Thursday, July 28, 2011






A president can be forgiven for compromising. That the health-care law doesn’t include a public option, that financial reform doesn’t limit the size of the biggest Wall Street banks, that the NSA is still spying on Americans, even that cuts may have to be made to Medicare or Social Security—all are worrisome.




Crystal Nicely: For most of the family members, we were thrown into this new role unexpectedly and unprepared, but we have taken it in stride with determination and hope of the future. We have discovered is that we could never have prepared ourselves for what we face on a day to day basis while taking care of our loved ones. For me, I am not only my husband's caregiver, non-medical attendant, appointment scheduler, cook, driver and groomer, but I am also his loving wife faced with my own stresses and frustrations. To be clear, this is not an issue of being overwhelmed with caring for my husband for there is no other place on earth I want to be other than by his side. I am sure that many of the other caregivers would agree. What is upsetting is the lack of support, compassion and benefits for these individuals. It needs to be just a little bit easier. Many of us left our lives back at home and assumed a new role and life at Walter Reed -- as many caregivers have done across the country. Simply put,life her isn't a picnic. It is a bittersweet struggle of coping with new identities and new norms, whatever those may be. I first wish to address the most difficult and disheartening issue that continues to be a problem and barrier at Walter Reed. There is not much these days my husband can do without me or someone at his side. We attempt to function independently, but the reality of his injuries requires that I be close to his side, and even if I am away for only short periods someone must be there. This is part of our new normal. Without his prosthetics Todd is unable to perform many of the very basic Activities of Daily Living (ADL) that are taken for granted by so many. The process to serve as an NMA is tedious, particularly at a time when we must oversee all the other parts of our household and our lives. I am not enlisted so it is frustrating when I'm expected to carry on as if I were, when the circumstances I have now are so much bigger than that. This is an additional and unnecessary burden for the spouses and family members. This continual process of reapplying to be an NMA feels as though I am being assessed on my love and care for Todd, or my value to him and his condition. But helping him through his treatment is what I want to do. How could I ever ask someone else to step away from their lives to come do what we so proudly do, loving and caring for our husbands. It's almost disheartening to think that someone no matter how willing they may be can care for my husband more than I can. It hurts just to consider having someone else there instead of me sharing and growing in this experience with my husband. A lot of us come from jobs or school, and there are those that have children to look after as well. Personally, I was attending school before this. Now I have to consider the very expensive life that lies ahead for my husband and me.
Crystal Nicely was testifying to Congress this morning. In her opening remarks, she broke down several times -- more than understandable. We're going with her prepared remarks above and not what she delivered due to the fact that she edited for time and I felt there were too many details in her written remarks that needed to be shared. When a VA official drones on and on forever, you're glad there's a time limit for opening statements. When someone is sharing the details they live with, as Crystal Nicely did, there just isn't enough time to get it all in. I'm noting this because someone's going to e-mail (or call) and say, "Oh, you ignored her crying" or something similar. There is nothing wrong with crying and she was speaking of difficulties she faces. It was very brave and strong of her to speak, it was very brave and strong of her to continue speaking. Repeating, we're excerpting from the written statement because it includes the points she made plus additional details and I think those details need to be included.
"Good morning and welcome to today's hearing where we are going to examine the lifetime costs of supporting our newest generation of veterans," declared Senator Patty Murray bringing the Senate Veterans Affairs Committee hearing to order. "As we all know, when our nation goes to war, it's not just the cost of fighting that war that must be accounted for, we must include the cost of caring for our veterans and families long after the fighting is over. And that is particularly true today at a time when we have more than a half a million Iraq and Afghanistan veterans in the VA health care system. That's an over 100% increase since 2008. This presents a big challenge and one that we have no choice but to step up and meet if we're going to avoid many of the same mistakes we saw with the Vietnam generation. But it's more than just the sheer number of new veterans that will be coming home that presents a challenge for the VA. It's also the extent of the wounds -- both visible and invisible -- and the resources it will take to provide our veterans with quality care. Through the wonders of modern medicine, service members who would have been lost in previous conflicts are coming home to live productive and fulfilling lives. But they will need a lifetime of care from the VA. Today we will hear from the Congressional Budget Office, the Government Accountability Office, the RAND Corporation and Iraq and Afghanistan Veterans of America. In an effort to help us understand and quantify these costs and to ensure that we meet the future needs of our veterans and their families. And today we are so fortunate to be joined by one of those brave family members, Crystal Nicely, who's not only a wife but also a caregiver to her husband Marine Cpl Todd Nicely. Todd was seriosly injured by an IED in the southern Helmand province of Aghanistan. Since that time, he's come home to fight every day, focus on his recovery and I even heard yesterday that he's already starting to drive again and I want to take a moment to say thank you so much for your service to our country. You have shown bravery not only as a Marine in Afghanistan but also through the courage you have displayed during your road to recovery. I invited Crystal here today because I think it's incredibly important that we hear her perspective. The costs we have incurred for the wars in Iraq and Afghanistan and will continue to incurr for a long time, extend far beyond dollars and cents. When I first met Crystal last month while touring Bethesda Naval Base, her story illustrated that. Crystal's here today to talk about the human costs and that cost is not limited exclusively to the service members and veterans who fought and are fighting our wars but it is also felt by the families of these heroes who work tirelessly to support their loved ones through deployments and rehabilitation day in and day out. Many like Crystal have given up their own jobs to become full time caregivers and advocates for their loved ones. Last month, while testifying before the Senate Appropriations Committee on Defense, Chairman of the Joint Chiefs of Staff Adm Mike Mullen told me that without the family members, we would be no where in these wars. I couldn't agree more and after you hear Crystal's story that will be even more clear."
Along with Crystal Nicely, the Committee heard from Iraq and Afghanistan Veterans of America's Paul Rieckhoff, the CBO's Heidi Golding, the RAND Corporation's James Hosek and the GAO's Lorelei St. James.
Commitee Chair Patty Murray: Mrs. Nicley, I want to start with you. You know when I first met you up at Bethesda, I was really disconcerted when you told me that you'd been waiting forever for your husband to finish his joint disability evaluation process. You had to wait almost 70 days for approval of a simple narrative summary. I went and checked and what I understand is that the summary only needed to state the obvious, that your husband was indeed missing two legs and two arms. And that essentially sat on someone's desk for more than two months. That is really unacceptable and my apologies to you and your family on behalf of that. But I wanted you, as you shared with me a little bit about what you were going through for those many days while this country essentially put you on bureaucratic hold.
Crystal Nicely: I think Todd's therapy is very important but he got to a point in his therapy where he was able to do more stuff more independently which didn't require his therapist to be there, I guess, during the whole time. So, it's kind of like -- I don't know if it's a requirement -- I don't know whether it's Marine Corps procedure that they go into therapy. And if Todd was not being taught new things or it was just getting redundant over and over again. So he had pretty much accomplished much of what he had wanted to in that time frame which meant he was taking up more space that other people could have been utilizing the therapist and so, I guess, why pay for his therapy? Or why if you could be paying it for somebody else? So it was a waste of time, I guess.

Committee Chair Patty Murray: What were you spending your time doing all of that time?
Crystal Nicely: Support. Taking Todd back and forth to therapy and just helping him with the daily living.
Committee Chair Patty Murray: You talked to me a little bit about Coordinators of Care, that they were coming through, changing every two months, and that you knew more than they did and they left and then you were training the Corrindators of Care. Can you share with us a little bit about that?
Crystal Nicely: I don't want to say that all of them are at fault due to the situation because of the way it is but the way that the military site has all of the liasons coming in and out is very frustrating because they're not MOS specific.trained in the jobs that are being asked of them. So they come here without the knowledge of what they're expected to do and take the time while they're here to learn what they're doing. And by the time that they've adjusted and maybe absorbed some of it, it's time for them to leave again and new individuals come in who are still not MOS specific. So that doesn't help us with what they're here for is the frustration and helping to take the stress off of the families and able to do the things that are necessary and instead, me personally, had to look for outside assistance from -- whether it was other family support or my case manager -- but was not assisted on the military side of things. That doesn't aid and for me in the beginning of the family process it's hard to open up to people and trust individuals. So to be able to get a connection with somebody and to have somebody there for the short period of time and then transition out and give us somebody else is not allowing us to have that connection or allow us to open up to them because, okay, if we come to you, what are you going to do for me because I know more than you do? So it's extremely frustrating. I know that they're working on it but it's extremely frustrating.
Committee Chair Patty Murray: You are a tremendous advocate for your husband and I am extremely impressed with what Todd is capable of doing and I know that that's -- your proud of that as well. I also know that he needs you at his side and you are there every single minute doing that. You met many people through this process. What does somebody do who doesn't have a wife or a live-in caregiver?
Crystal Nicely: I think -- Oh, boy. That's hard because you do see it in some cases. The family support is maybe not there or maybe not there for the right reasons. I think because of the lack of -- I don't want to say lack of knowledge, their ability to assist in a lot of ways and the lack of compassion when it comes to these guys, there next choice would be to reach out to somebody, I don't know, that whether it's through the military side of things or the hospital because the hospital staff is wonderful -- I guess there's not really a way to say this --
Committee Chair Patty Murray: Maybe if you can share with this Committee, like you did with me, a little bit of what your day is like.
Crystal Nicely: Well here recently a lot easier than normal because Todd has strived to become very independent with his prosthetics. Without his prosethetics, it would be -- I would be doing the work for two people. With his prosthetics and because of his knowledge with what he's been able to absorb with his therapist and his daily work in putting into therapy. I basically just observe and watch and if he needs assistance, then I assist him, if he asks of course.
Committee Chair Patty Murray: Well thank you and thank you again for your courage in being here too.
I am not interested in Paul Reikoff. As per usual, Paul wanted to go Water Cooler instead of addressing issues. No, not every veteran is worried about "the default." Adam Kokesh (Adam vs The Man airs on RT Monday through Friday at 7:00 pm EST and streams online) is an Iraq War veteran who's been mocking the 'crisis' (rightly so). But let's get one thing clear, if the doomsday that dime-store economist Paul used the hearing to portray came true, everyone would suffer. Don't whine that veterans benefits aren't getting paid. If the whole country were to go under (it's not going under), then, yeah, veterans would be up a creek without a paddle, just like everyone else. They are American citizens and they will suffer the same economic plight that other Americans suffer. Paul's grand standing was, as usual, done with one eye to the gallery, hoping he'd get some camera time. If a significant number of veterans are truly spooked by the White House and media narrative on the debt ceiling, shame on Paul for refusing to tell them that everything's fine. Life does go on and it will go on. Calm down, America. If we had a qualified leader in the White House, calm would be dictated. Instead we have someone who wants to gut the safety net and is willing to scare the nation in an attempt to get them to go along with that.
The government has many debts and obligations and they owe as much on any promise to any American citizens. In terms of paying, the government is taking in more than enough money to service the debt. It can't pay it off. But, as with a VISA or Master Card bill, it can make the monthly payment even though it can pay off the full charge currently. To pretend otherwise is outrageous and, when the manufactured crisis is over, people better be demanding answers from the White House over the administration's efforts to, in effect, create the equivalent of a Y2K panic. And should the White House not pay the bills, Barack should be impeached. Bill Clinton is correct in his legal assessment (though the White House wants to dismiss it -- and, on top of that, to question his understanding of the Constitution because he's not taught it in X years -- the Constitution hasn't changed with regards to the powers of the president). Not only could Barack raise the ceiling right now on his own but if the magic day arrives and it's not raised, he can raise it under the powers of the presidency in a national emergency. The money is there. The powers are there. This stinks of self-created drama on Barack's part.
FYI, if you still don't grasp Harry Reid's proposal, Brian Montopoli (CBS News) covers it here in a realistic manner. Back to the hearing, last excerpt:
Committee Chair Patty Murray: Ms. St. James, I wanted to ask you while you were here, I recently heard some very disturbing complaints from a female veteran. She told me she had a great deal of difficulty in accessing appropriate, safe care for herself. She'd had some exams from a doctor with the exam room open to a crowded hallway, had been harassed by male veterans while trying to get mental health care and other things. And I'm concerned about the lack of separate women only in-patient mental health care units that we're hearing about as well. So I'm very concerned that the VA is not strategically planning for the increasing number of women veterans, something Mr. Rieckhoff mentioned as one of the costs of this war. Can you share with this Commitee how many of VA's backlogged construction projects involve improvements needed just to protect the privacy and safety of women veterans?
Lorelei St. James: I really, excuse me, don't have that specific information. I do know that there are initiatives that VA includes in its planning process but I don't know specifically if that's one.
Committee Chair Patty Murray: Is that something you can find out for us?
Lorelei St. James: We can certainly get back to you on that.
Committee Chair Patty Murray: Okay. I'd really appreciate that. Ms. Golding you testified that the medical cost for Iraq and Afghanistan veterans between 2011 and 2020 totaled between $40 billion and $55 billion. That number of course doesn't take into account the cost of paying for previous generations that we're still responsible for. CBO did another report earlier this year on possible ways to reduce the deficit where they made a couple of recommendations about veterans programs. I don't support those specific proposals because they negatively impacted benefits which I believe we shouldn't be touching. But I do believe that there are ways we can be more effective with tax payer dollars but not diverting it from direct delivery of services and health care. I wanted to ask you this morning do you believe there's enough excess and duplication that can be addressed to make VA more efficient without negatively impacting services?
Heidi Golding: Uhm, just one or two points that I want to make on that. And the first is that we also have projections for the 2011 - 2020 time frame for VHA for all veterans and the budget would grow -- not the budget but the amount of -- the cost to treat those individuals would rise from the $48 billion in 2010 to under the one scenario $69 billion and the higher scenario -- which included higher medical inflation and so forth, I think it was $85 billion so in the lower case, we're talking about an increase of about 45% over the next ten years which is a substantial increase in order to be able to provide health care for all enrolled veterans. Now we have not -- We do not make policy recommendations and we do not in that paper look at options to and we have not looked at efficiencies. I cannot tell you about that specifically. You're aware of our budget options so we do have a couple of options in that. But it may also involve just not efficiencies but it may involve shifting some costs or --
Committee Chair Patty Murray: If we just do efficiency and shift costs will we meet that projection that you just made.
Heidi Golding: I cannot tell you unfortunately.
Committee Chair Patty Murray: Mr. Hosek a 2008 RAND study concluded that there was a possible connection between having PTSD, TBI and major depression and being homeless. Last month Amd Mike Mullen expressed concern about repeating the mistakes we made after the Vietnam War and said, "We are generating a homeless generation, many more homeless female veterans. And if we're not careful, we're going to do the same thing we did last time." I'm quoting him. Can you walk me through the costs -- both budgetary and human -- of caring for veterans after they become homeless and of using care as a tool to prevent homelessness?
James Hosek: [. . .]
Committee Chair Patty Murray: You want to turn on your mike?
James Hosek: Thanks. Unfortunately, I can't give you estimates of the costs. My concern, which I foreshadowed in my testimony is that there may be a value in being more pro-active in guiding people as they leave the service. Right now when service members leave the service, they receive an out brief. That out brief covers, among other things, the benefits they're entitled to and-and of course advised them that they'll have a post-deployment health assessment and a six month follow-up of that if they're still in the service and leave later on. But this information comes at them very fast. And even though it's provided -- which is a good thing -- I'm afraid that many of them don't really absorb it at the time. And when they leave the military and go out and need care or need to learn about their VA benefits or need to learn about job search upport, they really don't know where to turn. They haven't necessarily absorbed or remembered what they were told. And what our research indicates is there isn't readily available, cohesive, easily accessible sources of information. Now people absorb information in two ways: When it's pushed at them or when they pull for it. And a lot of the discussion that we've received has to do with the push of information, that is just making it available. But the fact that there isn't readily available, cohesive sources of information -- something that Paul referred to -- I think is important to.
And we'll stop there. Do you even remember the question he was asked? About homeless veterans, about the cost and about whether care could impact that. He goes on and on and uses his own buzzwords but where is his answer? Okay, they're getting info as they leave and it's not being recalled because the info is overwhelming. That's one sentence. And I didn't need to whine about "available, cohesive sources of information" or any other time waster.
I am not including Senator Scott Brown who acted as the Ranking Member for the hearing because Ava covers Brown and will be covering him tonight at Trina's site as usual. For an overview of Brown's hearing style, you can see "Ava spills Scott Brown's dirty secret" from June. Right now Wally's planning to cover Senator Johnny Isakson (cover at Rebecca's site tonight) and Kat's going to go into the economy at her site.