Tag Archives: health care reform

Top U.S. Commando Tells Troops: Get Counseling, I Did


Votel_official_photo_USSOCOM                                                   http://en.wikipedia.org/wiki/Joseph_Votel


“I have, with my family, sought counseling and assistance,” said Special Operations Command’s General Joseph Votel…

In laymen’s terms, a body under constant threat that goes on missions night after night pumps out adrenaline at such a constant rate that it gets out of whack and can’t readily adjust to the relatively threat-free environment at home.

The therapy can help troops deal with the grief of losing a teammate or unlock a traumatic memory so the brain can stop going over it repeatedly. But sometimes, the counseling is simply to train an operator to “down regulate” after deployment.

The Pentagon’s health affairs department has budgeted nearly $15 million this fiscal year to behavioral health resources for special operations Plus, there’s another $10 million in the special operations budget toward behavioral health and suicide prevention efforts. There’s also $1.2 million budgeted for the spiritual domain—including giving chaplains suicide intervention training, and some basic counseling training. (For many in the military—older troops—it’s easier to talk with a chaplain than with a therapist.)

Suicides by special operators have fallen for two years straight. But the rates are still among the highest in the military. And that’s prompting the ordinarily tight-lipped commander of the elite forces to speak frankly about seeking help, and all but ordering his troops to do the same.

The high rate of special operations suicides as compared to the other services reflects the strain of more than a decade of deployments since the attacks of Sept. 11, 2001—a trend that continues for special operators even as most conventional forces come home.

It also reflects the continued stigma against seeking counseling that is arguably even fiercer among special operators than conventional forces. It literally goes against their training, which often requires pushing through pain to reach a target on the battlefield.

Votel, who last led the elite Joint Special Operations Command, said that is changing, with more special operators seeking help.

“I’m also seeing an increase in friends, in peers, in numbers in the chain of command who are referring to their people for help, without any further ramifications,” in terms of their careers, he said.

The famously reticent U.S. Army Ranger is speaking out because he faced a suicide crisis shortly after taking charge last summer.

In the four months from August to November of 2014, there were seven apparent suicides, five suicide attempts, and 14 cases where troops were hospitalized for “suicide ideation,” meaning they were considering taking their own life.

“We are not winning this battle yet and we need your help,” Votel wrote in a November 2014 missive to his troops, obtained by The Daily Beast.

Votel pointed to one bit of silver lining in that those 14 cases of “ideation” meant someone—either the operator, a family member or a fellow operator—had spotted the problem and intervened.

“When our leadership or people identify a person who is exhibiting behavior that indicates they may harm themselves—we act quickly,” Votel wrote.

Since then, Votel has ordered stepped-up training of how to spot the signs of stress, and the Pentagon has worked to make more counseling resources available to his people.

The Pentagon’s health affairs department has budgeted nearly $15 million this fiscal year to behavioral health resources for special operations Plus, there’s another $10 million in the special operations budget toward behavioral health and suicide prevention efforts. There’s also $1.2 million budgeted for the spiritual domain—including giving chaplains suicide intervention training, and some basic counseling training. (For many in the military—older troops—it’s easier to talk with a chaplain than with a therapist.)

Almost a fifth of special operators anonymously surveyed by Doolittle’s office this year reported that they’d sought out some form of behavioral health support, with most of them going to the psychologist, counselor or chaplain who is part of their unit, Doolittle said. That’s up from only 15 percent of those surveyed last year and 11 percent the year before.

“I can think of several peers and senior enlisted [officers] that have gone through various forms of psychological treatment,” said Doolittle.

“Some kept it on the down-low, but some folks have been very vocal,” which has helped degrade the view of seeking counseling as weakness, he said.

What has arguably helped the most is embedding psychologists and other types of counselors available in special operations units and also borrowing the practice of using “military family life counselors” for operators and families alike. They provide what some troops refer to as “Starbucks therapy”—meetings outside the base that don’t appear in the service member’s record, or even get written down at all.

“When you are talking about convincing the guy to drive across base and go see a psych at a medical treatment facility—quite honestly, we’ve had problems with that,” Doolittle said. But give them a chance to talk to someone they see in the gym and the chow hall every day, and there’s less stigma—one reason chaplains in places like Afghanistan invest in expensive coffeemakers to plant outside their offices to give troops one more reason to stop by.

“For every one operator or support person that’s gone to a medical treatment facility, roughly another three are going to that ‘embedded’ care [team],” Doolittle said.

In 2015, there will be a total of 131 special operations-specific behavioral health professionals “embedded” in SOCOM units and bases, up from just 60 in 2013.

That’s on top of dozens more made available by the various services who are both embedded in special operations units and across the military health system.

There are also counselors available to help families get re-acquainted after multiple deployments that can turn an operator into a stranger in his or her own home.

The harder-to-teach skills are convincing an operator to incorporate breathing or meditation into their daily training and getting regular sleep, so their brains can process and deal with the memories of whatever they saw during the day.

But SOCOM is trying to teach that, too, experimenting with programs that teach everything from yoga to “accelerated resolution therapy,” in which an operator replays an incident in his or her head like a movie, allowing the brain to “process” the tough memory and put it away.

The sting in the tail: Those who don’t take aim at their issues end up in a spiral of drinking, divorce, and worse, and end up out of the brotherhood that is the reason they stay quiet about the trauma in the first place.

That’s why the leading quiet professional Votel is slightly less silent when it comes to suicide.”


VA Recruits Watson Analytics, Cloud to Fight PTSD


VA recruits Watson analytics, cloud to fight PTSD


“The Department of Veterans Affairs launched a pilot project to test the ability of IBM’s Watson analytics technology to help VA doctors rapidly sift electronic medical records for treatment and research data that could support clinical decisions in the care of veterans.

The VA will also assess how the Watson technology, which became famous by competing against Jeopardy! quiz show winners, might help speed data-driven clinical decisions, including those involving post traumatic stress disorder cases.

“Physicians can save valuable time finding the right information needed to care for their patients with this sophisticated and advanced technology,” said Interim Under Secretary for Health Dr. Carolyn M. Clancy in announcing the project.

“A tool that can help clinicians quickly collect, combine and present information will allow them to spend more time listening and interacting with the veteran. This directly supports the patient-centric medicine VA is committed to delivering every day,” she added.

The VA-Watson project leaders also want to study the potential of the technology for producing relevant medical data at the point of care as well as to reduce the number of systems and tools physicians have to juggle in clinical settings.

According to IBM, analyzing a single EMR is on a par with scanning up to 100M of structured and unstructured data, much of it in the form of plain text, across a patient’s lifetime of clinical notes, labs and treatments.

Using Watson, Veterans Health Administration physicians, “can now interact with the data in natural language, process vast amounts of big data to uncover patterns and insights and learn from each interaction,” said Anne Altman, IBM general manager for U.S. federal in a blog post.

During the pilot, clinical decisions will not be made on actual patient encounters, but instead will use realistic simulations.

The project will also use IBM Watson Discovery Advisor, a new tool that uses visualization techniques to help uncover patterns in data.  The cloud-based service can help accelerate research from months to days and hours, IBM said.

The VA project isn’t the first time Watson has been enlisted to support healthcare or veterans programs.

The company announced in October it was partnering with the Cleveland Clinic to use Watson Genomics to study cancer treatment options based on a patient’s genome. The Memorial Sloan Kettering Cancer Center in New York and the Anderson Cancer Center in Houston, Tex., both use Watson-based tools in analyzing cancer treatments.

And earlier this year, Watson was used in pilot program to advise military members how to navigate their financial affairs in returning to civilian life.”



When All Else Fails – Reorganize – Largest Reorganization in Veterans Administration (VA) History



“The Veterans Affairs Department is reorganizing its labyrinthine structure into a single, five-region national framework as part of a large-scale effort to improve services to veterans and reduce an entrenched bureaucracy responsible for mismanagement throughout the organization.

The department’s organizational realignment is part of what officials are touting as the largest reorganization in the VA’s history, sparked by last year’s scandal involving excessive patient wait times and the falsification of appointment scheduling records.

Microsoft Word - MyVA Regional Map.docx

“The regions, when complete and fully mature, will allow us to create a more cohesive and singular department from the veteran perspective,” said Scott Blackburn, director of the MyVA program management office in the department. “VA components will have better internal coordination and the ability to leverage shared services and experiences.” Blackburn said the realignment also would help the department offer enhanced training to employees across VA to better serve vets, as well as improve coordination and communication among workers.

(Related: Report Finds VA’s Monitoring System is Not Doing Its Job)

The current VA structure varies widely among the agencies and internal offices within the department. For instance, the Veterans Benefits Administration, which oversees benefits including compensation, home loans and education, is made up of four regions. The Veterans Health Administration has 152 medical centers within 23 Veterans Integrated Service Networks throughout the country. The National Cemetery Administration has five Memorial Service Networks and a central office. Several internal staff offices, including public affairs offices and information technology, have their own structures and are sprinkled across the United States.

“A lot of the whole point [of the realignment] is to internally sync up our structures for better coordination and more efficient operations,” Blackburn said during a Monday conference call with reporters. Bob Snyder, executive director of the MyVA program management office, said VBA, VHA, and NCA led the discussion on the realignment, settling on five regions after considering other options.

Practically speaking, however, the impact of this change on vets and employees at this point is not yet clear. But slashing VA jobs isn’t part of the plan to streamline the enterprise, Snyder said.

“This [realignment] is not about losing jobs,” Snyder said, responding to a reporter’s question. “There’s more than enough work to do across the VA that we need everybody we’ve got, and then some. Depending on what analysis you look at, we’ve got significant shortages in many of our specialties. This is not about cutting jobs.” Snyder added that the department is conducting “a thorough analysis of the positions we have.”

Both Snyder and Blackburn reiterated throughout the press briefing that the announcement was a “first step” in a long process, and that more analysis is necessary before a final plan is implemented.

“We want to make sure we are communicating early, often and honestly,” Blackburn said, responding to reporters’ confusion over the practical effects of the realignment, and officials’ inability to offer specific details right now. Blackburn said the VA would continue to share information about the plan as it unfolds.

As Secretary Bob McDonald said when he officially announced the reorganization in November, the goals is for vets to “know who to contact, know where to go on the websites, know what benefits are available” so that they can “easily connect with us to get the benefits and the services that they’ve already earned and deserved.”

The “MyVA” approach is designed to rebuild trust with vets, employees and the public. It revolves around five main areas: improving the veteran experience; improving the employee experience so they can better serve veterans; improving internal support services, such as human resources and financial management; establishing a culture of continuous improvement; and enhancing strategic partnerships.”


What Should a Wounded Veteran Value Most – Disability Pay or Civilian Professional Opportunity?


Image by Nathen Brooks for NY Times“New York Times” 

Lt. Col. Daniel Gade is not your typical messenger. He is a combat veteran who lost a leg while serving as a tank company commander in Iraq in 2005.

Today he is a professor of public policy at the United States Military Academy at West Point, but he spends much of his spare time publishing essays and traveling the country pushing the idea that the Department of Veterans Affairs should move away from paying veterans for their wounds and instead create incentives for them to find work or create businesses.

Nearly 200 sick and wounded soldiers in a gym at Fort Carson last month listened silently as Lt. Col. Daniel Gade offered a surprising warning: The disability checks designed to help troops like them after they leave the service might actually be harmful.

As he paced back and forth in front of the soldiers, some of them leaning on crutches, Colonel Gade said that too many veterans become financially dependent on those monthly checks, choose not to find jobs and lose the sense of identity and self-worth that can come from work.

“People who stay home because they are getting paid enough to get by on disability are worse off,” he said. “They are more likely to abuse drugs and alcohol. They are more likely to live alone. You’ve seen these guys. And the system is driving you to become one of them, if you are not careful.”

“It’s a difficult issue to broach. People immediately think you are trying to shortchange veterans,” he said in an interview. “But I’m in a position to do it because I have skin in the game, literally.”

Much like debate over Social Security, discussion of disability compensation is the third rail of veterans politics. It is a program with broad public support that has defied efforts at change even as it has consumed a growing portion of the $151 billion Veterans Affairs budget.

Since 2001, the number of veterans getting monthly checks for service-related disabilities, ranging from bad knees to catastrophic injuries, increased by 55 percent, and the overall cost of compensation nearly tripled, to $59 billion.

Despite the rising cost, revamping the program remains unpopular with both parties in Congress as well as with the country’s major veterans organizations, many of which employ large numbers of people to help veterans apply for benefits. Officials with those groups say the idea that disability compensation discourages work is unfair to veterans and potentially dangerous to a system that has helped many cope with the ravages of war.

“No one wants to be disabled; they want to work,” said Garry Augustine, the Washington director for Disabled American Veterans. Mr. Augustine was wounded by a land mine in Vietnam and lost the use of his left hand and foot. “I’m a perfect example,” he said. “I came back severely injured, couldn’t walk. I needed compensation because I couldn’t work. I went to school on the V.A., got job training through the V.A., and worked my way off disability. The V.A. gave me my life back.”

Some veterans’ advocates say that Colonel Gade is siding with fiscal conservatives who want to reduce federal spending, even if it comes at a cost to wounded veterans.

“It’s unclear what their end state is,” said Paul Rieckhoff, the chief executive and founder of the Iraq and Afghanistan Veterans of America. Mr. Rieckhoff said his organization would support testing alternative strategies to disability compensation. But, he added, “The larger problem right now is not that too many people are getting paid. The larger problem is not enough people getting care and support.”

Colonel Gade’s ideas have won support from some conservatives. A pilot program, which would provide financial incentives to veterans who work, is being started by the Philanthropy Roundtable, a donor organization that has pushed other reforms focused on individual choice, such as charter schools.

And two former secretaries of veterans affairs under President George W. Bush — Anthony J. Principi and Jim Nicholson — said in interviews that they pushed for overhauling the disability system but could not overcome resistance from veterans groups and Congress.

Colonel Gade, 39, says he wants to avoid a partisan fight over his ideas, which he says are first about helping veterans and second about saving money. “I think we can show we have a no-kidding better way to help veterans that is cheaper and more effective,” he said.

He is not completely alone. Some new veterans groups say labeling so many veterans “disabled” makes it harder for them to rejoin society.

“When vets come home from war they are going through a tremendous change in identity,” said Eric Greitens, a former member of the Navy SEALs and founder of The Mission Continues, a nonprofit that encourages veterans to volunteer in their communities. “Then the V.A., and others, encourage them to view themselves as disabled. We meet a number of veterans who see themselves as charity cases and are not sure anymore what they have to contribute.”

Colonel Gade sometimes uses his leg as an example of what needs updating in the system. A century ago, he says, he might have spent his life hobbling on crutches, dependent on government aid to provide for his three children. Today he has a lightweight aluminum and carbon fiber prosthesis guided by microprocessors that has allowed him to return to active duty. But the disability system still treats him as if he needs a crutch, he says.

He first noticed what he considers the misguided incentives of disability compensation while recuperating from his injuries at Walter Reed Army Medical Center in 2005. Many of the amputees in his ward, he said, had been there for years.

He left the hospital after five months and spent another six months in daily physical therapy. A year later, when a scandal over poor treatment of soldiers at the hospital erupted in 2007, he saw some of the patients he knew testifying before Congress.

His main goal is to reach young veterans who initially get modest compensation for less severe injuries, then seek a greater payout — a phenomenon critics call “the benefits escalator.”

He points in particular to a federal program known as Individual Unemployability, for which veterans become eligible when the government gives them a rating of 60 percent disabled or more. The program pays them as if they are 100 percent disabled, as long as they can show their disabilities keep them from maintaining “substantially gainful employment.”

The bump in benefits is substantial: Veterans getting $1,200 per month can receive up to $3,100 per month, as long as they do not work.

“From an economic standpoint, you would be crazy to get a job. It’s a trap,” Colonel Gade said.

At Fort Carson, he attempted to recruit people to test his alternative to that system. With funding from private donors, he hopes next year to give 100 participants $55,000 to use toward anything that will help them secure employment, such as equipment for a business, training or professional certification. The participants must agree not to increase their initial disability ratings or use the Individual Unemployability program during the trial.

Veterans in the group would get a 25 percent bonus on everything they earn up to $40,000, an incentive designed to push them into the work force. The program will also track 100 veterans that get only the bonus payments, and a control group of 100 that gets nothing.

“We are not taking away your benefits, but we don’t want you to ride the escalator,” Colonel Gade told his audience at Fort Carson.

It was difficult to know what the wounded soldiers thought, but some seemed receptive.

“The current system is just ‘Give me the money, who cares about anything else,’” a soldier from a military police unit told Colonel Gade. “Your idea says go out and work, be productive, feel good about yourself. There is where we do well. If we don’t have a mission, we don’t do well.”


Image Credit:  Nathan Brooks for NY Times

Nearly $1 Billion Spent To Elevate Afghan Women May Have Been Squandered


defense-largeImage: Massoud Hossaini/AP

“$64.8 million on 652 projects, programs and initiatives to support Afghan women in fiscal 2011 through 2013. $850.5 million on 17 projects, but could not identify the specific amount of funds within these projects that directly supported Afghan women, the IG said.”


“Improving the status of women has been a central challenge in Afghanistan since the 2001 overthrow of the Taliban. But current American efforts to boost access to jobs, health care, education and child care suffer from poor tracking of funds and an inability of U.S. agencies to connect their programs to demonstrated improvements in that war-torn country, a watchdog reported on Thursday.

……..the Special Inspector General for Afghanistan Reconstruction [SIGAR] said. “But none of the three agencies can readily identify the full extent of their projects, programs, and initiatives supporting Afghan women or the corresponding amount of funding expended on those efforts,” auditors found, and there is “no comprehensive assessment available to confirm” whether reported gains by women in recent years are the result of U.S. efforts.

SIGAR warned that the absence of more detailed information will limit the agencies’ ability to make informed policy, program and funding decisions, especially as the number of U.S. personnel on the ground decreases. “Although the agencies monitor and evaluate most of their individual efforts at the program or project-level, none of the agencies has compiled this information into an agency-level assessment of the impact these efforts have had on the lives of Afghan women, in accordance with best practices in managing and assessing government programs,” it said.

Despite past progress reported by the agencies in measures such as girls going to school and construction of women’s shelters, the Afghan people continue “to face barriers recruiting women into the Afghan National Security Forces,” the report said. It cited “a lack of programs and facilities, such as child care, latrines, and dormitories, to support women in the ANSF; adequate career paths for women; training that would provide females with skills equal to their male colleagues; and a general understanding of the need for acceptance of females in the forces.”

What’s more, reported cases of violence against women in 2013 rose by 25 percent compared with 2012, according to data SIGAR cited from the Afghanistan Independent Human Rights Commission.

The watchdog recommended that State, the Defense Department and USAID report within 90 days on new efforts to “develop and implement agency-wide mechanisms to track the number and funding—both obligated and disbursed—of projects, programs, and initiatives” to support Afghan women. It also called upon the agencies to use existing data for an agency-wide assessment of progress and develop a plan with timeframes.

The agencies partially agreed, but in some cases argued that existing data systems are sufficient.

The report is addressed to Secretary of State John Kerry, Defense Secretary Chuck Hagel and USAID Administrator Rajiv Shah, along with the U.S. ambassador P. Michael McKinley and Central Command Commander Gen. Lloyd J. Austin III.”




Record-Setting Year for Fraud Recovery




“It’s the holiday season again: the time of year when the Department of Justice (DOJ) announces its annual False Claims Act (FCA) fraud recovery statistics. For fiscal year 2014, the DOJ secured a record $5.69 billion in settlements and judgments in civil FCA cases—a dramatic increase over last year’s total of $3.8 billion and the first time the annual recovery has exceeded $5 billion. Since 1986, when Congress strengthened the FCA, more than $44 billion has been reclaimed from companies and individuals who committed fraud against the federal government.

The FCA, which dates back to the Civil War, is the government’s primary tool in recovering funds stolen from federal programs: Medicare and Medicaid, contracts and grants, housing programs, disaster relief loans, and agricultural subsidies.

The lion’s share of FY 2014 recoveries came from housing and mortgage fraud cases. Financial institutions such as Bank of America and JP Morgan Chase paid the federal government $3.1 billion to settle allegations of improper mortgage lending practices that triggered the 2008 global financial crisis. Health care fraud cases, which usually comprise the largest share of annual FCA recoveries, accounted for $2.3 billion. A substantial part of that came from pharmaceutical giant Johnson & Johnson’s historic settlement resolving federal and state claims of improperly marketing its prescription drugs and paying kickbacks to health care providers.

As for contract fraud-related cases, there were several notable recoveries this past year (most of these companies are in our Federal Contractor Misconduct Database):

  • Boeing: $23 million to settle claims of submitting false labor charges on C-17 Globemaster aircraft maintenance contracts
  • Hewlett-Packard: $32.5 million for allegedly overbilling the U.S. Postal Service
  • McKesson: $18 million to resolve allegations that it improperly set temperature monitors used in shipping vaccines under a contract with the Centers for Disease Control and Prevention
  • MPRI: $3.2 million to settle claims of submitting false labor charges on a contract to support the Army in Afghanistan
  • Northrop Grumman: $11.4 million for allegedly overbilling for employee costs on federal contracts
  • Samsung: $2.3 million to settle charges of misleading federal agencies about the country of origin of its products

According to the DOJ, nearly $3 billion of the $5.69 billion was recovered in lawsuits filed by whistleblowers under the qui tam provisions of the FCA, which entitles them to a share of the recovery. These whistleblowers—who put their personal and professional lives at great risk by filing suit—were awarded a total of $435 million. We are certain this will elicit howls of outrage from the Chamber of Commerce, which has been trying to gut the FCA for years.

Although the DOJ noted that more than 700 qui tam lawsuits were filed last year, we were disappointed that it neglected to report the current backlog of pending FCA and qui tam lawsuits. We blogged back in October that, as of January 2011, more than 1,300 lawsuits were under seal and stuck in legal limbo while the government decides whether or not to intervene. Nearly two months later, the DOJ still has not responded to our request for more recent numbers.”


Reining In An Out of Control Pentagon




“The Defense Department spends about $600 billion a year — more than the entire GDP of Poland — and employs 1.4 million men and women in uniform, 700,000 civilians and 700,000 full-time contractors. The Pentagon’s accounts are so vast and byzantine that it is probably impossible to do a thorough audit of them.

The F-35 Joint Strike Fighter program alone is now around $160 billion over budget. In other words, the cost overruns on one weapons system are more than the total defense budgets of Britain and France combined. A new presidential helicopter fleet was scrapped after the cost for a single chopper neared that of a Boeing 747 jumbo jet. And on and on.

And then there is the Pentagon pension program, which is almost unique in its generosity. After 20 years of service, one can retire with a full pension, indexed to inflation, and lifetime high-quality health care, for which a family pays about $550 a year.[ We believe writer meant month, not year].  So someone who served in uniform could retire at age 38, then take a new job, and for the rest of his or her life receive generous government benefits. In 2012, the cost of military retiree and survivor-benefit outlays totaled $52 billion. That’s more than the entire budget of the State Department.

The Pentagon resembles nothing so much as some kind of gigantic socialist enterprise, run according to its own principles, shielded from market discipline and accountable to no one. How does it continue to function and perform? The way socialist bureaucracies usually do. If you throw enough money and talented, energetic and determined people at it, things can work, until the money runs out.

Among the 15 countries with the highest military expenditure in 2013, the United States ranked first and spent more on defense than the next eight nations — including China and Russia — put together. What does it get for this massive investment? By any normal yardstick, the Pentagon’s performance — its output compared with its input — would surely be deemed a failure.

The president’s presumed choice as the next secretary, is a brilliant man and perhaps has made some friends at 1600 Pennsylvania Ave. But by far the best quality he has going for him is that he seems to understand the need to rein in a Pentagon now so out of control that it is difficult to fully comprehend or explain.  The good news is that Carter has already been a reformer and, as deputy defense secretary, attempted to untangle the procurement process.”





Investigation Finds 50,000 ‘Ghost’ Soldiers in Iraqi Army


Ghosts - Copy                                                                             Image: Newser.com


“The Iraqi army has been paying salaries to at least 50,000 soldiers who don’t exist, Iraqi Prime Minister Haider al-Abadi said Sunday, an indication of the level of corruption that permeates an institution that the United States has spent billions equipping and arming. The United States spent more than $20 billion on the force from the 2003 invasion until U.S. troops withdrew at the end of 2011. ….the Pentagon requests $1.2 billion to train and equip the Iraqi army next year. 

A preliminary investigation into “ghost soldiers” — whose salaries are being drawn but who are not in military service — revealed the tens of thousands of false names on Defense Ministry rolls, Abadi told parliament Sunday. Follow-up investigations are expected to uncover “more and more,” he added.

With entry-level soldiers in Iraq drawing salaries of about $600 a month, the practice of “ghost soldiers” is likely to be costing Iraq at least $380 million a year — though officials say that’s probably only a fraction of the true expense.

“It could be more than triple this number,” said Hamid ­al-Mutlaq, a member of the parliamentary defense and security committee, pointing out that more thorough on-the-ground investigations are planned. “The people who are responsible for this should be punished. Iraq’s safe has been emptied.”

The corrupt practice is often perpetrated by officers who pretend to have more soldiers on their books in order to pocket their salaries, experts say.

Abadi’s announcement was met with applause in parliament. He said that the perpetrators would be tracked down eventually but that his priority is to end the practice as soon as possible.

“We are losing money all the time,” he said. Since taking power, Abadi has retired dozens of officers who served under Maliki, who has been widely accused of promoting officers based on loyalty rather than merit.

“The problems are wide, and it’s an extremely difficult task which is going to involve some strong will,” said Iraqi security analyst Saeed al-Jayashi. “Training is weak and unprofessional.”

The United States is focusing its efforts on three divisions in order to begin effective counteroffensive operations against the Islamic State, which controls around a third of the country’s territory.

The Pentagon also has requested $24 million to train and equip tribal fighters and $354 million for Kurdish forces as part of its strategy to turn the tide against the Islamic State.

Abadi conceded that the process of arming the Sunni tribes had been slow, but he promised support for all those fighting the Islamic State. “We do not want to just give weapons randomly,” he said.”


What It Means To Kill in Combat




“If a war fails to achieve its stated objectives—as Vietnam did—it can make the reasons for killing even harder to accept. Some recent vets of Iraq and Afghanistan, said the psychiatrist, are already asking, “What was it all for?”

This is not to cast troops who kill in combat as victims. They shouldcarry the weight of what they did. But they should not be forced to carry it alone. Their leadership, from the company level all the way to the Chief of Staff, is part of every killing that’s carried out. So too are the civilian architects of these wars. And the rest of us bear some responsibility as well. The killing a country does through its soldiers is part of its fabric and identity. The less it is examined, the less a country will know about itself, its impulses, and the impact of what it has trained and dispatched its sons and daughters to do.

A more honest conversation about what war is and what war does is a good place to start. Those now calling for boots on the ground in Iraq, Syria, or anywhere else, should be first to have it. They should understand and explain exactly what it will mean if troops are deployed, and they should press the military to give its charges tools that not only help them kill when they should, but also how to live with the killing they’ve done later in life. More counseling must be made available as well, as part of the broader overhaul of the VA, and steps taken to remove the stigma that still exists around seeking help for the psychological wounds of war. And no one should ask a veteran if he or she has killed anybody unless they really want to hear the answer—and are prepared to listen.”


Military Suicides — Continued Failures Hold Lessons for Future Wars


brooke-caffrey-final                                     Tech Sgt. Brooke Leigh Caffrey. (Courtesy of the Telford family)


“Wayne Telford did not lose his daughter on any of her four deployments over 17 years of service in the Air Force—not in Kuwait, not for two tours at Bagram Airfield in Afghanistan and not during her last, to Sather Air Base near Baghdad International Airport, just before the U.S. withdrawal from Iraq in December 2011. Brooke Leigh Caffrey, a tech sergeant three years shy of full retirement, committed suicide on Jan. 5, 2012, on leave at her home in Arizona. She was 35 years old.

‘Not Just a Number’

At a dinner before last year’s State of the Union, Wayne Telford sat at a table with several senators, including his host, Colorado Sen. Michael Bennet and Minority Leader Mitch McConnell. Bennet stood up and introduced him.

“‘This is my guest, Wayne Telford,’” Telford recounted. “Then he said, ‘He lost his daughter in the war on terror.’ Everyone kind of lost the countenance on their face. ‘Share your story, Wayne,’ he said, and I did.”

“I don’t think they’re used to seeing it up front and personal, and putting a face to it — it’s not just a number,” Telford said of his experience at the State of the Union. “I think it had a dramatic impact on them that they just don’t see back there in Washington. Yeah, they’ll go to a ceremony at Arlington, on Memorial Day, Veterans Day, but hearing one man’s story about the loss of a child …” he trailed off.

“I see Washington as out of touch,” he said.

Though lawmakers are always eager to tout their work for veterans and the military, and many were vocal in the run up to the resignation of former Veterans Affairs Secretary Eric Shinseki at the end of May, since then Congress has largely been focused on other priorities.

But on Wednesday, as Congress runs out of days to pass any legislation, including a handful relating to mental health and suicide among veterans and military, the House and Senate veterans affairs committees each held hearings on the issues.

Both the Senate and the House are considering versions of the Clay Hunt Suicide Prevention for American Veterans Act, named after an Iraq War veteran who committed suicide in 2011. The legislation requires suicide prevention programs in both the VA and also the Defense Department to be evaluated by a third-party, collaboration between government agencies and outside advocacy groups and improvement to the process of transitioning back to civilian life.

The House VA committee is expected to markup the legislation after lawmakers return from the Thanksgiving recess. But the Senate VA committee hasn’t held a single hearing this year to markup any legislation, according to Alex Nicholson, legislative director for Iraq and Afghanistan Veterans of America. “When we started to focus on the suicide issue this year, we knew many things could come up and divert attention, that we’d have to struggle to bring it back,” Nicholson said.

In March, Sen. John Walsh, D-Mont., the only Iraq War veteran in the Senate, introduced his own Suicide Prevention for America’s Veterans Act with a bipartisan group of 15 sponsors, combined with a lobbying effort on the part of IAVA. When it became apparent Walsh wouldn’t be returning to the Senate in 2014 and that his legislation was effectively stalled in the Senate VA Committee, IAVA and a group of senators revamped it, introducing the Clay Hunt SAV Act on Nov. 17, now with the backing of heavy hitter Sen. John McCain, R-Ariz. But it remains unclear whether the legislation will be considered.

If the committees don’t take up the bills, Majority Leader Harry Reid, D-Nev., would have to agree to bring the measures, or their language, before the full Senate, but that would require a high level of support and cooperation. Given that unlikelihood, several sponsors of related bills are scrambling to include their proposals in the few must-do pieces of legislation that remain this year, such as the annual defense appropriations bill, expected to be taken up as part of a giant, trillion-dollar-plus omnibus bill to fund the government for the rest of the fiscal year beyond Dec. 11, or the annual defense authorization bill, the NDAA.

Days before the introduction of the Clay Hunt SAV Act, Walsh told Defense One he’d been catching senators on the floor to push for his legislation to be added to the annual appropriations bill. “I’m still hopeful,” he said.”