RoguePundit

Higher Suicide Rate Amongst Veterans

Last fall, CBS reported on what it called an epidemic of suicides amongst veterans.  Today, it had a follow-up story that focuses upon Oregon's suicide data.

The state health report, “Violent Deaths in Oregon: 2005” found 18 to 24-year-old male veterans had the highest rate of suicide among all males in the state from 2000 to 2005 – almost 5 times higher than non-veteran males the same age.

...

Data for the report was collected from local medical examiners, police reports and death certificates. In 2005, veterans accounted for 28 percent of all suicides in Oregon. The majority of the veteran suicides (97 percent) were committed by males. And overall, in the years 2000 to 2005, male veterans died of self-inflicted wounds in Oregon at more than double the rate of male non-veterans.

Switching to a paragraph from the report...

The reasons for higher rates of suicide among veterans are not clear.  There are many unexplored possible contributors.  For example, the difference could be due to baseline differences predisposing to suicide between those who choose to enter the armed services and those who do not, or could be due to exposure to traumatic events during combat, or a high prevalence of gun availability and familiarity among veterans.  Regardless of the cause, these results argue strongly for suicide prevention efforts targeted to veterans.   Two facts should prompt officials to make suicide prevention a prominent focus among older veterans: First, the high rate of suicide among veterans older than 65 and that approximately 70 percent of older males are veterans (2000 census).

For military members, conversations with military (or contracted) mental health professionals are not privileged.  What you say can come back to bite you career-wise.  It's somewhat safer to talk to a chaplain.  Nevertheless, I've often wondered whether that stigma makes vets less prone to seek help or be open with those trying to help them. 

Back to the article...

Researchers with Oregon's Violent Death Reporting System are now digging deeper into the issue of veteran suicides as a result of their recent findings. According to Millet, they plan to team up with the Oregon National Guard and the Portland Department of Veterans Affairs to gain more information about the individuals who died of suicide. Millet says "we need to see what can be done to reduce the problem."

They need to talk to friends and family as well.

Slowly But Surely

The destruction continues.

The U.S. Army Chemical Materials Agency announced Tuesday that half the nation's 30,000-ton stockpile of chemical agent used in weapons has been destroyed.

More than 3 percent of that stockpile has been destroyed at Oregon's Umatilla Chemical Depot since September 2004. There, an original stockpile of 3,719 tons has been reduced by 1,069 tons, or 29 percent, so far.

...

Umatilla is one of the five remaining sites and is home to about 12 percent of the country's original chemical agent stockpile. The depot finished destroying sarin-filled munitions July 8.

Since late October it has been processing its inventory of VX nerve agent, an oily, clear liquid that can cause seizures, paralysis and suffocation. It is found in rockets, spray tanks, artillery shells and land mines.

Work to destroy them could finish in mid-2009, Henrickson said. Then work will begin to destroy bulk containers of mustard gas. All work could be finished by 2012, though such time frames aren't guaranteed.

Sarin is also a nerve agent...that's been used a few times in recent memory.  Saddam attacked the Kurds with sarin (and mustard gas) in the late '80s, and Japanese cultists used it in a couple of attacks, including on the Tokyo subway system in 1995.  It was the Germans who developed sarin as a pesticide in the late '30s.

It is hoped 90 percent of the country's stockpile of chemical agent will be destroyed by 2017. The remaining 10 percent will be destroyed at facilities being built in Colorado and Kentucky.

North Korea has a huge chemical munitions arsenal and delivery systems which allow it to attack from afar.  It's one of the few nations which has never joined the Chemical Weapons Convention. 

Maybe Vets' Data is Safe...Maybe

The following article starts out with some good news, but ends up leaving me wondering even more whether the VA can be trusted on this issue. 

The government has recovered the stolen laptop computer and hard drive with sensitive data on up to 26.5 million veterans and military personnel. The FBI said Thursday there is no evidence that anyone accessed Social Security numbers and other data on the equipment.

Veterans Affairs Secretary Jim Nicholson, in announcing the recovery of the computer, said there have been no reports of identity theft stemming from the May 3 burglary at a VA employee's Maryland home.

The FBI, in a statement from its Baltimore field office, said a preliminary review of the equipment by its computer forensic teams "has determined that the data base remains intact and has not been accessed since it was stolen." More tests were planned, however.

Nicholson said the laptop and hard drive were turned in Wednesday to the FBI by an unidentified person in response to the $50,000 reward offer. No suspects were in custody.

...

Michelle Crnkovich, a spokeswoman for the Baltimore FBI field office, said tipster who turned in the laptop in Baltimore has not been charged and likely was not the thief. She said the FBI still believes the laptop was taken in a routine burglary and that the VA data was not the target.

Let's hope the computer forensic folks are correct.  Can one presume this also means the data hasn't been copied?  Obviously this has started a debate over whether credit monitoring (previous blog here) is still needed.

And then there's the following regarding the data, which is certainly different from what the VA has been saying...

According to documents obtained by The Associated Press, the data analyst faulted for losing the personal data had the department's approval to access millions of Social Security numbers on a laptop from home. One document shows the analyst, whose name was being withheld, had approval as early as Sept. 5, 2002, to use special software at home that was designed to manipulate large amounts of data.

A separate agreement, dated Feb. 5, 2002, from the office of the assistant secretary for policy and planning, allowed the worker to access Social Security numbers for millions of veterans. A third document, also issued in 2002, gave the analyst permission to take a laptop computer and accessories for work outside of the VA building.

The department said last month it was in the process of firing the data analyst, who is now challenging the dismissal.

Under questioning, Nicholson said he was not personally aware of the agreements. Tim McClain, the VA's general counsel, told the committee that the Social Security authorization is standard for an employee doing data analysis work, and that the laptop authorization was for a computer different from the one that was stolen.

"I can't comment on a pending action because it is still pending," McClain said.

We'd previously been told that the data analyst was fired for violating procedures--taking the data home without permission.  Now we find out that not only isn't he gone, but he may have had permission to take the data home? 

Remember that it took three weeks for the VA to publicize that the data had been stolen.  First it was just vets that were victims, but then we're told that the data from most active duty and many guard and reserve personnel had been stolen as well.  Initially it was just names, SSNs, birth dates, and some disability codes that had been stolen, but then we're told that addresses and phone numbers were also included. 

The data analyst's boss (VA deputy assistant secretary Michael McLendon) has resigned, and another senior VA official is on administrative leave while the investigation proceeds.  But, it's no secret that the VA has had security issues for a fair while.  When do we start holding the leadership responsible for those problems?

VA Identity Theft and Free Credit Monitoring

The government hasn't done a good job of protecting my personal information.  In late '02, the military HMO that handled my back surgery and related treatment had some computers stolen which evidently included info on me.  Luckily (knock on wood), I haven't seen an impact from the identity theft.  Then last month came the theft of a VA computer containing the personal information (and disability ratings when applicable) on millions of vets and active duty military.  I'd already seen that I'd eventually be eligible for free credit monitoring.  But now I may have to wait longer because of a class action lawsuit to get us victims a better deal?

A federal judge temporarily has barred the government from publicizing its free credit monitoring offer to veterans whose personal data was stolen and wants to see if they might get a better federal offer.

Lawyers who have filed a class-action lawsuit on behalf of the 26.5 million veterans and active-duty troops affected contend that accepting the government's offer could jeopardize their chance of winning more money in the privacy suit.

U.S. District Judge William Bertelsman in Kentucky scheduled a hearing this Friday to determine whether the Veterans Affairs Department should revise its offer. His order on the credit monitoring was issued late last Friday.

The suit seeks free monitoring and other credit protection for an indefinite period as well as $1,000 in damages for each person - or up to $26.5 billion total - in what has become one of the nation's largest information security breaches.

Why exactly is identity theft from the government worth $1,000 per victim?  The free monitoring and credit protection for some length of time (not indefinitely) certainly makes sense.  And if some of us run into significant problems from the identity theft, I can certainly see the government bearing the burden of that cost (though proof could be tough to assess).  But, a check for $1,000 on top of that?  Maybe that's just the lawyers setting up a bargaining chip. 

Last week, the department announced its plan to offer free monitoring for a year to millions of veterans and nearly all active-duty military troops whose names, birthdates and Social Security numbers were stolen May 3 from a VA data analyst's home in suburban Maryland.

The department said it would send out letters to affected veterans and military personnel in early August - after it solicits bids from contractors - on how to sign up for the free service. It also posted information on the government's Web site.

But in court papers, lawyers for veterans said the VA's deal was "incomplete and misleading." The VA must make clear whether veterans who take the government deal will have to give up their rights in court to a potentially larger payout, lawyer Marc Mezibov wrote.

...

Last week, a Senate committee approved $160 million to pay for the credit monitoring for veterans. It is one of many expected payments as the government struggles with fallout from data breaches crossing at least six agencies.

The VA alone has spent more than $14 million so far to notify veterans by letter and set up a call center, and it is spending an additional $200,000 a day to maintain the call center.

By the time the VA gets around to sending out those letters, it will have been three months since the identity theft...unless the lawsuit causes a greater delay.  Is it reasonable to expect that the criminal(s) won't act on the information very quickly?  Guess that's why the government and others have been giving us advice on how we can help ourselves until the government gets around to it.  The $160 million the Senate approved for the credit monitoring is only about $6 per victim. 

Our socialized medicine is sure efficient.

Large TRICARE Fee Increase Proposed

The Veteran's Administration (VA) primarily serves disabled vets, only a small percentage of whom are military retirees.  Because of funding limitations, the VA (which isn't part of the Department of Defense) prioritizes access to care, giving preference to vets with purple hearts and higher service-connected disability percentages.  Thus, some disabled vets also pay for TRICARE, the military's HMO, to ensure they get care when they need it.

Who provides the promised health care for the typical military retiree?  The Department of Defense.  It used to be when military retirees and their family members hit the age of 65, the responsibility for providing their medical care shifted to the Department of Health and Human Services via Medicare.  That changed in 2001 when the TRICARE for Life program was established.  Since the military started offering such service to its senior citizens, its healthcare costs have been accelerating faster than normal. 

The DoD wants to free up more money to spend on current defense priorities, so its leaders will soon lobby Congress for approval to significantly increase enrollment fees, co-pays, and deductibles for retirees under the age of 65.  The theory is that these retirees are still of working age and are likely to have some medical coverage through their current employer, thus they can better afford the increase.

...Defense officials want annual enrollment fees for TRICARE Prime, the military’s managed care plan, to triple by October 2008 for working-age retired officers, from $230/$460 a year (individual/family coverage) up to $750/$1500, and to double, to $450/$900, for under-65 enlisted retirees.

Retirees who use TRICARE Standard, the military’s traditional fee-for-service health insurance, would see their annual deductible raised too. They also would pay for the first time an annual enrollment fee. Beyond 2008, all TRICARE fees and co-payments would be indexed to medical inflation.

TRICARE retail pharmacy co-payments also would be raised, which would be the only change to impact Medicare-eligible retirees too. The goal would be to discourage purchase of maintenance medicines through the more expensive retail network, by increasing the $3 co-payment for generic drugs to $5 while offering free generic drugs by mail. The current $9 co-pay for brand drugs would jump to $15 retail and $10 by mail order. Officials assume a 14 percent shift of TRICARE retail users to base pharmacies or into the mail order program

Many retirees are already blaming the military and/or Congress for not funding retiree healthcare adequately.  Most see it as a broken promise--a benefit that's eroding.  But, few folks are immune from sharing some of the burden of rising healthcare costs.  At least there hasn't been a TRICARE fee increase since 1995.  The low fees have motivated a growing number of new retirees to not take advantage of the health insurance offered by their new employers.

If the military is going to achieve a 14 percent shift to base pharmacies and the mail order program, most of it's going to have to come through mail order.  Many retirees have run into the situation where the overcrowded local base pharmacy (if there's one anywhere nearby--certainly an issue here in Oregon) doesn't always carry the medication they need.  And, military hospitals sometimes try to protect their local budgets by restricting access to some of the more expensive medications.      

One officer described a likely scenario, early in 2006, of the nation’s top military leaders sitting shoulder to shoulder before the armed services committees to testify that medical costs are now a critical readiness issue.

Higher TRICARE fees for younger retirees also will be endorsed in the Quadrennial Defense Review report which the service chiefs are completing to propose a realignment of military programs to meet future needs. The QDR recommendations are expected to be unveiled in early February when the Bush administration also sends its 2007 defense budget request to Congress.

The “24-star” endorsement, a reference to the six four-star officers who comprise the Joint Chiefs – the chairman, vice chairman, and top officer of the Army, Navy, Air Force and Marine Corps – is seen as necessary to persuade Congress to accept the first TRICARE fee increases in a decade and then to help insulate supportive lawmakers from the wrath of angry retirees.

In both older unions and the military, the goals of the workers and the retirees sometimes conflict.  In for instance the autoworkers, the retirees have more voting power than do the workers, which gives them the upper hand when it comes to maintaining their benefits, even when those costs financially endanger the corporation and thus the workers' jobs. 

Meanwhile with the military, the Congress controls the pursestrings, using multiple strategies to achieve its financial goals.  It can specifically legislate changes, and/or it can appropriate less money than necessary to satisfy a range of requirements, thus leaving it up to the military to make the hard choices.  When stuck choosing between supporting the current mission and the retirees, the top military leadership often works against the people they will join in retirement in the near future.   

TRICARE officials estimate that the higher fees and a decline in users will dampen projected health care costs by $12 billion within five years and $32 billion through fiscal 2015. But the numbers are viewed as optimistic, even by senior analysts, one source explained. They assume that 600,000 current beneficiaries, facing higher fees, will shift to employer-provided health insurance by 2011. 

The “flaw” behind that figure, the official explained, is it’s based on civilian HMO surveys of disenrollments when their fees are raised. Most HMO users, however, seek lower-cost alternatives. For TRICARE Prime users, even if the $460 enrollment fee for families is bumped to $1500 a year, as proposed for under-65 retired officers, TRICARE still will be a better deal.

If so, most of the projected cost savings will flow from the higher fees, which it might be argued is just a budget move to have younger military retirees and their families cover some of the cost of TRICARE for Life and senior pharmacy benefits for older retirees, their spouses and survivors.

...

Other than the cost of war and contingency operations, CBO says, the greatest budget risk facing the military is health care costs. The CBO report encourages an increase in fees, but suggests that a “transformational” set of higher fees and co-payments would boost out-of-pocket user costs to the level of civilian HMOs, and hit not only younger retirees and their families but Medicare-eligible beneficiaries and active duty family members too.

CBO is the Congressional Budget Office. 

Evidently, a lot of the leadership in DC figures that reducing military healthcare benefits won't have much of an impact on recruiting...and they might be right.  Folks generally don't think a lot about their future healthcare needs when they're young and healthy.  But, it may be more important when it comes to retention.  The retirees have to hope that Congress doesn't finally decide to show a bit of fiscal conservatism--at their expense. 

One thing we know for sure...military members won't strike to fight for this benefit. 

Legal Ecstasy (Updated Below)

Color me hopeful, but suspicious.

American soldiers traumatized by fighting in Iraq and Afghanistan are to be offered the drug ecstasy to help free them of flashbacks and recurring nightmares.

The US food and drug administration has given the go-ahead for the soldiers to be included in an experiment to see if MDMA, the active ingredient in ecstasy, can treat post-traumatic stress disorder.

Scientists behind the trial in South Carolina think the feelings of emotional closeness reported by those taking the drug could help the soldiers talk about their experiences to therapists. Several victims of rape and sexual abuse with post-traumatic stress disorder, for whom existing treatments are ineffective, have been given MDMA since the research began last year.

Michael Mithoefer, the psychiatrist leading the trial, said: "It's looking very promising. It's too early to draw any conclusions but in these treatment-resistant people so far the results are encouraging.

"People are able to connect more deeply on an emotional level with the fact they are safe now."

He is about to advertise for war veterans who fought in the last five years to join the study.

Most military members are suspicious of mental healthcare, as information gained can be used against the members in a career-threatening way.  For instance, we don't want somebody who's unstable to be working with a nuclear missile.  But if you're a missileer or maintainer who's having marital difficulties and would like to talk with somebody about them, a psychologist in a military hospital doesn't provide a safe environment for such discussion. 

Chaplains can keep much more information privileged, so they are usually the preferred option, whether the member is religious or not.  In other words, most military members only go to see a hospital psychologist when forced to.  Giving members a drug whose use would ordinarily cost them not just their security clearance but their career is sure to make them more suspicious. 

But if you've already been diagnosed with PTSD, that changes the equation a bit, especially if you're close to getting out or retiring.  I can't imagine too many troops hoping to continue their careers would like to have experimental ecstasy testing in their medical records,  And how is the VA going to address such usage when it comes to potential disability...besides slowly?

According to the US national centre for post-traumatic stress disorder, up to 30% of combat veterans suffer from the condition at some point in their lives.

Known as shell shock during the first world war and combat fatigue in the second, the condition is characterized by intrusive memories, panic attacks and the avoidance of situations which might force sufferers to relive their wartime experiences.

Dr Mithoefer said the MDMA helped people discuss traumatic situations without triggering anxiety.

"It appears to act as a catalyst to help people move through whatever's been blocking their success in therapy."

Let's hope so, and let's hope that the usage doesn't have lasting side-effects that adversely impact the patients.  The military doesn't have a brilliant track record when it comes to medical experimentation with troops.  It's probably good that it's a small test (20 total, 12 who get the drug), and that it's being conducted by the Medical University of South Carolina.

The FDA approved clinical ecstasy testing in 2001, and the state of South Carolina eventually followed suit.  However, it took until 2004 for the DEA to approve such testing, 20 years after doctors first started seeking permission.  Ecstasy was also approved for other types of testing, including on terminal cancer patients to see if it can "lessen their fears, quell thoughts of suicide and make it easier for them to deal with loved ones."  Gee, maybe one day evidence from this test will be used to overturn Oregon's assisted suicide law.  Let's hope not.

The existing drug-assisted therapy sessions last up to eight hours, during music is played. The patients swallow a capsule containing a placebo or 125mg of MDMA - about the same or a little more than a typical ecstasy tablet.

Psychologists assess the patients before and after the trial to judge whether the drug has helped.

The study has provoked controversy, because significant doubts remain about the long-term risks of ecstasy.

Animal studies suggest that it lowers levels of the brain chemical serotonin, and some politicians and anti-drug campaigners have argued that research into possible medical benefits of illegal drugs presents a falsely reassuring message.

The South Carolina study marks a resurgence of interest in the use of controlled psychedelic and hallucinogenic drugs. Several studies in the US are planned or are under way to investigate whether MDMA, LSD and psilocybin, the active ingredient in magic mushrooms, can treat conditions ranging from obsessive compulsive disorder to anxiety in terminal cancer patients.

Let's hope the ecstasy helps.  PTSD is miserable to endure.

Update:  Well, with the Supreme Court having agreed to hear the Assisted Suicide Law challenge Tuesday, the ecstasy testing won't be done in time to affect the decision, at least this time.

Mad Cow Found in a Goat

Remember that decorated Green Beret who the Army was kicking out for various disciplinary issues when it was discovered he had Creutzfeldt-Jakob disease, the human form of mad cow disease?  No one could figure out how he got it, though he thought it was from eating a ceremonial meal of sheep brains while deployed in Oman.  His parents thought he maybe ate some contaminated beef a few yeas ago in England.  No one knows. 

Sheep and goats can get a related "transmissible spongiform encephalopathy" (TSE) known as scrapie.  But, the only two TSEs that have been found in humans are Creutzfeldt-Jakob and kuru, found in cannibalistic Fore tribes in New Guinea.  Other TSEs we hear about in the news are chronic wasting disease in deer and elk, and FSE (the "F" for feline) found in cats in Europe.

Three years ago, British scientists thought they'd found mad cow occurring naturally in sheep, but it turns out the researchers were accidentally dissecting cows brains.  Then in France this week, testing showed that a goat slaughtered because officials thought it had scrapie actually had mad cow disease.  Maybe the Green Beret was right.  The EU is now going to test 200,000 goats throughout the EU over the next six months. 

Meanwhile, Sgt. Alford--the Green Beret in question--is still alive but is "in a vegetative state."  There is no cure for Creutzfeldt-Jakob, and it's only been injections of an experimental drug (pentosan polysulphate, a paint thickener with medicinal uses) that has extended his life. 

It's a point of honor to his parents (his dad is a retired Army command sergeant major) that Sgt Alford be allowed to die on active duty.  So they're fighting the Army's efforts to medically retire him.  Both the Army and his parents understand that the death benefits are better for retired soldiers.  In fact, the military sometimes goes to extraordinary means to retire soldiers who are about to die on active duty.

Example...a good friend of mine (Ed) drowned on a family weekend to North Carolina's outer banks.  A sudden rip tide pulled him and one of his daughters into danger, and he drowned while saving her.  If was 30 minutes until rescue crews could find his body, which they then successfully "revived."  His wife is a nurse, so she knew he was brain dead, and in fact asked the emergency medics working to revive him to leave him be. 

Once his heart was beating, they rushed Ed to the hospital and put him on several machines to keep his body alive...he was brain dead with several other organs failing.  She called his boss, a commander he and I had worked with in a previous assignment.  He told her to keep the machines on while he initiated the emergency paperwork to retire him (Ed had about 15 years in...and a wife and three kids).  It was done in a matter of hours, then she had him unplugged and he quickly died.

One thing Hollywood military funerals rarely get right is how startling the rifle cracks are.

Risks and Being Uninsured

A friend of mine works in the construction industry. Like most construction jobs, the pay is only okay, and the benefits are few. For instance, he gets no medical coverage for himself, his wife, and two kids. His wife doesn't get any coverage from her job either. They made the conscious decision to forego the $400-$500 per month it would cost to purchase medical coverage through an HMO, because financially it would be very stressful to their budget. They are taking the risk that they and their kids will stay relatively healthy, giving them medical bills that cost less than HMO coverage.

One would think that in such an exposed state, they would try to live more carefully healthwise. Not always. He had his first day back at work yesterday after missing a month because of a dirt bike accident...that occurred after he'd had a couple beers. His wife was understandably livid.

If we had socialized medicine, healthcare for doing something stupid would be covered. He knows he doesn't want to pay the taxes necessary to support such a system, so he just grouses at himself for how much his medical care is costing...and he may be risking getting too little medical care to save money. I suppose it could be a few years before we'll know if he's truly learned his lesson or will continue to be a thrill-seeker without a financial parachute.

It's generally the rich, poor, and idealistic who support free healthcare. The rich would have to pay for most of it, many of the poorest don't pay for their healthcare already, and the idealistic generally have a pollyanna-ish view of how much free healthcare would cost the average taxpayer. Socialism can't be successful unless the majority of the population believe they're getting at least their money's worth from their tax dollars. That belief is easy when you're not paying much in taxes in the first place, or if you're rich. That's why much of the middle-class rejects socialized medicine.

Few Americans truly know how well socialized medicine does and doesn't work unless they've lived overseas, have relatives in someplace like Canada, or have been in the military. I'm certainly glad that as a disabled vet, my VA medical care is free. I'm angry that it's so slow, but then the government knows that it can underfund the care all it wants so long as it doesn't cost the offending politicians votes. Less money equals slower care...check the waiting lists for many basic healthcare services in Canada, England, etc.

The Republicans have been as bad as the Democrats at supporting disabled vets over the years. The Democrats have made a big show this year of supporting a greater increase to the VA budget than the Republicans proposed. Guess who won? You know why? Because the Democrats tied their version of an increased VA budget to rescinding the tax cut for the wealthy. In other words, their great promises were dead on arrival with our current Congressional composition. It was just political posturing and empty words, once again.

Because the VA offers no emergency medical treatment, if I'd been in a dirt bike accident like my friend was (and with my back, I'm never getting on another dirt back), I would be out of luck if I didn't pay for HMO coverage. I've made the decision both to be more careful in my behavior plus to cover myself in case such precautions aren't enough to prevent a major accident. I'm paying to supplement my free medical care. Do I also want to pay more in taxes to cover others' stupid behavior? Stupid question.

There's a balance out there somewhere regards how much medical care the government should provide and how much folks should fund themselves. Neither political party have proposed ideas anywhere close to that balance. That's nothing unusual in these polarized times, but at least healthcare is a complicated subject upon which to be gridlocked...except for that flawed drug bill for seniors.

Pretend to Help Vets by Raising Taxes

The politicians in Klamath County are up to an old trick in trying to raise the amount of tax dollars they can spend. They're trying to remove something from their existing budget and institute a new tax levy to fund it. That would of course provide a net increase to their existing budget, since there would be the same amount of revenue to fund less initiatives. No matter how unoriginal the concept is, it's still slimy.

The Klamath County Budget Committee is considering a modest property tax increase that would fund the county's Veterans Services department. The six-member committee has been meeting for the past two weeks, and was expected to finish the 2004-05 budget this morning. The committee has been whittling down a $1.9 million budget shortfall since hearings began May 4. As of 9 a.m. today, there was still a $753,000 gap between revenues and expenses.

Commissioner John Elliott brought up the tax increase idea Thursday afternoon. He said while researching state laws, he found a provision that allows counties to levy a tax of up to 1/80th of 1 percent of property values to fund veterans services.

If the county levied the maximum amount allowed, it would mean a tax increase of about $12.50 per year for taxpayers with a $100,000 home. At that rate the levy would raise more than $400,000 for veterans services, according to preliminary estimates by Elliott.

The county currently has $112,000 in general fund money allocated for veterans services.

"What I'm suggesting is that we would take the Veterans Service office out of the general fund, set it up under this levy, and fund it adequately," he said. "I'm suggesting there is a way to reduce the load on the general fund, as well as meet the needs of veterans."

The commissioner was so desperate to raise taxes that he researched state law to find a means. If he could get the whole $400,000 for the county's vets, that would correct their services not being funded adequately? Interesting admission. Nice of the paper to define the tax increase as modest.

So what does this office do for vets, and with more money what would it do for vets? Well, at a budget of $112,000 with two employees, it must be mostly services. Here's the office's mission statement.

Provide assistance to veterans, dependants and survivors in filing for Federal and State benefits.

This is a nice service to offer veterans. The systems providing benefits to veterans are tremendously convoluted and anything but user friendly, so having experts to help vets is a good thing. Of course, simplifying the systems so that vets wouldn't need expert assistance would be even better. But, that's not a realistic goal.

Commissioner Steve West said he would not support a tax increase, no matter how small, without voter approval. "I don't support the board of commissioners imposing taxes on people," he said. "If it was a ballot measure, and the citizens of Klamath County voted to do it, it would be just swell."

West said that the budget committee did not have the authority to recommend or approve a tax increase, although other committee members disputed his position.

Commissioner Al Switzer said he wanted more information about the idea.

"We do so little for our veterans as it is," he said.

The county could impose a smaller levy than the maximum amount allowed.

Klamath County Budget Officer Mike Long said a tax increase of about $3.75 for a $100,000 home would cover the size of the existing $112,000 Veterans Services budget.

Voting costs money. Oregon's government spends (and as the results show, wastes) money every time it asks us Oregonians to support a sales tax or income tax increase. Meanwhile, local politicians roll the dice with our services, trying to figure out which ones we might directly pay. If they guess right, we pay a special levy (like Josephine County and its library) and the politicians get to spend (and maybe waste) more on our remaining services, many of which we don't care enough about to fund separately.

Slowly but surely, we taxpayers are ending up paying directly for a number of the government services we care about. With the general budget, the government ends up managing mostly a bunch of services we don't care much about. And they wonder why they have trouble getting majority support for tax increases to support that stuff. The government does some important but very unsexy things with our tax dollars. Pay-as-you-go government is a bit too anarchic for the good working order of society.

If a veterans services levy were floated to the voters and turned down, would Klamath County cut or try to shut down services to vets? There's no law in Oregon that says counties have to offer such services, and not all counties do. What would the county fund, or cut, if the levy didn't pass?

If the county commissioners truly cared about vets, veterans services would be a high enough priority in the general fund that vets wouldn't have to worry. In showing how much they care, the Klamath County commissioners are letting vets know they should be worried.

Old Technology at the VA

This article, where accurate, is nothing new to most of us vets. However, it might be of interest to folks who want to know how our country takes care of us vets.

When Willie Buckels applied for veterans health care after returning from Iraq, the back and knee injuries he suffered while rescuing a fuel truck during a mortar attack were not enough to guarantee him treatment.

The Mississippi reservist had to bring along Army paperwork proving his combat service because the Veterans Affairs Department still lacks a computer system that tracks a new applicant's service record.

More than a half-century ago, soldiers who fought in World War II were showing similar paper documents to ensure they got medical care.

"I took my paperwork, showed it to the VA, they got me in the system, got me an ID card and made appointments for doctors," said Buckels, who did not complain about his experience.

More critical, however, are lawmakers who have pressed the agency to make amends for the highly publicized problems it had serving veterans of the first Iraq war a decade ago.

"In this technologically advanced age," proof of service "can't be a sheet of paper crumbling around the edges," said Republican Rep. Christopher Smith of New Jersey, chairman of the House Veterans Affairs Committee.

Rep. Smith ought to know that the military still uses paper medical records and discharge forms, and the VA uses those records to determine a vet's disability. Often, there is a 6-12 month lag between one's discharge/retirement from the military and being approved by the VA for disability (if applicable). That disability level is what the VA uses to prioritize medical treatment, because they are chronically underfunded and understaffed. To counter this delay, the VA allows vets to bring in copies of their medical records and discharge forms to gain medical treatment while awaiting a disability determination.

If the Rep. is going to update the VA system, it would certainly help if he'd update the military's medical and personnel systems and link them to the VA systems. Linking the computerized pay systems would help as well. Since it's Congress that funds both the military and the VA, why doesn't Rep. Smith get busy and direct/fund the changes?

Nearly 18,000 soldiers who have returned from Iraq have sought care at VA health facilities, officials reported at the end of March. A separate report in mid-April said 4,000 troops from the war in Afghanistan sought care, although there is some overlap from those who served in both conflicts.

About 60 percent of the Iraq veterans and 84 percent of those from Afghanistan who sought VA care came from the National Guard and Reserves. The most common problems affected joints and back, teeth and the digestive system.

Mental disorders were diagnosed in 16 percent of the Afghanistan veterans and 15 percent of the Iraqi veterans.

The statistics reflect medical conditions regardless of their origin. They are not broken down by causes such as bullet wounds, blast injuries, accidents and illnesses.

With thousands more veterans expected to seek benefits and health care, the VA faces its biggest challenge since the early 1990s. Officials are well aware of the stakes.

"I believe the agency will be defined for generations by how well we take care of these returning troops," Veterans Affairs Secretary Anthony Principi, a combat-decorated Vietnam veteran, said in an interview with The Associated Press.

Sounds like the Congress needs to address the chronic underfunding of the VA if it expects the organization to respond well to the influx of disabled vets. Of course with WWII vets (sadly) dying off so quickly, maybe Congress thinks the funding is already built in.

Most of the mental disorders are related to post traumatic stress syndrome--what the WWII vets usually called battle fatigue. It's no fun. Without proper counseling, some vets turn to substance abuse. With the Dom specializing in addiction treatment, this is another good reason the VA kept it open.

The agency has a mixed record in dealing with the crush of new veterans.

The lack of a 21st-century computer operation is a black eye. Recently the VA health care director, Dr. Robert Roswell, resigned after the failure of a $472 million hospital computer system for veterans in Florida that was supposed to become a national model.

The department, in a statement, said it does not now have an automated way of identifying veterans who served in Iraq of Afghanistan. "We rely on military records provided by the veteran," the VA said.

The Defense Department has compiled a computerized roster of Iraq and Afghanistan veterans for the VA, but the list has many discrepancies, officials said.

Nonetheless, some returning veterans who expected long delays in qualifying for medical treatment say they were surprised how quickly they entered the VA system.

Once again, the article misses the point that the VA is on the receiving end of how the military operates. How can the VA have a computerized medical system unless the military does, or unless the VA computerizes the military medical (and personnel) records once it receives them. In fact, this is what the VA tries to do.

The VA uses the military's paper DD-214 (the retirement form the military uses to very succinctly document each member's service) to determine in what conflicts a vet served. The DD-214 can miss conflicts, and the system doesn't care that I served in South American jungles doing counterdrug, as it doesn't count as an official conflict. The War on Drugs isn't really a war.

The VA uses the military's paper medical records and accomplishes medical exams to determine the level of disability (if any) for each vet. Once a vet is in the VA system, all the VA's medical records are computerized, but the historical military medical records aren't scanned into the system. I bring a copy of my military medical records when they could help my ongoing VA treatment.

A note to all military members out there...make copies of your medical records, and keep/get copies of your X-rays, MRIs, and the like. The VA gets just the written medical records from the military upon discharge or retirement...and they can get lost...and the X-rays and like are evidently tossed. The photo records of my back treatment were worth 1,000 words when proving my disability. Once the VA determines a vet's level of disability, the medical records are archived, meaning they're not readily available.

Sabrina Sue, a reservist from New York City, was told by a veteran of the first Gulf War to expect a year's wait to see a doctor for a service-connected thyroid condition. She waited only two weeks.

"I was amazed," said the supply specialist with the 340th Military Police Company, who also is entering a VA educational program.

Also impressed by his first VA experience was First Sgt. Gerry Mosley. He was injured with Buckels when the two members of the Army's 296th Transportation Co. freed the jammed air brakes of a truck in their convoy and jumped to the ground as mortars exploded around them.

"They're just awesome representatives," Mosley said.

To address the backlog of cases that delayed disability pay for veterans, the VA has hired 1,500 workers and formed special teams to reduce the March, 2002 peak of 233 days for an initial disability ruling. Today, the wait averages 171 days.

The agency also has extended hours at medical facilities, added examination rooms and hired or moved employees to reduce the backlog of veterans waiting for doctor's appointments. There were 176,000 veterans waiting for their first doctor's visit in July 2002, a number reduced to 3,242 currently.

This is a great improvement. Of course, most of the vets who were awaiting their first VA medical appointment were not disabled...their low priority used to mean they never got in the door for any treatment. This backlog number also doesn't include those of us already in the system who are waiting for appointments with specialists. As I've noted before, it takes many months to see a specialist, and the drive can be long once one finally gets an appointment.

I waited nearly 9 months for an initial disability ruling (retired in mid-2001), though about 2 months of that were because after the back surgery and convalescent leave at the end of my career, it took a couple more months before the doctor would allow me to travel home to Oregon...and I wouldn't have been in the VA system yet to get continued treatment.

Principi, who worked as the top deputy at the VA during the first Gulf War, is determined to avoid a repeat of the 1990s. Backlogs then led a congressional committee to accuse the agency of having "a "tin ear, cold heart and a closed mind" in caring for sick veterans.

The VA chief promises the new veterans, "I'm not going to wait until every "i" is dotted and every "t" is crossed to care for them."

If costs and money were not enough to challenge, there also is politics.

Veterans' attitudes toward government are crucial this election year, with President Bush's conduct of the Iraq war a growing campaign issue.

A Bush ad highlighted Democratic challenger John Kerry's vote last year against an $87 billion aid package for Iraq and Afghanistan, contending the vote denied body armor and higher combat pay for troops and better health care for reservists. Kerry has run ads featuring fellow Vietnam veterans to boost his claim that he can confront Bush on national security.

Veterans groups, who keep a close eye on the VA, give the agency a passing grade in absorbing the new entries but are not fully convinced the agency is up to the task.

"We're encouraged that the VA is reaching out to veterans" of the two recent wars, said Steve Robinson, executive director of the National Gulf War Resource Center.

"But we feel it's very important that the VA address the veterans' needs physically, emotionally and spiritually to include psychological screenings, information pamphlets and hot lines for prevention of suicides. It's obvious to us that mental health disorders and psychological injuries are going to play an important role for the next 20 years."

The VA system is labrynthine, but it eventually works. The problem for many vets who know they are disabled when they exit the military is that the military is populated with people who aren't disabled...most have little-to-no idea how the VA works. Thus, the transition from healthy military service to disabled post-military life can be rather scary (I speak from personal experience). The various agencies involved in transition assistance are essential in helping unknowing vets learn what the VA and other organizations can and will do for them once they're back in civilian life.

The VA is an entirely new and strange bureaucracy to the average vet, especially if the vet needs continued medical treament as he/she retires. The VA is definitely improving its ability to roll out the red carpet for new vets. However, unless our politicians do a better job with VA funding, these vets will become disappoited like many of the rest of us once they see how slow their medical care can be. Both political parties are complicit in over-promising and underfunding the VA.

The technology issue the AP article harps on does matter, but it shows how little understanding the AP has of how the military and VA work. No matter how modern of computer system the VA might install, it's only as good as the folks who scan in the paper military records and highlight the critical written data. The military medical records system needs a significant update, but it has to compete against weapons, pay, and other military priorities for funding. It should be much easier to link the military's and VA's personnel and pay systems...but that was true a decade ago too.

Congress (and the president) can help us vets with the funding and prioritization, or just grandstand and bitch. We've sure got plenty of the latter.