Ivanka, Where Art Thou?

As the world watches horrified at the images of migrant children ripped away from their parents at the US southern border, I couldn’t help but notice the absence of the Trump administration’s self-appointed champion of women and children’s rights: Ivanka Trump. As a senior aide in her father’s West Wing, Ivanka has frequently been the leading (and sometimes only) voice advocating for women and children; some of her pet policy projects have been the expansion of the Child Care Tax Credit and the establishment of the World Bank’s We-Fi Fund to invest in female entrepreneurs around the world. Given her supposed interest in aiding women trying to support their families, it is particularly galling that Ivanka has remained silent about the plight of migrant parents and children.

With this shameful silence, Ivanka might be showing us her true colors. Thus far, she has been able to disclaim responsibility for some of the administration’s other unpopular actions (Muslim ban, ACA repeal) by maintaining that such issues are outside her wheelhouse. However, through her policy work and her curated image as a working mother, Ivanka has made women and children the epicenter of her wheelhouse.  In fact, she highlighted the challenges of working motherhood as a central theme in her best-seller, Women Who Work. So then, what can be inferred when this “champion of women” remains silent as our government rips children away from mothers who are trying to give them a better life?

Two cynical theories come to mind. The first is that Ivanka’s pro-women stance is simply a façade- designed to render her father more palatable to conservative women. The other theory is that Ivanka truly cares about women, but only white women and their children. Perhaps this is why she swiftly condemned Roy Moore when he was accused of molesting white teenage girls forty years ago, but has stayed silent on the plight of migrant women who are fleeing the threat of sexual assault. Perhaps this is why she insensitively brags about spending time with her children while showing indifference to thousands of women who are forcefully separated by theirs. Now, I’m not saying that Ivanka Trump is a racist, but I do think that her failure to speak out against brown children being confined to cages speaks loudly to her true priorities.             

I’ll end this piece with a fun fact: I was in the same Marketing class as Ivanka in college. Even back then, she was keenly aware of the value in personal branding. Upon her father’s election, it became clear that Ivanka sought to re-brand herself from mid-tier socialite and “businesswoman” to an international humanitarian, a la Angelina Jolie, who uses her wealth and power to advocate for those less fortunate.  The only problem with this strategy is that you need to constantly reinforce your chosen brand image in order for it to stick. Now that Ivanka’s chosen brand is clashing with her father’s brand as a cruel, xenophobic authoritarian, Ivanka’s silence is showing us whose brand is strongest.  

What a Lot of Americans Don't Understand about the NFL "Kneeling" Protest

On a Sunday afternoon last fall, some friends and family gathered around our television to watch my beleaguered Washington Redskins. During the playing of the National Anthem a few of the players took a knee. As you can imagine, a discussion ensued.

I find myself at the intersection of a rather interesting Venn diagram. I am a combat veteran of Operation Desert Storm. I am a career Naval officer. I am a voting Republican. I grew up in Alabama. And, I am a black man.

I am also a contrarian- meaning that I avoid jumping on bandwagons. If there is an argument “for” something, I try to remain open to hearing the opposing points of view. Life has taught me to look both ways before crossing any street or climbing onto any platform. This approach also has the added value of keeping at bay bad surprises.

Back to the football game: One of my guests complained aloud, ”I am so sick of these overpaid jerks dishonoring our military.” In most other settings I would have let the comment pass without reaction or response. However, we were in my house, watching my television, so I decided to let my contrarian alter ego take the helm.

“Can I see a show of hands of everyone who has served in the US Military?” I
asked. Not surprisingly, I was the only person holding up their hand. I was also the
only black person in the room, but not the only Republican.

“I won’t speak for all military veterans, but I will speak for myself. While I am
not comfortable with any protest involving the National Anthem, I am comfortable
with their right to protest. As a matter of fact, I’ve taken the oath to defend that right
eight times and actually gone to war to defend that right.”

Before this goes any further, let’s look at some facts: In 2017 police shot and killed
987 people. According to data from the Washington Post, nearly 40%, 402, were
black or Hispanic. Data on another 128 deaths remains unconfirmed. These
statistics create a remarkable picture when one considers that blacks and Hispanics
only comprise 12.1% and 17% of the US population, respectively.

“Can’t they find another way?” someone asked.

“Sure, they could,” I responded. I went on to explain why they don’t have to
find alternative methods.

Protest in itself is designed to make people uncomfortable. Protest is designed to
shake people out of their comfort zones drawing attention to something that might
otherwise go unnoticed – like the issue of the disproportionate use of deadly force
by police against poor people and people of color. The kneeling form of protest
dovetails perfectly with Black Lives Matter, the preeminent group leading the
charge against racial injustice at the hands of Law Enforcement.

One of the criticisms often heard from my fellow conservatives, friends and family,
about Black Lives Matter is that they are racist in their actions. Further, their very
name implies racist overtones. “All lives matter,” is a retort often used by those
countering the group. Any rational and fair person would be an idiot not to agree
with that sentiment. Accordingly, any rational or fair person looking at the statistics
presented previously would also be hard pressed not to conclude a deadly animus
exists between American Law Enforcement and persons of color.

Last Friday President Trump issued a challenge to players in the NFL to provide him names of people they feel have been unjustly treated by the legal system for potential pardons. Many of the news media heralded this as an olive-branch extended by the President who once called these men, “sons of bitches.” President Trump’s challenge makes the point of this article precisely; he and many of my fellow Americans just don’t get it. These players are protesting the aforementioned deaths at the hands of police. Pardoning someone who is dead does little to correct an emotional perception and a statistical reality.

One of the current criticisms of President Obama is that during his term in office he “criminalized” the police. Further, that many of his words and policies took the side of assumed criminals vs. the police facing them. From his inappropriate “Beer Summit” for his friend Dr. Louis Gates to his totally appropriate commissioning of the Justice Department’s investigation of the police in Ferguson, Missouri, the Obama administration is viewed by some conservatives as all but abandoning Law Enforcement.

On the other side of the argument, President Trump has told Law Enforcement groups, “I’m with you.” Further, he has declined to make any comment regarding questionable actions of police in events that have occurred during his tenure. In the minds of many persons of color, President Trump has signaled “open season” further driving a wedge between the police and the populace they are sworn to protect and serve.

Just last week the images of Mesa, Arizona police officers beating an unarmed black man into unconsciousness flashed across our television screens. It is important to note that police body-camera equipment showed a very different story than the images from a security camera that the involved officers did not know was present. Republican activist Ben Ferguson suggested this was not a racial incident because one of the officers involved in the incident was also a black man. For those of you reading this passage that also hold that belief, I urge you to seek out a friend, colleague, family member or acquaintance who is a person of color and discuss the fallacy of this viewpoint. And if you are without a person of color that can provide you insight into this perspective, I recommend watching Samuel L. Jackson’s character in the move Django Unchained. Addressing it here would dramatically detract from the point of this article. However, Ferguson’s attitude definitely underscores the point there are two radically different perspectives on race in our country.

The bottom-line here is that in the upcoming football season, we can expect to see further expressions of this line of protest. This is despite the President’s condemnations and the actions of the NFL owners. There are two reasons I predict these protests will continue. First and foremost, the base problem fomenting the protest has yet to be resolved. 2018 statistics thus far support this viewpoint. Secondly, every American has the right of free expression. And if you doubt that, pick up the Constitution. Our history is replete with expressions of discontent with
the status quo: the Boston Tea Party, Women’s Suffrage, and the Civil Rights Marches of the 1960’s, to name but a few. My hope is that this protest, like those listed above, will achieve genuine change.

As a father, I would like not to feel the need to counsel my children regarding encounters with police, something my friends and relatives who are white don’t worry about. As a life-long member of the Republican Party, the Party of Lincoln, I would like to see more people standing up to address this problem. As a Navy combat veteran, I am not offended or trampled on by the actions of these football players. Finally, as a career military officer, nothing offends me more than Americans trying to keep other Americans from exercising the rights I have literally fought to protect.

In Defense of the Porn Star

Former New York City Mayor and current presidential lawyer Rudy Giuliani created another round of unflattering headlines for himself last week regarding comments he recently made about Stormy Daniels. In case you’ve been living under a rock, Daniels (real name: Stephanie Clifford) is the adult-film actress who claims to have had a sexual encounter with Donald Trump in 2006 and was paid $130,000 by another Trump attorney, Michael Cohen, to keep silent about the affair. In 2011, Daniels discussed the affair during an interview with In Touch magazine, which ultimately declined to publish the interview after Cohen threatened the magazine with a lawsuit. At the same time, Daniels claims that she and her infant daughter were approached by a strange man in a parking garage who threatened her unless she stopped speaking publicly about Trump. In April 2018, Daniels revealed a police sketch of the man who allegedly threatened her. In response, President Trump tweeted: “A sketch years later about a nonexistent man. A total con job,” alleging that Daniels lied about being threatened. As a rejoinder, Daniels sued President Trump for defamation- claiming that he used his position as President of the United States to impugn her integrity and to accuse her of a crime (falsely accusing a man with threatening her).

All this background brings us back to Rudy Giuliani. At a conference in Israel, Giuliani opined on the Daniels lawsuit with the following comments:

“But I’m sorry I don’t respect a porn star the way I respect a career woman or a woman of substance or a woman who has great respect for herself as a woman…So Stormy, you want to bring a case, let me cross examine you. Because the business you’re in entitles you to no degree of giving your credibility any weight. And secondly, explain to me how she could be damaged. I mean, she has no reputation. If you’re going to sell your body for money, you just don’t have a reputation.”

As a woman and a feminist, I am appalled by these statements. As a lawyer, I am flabbergasted. On top of being misogynistic and anachronistic, Mr. Giuliani’s statements have no basis in fact. Let’s take a look at why his statements are at conflict with the actual law:

Her Business Entitles Her to No Credibility

While Giuliani’s assertion about the credibility of a porn star might hold weight in the court of public opinion, it has no relevance in a court of law. In order to impeach a witness’s credibility at trial, the opposing attorney must produce evidence that the witness is a known liar, has a criminal record, or has committed acts of bad character. Even if you find the adult entertainment industry distasteful, there is no question that Ms. Daniel’s business is entirely legal and she has never hidden her association with it. Furthermore, if involvement in the adult film industry renders Ms. Daniels automatically un-credible, what does that say about those who knowingly and happily associated with her, such as Mr. Giuliani’s main client? If involvement with adult films takes away someone’s credibility, that would mean that President Trump, who has appeared in several soft-core Playboy videos, is equally non-credible. However, you don’t hear Rudy Giuliani making that argument.

Porn Stars Cannot Suffer Damages

Let’s first be clear about how sexist this statement is. Giuliani’s assertion that, as a porn star, Ms. Daniels cannot suffer damage to her reputation stems from the antiquated notion that a woman’s most valuable asset is her virtue. According to men like Giuliani, no amount of a woman’s intelligence,

achievement, or wealth is as important as her sexual integrity. Skipping over the blatant chauvinism, there is no legal merit here. Stormy Daniels is suing President Trump for defamation, specifically for making false and defamatory statements about her. A statement can be considered defamatory if:

  1. It suggests that the victim was involved in a serious crime;
  2. It exposes the victim to ridicule;
  3. It reflects negatively on the victim’s character, morality or integrity;
  4. It impairs the victim’s financial well-being; or
  5. It suggests that the victim suffers from a physical or mental defect that would cause others to refrain from associating with him/her

Giuliani obviously believes that Ms. Daniels’ profession makes her a person of low character/morality, so it is not possible to suggest that her character is lower than it already seems. However, there are clearly other ways to demonstrate that a defamatory story has damaged a plaintiff. If Ms. Daniels and her attorney can prove that the President’s Twitter statements damaged her financially or reputationally, then the President will be liable- and no amount of Mr. Giuliani’s sanctimonious bloviating will make a difference.

Denigrating a porn star might not seem like a big deal, but this episode is important because it is the latest example of Rudy Giuliani deliberately misstating the law for political ends. Having held some of our nation’s top law enforcement positions (as US Attorney and Associate Attorney General), we should all find it unconscionable that Giuliani is deliberately misleading the American public about the nature of the law. While fabrications and falsehoods are endemic to this White House, I always expected better from someone who dedicated himself to upholding and enforcing the rule of law. I think I’ll keep being disappointed.

The Loss of A Dear Friend, Congressman Al Swift

Al Swift, an eight-term Democratic congressman from Washington who helped pass the “motor voter” law of 1993, legislation credited with helping millions of Americans register to vote, died April 20 at a hospital in Alexandria, Va. He was 82.

He had recently been diagnosed with idiopathic pulmonary fibrosis, a lung disease, and last week underwent abdominal surgery for an unrelated issue, said his brother, Larry Swift. 

A former TV broadcaster with a smooth baritone voice, Mr. Swift was a master at public relations who nevertheless focused on issues of crucial importance but negligible appeal.

“Over his seven terms,” the Seattle Times wrote in a 1991 profile, “he has specialized in complex legislation that carries little or no political benefit — regional power conservation, broadcast deregulation, the breakup of AT&T, elections laws. These days, he spends most of his time sorting through the intricacies of hazardous waste and the economics of recycling.”

Mr. Swift was elected in 1978, and represented a broad swath of northern Washington, where he had received a regional Emmy Award years earlier for his work on a children’s program about marine life in tide pools.

In office, he drew on his TV experience to defend the Federal Communications Commission’s long-standing “fairness doctrine,” which required broadcasters to devote time to both sides of an issue. (Under President Ronald Reagan, the FCC repealed the rule in 1987.) He also took part in the complex regulatory effort that resulted in the breakup of “Ma Bell” — the telecom giant AT&T — in the early 1980s.

“I don’t know if I’ve been eating magic mushrooms or wandering around Alice’s Wonderland, but the more I learn about this field the bigger it gets,” Mr. Swift joked during a discussion on the company’s pricing policies. “I’m always losing ground. I think I’m going to cry.”

He held leadership positions on the Energy and Commerce Committee, where he chaired a subcommittee that oversaw entities including the Environmental Protection Agency’s Superfund cleanup program, and on the Rules Committee, where he chaired the elections subcommittee.

In that role, he sponsored what became the National Voter Registration Act of 1993, known as the “motor voter” bill for its mandate that states allow citizens to register to vote while applying for a driver’s license. It also required states to allow voter registration by mail and at certain state and local offices.

More than two dozen states, including Washington, already had similar systems in place, but some Republicans argued the legislation was too costly and would increase the chances of election fraud. An earlier version of Mr. Swift’s legislation was vetoed by President George H.W. Bush in 1992 before President Bill Clinton signed it into law on May 20, 1993.

“I think it’s going to make it easier for every single American to be registered if they want to,” Mr. Swift said. “Somewhere in all of the debate, that got lost.”

A 2013 report by the Congressional Research Service found that voter registration grew by more than seven percentage points between 1992 and 2012. For the 2016 general election, the Election Assistance Commission reported that 33 percent of voters registered through their department of motor vehicles — dwarfing the number of voters who registered online, or those who registered by mail, email or fax.

Still, Mr. Swift expressed regret that he was unable to push through significant campaign finance reforms while in office. He announced in 1994 that he had decided not to run for reelection because campaigning was increasingly tedious, impersonal and expensive.

“What you have to do to get the job is something I’m just not willing to do anymore,” he told the New York Times. “Money has virtually divorced campaigning from people. Money has allowed us to professionalize campaigns, when they should be an amateur sport. I did negative research the last time. I’m appalled at what you can find out about people, all legally.”

Allan Byron Swift was born in Tacoma, Wash., on Sept. 12, 1935. His father was a truck driver for Coca-Cola; his mother was a homemaker and superintendent of Sunday school at a nearby United Methodist church.

He became interested in radio at a young age, and as a teenager would produce a Sunday afternoon request show for patients at a tuberculosis sanatorium. By the time he graduated high school, he had become so proficient he was hired for a full-time broadcasting position at KUJ, a radio station in Walla Walla, Wash.

Mr. Swift studied at Whitman College before transferring to Central Washington University in Ellensburg, where he was offered a higher-paying job in radio and graduated in 1957.

Switching to television, he was named director of news and public affairs for KVOS-TV in Bellingham, near the Washington-Canada border. He also became active in city politics, chairing a citizens’ advisory committee on schools and serving in Bellingham’s local housing authority.

He ran a successful congressional campaign for Democrat Lloyd Meeds in 1964, and served as his administrative assistant for several years before returning to television.

When the congressman became embattled over his support of Native American tribes in a dispute with commercial fishermen, Mr. Swift rejoined his staff, expecting to oversee Meeds’s 1978 reelection campaign, his brother said. Instead, Meeds dropped out of the race and Mr. Swift ran in his place.

During his first term, Mr. Swift successfully spearheaded the passage of the Northwest Power Act, which in 1980 created a framework for Idaho, Montana, Oregon and Washington to share electricity from dams in the Columbia River basin; it also mandated funding for environmental protections for fish and wildlife in the region.

He married Paula Jackson, whom he had begun dating in high school, in 1956. She died in 2012. In addition to his younger brother, survivors include two daughters, Lauri Swift of Reston, Va., and Amy Donovan of Ellicott City, Md.; three granddaughters; and a great-grandson.

After leaving office, Mr. Swift was vice president of government affairs for Burlington Northern Railroad and a partner at Colling Swift & Hynes, a Fairfax City, Va.-based lobbying firm. He also returned to radio, co-hosting the weekly show “Backroom Politics”from inside a Washington cigar lounge, Shelly’s Backroom.

Obituary written by Harrison Smith of the Washington Post. 

Michael Cohen: America’s Worst Lawyer

With the recent news that President Donald Trump’s longtime personal attorney was raided by the FBI and is now the subject of a criminal investigation, my oft-stated assertion on the show is becoming evident. Michael Cohen can officially be named the Worst Lawyer in America. Given the scope of Cohen’s misdeeds, he has surpassed the former reigning champion, Sam Nunberg, who famously tried to ignore a subpoena from Special Counsel Robert Mueller, only to quickly reverse course when he realized that, duh, he could be arrested for doing so. However, Michael Cohen deserves the “WorstLawyer” distinction far more than Nunberg because Cohen’s downfall was caused by even more flagrant instances of behaving in the exact opposite of the way lawyers are supposed to behave.

Allow me to explain:
1) Cohen Violated Basic Legal Ethics. Every first-year law student is required to take a Legal Ethics class and all aspiring attorneys must pass a legal ethics exam (the MPRE) before they can be admitted to the bar in any state. Literally the first rule of legal ethics is that a lawyer cannot
make decisions for their client without the client’s knowledge and consent. When news broke
that Michael Cohen paid hush money to Stormy Daniels, Cohen immediately claimed that he did
so with his own money and without Donald Trump’s knowledge. This claim is ridiculous to begin
with, and became even more so when the “hush agreement” was made public. The Non-
Disclosure Agreement signed by Stormy Daniels specifically obligates both Stormy and her illicit
lover, “David Dennison” (who is Cohen’s client) to keep silent about their sexual relationship.
This is problematic because, as any 1L can tell you, a contract that is entered into without one
party’s knowledge or consent is not valid. Stormy Daniels is already challenging the agreement
based on the fact that David Dennison never signed the agreement. If you add in the fact that
Dennison never knew about the agreement in the first place, it could be thrown out on the spot.
Of course, this issue could be resolved if “David Dennison” was someone other than Donald
Trump, but Michael Cohen didn’t even think to make that argument.

2) Cohen Admits to Committing Crimes. In addition to complying with legal ethics, another basic
standard that most lawyers hold themselves to is: don’t commit crimes. In fact, the whole point
of being a lawyer is to advise other people on how NOT to commit crimes or break laws. Cohen
freely shared that he used the proceeds of a home equity loan to pay Stormy Daniels. In order to
receive a bank loan, a borrower must state the purpose for the funds in the loan application. To
use the proceeds of a bank loan for something other than its stated purpose is a crime. Unless
Cohen wrote “Bribery Payment to Porn Star” in his loan application, he has admitted to
committing all the elements of bank fraud. Aside from criminal penalties, committing a crime
like this can also get an attorney disbarred. So, what kind of lawyer endangers their career and
freedom to commit easily proven crimes on behalf of their client? A very, very bad one.

3) He Calls Himself a “Fixer”: In The Godfather, Tom Hagen, the family consiglieri, always
introduces himself as a lawyer with a very specialized practice. He leaves it unsaid that he is the
Corleone family’s fixer and enforcer. Unlike the fictional Mr. Hagen, however, Michael Cohen routinely describes himself as the Trump family fixer. This is idiotic for two reasons. First, by
openly claiming that the services he provides to Donald Trump extend beyond typical legal
advice, Cohen jeopardizes his ability to claim that communications are protected by attorney-
client privilege. The privilege only applies to communications with an attorney that contain legal
advice; if the communications are not about legal matters, then the privilege does not apply.
Second, Cohen is attracting much more scrutiny to his activities by proclaiming himself as a full
service “fixer.” Imagine if Tom Hagen started conversations by telling you that you’d wake up
next to a horse head; he’d be a lot less effective. Most successful attorneys use subtlety and
discretion to achieve results for their clients, but Cohen (much like Donald Trump) possesses
none of those qualities. The result is that Cohen’s name is splashed all over the news and his list
of other clients is subjected to scrutiny. So now Cohen’s indiscretion has also led to unwanted
attention and embarrassment for his other clients, who have nothing to do with the Special
Counsel investigation. Not the type of lawyering that inspires confidence.

4) There Might be Tapes! There are reports that the FBI seized taped recordings of Cohen’s
conversations with other individuals doing business with the Trump enterprises, in order to use
them as “leverage” (i.e. blackmail) at a later date. I cannot even begin to explain how
problematic this is. The fact that the President and many of his close associates are panicking
about these tapes falling into the hands of Robert Mueller says everything about how
incriminating they likely are.

So there you have it- a recap of Michael Cohen’s many offenses against the legal profession. Whether his actions are due to incompetence or willful disregard for the law, I’ll leave it for you to decide. Eitherway, the title of America’s Worst Lawyer seems appropriate.

Needed: A New Way Ahead for the Department of Veterans’ Affairs in the New Millennium

Since its official inception in 1930, the Department of Veteran’s Affairs or Veterans Administration (VA) has struggled to keep up with servicing America’s Veterans. World War II, Vietnam, and Korea created their own challenges to the organization’s ability to provide services. However, the Global War on Terror has caused almost overwhelming surges in the number of Veterans requiring health assistance as well as those seeking educational and other benefits offered by a country grateful for their service. 2014’s scandal that culminated in the VA Secretary’s resignation serves as the most recent major outing of VA failures to consistently provide quality healthcare to its Veterans. This article asserts that the organization is not operating nor is it structured for finding and maintaining on-going success in the new millennium.

With almost four hundred thousand employees distributed across the United States and its territories, VA stands as the Nation’s second largest governmental organization. The Department has three main subdivisions, known as Administrations, each headed by an Undersecretary:

·Veterans Health Administration (VHA): responsible for providing health care in all its forms, as well as for biomedical research, Community Based Outpatient Clinics and Regional Medical Centers.

·Veterans Benefits Administration (VBA): responsible for initial Veteran registration, eligibility determination, Home Loan Guarantee, Insurance, Vocational Rehabilitation and Employment, Education (GI Bill), and Compensation & Pension.

·National Cemetery Administration (NCA): responsible for providing burial and memorial benefits, as well as for maintenance of VA cemeteries.

In the FY 2019 Budget, President Trump proposes a total of $198.6 billion for the Department of Veterans Affairs. This request, an increase of $12.1 billion over 2018, is designed to ensure the nation’s veterans receive high-quality health care and timely access to benefits and services. The 2020 AA request includes $79.1 billion in discretionary funding for Medical Care including collections and $121.3 billion in mandatory funding for Veterans benefits programs.

The Veterans Administration reports there are 18.8 million veterans currently living in the United States, and that they serve 9 million of them each year. At the time of this writing, it was not possible to determine how many Veterans were serviced at their 1,065 outpatient sites and 170 VA Medical Centers. Presumably, VA services the remaining 9.8 million Vets through contracted private sector resources. No information could be found amplifying this area, as well. If these numbers are correct, the US is spending $196 billion to service veterans at a cost between       $10, 425 and $21,777 per Veteran per Year. Either way, these numbers are troubling because even with the use of VA-owned facilities and private sector resources, the Veteran population remains underserved.

Further, Veterans need a “Continuum of Care” patient care model where the system guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity. The current VA healthcare delivery system falls short in this area. Unnecessary tests are often performed because the VA does not accept military health care records for use in designing care and addressing issues encountered while Veterans were on active duty. Rather, the VHA only uses military records to determine eligibility through their disability rating system.

The VHA does not operate as a “Best Practices” system. They do not systematically benchmark medical treatment by diagnosis. Benchmarking leads to better care, better outcomes and improved efficiency (i.e., saving money). Private sector healthcare systems began benchmarking care over 20 years ago. Medicare’s payment system was modified in the 1980’s to reflect analyses of care data and they transitioned to using Diagnosis Related Groupings (DRGs). Data continues to drive the system and is used by private insurers as well to effect improvements in the healthcare delivery to patients while simultaneously improving lives and money.

The US Department of Health and Human Services runs the Agency for Healthcare Research and Quality. AHRQ runs a metrics system that measures the quality of service of 656 healthcare systems. VA is not one of them. Why? In 2016 the VA quietly stopped sharing data on the quality of care at its facilities with a national database for consumers; despite a 2014 law requiring the agency to report more comprehensive statistics to the site so veterans can make informed decisions about where to seek care. Rather than take part in public and benchmarked rating systems, VA uses its own platform, Strategic Analytics for Improvement and Learning (SAIL). The biggest issue with SAIL is that it does not show key metrics by facility over time. Rather, it shows a vague chart of “Star” ratings by facility and whether, in the VA’s opinion, it improved, stayed the same or declined. To truly report how well the Agency serves Vets, they must institute transparency and benchmarking against other healthcare systems.

SAIL is designed to include actionable metrics that are important to assess healthcare delivery and quality. However, many of these metrics are not publicly reported, and many are the same as public hospitals and care systems. How do those compare? Therefore, it is not possible to directly compare evaluation findings derived from SAIL with other systems published by public and private sectors. Instead, SAIL is developed for the VA to drive internal system-wide improvement.

Because of metrics and issues like the ones cited above, growing choruses of voices are shouting for the privatization of the agency, specifically the Veterans Health Administration. Proponents cite the fiscal gains and agency’s overall failure to effectively and efficiently utilize its resources. Opponents cite concerns over the private sector’s failure to provide adequate access to quality healthcare and its inability to deal with the mental issues caused by battlefield experiences.

Perhaps the best path ahead is an expanded public-private partnership with Government oversight.

 

A New Way Ahead

As stated above, VA’s three main organizations are managed from its headquarters in Washington DC. Examining each organization to determine how much of their function can be “contracted out” and managed by Headquarters as a “program” with Government oversight constitutes a new and untried approach to managing the agency.

Veterans Health Administration: Fund a healthcare insurance program to be managed by a US healthcare insurance company and give each Veteran an insurance card usable at any hospital or doctors office in the United States, with no Co-Pay. Of course this would require policy directing how the 3rd party insurer would manage care to prevent it from morphing into a “denial” system preventing Veteran treatment. This is a must as some 3rd Party insurers tie bonuses to saving money at the expense of their patients. Just as it occurs in the private sector, the VA would evaluate these plans on an annual basis for effectiveness and efficiency. Accordingly, health plans would bid for the Government's business.

 Government contracting of private sector health insurers is not a unique approach. For example, Federal Employees Health Benefits (FEHB) Program, the Federal government employees’ health insurance comes from a program backed by a private sector healthcare plan that provides many options. However, in the interest of clarity, it must be noted that in the example cited above, employees pay as well. To be clear, the program being suggested here should require no participation payment by Veterans.

How should the Government fund this insurance program? Shutter all VA hospitals and clinics. In plain words, the US Government is running a healthcare program that competes with world-class hospitals for physicians, nurses, technicians and equipment, often in the same neighborhood. And the contest is not going well for the VA.

In the case of Boston, the VA hospital is 20 minutes from Massachusetts General. In Washington, DC, the VA hospital is .3 miles from Medstar Washington Hospital Center, literally across the street from one another. Another example, the state of Wyoming has two major Veterans hospitals, one each on the northern and southern borders, and both on the eastern side of the state. Allowing veterans to access any hospital in the state would eliminate the need for some Vets to travel across the state for service. Additionally in the case of Wyoming, the two Veterans hospitals also have close proximity to major private sector health delivery systems.

Veterans Benefits Administration: Contract out this activity in total with oversight by a VA Program Manager. Benefits Management is not a new area of business in the United States. These companies feature state of the art business processes and telecommunications platforms. Anyone who has tried to contact the VA on a Monday or Tuesday knows the anxiety that accompanies an hour-long, or worse, hold-time. In an effort to resolve wait times, VA instituted a "call back" system - a great step. However, this system has frequent outages resulting in the aforementioned extended wait times.

Again, savings from outsourcing this function can go to fund the aforementioned veterans healthcare insurance program.

National Cemetery Administration: Of all the functions under the VA umbrella, this is perhaps the most unique. Traditions and ceremonies surrounding the internment of our Veterans are sacrosanct and not easily replicated by the private sector. That said, the memory of the issues at Arlington National Cemetery still resonate. Any modernization analysis should also include the possibility of outsourcing this function.

 

Other Concerns

Veterans Mental Health: Outgoing VA Secretary David Shulkin cited his concerns for the viability of Veterans mental health treatment as one of the reasons that privatization would not work. Granted, providing good access to mental health services continues to challenge even the best healthcare systems in the US. While private sector health systems continue to struggle with this front, the VA has hardly set the bar for delivering the service. So the challenge then is to not negatively impact the delivery of this service to Veterans. Most of the larger hospitals that would provide non-mental health services, as described above, offer some form of mental health care services. With the expanded outreach that a greater number of hospitals would provide, the ability to detect and triage Veterans in need of mental health services would also expand. The new challenge then would be to ensure hospitals providing services to Veterans receive the appropriate level of training and exposure to best practices.

Mental Health is a valid concern and it may be an area that can serve as a base program for an improved mental health program within the private-sector healthcare system. To explain, the issue in the private sector is that insurers, both private and Government, stopped paying for most inpatient therapies and moved them to outpatient settings. Then, they greatly reduced rates of payment for outpatient treatment making it economically unfeasible for most healthcare delivery systems to provide that service. By funding payments to providers for the treatment of Veterans with PTSD and other mental health diagnoses, it may help to broaden the base of mental health services as a whole. The VA will probably argue that their mental health program is unique and cannot be replicated. Perhaps so, but the VA is treating a very small percentage of the affected Veterans. Questions remain: How do we broaden the net to serve those Veterans not receiving these much-needed services? And what are the consequences when a Veteran goes untreated? To the Vet? To the community?

Jobs: The closure of a large percentage of the VA’s 1,065 outpatient sites and 170 medical centers would certainly create a temporary unemployment challenge. Since most of these personnel work in the healthcare industry, presumably the most qualified of them will find work at other medical facilities. The remaining workers will have to find a way to transition their skills for use in other fields. A good transition plan should greatly minimize the impact.

 

The Department of Veterans Affairs is Dedicated to Service

This writing is designed to challenge the belief that the VA as it is currently structured can serve the Nation’s Veterans in the years to come. It offers a different approach to providing services to Veterans, both those who have already seen the horrors of war and those yet to do so. Today’s Veterans Administration struggles against a superior private-sector and benefits management system, its own internal management and technology systems, and finally, public perception of their abilities. As a leader, I believe that most people come to work with the best intentions. Consequently, no ill is intended toward the VA leadership or its many employees-they are serving our country under extraordinary circumstances. Rather, a close examination should be made as to how the VA operates and how it is structured. Changing the chief administrator alone will not allow the organization to meet its challenges. It is said the United States of America has the greatest healthcare in the world - first class. We routinely thank our Veterans for their service and sacrifice. Then, we give them 2nd rate…no…3rd rate healthcare. We can do better.

The Veterans’ Administration: A case for “The Fish Rots from the Head Down”

The Veterans’ Administration, by even the most casual observation, is a broken organization. Nearly two years ago we were peppered with stories of vets literally dying in queue waiting for treatment. Those stories and the media wave they generated led to the ultimate, and in my opinion, the righteous firing of General Eric Shinseki.

In the last few weeks, the news of VA Secretary David Shulkin’s European Vacation has dominated the news cycle. We have all watched with amazement as the VA leader tries to defend using tax dollars to fund a vacation with his spouse.

The Veterans Administration has decrepit field facilities. They do not maintain a stable of quality practitioners. And how could they when they must compete with Level 1 & 2 hospitals across the United States. Finally, VA employs archaic technology systems to administer their health and logistics programs. At what point do we say, “Enough is enough?”

During his run for the Presidency, Donald Trump promised to “fix the Veterans Administration because our vets deserve the very best.” What did he do? He kept the same leadership team in place that, by all reasonable analysis, had already proven their inability to get the job done.

VA is a large and complex organization. Further, it is one of the oldest organizations in the Federal government. Fixing its ills requires radical thinking based on the use of services best practices and processes. Successful modernizing of the VA requires leadership that is not only ethical but also knowledgeable. Changing an organization comes from the top. 

Once again, President Trump has been given the opportunity to put good leadership in place at Veterans Administration. And once again, I fear, he has let this opportunity pass. To be clear, this is not a criticism of another Navy Flag Officer. My words below are not an indictment of RADM Ronny Jackson, rather I am criticizing his selection as the new VA Secretary.

 Navy Medical Officers do not command ships, submarines, squadrons, or battle groups. Officers who do that work are called “Line Officers.” Doctors, logisticians, and oceanographers are part of the Navy Staff Officer Corps. Staff Officers bring great and needed skills to the fight. The Navy could not function without them. However, they do not experience the same levels and breadth of command as their Line Officer counterparts.

RADM Jackson’s official bio is a compendium of education, tours, and stations. These biographies are vetted before being placed on the Navy’s website. If one reviews RADM Jackson’s biography, they would find nothing in his background that prepares him to run the Department of Veterans Affiars.

RADM Jackson has experienced a superlative career. The Navy should be proud that one of their own was selected to serve as the President’s physician, a role that could have gone to one of our Air Force or Army counterparts. As a fellow Flag officer, I know all too well what it took for him to attain two stars. Make no mistake; I assume Admiral Jackson is a fine Navy Officer.

That said, not all Flag Officers are created equal. We are provided the ability to serve at the Flag and General Officer rank because of our track record of success in our various areas of specialization. Consequently, I anticipate he will undergo a turbulent confirmation process. Further, I fear it will bring a level of humiliation that no dedicated public servant should experience.

VA needs ethical, qualified, serious, and courageous (in equal parts) leadership. Secretary Shulkin was a fifty-percent solution. I am afraid that Rear Admiral Jackson is seventy-five percent solution. As a veteran, I don’t think it is too much to desire a complete leadership solution.

 

By: Rear Admiral Ken Carodine


 

Male Wall of Silence

After several months, it seems the #MeToo movement has finally reached the White House. The resignation/firing (depending on who you want to believe) of Rob Porter, President Trump’s Staff Secretary, represents the first instance where a member of the Executive branch has been ousted from his post due to alleged misconduct against women. According to Porter’s two ex-wives and an ex-girlfriend who remains anonymous, Porter was physically and verbally abusive to each of them during their respective relationships with him. The evidence supporting these accusations includes a protective order against Porter granted to his second wife and a photo of his first wife with a large black-eye, which she claims she sustained after Porter allegedly punched her in the face.

Most of the media criticism has been focused on President Trump’s predictable defense of Porter - saying Porter “did a very good job” and later bemoaning the fact that “lives are shattered and destroyed by a mere allegation.” He said all of this while never acknowledging the alleged victims of Porter’s violence or speaking out against domestic violence at all. At this point, no one should be surprised that President Trump believes men accused of misconduct over the women accusing them (see: Steve Wynn, Roy Moore, Bill O’Reilly, etc.). Personally, I can no longer muster any more outrage at the President’s perpetual displays of sexism and disregard for women’s pain.

That being said, I find my outrage directed at three other individuals involved in the Rob Porter saga who are supposed to be men of integrity: Chief of Staff John Kelly, Sen. Orrin Hatch, and White House Counsel Don McGahn. These men’s actions and statements regarding the Porter allegations all exemplified the “Male Wall of Silence” that occurs when a man is accused with crimes against women, and that allows men to get away with these crimes time and time again. Similar to law enforcement’s “blue wall of silence,” where police officers opt to protect each other rather than reveal the truth about abuses, there is an impulse among men to preserve the standing of an accused man while sweeping his misdeeds under the rug and/or discrediting the accusers.

Look first at Don McGahn, whose office is responsible for leading the White House employee vetting process. McGahn first learned of the allegations against Porter in January 2017 (13 months ago) but declined to act because he believed Porter was valuable in his role as Staff Secretary. He continued to do nothing in June, when the FBI affirmed the allegations; in September, when he learned that the accusations would delay the security clearance required for Porter to perform his role; and in November, when Porter’s ex-girlfriend contacted him to relay her similar experience with Porter.  Despite multiple credible warnings that the White House was harboring a domestic abuser, McGahn chose to protect Porter and keep him in his position, because hitting women seemingly did not affect Porter’s ability to be effective in his job.    

Look next at John Kelly, the man touted as “the adult in the room” at the White House. Once the abuse allegations were published last week, Kelly’s first response was to issue a statement calling Porter “a man of true integrity,” about whom he “couldn’t say enough good things.” After additional evidence about the abuse emerged, Kelly issued a second statement condemning domestic violence, but followed it by standing by his previous statements about Porter and arguing that “every individual deserves the right to defend their reputation.”  Later news reports allege that Kelly encouraged Porter to “stay and fight” even after the full extent of the alleged abuse became public. By paying lip service to domestic violence victims while defending Porter in the same breadth, you learn all you need to know about John Kelly’s priorities in this situation. Like McGahn, Kelly opted to believe and protect the man of privilege over women who suffered at his hands and had nothing to gain by telling their stories.

Lastly, we come to Sen. Orrin Hatch, Porter’s employer prior to the White House. Hatch’s defense of Porter went one step further than Kelly- praising Porter as a friend and colleague but also calling the accusers “morally bankrupt character assassins.” Before even reading the accusations, Hatch decided that anyone accusing a clean-cut white man must be a liar with no morals. Again, after learning more details about the abuse, Hatch issued a second statement decrying domestic violence, but still containing a defense of Porter and no apology to the women he maligned 24 hours earlier.

Through the actions of these three men, we see the GOP’s Male Wall of Silence in action. This is the reason why domestic violence persists in our society; because the reputations and careers of men are more important than the physical safety of women. This is why women do not report violence against them; because they see their abuser defended while they are branded as liars and opportunists. When men in power diminish domestic violence as a lesser concern, they are sending a clear message to women that a man’s rights will always come first. Essentially, a man’s right to create the best life for himself outweighs a woman’s right to live free of fear and mistreatment.

Shame on Don McGahn and John Kelly. Shame on Orrin Hatch and the Mormon Church leaders who told Porter’s then-wife, Jennie Willoughby, to prioritize his career ambitions over her suffering. Shame on the male dominated power structure that takes a “see no evil, speak no evil” approach to violence against women. Shame on those who would diminish a woman’s basic humanity in favor of political expediency. 

The GOP has long fretted its inability to attract more women to its ranks and the Porter saga is a perfect example of why. If Republican leadership cannot unequivocally denounce violence against women and adopt a zero-tolerance policy towards bad conduct (which so far no one has), then women will increasingly turn towards those candidates who demonstrate that their lives and dignity are worth prioritizing. Come November, women will remember the GOP’s moral failure on this issue when they are in the voting booth. Don’t think they won’t.

By: Sharmila Achari 

What is Steve Bannon’s end game?

You might think I’m crazy, but I’m going to say it: I don’t think this the end for Stephen K. Bannon, not by a long shot. While the majority of my liberal brethren have been gleefully celebrating his demise, I have a different take on the fallout from Bannon’s statements in Michael Wolff’s new book, Fire and Fury: Inside the World of Donald Trump. In the book, Bannon takes multiple swipes at Donald Trump Jr., Jared Kushner, and Ivanka Trump, labelling the former two’s meeting with Russians at Trump Tower as “treasonous” and “unpatriotic,” and calling the latter “dumb as a brick.” Bannon also intimated that the President’s oldest son and son-in- law were guilty of money laundering.

These statements no doubt undermine the Trump administration and surely enraged the President, but they are also notable for what Bannon did not say. In the excerpts, Bannon does not directly criticize or disparage President Trump himself. While there are some derogatory allusions to then-candidate Trump’s comprehension of issues, Bannon is not on the record calling him “like a child,” “crazy,” or “a f***ing fool,” like other Trump staffers. Moreover, since his ouster from the White House, Bannon has done nothing but praise the President and his agenda in public, including (and especially) since the excerpts from Wolff’s book were made public.

While many Democrats and Republicans (including I’m sure, one Mr. Mitch McConnell) are gloating that Bannon’s loose lips resulted in political harakiri, I think Bannon has a much different outcome in mind. Bannon is anything but a rube when dealing with the media, and no matter how large his ego or deep his frustration with the President, he is not stupid enough to serve up quotes blowing up his relationship with the most powerful man in the world for no reason. My theory is that Bannon’s long-game is to ultimately bring Trump closer to him (Bannon) by undermining Trump’s trust in everyone else around him, including (and especially) his family. The reasons I think this are threefold:

Firstly, It is well known that Trump does not trust the competence of his staff and frequently calls
friends outside the White House to survey them on the performance of various staffers. This includes his family members- for example, it’s an open secret that the President believes Iavanka should do everyone a favor and return to New York. As Kushner and Trump Jr. become further entangled with Robert Mueller’s Russia probe, Bannon’s remarks about their incompetence will be vindicated in the President’s mind. Trump reflexively turns against those who make him look bad, so as Kushner and Junior’s stock goes down in 2018, I predict Bannon’s will creep back up.

Secondly, since Bannon’s departure, the Trump administration is markedly bereft of any senior officials, other than Stephen Miller, who are true believers in the “MAGA” ideology. Rather, the President is almost entirely surrounded by Establishment/moderate figures á la Kushner, John Kelly, and MitchMcConnell who seek to curb his populist rhetoric and undignified conduct. We know from reporting that Trump abhors being controlled and gravitates towards those who share his worldview and indulge his behavior. As his aides seek to further contain him in order to: a) prevent more unforced errors and b) actually get legislation passed, I predict Trump will lash out and reconnect with Bannon, with whom he shares a genuine ideological connection and anti-establishment streak.

Thirdly, Trump always brings people back. Just look at his infamous on-off relationships with Roger Stone and Corey Lewandowski. Trump especially goes back to people who he believes were correct in their actions and/or predictions. Steve Bannon knows this and has been laying the seeds for months. Katy Tur blithely observed that one can easily manipulate President Trump by being nice to him. As I observed above, Bannon never directly criticizes the President in Wolff’s book and has been showering him with support since August. The effect of Bannon calling Trump a “great man” on Wednesday night is already apparent. On Thursday, the President adopted a much more restrained tone in his first public comments on Bannon than in the irate screed the White House put out after the initial excerpts from Wolff’s book were published. Bannon is smart enough not to take the bait by engaging in a public feud with Trump; if Bannon does not pour fuel on the fire, he knows that Trump’s current rage will burn out. As others around the President continue to defy and disappoint him, Bannon understands that Trump will turn back to the person who supports his purpose in the Oval Office. By all accounts, Bannon s a voracious reader, so I’m sure he is familiar with Sun Tzu. His current actions smack of The Art of War: seeing that opportunity exists in the weakness of others within the WhiteHouse and responding successfully to shifting circumstances. Steve Bannon may be persona non grata for the present time, but given everything we know about President Trump, I doubt this is a permanent
state of affairs.