The New President and Healthcare - Part II - Medical Services

Before wholesale changes are made to US healthcare system, Mr. Obama should fix the two health systems that federal government controls. The Military Health System and the Veterans Administration are two of the largest health systems in the United States and have serious problems.

The critical problems with these entities are led by incompetent, indifferent and anti-scientific management. Mr. Obama should immediately request the Bush Administration remove S. Ward Casscells, M.D. and Ellen Embrey. These two individuals are directly responsible for the lack of progress in the treatment of mental illness, mild-traumatic brain injury, traumatic brain injury, suicide and PTSD. They have led a campaign to continue the Bush Administration policy to underreport casualties in the Iraq and Afghanistan conflicts. Further, these individuals have aided and abetted the US Army’s program to deny benefits to wounded and disabled service members. Finally, they will babble endlessly about what we don’t understand about these injuries so it will require years of research. In fact, much more is known about these injuries then they would like Congress to believe. However, these scientific facts fly in the face of their political objectives so they have let contracts to friends of the US Army who will confuse the issue for years.

What to do following the dismissal of Dr. Casscells and Ellen Embrey.

First, quickly review all contracts let by these individuals for contract irregularities and pursue criminal prosecution. Next, remove the US Army from all leadership positions in programs related to mental health and brain injury. The US Army personnel should be replaced by officers from the Air Force and the Navy. The Air Force and Navy are more technologically enabled and lack a political agenda as both branches have honored their disability payments. It is not to say the US Army lacks officers with technical expertise in the areas of mental health or traumatic brain injury but they were excluded from the process because they could not get with the program. Instead, the US Army replaced them with people qualified as occupational therapists and physicians’ assistants. It is time to get organized and led by the right talent. Mental health and traumatic brain injury issues can be solved and could have been largely avoided if it had not become political. Finally, embrace the civilian medical sector. Much of the most advanced research in mental health and traumatic brain injury is at specialized centers such as the Kessler Institute in New Jersey. Civilian entities were willing an able to take a leading role in solving these problems but were denied participation by the hacks running MHS and the VA.

With regard to the VA, Mr. Obama should immediately remove the entire senior management. Dr. Jim Peake is the former US Army Surgeon General. When in uniform, he was part of the program that left the nation unprepared to deal with mental health and traumatic brain injury issues. He not only failed for active service members but also rewarded with even greater responsibility so he could fail them once of service members became veterans. Since the VA is evolved into a system to treat geriatric patients, the surge in younger service members should be guided to civilian medical resources at government expense. The major exception is in PTSD where the VA and CDC did some of the most distinguished work both scientifically and clinically. The VA needs to get some younger more aggressive leadership in this area and capitalize on the VAs expertise. It should also embrace private psychologists to screen and treat the less serious cases locally and triage the most complex cases to VA centers of excellence.

Again, the medical failure at MHS and the VA is not as much a monetary problem as it is a management problem. Last year $2,1B was distributed by Congress to the VA and MHS to treat wounded with TBI and mental health issues. Nonetheless, the leadership is unable to account for much of the spending and the results have been almost nonexistent. With little doubt, the bulk of our service members could have been identified and started treatment. It does and will require funds but funds well spent. Let’s fix the problem and stop the talk.