trying to fix the VA by replacing the Secretary but not the whole system is like trying to obtain white beads by replacing the person dipping blindly into the bin.

In private industry, businesses have used information and communications technologies to create highly reliable, efficient, personalized, and instantaneous new systems. The ATM is a good example. Anywhere in the world you can walk up to an ATM, stick in your card, and within seconds get cash from your bank account. There is no bank teller involved. There are no business hours involved. At most banks even deposit slips are a thing of the past.

Government bureaucracies like the VA have seen little innovation. In many cases they have gotten worse as more layers of bureaucracy grow on top of the existing systems.

The VA may be the best place to start applying breakout thinking because of the scale of its bureaucracy and the scale of its problems.

The VA workforce is larger than the Marine Corps. More than 314,000 work for the VA compared to in the Marine Corps (potentially shrinking to 150,000–at which point there would be half as many Marines as VA bureaucrats).

The VA treats some six million veterans a year at more than 1,400 different sites including hospitals, clinics, nursing homes, etc. In 2013 there were nearly nine million veterans enrolled–or better than one out of every three veterans in the U.S.

Just the size of the VA training system is enormous. According to the VA, it helps train 90,000 health professionals every year in its medical centers. Over 50 percent of all American physicians have had some training in the VA system.

The scale of VA bureaucracy has grown dramatically. Between 2006 and 2013, the number of full-time employees jumped more than 40 percent, from 220,000 to 314,000. Yet with 94,000 additional government employees, the system has not been able to match the private sector’s standard of care.

Consider the issue of waiting times for treatments. The national average waiting time in an emergency room is 26 minutes. At VA facilities, veterans wait twice that time on average and that understates the problem in especially mismanaged sites.

The Washington Times reports:

A recent inspector general investigation of a VA facility in Las Vegas found that up to 25 percent of patients experienced a length of stay of more than six hours on all but one of the days in a week monitored…

During a 2011 investigation, the watchdog found that a majority of ER patients had an average length of stay exceeding nine hours at a facility in Memphis, Tennessee, and roughly 27 percent of veterans spent over six hours in the emergency room.

This means that one out of four veterans in those sites was experiencing a wait more than 12 times longer than the national average. That is a systems problem, not a scapegoat problem. Simply firing a couple of managers without replacing systems, structures, and culture will not solve systemic problems.

Waiting times are just the tip of an extraordinarily large iceberg. This map shows the serious problems at VA centers around the country. We are finding new issues to add to the map every day.

Compounding the VA challenge is the fact that it has to be considered in combination with the Department of Defense’s Military Health System, which serves nearly 10 million people at a cost of more than $50 billion a year.

Every effort to integrate Department of Defense and the VA medical record systems has failed. The result has been an absurd process of transitioning from active duty health services to VA health services.

At a time when you can instantly make airline and hotel reservations or get money from an ATM worldwide in seconds, it takes 175 days to transition a veteran’s care from the Defense Department to the Department of Veterans Affairs.

The DoD and VA spent $1.3 billion to build a joint electronic medical record system for their health care services before the two secretaries announced in February that they were abandoning the effort. This is on top of the over $2 billion the Defense Department has spent on a failed upgrade to its own electronic medical system.

In other words, even though military health costs are growing rapidly and taking up more and more of the DoD budget, the Department is failing to modernize its system and to integrate it with the VA. But this is where the solution for the MHS and the VA must begin.

Sadly, this dysfunction is not new. Anyone upset at today’s Veterans Administration should consider the founding of the Veterans Bureau in 1921 and take comfort that the admittedly appalling corruption or mismanagement we see today pales in comparison to that which marked the first two years of the original Veterans Bureau.

The first director, Charles Forbes, hired tens of thousands of bureaucrats. Many were cronies or patronage positions. They did such a bad job that fewer than 50,000 veterans were getting help out of more than 200,000 wounded veterans from World War I. Forbes stole hundreds of thousands of dollars of taxpayer money. As the scandal broke, President Harding summoned Forbes to the White House and “took him by the neck and shook Forbes ‘as a dog would a rat,’” as Amity Shlaes writes in her book Coolidge ending the tenure of the first director of the modern Veterans Administration. Appropriately, Forbes wound up in jail for this corruption.

We can take some comfort that for all its current problems the system is vastly more honest and accountable than it was in 1921.

Now we have to have the courage to develop a system worthy of our veterans, our active duty military and their families for 2021 and beyond.

From Newt Gingrich.