Tom Philpott .. firstname.lastname@example.org, | November 25, 2009
Vets Shielded From Health Care Reform
Military Beneficiaries, Vets Shielded From Health Reform
The national health reform bill passed by the House last month and the Senate version to be debated in early December pose no threat to current health care benefits provided to military families, retirees or veterans, say advocates for these beneficiaries as well as congressional committee staffs.
The House-passed Affordable Health Care for America Act (HR 3962) states in Section 311 that "nothing" in the bill "shall be construed as affecting" authorities used by the departments of Defense and Veterans Affairs to provide TRICARE programs or VA health care benefits.
The Military Officers Association of America (MOAA), the Fleet Reserve Association of America, the American Legion and other veterans' service organizations have studied the legislative language of both bills. Their own reviews, and assurances they've received from relevant committees, give them confidence that the bills won't impact benefits or fees charged by TRICARE or VA, nor will these beneficiaries be exposed to any new tax liabilities.
"We have not talked to anybody – Republican, Democrat, anyone in the [Obama] administration or serving in Congress -- who is trying to do anything to affect military people" as part of national health reform legislation, said Steve Strobridge, MOAA's director of government relations. "They all are trying to hold military beneficiaries harmless."
Steve Robertson, legislative director for the American Legion, said he has assurances from the armed services committees, veterans' affairs committees and congressional leaders including House Speaker Nancy Pelosi that health reform will not impact TRICARE programs or VA health care.
"My comfort level is pretty high," Robertson said.
Confusing the issue for many beneficiaries has been an e-mail being passed among military retirees that warns falsely that the Congressional Budget Office has drafted legislation to attach new fees to TRICARE for Life, the prized insurance supplement relied on by Medicare-eligible retirees.
The e-mail is filled with misinformation. CBO has no authority to draft legislation. CBO did release a report last December presenting options for holding down federal health care costs; a few of those options would raise fees on military retirees and veterans. But neither the Obama administration nor any members of Congress have embraced any of these ideas.
"Everyday I get to answer e-mails from people who are still telling me that this ‘CBO legislation' is moving through rapidly," said Robertson.
Other military retirees and disabled veterans are worried by news reports that national health care reform will impose an excise tax on "Cadillac" health insurance programs. Will that include TRICARE or VA health care? It will not, say service groups and informed congressional staffs.
Strobridge noted that the Senate bill, the Patient Protection and Affordable Care Act (HR 3590), doesn't contain the same specific language of the House bill does to shield TRICARE programs and VA health benefits.
However, the Senate bill's provision to allow an excise tax on "applicable employer-sponsored coverage" lists, among government plans, only the Federal Employees Health Benefits Plan for possible inclusion. TRICARE and VA health care benefits are not named. Finance committee staffers have explained that this was intentional to shield these programs.
MOAA has urged senators to add three clarifying provisions to their bill. One would duplicate language of the House bill that nothing in the legislation alters health care program authorities for DoD and VA.
Other language is sought to explicitly exclude TRICARE, TRICARE for Life and VA health care programs from any health reform bill excise tax on certain employer-provided plans. Finally, MOAA wants language in the Senate bill calling for a study of national health reform's impact on veterans to include a study of the impact on TRICARE and TRICARE for Life.
Military people who seek assurance that the Senate health reform bill won't impact them negatively end up "looking for something that isn't there," Strobridge said. The Senate, like the House, should make it clear, he said.
"There are lots of people out there who would like to raise military fees" on health benefits, Strobridge said. "But they are not trying to do it in this legislation…As far as we can see, everybody in Congress is trying to bend over backwards to protect the military. And that's true of both parties."
The only real threat to military and veteran benefits posed by national health reform, he continued, is the likelihood that it will add to the annual federal budget deficit which was $1.4 trillion last year. That will increase political pressure, over time, to curb federal entitlements including military health care and retirement plans, said Strobridge. Pressure on defense budgets already is enormous.
"That's why Defense leaders have been saying for years ‘I don't what to pay this $10 billion for TRICARE for Life that we put in the defense bill every year.' I want to shift more costs to the beneficiary.' That is what the Bush administration said the last three years," Strobridge said.
"We haven't even started to talk about the effect of the baby boom generation on Medicare and Social Security" on future budgets, he added.
Given that pressure, MOAA has been pressing Congress to define in law that military members and retirees have earned through service certain unassailable rights to promised retirement and health care benefits.
"What we're concerned about is that budget pressure will drive arbitrary decisions. That is what has hurt us in the past," said Strobridge. Congress should take steps to spell out what military folks have earned.
"If you don't have any rules to rely on," he said, "when the budget tidal wave comes it will sweep you away."
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A syndicated columnist and freelance writer, Philpott has covered the U.S. military for almost 30 years. His weekly news column, Military Update, appears in daily newspapers across the U.S. and in Stars & Stripes overseas. He also publishes a weekly reader reaction column, Military Forum. His freelance articles have appeared in numerous magazines including The New Yorker, Washingtonian, Readers' Digest and Kiplinger's.
Military Update, which reaches two million readers, covers breaking news affecting the lives of service members, retirees, Reserve and Guard members and their families. He also writes the Observation Post, a monthly column for Today’s Officer magazine. He is associate editor (U.S. section) for Jane's Fighting Ships and is a regular contributor to Military Officer, the magazine of the Military Officers Association of America.
Friday, November 27, 2009
Tom Philpott .. firstname.lastname@example.org, | November 25, 2009
Tuesday, November 24, 2009
Vets get aid with legal problems
Special courts work with VA, bar association
By Donna Leinwand
Marshall Callahan had $300 in his pocket and a powerful craving for booze when he got stranded in Lee's Summit, Mo., on a cross-country drive two years ago.
The former Marine Corps aviation mechanic says he drank until he was broke, blacked out and woke up in jail. It wasn't the first time. Callahan, 47, has been homeless on and off for 15 years.
"I've been in all the jails here. I've been in all the detoxes. Any life I had that I could ruin, I ruined," says Callahan, who served in the Marines from 1981 to 1985 in Cherry Point, N.C.
Now Callahan, sober since Oct. 15 and living in a Salvation Army shelter, is eagerly awaiting Dec. 9, his day in a Kansas City, Mo., veterans court, where a volunteer lawyer will assist him with his thicket of nuisance citations, such as sleeping in public.
"This is a big deal for someone used to living on the street and not having any money," Callahan says. "This is a golden opportunity."
Special courts aimed at helping veterans with legal problems are emerging around the country as servicemembers return from wars in Iraq and Afghanistan, spurring efforts to help them and others who served in the military.
In the past two years, 22 cities and counties, such as Buffalo, Chicago, Tulsa and Pittsburgh, have opened courts with dockets reserved for veterans. Kansas City held its first session in August. At least 39 others are planned for next year, Department of Veterans Affairs records show.
The courts coordinate with the VA and other service providers so veterans such as Callahan charged with minor infractions can opt into services such as drug treatment or job training to avoid jail or fines and ultimately have their cases dismissed. The VA estimates that veterans account for 10% of the people who have criminal records.
"In most instances, the folks in need of this special service are people who are suffering or have had legal issues as a result of their military service," says Brian Christensen, a former Navy lawyer who helped organize the Kansas City court and will represent Callahan for free at the once-a-month veterans docket. "They deserve a little bit extra from society."
The special courts began after judges and lawyers saw a growing number of veterans from the wars in Iraq and Afghanistan with signs of post-traumatic stress disorder or substance-abuse problems, says Paul Freese, a Los Angeles attorney who advises the American Bar Association's Commission on Homelessness and Poverty.
Many veterans who come to the courts are homeless and have amassed citations for minor, non-violent offenses, such as sleeping in public or loitering. They could not pay the fines or get to court, so judges issued warrants that prevent them from getting jobs, housing and benefits, Freese says. Neither the ABA nor the VA tracks how many of these veterans successfully completed their programs.
"Communities want to help these soldiers come back without the outcomes we saw after the Vietnam War," such as homelessness, unemployment and substance abuse, Freese says. "I think we're at a critical juncture where these courts can exponentially increase."
This month, VA Secretary Eric Shinseki announced a five-year goal to end homelessness among veterans. The VA estimates 131,000 veterans are homeless, but Shinseki said homelessness could increase by 10% to 15% over the next five years without aggressive steps to help veterans.
In May, he directed every veterans center to designate a staff member to work with the courts to ensure veterans in the criminal justice system can tap into VA services, says Jim McGuire, who manages the agency's Health Care for Reentry Veterans program.
"The VA in the past hasn't been as aggressive about reaching out to the courts. We want to ramp that up," says Sean Clark, national coordinator for Veterans Justice Outreach at the VA.
Callahan, after eight months sober, went on a drinking binge two days before his first scheduled court date in October and missed it. He returned to the Salvation Army shelter to detox. Then, "in through the Federal Express mail comes a letter saying the lawyer went to court and got a continuance," giving him a second chance to show up at court. "I couldn't believe it," he says.
Callahan vows not to miss his December hearing. He wants to finish cosmetology school, get a job in a salon and learn to play the cello.
"I have a chance," he says.
Vets get aid with legal problems
Monday, November 23, 2009
Outside View: Army throws money at mental health
Published: Nov. 20, 2009 at 11:00 AM
By LAWRENCE SELLIN, UPI Outside View Commentator
HELSINKI, Finland, Nov. 20 (UPI) -- The U.S. Army recently funded a five-year, $50 million study by the National Institute of Mental Health to examine the factors possibly associated with suicide, including combat-related trauma, personal and economic stress, family history, childhood abuse, a military unit's cohesion and general mental health.
With all due respect to the eminent scientists at NIMH, I wonder if much of that information is available already from civilian sources, both online and in paper-bound publications. I would doubt that surveying hundreds of thousands of recruits and interviewing soldiers will, in the end, provide that eureka moment they seem to anticipate. Five years seems like a long time to wait for conclusions of which we may already be aware.
There is a humorous aphorism floating around the consulting community, courtesy of despair.com, that if you can't be part of the solution, there is good money to be made prolonging the problem. A five-year study has the added benefit that it will likely outlive the tenure of the Army bureaucrats currently responsible for initiating it.
During a Defense Department news conference Tuesday, Army Vice Chief of Staff Gen. Peter W. Chiarelli said: "As I look across all the factors, from the number of deployments individual brigade combat teams have gone through, to everything else, I cannot find a causal link that links anything, other than what the Army Science Board gave me that said that soldiers who are in geographically separated locations -- OK? -- have a higher incidence of suicide. I guess the statisticians can prove that. But I can't find it."
According to the Suicide Prevention Resource Center, a sociocultural risk factor is a "lack of social support and sense of isolation." This can occur when a combat soldier leaves the support network of his combat buddies, when soldiers return home and undergo the often dangerous transition to "normalcy" or even new recruits working under stress in an unfamiliar environment. It is about unit cohesion.
Remedies include strong connections to family and community support, easy access to a variety of clinical interventions and support for help-seeking, effective clinical care for mental, physical and substance use disorders, support through ongoing medical and mental healthcare relationships, skills in problem solving, conflict resolution and nonviolent handling of disputes, and cultural and religious beliefs that discourage suicide and support self preservation.
"I've scrubbed the numbers every way I possibly can," Chiarelli said. "I cannot find a causal link."
First of all, there is no "causal link." Suicide is a process, sometimes fast, but mostly slow. One is carried down a river of emotions with various eddies and currents affecting the direction and speed of the journey. With help, you can be pulled to the shoreline. Without it, you may eventually go over the waterfalls.
Courtesy of The Times of London, one Army wife, whose husband committed suicide, accurately described the process: "It seems to be a perfect storm of issues. Someone comes back with post-traumatic stress disorder. They get into difficulties with money and relationships. They turn to drink or drugs and are unable to ask for help. They feel they are no longer of value to their unit; that the army and their family would be better off without them. That's when they are at risk."
Secondly, I don't believe that we have fully examined the data we have, both structured and unstructured, in an efficient and contextual way. There are highly sophisticated information technology tools and methods to do that right now both quickly and effectively by a combined analysis of biopsychological, environmental and sociocultural risk factor with known pre-suicidal symptoms and how they match with soldiers' experiences.
It is interesting to note that in a study titled "Is Suicide at MIT a Poisson (random) Process?" the authors with only a sample of 33 were able to statistically demonstrate that suicides were most related to stress during or after exam periods. Yes, it appears obvious, but that is my point, because I do not think the Army has done a rigorous analysis of the data that are already available.
Col. Elspeth Ritchie, the Army's lead psychiatrist, was asked in a 2009 Salon interview if she has had the opportunity to query enlisted soldiers, personally, in an off-the-record environment by strolling the barracks or hanging out in a hospital smoking area. She said no.
The Army's senior officers need to lead from the front, try to get to know their soldiers better and spend enough time with them such that they feel that you know and care about their stresses and difficulties.
The Army's mental-health challenge will be won more quickly and effectively by leadership rather than through cash or complacency.
(Lawrence Sellin, Ph.D., is a colonel in the U.S. Army Reserve and a veteran of the conflicts in Afghanistan and Iraq.)
It's not often I will agree with an Army PHD on issues like this, but Colonel Sellin is accurate, if the Army's top mental health doctor does not have enough sense to walk around the smoking area of a Army mental health clinic, or sit at the PX snack bar and listen to the soldiers talk about the problems they are dealing with, because they do talk, I have spent enough time in all of those places during my 15 years of Army service, better yet spend an hour a week at the NCO club at the bar and just watch and listen, they could learn a lot in a week or two, and it would be more beneficial to the Army and the soldiers in it now than to wait for a 5 year new study to be completed. but as long as the study is going on the Army can claim they are "doing something" while nothing gets done.
My experience is from the Vietnam War era (I served on the DMZ in Korea) and Gulf War One, I served with a lot of NCO's that have PTSD, I saw a lot of soldiers get thrown out on PDO discharges when they shouldn't have been. I am 11B3M a combat infantryman for mechanized vehicles (M113) I entered the army after I enlisted a PV1 in 1973 and was a Staff Sergeant on the SFC list when I left active duty in 1982. I was a member of the Georgia National Guard when activated for GW1. I was also a med vol at Edgewood Arsenal in the summer of 1974, I am pretty sure Colonel Sellin might be familiar with that program and what it entailed, now talk about nightmares, read up on the CIA liason Sidney Gottlieb the master of disaster....
Yes, soldiers and their families need help, not more studies the NIMH and and NCPTSD have all the data they could ever want, they just need someone that can read and comprehend what they are reading.
Study sheds light on post-combat mental problems
Tuesday, September 8, 2009
By Anne Harding
NEW YORK (Reuters Health) - Symptoms of posttraumatic stress disorder (PTSD) are typical after deployment to a war zone, and may even represent a healthy reaction to stress, but can lead to problems with mental functioning if they persist, new research in Iraq vets suggests.
Past research has demonstrated that people exposed to life-threatening situations will show changes in their nervous and hormonal systems, Dr. Jennifer J. Vasterling of the VA Boston Healthcare System and her colleagues note, but it's not clear how long such symptoms last after exposure ends, and if they do last, what the consequences might be.
Vasterling and her colleagues are conducting a long-term study called the Neurocognition Deployment Health Study to help answer these questions.
In the current report, Vasterling and her team report the outcomes of neurological and psychological assessments of two groups of soldiers before and after deployment to Iraq.
Their study included 164 male and female Army soldiers assessed about a year after their return, and 104 tested an average of just 122 days after they had returned.
The researches found no relationship between the amount of time since a soldier had returned from deployment and his or her "neuropsychological" function.
There was no relationship between PTSD symptoms soon after deployment and the ability to pay attention, but the soldiers who still had PTSD symptoms a year after they returned from combat had a harder time focusing and paying attention.
The researchers also found that soldiers who had experienced more intense combat showed improved reaction time both soon after their return and a year later.
Attention problems can be very relevant to how a person functions in daily life, Vasterling noted in an interview, even though the deficits that she and her colleagues identified were relatively mild.
The hope, she said, is that these problems will resolve once a person's PTSD is treated. However, the researcher added, there are also strategies that can help people cope with their attention problems until they get better.
She and her colleagues are continuing to follow the soldiers, and one interesting question, she noted, is whether the increased reaction time they identified in those exposed to more intense combat might have a downside.
"You have to wonder how taxing that gets, to be constantly prepared for a long, long period of time," Vasterling said.
SOURCE: Archives of General Psychiatry, September 2009.
I am not the brightest bulb in the bunch, but the military has seen this since 1776, the Civil War, WW1, WW2, Korea and Vietnam, this is not exactly a new problem, but the past has had different names for it "soldiers heart" "weak" "drunks" etc it was not until 1980 when the diagnosis of PTSD was added to the DSM as a mental health problem.
One of the main reasons is that after Vietnam there were to many veterans that could not function in society, they withdrew, the Army did not offer mental help, instead if you asked for help you were accused of being a coward, they labeled the PTSD veterans with Personality Disorders (which they were still doing as late as 2006) which keeps the combat veterans from getting either retirement benefits or veterans benefits (save the Army and the VA money).
I agree that if help is available and the soldier will not ruin his career after asking for help then they would be more willing to seek assistance, but if they pull the security clearance or the soldiers ability to handle weapons, that means that they can not stay in the Army and they have ended their military career for asking for mental health care. It would be easier to resolve the stress with early care, help for the entire family, wife and kids make the adjustments when the soldier comes home, as it is stressful on the entire family, look back at the Vietnam POWs and look at their divorce rates, it was high, a lot worse than other career soldiers, which is also higher than the average for the United States, the spouses can't handle the constant coming and going or the soldier themselves feel out of place when they come home, and find out that the house has a routine that does not "need them" in it to function. Then everyone is walking on eggshells and a lot of the "eggs get broken"......
the earlier the help the better it works, let it stew and for many it becomes permanent......