AUSA President Meets with DoD Health Affairs Nominee


AUSA President Gen. Gordon R. Sullivan, USA, Ret., met recently with Dr. S. Ward Casscells, the nominee to be the new Assistant Secretary of Defense for Health Affairs.

Dr. Casscells, a cardiologist and Vice President of Biotechnology at the University of Texas Health Science Center at Houston is also a colonel in the Army Reserve. He recently returned from a three-month tour of duty in Iraq.

After touching on several topics important to the Association and its members, Gen. Sullivan assured Dr. Casscells that the Association is prepared to assist him in any way with his new endeavor.

During his confirmation hearing last week, we were pleased to hear Dr. Casscells' response to a question regarding TRICARE from Sen. John Warner, R-Va., ranking member of the Senate Armed Services Committee.

Sen. Warner noted that Dr. Casscells said in his written responses to the committee's advance questions that one of the TRICARE's strengths is that it is very inexpensive for the beneficiary compared to other health care plans. Sen. Warner said, “This statement may well be inconsistent with the views of senior leaders in the department who have described TRICARE as unsustainable in its present form. So therein rests a challenge for you to sort that out. I don't presume at this point in time that you can give us a great deal of insight into how you would treat TRICARE, but it's viewed by the men and women of the Armed Forces and their families as a very essential part of the contract America makes with these families when they undertake their role in the military. I hope that you give us your assurances you'll do the best you can to strengthen that program.”

Dr. Casscells replied, “I share your concern…, that increasing copays and deductibles, particularly at this time, runs the risk of making it harder for us to recruit and retain the very best because people value enormously the health care given in the military. They are willing to sleep in tents, on cots -- they don't demand the Ritz, but they would like and deserve the very best medical care. And this is true for the families, and their budgets are lean. And I know that the copays and the deductibles have been flat for 12 or 13 years, and there's understandable interest in raising them because the private sector is raising theirs to decrease utilization. But sir, there are other efficiencies which can be sought.”

Additionally, in an exchange with Sen. James Inhofe, R-Okla., regarding recent problems at Walter Reed Army Medical Center, Dr. Casscells, who was wounded in Iraq, said he’d bring a patient’s perspective to the job if confirmed. He told the senators he’d experienced DoD health care firsthand and was frustrated by “the bureaucracy that has been in the news lately” upon his return.

“If it's frustrating for a colonel, you can imagine how frustrating it is for a sergeant or corporal,” he said, “particularly if they've had a head injury or their family is 1,000 miles away and can't be advocates for them. So… we've got to fix that and make it fair and fast.”

Dr. Casscells suffered an elbow injury when the Humvee he was riding in swerved to avoid an improvised-explosive-device tripwire. The injury became infected, and he was treated at the 10th Combat Support Hospital in Baghdad.

“I wasn't badly injured,” he said. “It was a small injury, but it was just enough to get me into the system as a patient.” He added that his experience gave him “an interesting insight” into the dedication of the military’s medical personnel.

Dr. Casscells said he would continue -- and accelerate, if possible -- efforts by current Assistant Secretary of Defense for Health Affairs Dr. William Winkenwerder Jr. to implement electronic medical records and other improvements to efficiency and accountability. He cited his own experience in acknowledging that the current system needs attention.

“I do know that when I was in Iraq, it amused me to look up my record on Army Knowledge Online -- one of our Web sites -- and to find that my deployment status was ‘amber,’ which means I was not fit to be deployed, and yet there I was,” he said. “So clearly there are issues like that.”

He also said that, if confirmed, he’ll need time to assess the findings of various task forces and hearings investigating issues related to military health care and its bureaucracy, but he added it’s clear to him the military is taking these matters “very seriously.”

“It sounds like there’s a lot of support for improving things – to take a system which is very good and make it absolutely superb,” he said.


Army Recruiting/End Strength Topic at Personnel Hearing

The Defense Department’s top civilian for personnel and readiness said, “I do underscore the need of broad public support” to encourage young men and women to enlist in the armed forces.

Testifying last week before the Senate Armed Services Personnel Subcommittee, David Chu, under secretary, said that recruiting remains a challenge, particularly as the Army and Marine Corps are increasing their end strength.

LTG Michael Rochelle, the Army’s top personnel officer and a former head of the Army Recruiting Command, told the panel “I am very optimistic we will exceed our mission in active force and the Army National Guard.”

He said the overall recruiting goal was 171,000 for the active force, Army National Guard and Army Reserve and the Army’s active end strength at the end of fiscal 2008 would be 518,000.

“Since the beginning of the All Volunteer Force, we have maintained DoD standards. We will not ask to change those standards” on percentage holding high school diplomas or equivalents, scoring in the upper levels of armed forces standardized entrance test and the number of recruits from the lowest testing categories.

Committee Chairman Sen. Ben Nelson, D-Neb., asked LTG Rochelle: “If we scale down in Iraq, is 547,000 right?” Five hundred and forty-seven thousand is the Army’s end strength goal in the next five years.

LTG Rochelle said he believed so and he said that the goal was reachable because of continued successful recruiting programs, in some instances borrowed from the Army National Guard, strong retention rates and reducing attrition among first-term soldiers in basic training from more than 18 percent to about 7 percent.

In his prepared testimony, LTG Rochelle said that the Army Advantage Fund is expected to be “the next Army College Fund.” The fund provides a choice between a down payment for a home loan or seed money for a small business loan to new soldiers.

Also in his prepared testimony, he wrote that the Army “adjusted our incentive programs to target” mid-career soldiers.

“We do know that soldiers are most concerned with limited time at home between deployments. … [The goal is to have] at least 24 months with their families, before their next deployment,” he said.

LTG Rochelle also submitted to the committee details on how the Army is focusing on retaining mid-career officers as well, including offering captains their branch/functional areas of choice, the opportunity attend or military school or obtain language training, the opportunity attend a fully funded graduate degree program or receive a $20,000 Critical Skills Retention Bonus in exchange for three years additional service.

He added the Army was trying to minimize the use of stop-loss. Seven thousand soldiers in the active force are serving under stop-loss, while there are another 3,000 in the Army National Guard and Army Reserve in the same status.


Fiscal 2007 Emergency Supplemental Heads to Conference

The Senate has passed their version of the fiscal 2007 emergency supplemental spending bill clearing the way for conference negotiations.

Both the House and Senate supplementals contain timetables for withdrawing U.S. troops from Iraq, language that has prompted repeated veto threats from President Bush.

Senate Majority Leader Harry Reid, D-Nev., and House Speaker Nancy Pelosi, D-Calif., sent a letter to President Bush yesterday, urging him to "sit down and work together on behalf of the American people and our troops."

White House spokeswoman Dana Perino responded by saying that President Bush is willing to discuss troop withdrawal language with Democratic leaders.

"If they want to compromise -- and I understand that the Speaker and the Majority Leader said that they do -- then we're willing to talk to them on ways that their bills can be changed in order to get to the president's desk so that it doesn't meet his veto," Perino told reporters.

Although Perino would not say it explicitly, she did not reject the notion that President Bush may be willing to sign a supplemental with some sort of non-binding withdrawal provisions. "I'm just not going to rule it out," she said.

The Senate's supplemental contains a "goal" of withdrawing most U.S. troops from Iraq by March 2008, but requires that a pullout begin within 120 days of the enactment of the supplemental.

The House's supplemental calls for a troop pullout by August 2008, and ties U.S. military support to security and political benchmarks that the Iraqi government must meet.

The White House is pointing to the Senate’s "120 days" mandate as the reason for the veto threat, arguing that it is an arbitrary timetable that will tie the hands of the commanders on the ground.

Meanwhile, Joint Chiefs of Staff Chairman Peter Pace told House appropriators that the Army "will have to begin curtailing some training" for Guard and Reserve units if the supplemental is not enacted by April 15.

"Quality of life initiatives for the service will have to be reduced..., because money that is allocated to that will have to be shifted to the funding of the war," he said. "If it goes past [May 15], then you have those, plus additional problems. It will begin to impact our depots, which is where the backlog of our major equipment is right now."


National Guard Chief: Only 12 Percent of Army Guard Units are Equipped to Acceptable Levels

National Guard Bureau Chief LTG Steven Blum told a key House panel last week that the Army Guard, in particular, has only 40 percent of its equipment on hand for the homeland defense mission and much of that is old and unusable.

During testimony before the House Armed Services Readiness Subcommittee, LTG Blum acknowledged that a "few" Army Guard units have more equipment, but no non-deployed unit has more than 65 percent of its gear.

The equipment shortage, due in part to gear left behind in Iraq and Afghanistan, hinders training exercises and impedes the guard's ability to respond rapidly to domestic disasters, LTG Blum said.

Additionally, he said only 12 percent of Army Guard units are equipped to levels he feels are acceptable. For the Air Guard, only 40 percent of units are equipped to the chief's standards.

When asked about excess equipment in Afghanistan and Iraq, he said there probably was some, but the real question there centers on: “Does it make economic sense to ship it back?”

Adding, “Governors measure response in minutes and hours – not in days and weeks. We are the first military responders you will see in the zip codes where you and your families live” in case of a natural or manmade disaster.

"We are now in a degraded state back at home," LTG Blum testified.

The Army has pledged $21 billion to upgrade and replace old or damaged guard equipment. “I applaud that," LTG Blum said. But even if the National Guard receives all of the funding pledged by the Army and Air Force, its equipment accounts still will be short $40 billion, to bring these units back to a 90 percent level of readiness.


Trivia of the Week
What happened on this date in 1917? (Click on link for answer)

Answer -
On April 2, 1917, President Woodrow Wilson appeared before Congress to ask for a declaration of war against Germany.

On February 3, the German Navy sank the American cargo ship Housatonic causing Wilson to break off diplomatic relations. With German submarine warfare continuing unabated, the final straw came on April 1, when the armed U.S. steamer Aztec was torpedoed near Brest and 28 of its crew members drowned. The next day, Wilson stepped before Congress to deliver his historic war message. Despite the risks, Wilson felt the U.S. could not stand by any longer; in the face of continued German aggression, the nation had the moral obligation to step forward and fight for the principles upon which it had been founded.

On April 4, the U.S. Senate voted in favor of war by 82 votes to 6; two days later, the House of Representatives delivered their own yes vote by 373 votes to 50, formally announcing the entrance of the United States into the First World War.

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