An e-mail from Tina asked who my favorite all time country music performers were?
I think I'd go with Tammy and George.
Because (a) they lived the country life (if Tammy took away his car keys to keep him from going out and getting drunk, he'd hope on a riding lawnmower and drive it) and (b) they made such great country music individually and together (they had three number one duets, for example).
I love Dolly Parton though so I think I'd go with her.
I think she changed country music in so many ways.
And her songs are among the finest songs written -- country or whatever genre.
I love "The Bargain Store," "Just Because I'm a Woman," "Joshua" and so many more.
"I Will Always Love You" is a song the whole world knows.
"Coat of Many Colors" created a full story long before the tele-film just from those strong lyrics.
And whose feet can stay still during "Two Doors Down"?
"Love Is Like A Butterfly" just floats through the air with a melody so comfortable you feel like you've heard the song your whole life, it's comfortable and familiar.
I could go on and on but I'd certainly need to mention "9 to 5" and "Eagle When She Flies."
Dolly's a one of a kind talent.
You see her talking on TV and she's always smiling and friendly.
And she can write songs like that.
She can also write songs much deeper than anyone might expect.
I think she's the most important country music performer of all time.
I also like George Strait, Nanci Griffith, Patti Loveless, Kathy Mattea, Brad Paisley, Willie Nelson, Emmylou Harris, Dottie West, the Dixie Chicks and Johnny Cash and June Carter-Cash (especially for "Jacksonville" -- "We got married in a fever hotter than a pepper sprout . . .").
I'm sure I've left out a few that I'll remember five seconds after I post.
Closing C.I.'s "Iraq snapshot:"
Friday, December 2, 2016. Chaos and violence continue, FOREIGN POLICY
IN FOCUS uses psycho babble to white wash greed, Senator Tammy Baldwin
hosts a roundtable on veterans issues, and much more.
Starting with nonsense. Rabbi Michael Lerner.
At this late date no one needs you.
If you can't tell the truth, just stop it.
We don't need you on Iraq, you haven't done a damn thing on Iraq and your recent garbage post at FOREIGN POLICY IN FOCUS is so bad I'm thinking of pulling the link that they had asked for.
What's wrong with the article?
Bully Boy Bush started the illegal war because Saddam Hussein (supposedly) tried to kill his daddy?
I'm so sick of people trying to ascribe motive based upon whispers.
And it's especially dishonest of FPIF to publish the rabbi's nonsense.
From PROJECT CENSORED, the eight most censored story of 2010:
April 29, 2010
It was about oil.
When Alan Greenspan admitted that on live TV (DEMOCRACY NOW!) you could tell he didn't think he was saying anything shocking -- the former Chair of the Federal Reserve (1987-2006) had recently stepped down from his post and was promoting his book THE AGE OF TURBULENCE: ADVENTURES IN A NEW WORLD.
In the book, he writes, "I'm saddened that it is politically inconvenient to acknowledge what everyone knows -- the Iraq war is largely about oil."
From September 24, 2007's DEMOCRACY NOW! broadcast:
AMY GOODMAN: Alan Greenspan, let’s talk about the war in Iraq. You said what for many in your circles is the unspeakable, that the war in Iraq was for oil. Can you explain?
ALAN GREENSPAN: Yes. The point I was making was that if there were no oil under the sands of Iraq, Saddam Hussein would have never been able to accumulate the resources which enabled him to threaten his neighbors, Iran, Kuwait, Saudi Arabia. And having watched him for 30 years, I was very fearful that he, if he ever achieved — and I thought he might very well be able to buy one — an atomic device, he would have essentially endeavored and perhaps succeeded in controlling the flow of oil through the Straits of Hormuz, which is the channel through which 18 or 19 million barrels a day of the world 85 million barrel crude oil production flows. Had he decided to shut down, say, seven million barrels a day, which he could have done if he controlled, he could have essentially also shut down a significant part of economic activity throughout the world. The size of the threat that he posed, as I saw it emerging, I thought was scary. And so, getting him out of office or getting him out of the control position he was in, I thought, was essential. And whether that be done by one means or another was not as important, but it’s clear to me that were there not the oil resources in Iraq, the whole picture of how that part of the Middle East developed would have been different.
Less noted was that Greenspan had made the same public statements in a September 17, 2007 interview with NBC's Matt Lauer.
The Iraq War has dragged on for over 13 years.
We don't have any more time for nonsense.
At this late date, for Lerner to pretend that the oil maps never existed and pin the war on 'daddy issues' is embarrassing. Even more so since FPIF has previously addressed these oil maps.
Also embarrassing is how Barack gets a pass yet again.
He is mentioned in only one sentence by the bashful rabbi, "Perhaps worst of all, when people voted for a president who boasted that he opposed the war and the torture, President Obama declined to prosecute anyone who had been involved in the legitimating of torture."
Really?
Bully Boy Bush presided over the Iraq War for five years.
Barack has presided over it for eight.
Barack overturned the results of a democratic election which is how Nouri al-Maliki got a second term as prime minister and was able to send Iraq further into turmoil and give rise to the Islamic State.
Barack looked the other way when Nouri's secret prisons were exposed.
Barack looked the other way when Nouri used Shi'ite militias and the federal police to attack the LGBTQ community in Iraq.
Barack looked the other way as the federal police was sent into Iraqi schools to incite children and teens against gay people and encouraged to attack and kill anyone even suspected of being gay.
We could go down the list -- it's endless.
Rabbi Lerner is no help to anyone with his lies.
In Iraq, the slog continues.
Yes, it is a slog.
As Elaine noted last night:
Elise is such a joke.
From REUTERS:
The Iraqi government's assault to retake the city of Mosul could take months, prompting more and more civilians to try to flee to avoid being trapped between frontlines, a senior official of the International Committee of the Red Cross told Reuters.
[. . .]
"Elise Labott of CNN making like she was at a county fair pig hollering contest by hollering "NO!" in the midst of an October State Dept press briefing when a reporter offered that it was a slog."
[. . .]
Elise Labott speaks on behalf of the government in a press briefing and no one cares?
She shoots down another reporter?
She's so unprofessional.
It is a slog.
It was always going to be one.
Elise Labott is an idiot.
And Mike observed:
Mosul was seized by the Islamic State in June 2014.
Don't tell me that in two plus years of planning for the current 'liberation' effort no one factored in the refugees?
Don't tell me that they just forgot about the refugees.
The reality is that they didn't care about the refugees.
Not the Iraqi government.
Not the US government.
They didn't care.
And, boy, does it show right now.
I was in high school when this war started.
I've gone on to college and law school.
This war apparently will never end.
The war has dragged on forever -- 13 years and counting.
Mosul?
The Islamic State has occupied it since June of 2014.
The liberation or 'liberation' effort began 46 days ago and still continues.
Turning to the US . . .
Senator Tammy Baldwin: Families like the Simcakoski family who we are so grateful to have here today have told a story that needs to be heard -- a tragic story of loss -- a son, a father, a husband, a brother -- a tragic story of a sacred trust that has been broken -- a trust we should have always with our veterans and their families. Their story is how that trust was broken when they -- and Jason, in particular, didn't receive the VA care that he had earned. I was proud in June of 2015 and, frankly, so many weeks and months since to stand with the Simcakoski family and I was inspired to act to fix what was broken. That's why I worked with Jason's family, also with medical professionals, veterans service organizations, to offer solutions. Our goal was to enact meaningful reforms to prevent Jason's tragedy from happening to other veterans and other veterans families. Our reforms strengthen the Dept of Veterans Affairs opioid prescribing guidelines, they put in place stronger oversight and accountability and provide safer and more effective pain management services for our nation's veterans. Now with today's event, we will discuss how to realize the goals of Jason's law and also receive an update on the VA's progress in addressing opioid prescribing practices and critical health care needs of veterans that Congress should be focusing on in the upcoming year.
July 22, 2016, US President Barack Obama signed into law The Jason Simcakoski Memorial Opioid Safety Act. Senator Baldwin was speaking at Wednesday's roundtable which included members of Jason Simcakoski's family (father Marv Simcakoski and widow Heather Simcakoski), US House Rep Gus Bilirakis, Warren Goldstein with The American Legion, Dr. Yngvild Olsen of The American Society of Addiction Medicine, David Riley with the Disabled American Veterans and Carlos Fuentes with The Veterans of Foreign Wars as well as VA official Dr. Carolyn Clancy and Josh Rising of The Pew Charitable Trust.
Marv Simcakoski stated in his opening remarks, "I mean the reason everybody's here is because they want to make it better for our veterans. My son didn't have that chance but I know now -- and I see what's going on all over and I'm just proud to be a part and so is my family of something like this that's really taking place and there is big changes being made."
Heather Simcakoski declared, "I know change takes time. As Marv mentioned, we're starting to see some change. But I really can't wait for the day that we look and know we've made a difference and see drastic improvements in the amount of people that are addicted to opioids or doctors that are prescribing opioids. It seems like every day I open the news or a newspaper and read that another doctor over-prescribed something to somebody and that they've overdosed. It's definitely time for that to stop. I know Jason would be extremely proud and his gratitude for every person in this room that's helped make this happen, I know that he would just be extremely proud of where we are today."
We'll note this section where they are discussing patient advocates -- they are their to advocate for the veteran and help them.
Carlos Fuentes: Josh, if I may, I just want to add having someone -- as a veteran, having someone that listens to me and is working for me improves my satisfaction and, in turn, improves the quality of care that I receive. That is an invaluable aspect of the patient advocacy if it works appropriately. And unfortunately for Jason, it didn't work appropriately. For Matt O'Reilly, it hasn't worked appropriately and for so many other veterans. And if we're able to get that to work well, you're going to see an increase in satisfaction, you're going to see an increase in the quality of care the veterans receive.
Warren Goldstein: I couldn't agree more. I think Marv hit the nail on the head here when he said that the patient advocate needs to feel empowered to help or serve their client and their client is the veteran -- not the medical center director or their boss. So I couldn't agree with you more when you said that the patient advocate needs to be sort of independent on their own working for their client which is the veteran, not the medical center director.
Marv Simcakoski: And one other thing I liked to mention, for David Riley, you know, to go in and get a prescription refilled and just to be said "no" -- I mean, that's crazy. If any doctor's know anything about pain meds and that you can't tell somebody "no" cold turkey because, you know, all it's going to lead to is a withdrawal. And that's just painful and, I guess, to me that-that tells me that who ever was in charge didn't know anything about prescriptions and how they effect the patient so I feel for you there.
Heather Simcakoski: One thing I want to ask is that, you know, all of the changes are hopefully really wonderful. But how are we really going to measure the success of the patient advocacy? One of the questions I asked when I was in Tomah [Wisconsin] was what their goals are for their patient satisfaction and they gave me a goal. And I said, "Well is that a standard across all VAs?" And, from what I understand, there's really not a standard of quality care . And it would be nice to see that there are goals and customer satisfaction that all VAs are kind of held to the same standard and we're measuring that across the board because there wasn't, from what I understand, to measure what is success at one location might not be success at another.
Dr. Carolyn Clancy: So could I just respond to that? Uhm. We use the same metrics and tools that the rest of healthcare does. In fact, our -- actually, for access, our overarching goal is what the veterans tell us -- it is a patient satisfaction, patient experience survey, that we take out some of the items and basically say 'in the last six months, when you needed care, urgently or right away, could you usually or always get it?' Same thing for routine care and we break that up by primary care and specialty care and so forth. But that is the goal rather than wait times which can mean a whole lot of different things and different circumstances. The question of how do we map that onto managing pain and the issues that we are talking about today, I think that is really interesting so I will take that back. But we actually are comparing ourselves a lot to some of the best in the private sector and we do actually make a lot of this information publicly. We need to do a much better job of making it understandable, that's very high on our list but we take that very seriously.
Josh Rising: And I think a related question I heard too was assessing the performance of the office of the patient advocacy in terms of how well that that office was doing in terms of meeting the goals that had been set out. So that's also a kind of --
Dr. Carolyn Clancy: Yes.
Josh Rising (Con't): -- challenge.
Dr. Carolyn Clancy: I think that's going to be a very big challenge in sort of setting this up in making sure that we've got a consistent approach. Uh, our facilities will all be having community meetings as they do on a regular basis and raising this issue for the veterans and so forth in their communities as well because I think we'll get some ideas because that is the essence of the chain of command issue, right? And what you need is an approach that doesn't just work sometimes because with one leadership team it worked great but you know when people change and rotate out so some of our facilities have the patient advocate report up through those who worry [?] and are in charge of quality and safety and so forth -- which makes a lot of sense. If you've got a gifted person in that role, you know, that works very well. If you have a person who is not as skilled, it probably wouldn't work so well. So what we need to get and arrive at is a consistent approach because I think you said that -- right? -- how do we know that this is working well? Ultimately part of how we know is going to come from the veterans. And Secretary [of VA]'s approach means that we are testing a variety of ways not only to use standard surveys because those are part of the healthcare landscape now but also trying to get more real time data. Believe it or not, like many other spheres of life, veterans have a lot to say on Twitter, in Facebook and so forth. And the really great news is we can learn a great deal from that if we're -- and translate what we're hearing into actions to address the problems.
Does anyone see the problem?
The VA's Dr. Clancy seems to think it's her meeting.
Throughout she tries to dominate.
To impart wisdom?
No, just to flap her gums.
She misunderstands what Heather says and yet goes on and on. Josh Rising nicely redirects her and she's still yammering away.
The VA needs to start coming to roundtables and hearings to listen.
It might be really great if officials were just instructed to listen.
In a roundtable, they could speak at the end.
But clearly Dr. Clancy isn't able to listen and pay attention.
ADDED 12/2/16 at 4:27 pm EST: A number of e-mails are expressing interest in the roundtable. I'm adding the video:
The following community sites updated:
Iraq
Starting with nonsense. Rabbi Michael Lerner.
At this late date no one needs you.
If you can't tell the truth, just stop it.
We don't need you on Iraq, you haven't done a damn thing on Iraq and your recent garbage post at FOREIGN POLICY IN FOCUS is so bad I'm thinking of pulling the link that they had asked for.
What's wrong with the article?
Bully Boy Bush started the illegal war because Saddam Hussein (supposedly) tried to kill his daddy?
I'm so sick of people trying to ascribe motive based upon whispers.
And it's especially dishonest of FPIF to publish the rabbi's nonsense.
From PROJECT CENSORED, the eight most censored story of 2010:
April 29, 2010
JUDICIAL WATCH, July 17,2003
Title: Cheney Energy Task Force Documents Feature Map of Iraqi Oilfields
Author: Judicial Watch staff
FOREIGN POLICY IN FOCUS, January 2004
Title: “Bush-Cheney Energy Strategy:Procuring the Rest of the World’s Oil”
Author: Michael Klare
Faculty Evaluators: James Carr, Ph.D., Alexandra Von Meier, Ph.D.
Student Researcher: Cassie Cypher, Shannon Arthur
Documents turned over in the summer of 2003 by the Commerce Department as a result of the Sierra Club’s and Judicial Watch’s Freedom of Information Act lawsuit, concerning the activities of the Cheney Energy Task Force, contain a map of Iraqi oilfields, pipelines, refineries and terminals, as well as two charts detailing Iraqi oil and gas projects, and “Foreign Suitors for Iraqi Oilfield Contracts.” The documents, dated March 2001, also feature maps of Saudi Arabian and United Arab Emirates oilfields, pipelines, refineries and tanker terminals. There are supporting charts with details of the major oil and gas development projects in each country that provide information on the project’s costs, capacity, oil company and status or completion date.
Documented plans of occupation and exploitation predating September 11 confirm heightened suspicion that U.S. policy is driven by the dictates of the energy industry. According to Judicial Watch President, Tom Fitton, “These documents show the importance of the Energy Task Force and why its operations should be open to the public.”
When first assuming office in early 2001, President Bush’s top foreign policy priority was not to prevent terrorism or to curb the spread of weapons of mass destruction-or any of the other goals he espoused later that year following 9-11. Rather, it was to increase the flow of petroleum from suppliers abroad to U.S. markets. In the months before he became president, the United States had experienced severe oil and natural gas shortages in many parts of the country, along with periodic electrical power blackouts in California. In addition, oil imports rose to more than 50% of total consumption for the first time in history, provoking great anxiety about the security of the country’s long-term energy supply. Bush asserted that addressing the nation’s “energy crisis” was his most important task as president.
That's an excerpt.
You'll note PROJECT CENSORED notes FPIF covered this in 2004.
Now in 2016, they let Lerner scribble whatever he wants and they publish it.
Want to talk about Fake News?
Stop your damn lying.Title: Cheney Energy Task Force Documents Feature Map of Iraqi Oilfields
Author: Judicial Watch staff
FOREIGN POLICY IN FOCUS, January 2004
Title: “Bush-Cheney Energy Strategy:Procuring the Rest of the World’s Oil”
Author: Michael Klare
Faculty Evaluators: James Carr, Ph.D., Alexandra Von Meier, Ph.D.
Student Researcher: Cassie Cypher, Shannon Arthur
Documents turned over in the summer of 2003 by the Commerce Department as a result of the Sierra Club’s and Judicial Watch’s Freedom of Information Act lawsuit, concerning the activities of the Cheney Energy Task Force, contain a map of Iraqi oilfields, pipelines, refineries and terminals, as well as two charts detailing Iraqi oil and gas projects, and “Foreign Suitors for Iraqi Oilfield Contracts.” The documents, dated March 2001, also feature maps of Saudi Arabian and United Arab Emirates oilfields, pipelines, refineries and tanker terminals. There are supporting charts with details of the major oil and gas development projects in each country that provide information on the project’s costs, capacity, oil company and status or completion date.
Documented plans of occupation and exploitation predating September 11 confirm heightened suspicion that U.S. policy is driven by the dictates of the energy industry. According to Judicial Watch President, Tom Fitton, “These documents show the importance of the Energy Task Force and why its operations should be open to the public.”
When first assuming office in early 2001, President Bush’s top foreign policy priority was not to prevent terrorism or to curb the spread of weapons of mass destruction-or any of the other goals he espoused later that year following 9-11. Rather, it was to increase the flow of petroleum from suppliers abroad to U.S. markets. In the months before he became president, the United States had experienced severe oil and natural gas shortages in many parts of the country, along with periodic electrical power blackouts in California. In addition, oil imports rose to more than 50% of total consumption for the first time in history, provoking great anxiety about the security of the country’s long-term energy supply. Bush asserted that addressing the nation’s “energy crisis” was his most important task as president.
That's an excerpt.
You'll note PROJECT CENSORED notes FPIF covered this in 2004.
Now in 2016, they let Lerner scribble whatever he wants and they publish it.
Want to talk about Fake News?
It was about oil.
When Alan Greenspan admitted that on live TV (DEMOCRACY NOW!) you could tell he didn't think he was saying anything shocking -- the former Chair of the Federal Reserve (1987-2006) had recently stepped down from his post and was promoting his book THE AGE OF TURBULENCE: ADVENTURES IN A NEW WORLD.
In the book, he writes, "I'm saddened that it is politically inconvenient to acknowledge what everyone knows -- the Iraq war is largely about oil."
From September 24, 2007's DEMOCRACY NOW! broadcast:
AMY GOODMAN: Alan Greenspan, let’s talk about the war in Iraq. You said what for many in your circles is the unspeakable, that the war in Iraq was for oil. Can you explain?
ALAN GREENSPAN: Yes. The point I was making was that if there were no oil under the sands of Iraq, Saddam Hussein would have never been able to accumulate the resources which enabled him to threaten his neighbors, Iran, Kuwait, Saudi Arabia. And having watched him for 30 years, I was very fearful that he, if he ever achieved — and I thought he might very well be able to buy one — an atomic device, he would have essentially endeavored and perhaps succeeded in controlling the flow of oil through the Straits of Hormuz, which is the channel through which 18 or 19 million barrels a day of the world 85 million barrel crude oil production flows. Had he decided to shut down, say, seven million barrels a day, which he could have done if he controlled, he could have essentially also shut down a significant part of economic activity throughout the world. The size of the threat that he posed, as I saw it emerging, I thought was scary. And so, getting him out of office or getting him out of the control position he was in, I thought, was essential. And whether that be done by one means or another was not as important, but it’s clear to me that were there not the oil resources in Iraq, the whole picture of how that part of the Middle East developed would have been different.
Less noted was that Greenspan had made the same public statements in a September 17, 2007 interview with NBC's Matt Lauer.
The Iraq War has dragged on for over 13 years.
We don't have any more time for nonsense.
At this late date, for Lerner to pretend that the oil maps never existed and pin the war on 'daddy issues' is embarrassing. Even more so since FPIF has previously addressed these oil maps.
Also embarrassing is how Barack gets a pass yet again.
He is mentioned in only one sentence by the bashful rabbi, "Perhaps worst of all, when people voted for a president who boasted that he opposed the war and the torture, President Obama declined to prosecute anyone who had been involved in the legitimating of torture."
Really?
Bully Boy Bush presided over the Iraq War for five years.
Barack has presided over it for eight.
Barack overturned the results of a democratic election which is how Nouri al-Maliki got a second term as prime minister and was able to send Iraq further into turmoil and give rise to the Islamic State.
Barack looked the other way when Nouri's secret prisons were exposed.
Barack looked the other way when Nouri used Shi'ite militias and the federal police to attack the LGBTQ community in Iraq.
Barack looked the other way as the federal police was sent into Iraqi schools to incite children and teens against gay people and encouraged to attack and kill anyone even suspected of being gay.
We could go down the list -- it's endless.
Rabbi Lerner is no help to anyone with his lies.
In Iraq, the slog continues.
Yes, it is a slog.
As Elaine noted last night:
Elise is such a joke.
From REUTERS:
The Iraqi government's assault to retake the city of Mosul could take months, prompting more and more civilians to try to flee to avoid being trapped between frontlines, a senior official of the International Committee of the Red Cross told Reuters.
[. . .]
"Elise Labott of CNN making like she was at a county fair pig hollering contest by hollering "NO!" in the midst of an October State Dept press briefing when a reporter offered that it was a slog."
[. . .]
Elise Labott speaks on behalf of the government in a press briefing and no one cares?
She shoots down another reporter?
She's so unprofessional.
It is a slog.
It was always going to be one.
Elise Labott is an idiot.
And Mike observed:
Another fine mess on the part of Barack.
Mosul offensive takes toll as Iraqi casualties soar goo.gl/ITjbZ9 #Middle_East
Mosul was seized by the Islamic State in June 2014.
Don't tell me that in two plus years of planning for the current 'liberation' effort no one factored in the refugees?
Don't tell me that they just forgot about the refugees.
The reality is that they didn't care about the refugees.
Not the Iraqi government.
Not the US government.
They didn't care.
And, boy, does it show right now.
I was in high school when this war started.
I've gone on to college and law school.
This war apparently will never end.
The war has dragged on forever -- 13 years and counting.
Mosul?
The Islamic State has occupied it since June of 2014.
The liberation or 'liberation' effort began 46 days ago and still continues.
Turning to the US . . .
Senator Tammy Baldwin: Families like the Simcakoski family who we are so grateful to have here today have told a story that needs to be heard -- a tragic story of loss -- a son, a father, a husband, a brother -- a tragic story of a sacred trust that has been broken -- a trust we should have always with our veterans and their families. Their story is how that trust was broken when they -- and Jason, in particular, didn't receive the VA care that he had earned. I was proud in June of 2015 and, frankly, so many weeks and months since to stand with the Simcakoski family and I was inspired to act to fix what was broken. That's why I worked with Jason's family, also with medical professionals, veterans service organizations, to offer solutions. Our goal was to enact meaningful reforms to prevent Jason's tragedy from happening to other veterans and other veterans families. Our reforms strengthen the Dept of Veterans Affairs opioid prescribing guidelines, they put in place stronger oversight and accountability and provide safer and more effective pain management services for our nation's veterans. Now with today's event, we will discuss how to realize the goals of Jason's law and also receive an update on the VA's progress in addressing opioid prescribing practices and critical health care needs of veterans that Congress should be focusing on in the upcoming year.
July 22, 2016, US President Barack Obama signed into law The Jason Simcakoski Memorial Opioid Safety Act. Senator Baldwin was speaking at Wednesday's roundtable which included members of Jason Simcakoski's family (father Marv Simcakoski and widow Heather Simcakoski), US House Rep Gus Bilirakis, Warren Goldstein with The American Legion, Dr. Yngvild Olsen of The American Society of Addiction Medicine, David Riley with the Disabled American Veterans and Carlos Fuentes with The Veterans of Foreign Wars as well as VA official Dr. Carolyn Clancy and Josh Rising of The Pew Charitable Trust.
Marv Simcakoski stated in his opening remarks, "I mean the reason everybody's here is because they want to make it better for our veterans. My son didn't have that chance but I know now -- and I see what's going on all over and I'm just proud to be a part and so is my family of something like this that's really taking place and there is big changes being made."
Heather Simcakoski declared, "I know change takes time. As Marv mentioned, we're starting to see some change. But I really can't wait for the day that we look and know we've made a difference and see drastic improvements in the amount of people that are addicted to opioids or doctors that are prescribing opioids. It seems like every day I open the news or a newspaper and read that another doctor over-prescribed something to somebody and that they've overdosed. It's definitely time for that to stop. I know Jason would be extremely proud and his gratitude for every person in this room that's helped make this happen, I know that he would just be extremely proud of where we are today."
We'll note this section where they are discussing patient advocates -- they are their to advocate for the veteran and help them.
Carlos Fuentes: Josh, if I may, I just want to add having someone -- as a veteran, having someone that listens to me and is working for me improves my satisfaction and, in turn, improves the quality of care that I receive. That is an invaluable aspect of the patient advocacy if it works appropriately. And unfortunately for Jason, it didn't work appropriately. For Matt O'Reilly, it hasn't worked appropriately and for so many other veterans. And if we're able to get that to work well, you're going to see an increase in satisfaction, you're going to see an increase in the quality of care the veterans receive.
Warren Goldstein: I couldn't agree more. I think Marv hit the nail on the head here when he said that the patient advocate needs to feel empowered to help or serve their client and their client is the veteran -- not the medical center director or their boss. So I couldn't agree with you more when you said that the patient advocate needs to be sort of independent on their own working for their client which is the veteran, not the medical center director.
Marv Simcakoski: And one other thing I liked to mention, for David Riley, you know, to go in and get a prescription refilled and just to be said "no" -- I mean, that's crazy. If any doctor's know anything about pain meds and that you can't tell somebody "no" cold turkey because, you know, all it's going to lead to is a withdrawal. And that's just painful and, I guess, to me that-that tells me that who ever was in charge didn't know anything about prescriptions and how they effect the patient so I feel for you there.
Heather Simcakoski: One thing I want to ask is that, you know, all of the changes are hopefully really wonderful. But how are we really going to measure the success of the patient advocacy? One of the questions I asked when I was in Tomah [Wisconsin] was what their goals are for their patient satisfaction and they gave me a goal. And I said, "Well is that a standard across all VAs?" And, from what I understand, there's really not a standard of quality care . And it would be nice to see that there are goals and customer satisfaction that all VAs are kind of held to the same standard and we're measuring that across the board because there wasn't, from what I understand, to measure what is success at one location might not be success at another.
Dr. Carolyn Clancy: So could I just respond to that? Uhm. We use the same metrics and tools that the rest of healthcare does. In fact, our -- actually, for access, our overarching goal is what the veterans tell us -- it is a patient satisfaction, patient experience survey, that we take out some of the items and basically say 'in the last six months, when you needed care, urgently or right away, could you usually or always get it?' Same thing for routine care and we break that up by primary care and specialty care and so forth. But that is the goal rather than wait times which can mean a whole lot of different things and different circumstances. The question of how do we map that onto managing pain and the issues that we are talking about today, I think that is really interesting so I will take that back. But we actually are comparing ourselves a lot to some of the best in the private sector and we do actually make a lot of this information publicly. We need to do a much better job of making it understandable, that's very high on our list but we take that very seriously.
Josh Rising: And I think a related question I heard too was assessing the performance of the office of the patient advocacy in terms of how well that that office was doing in terms of meeting the goals that had been set out. So that's also a kind of --
Dr. Carolyn Clancy: Yes.
Josh Rising (Con't): -- challenge.
Dr. Carolyn Clancy: I think that's going to be a very big challenge in sort of setting this up in making sure that we've got a consistent approach. Uh, our facilities will all be having community meetings as they do on a regular basis and raising this issue for the veterans and so forth in their communities as well because I think we'll get some ideas because that is the essence of the chain of command issue, right? And what you need is an approach that doesn't just work sometimes because with one leadership team it worked great but you know when people change and rotate out so some of our facilities have the patient advocate report up through those who worry [?] and are in charge of quality and safety and so forth -- which makes a lot of sense. If you've got a gifted person in that role, you know, that works very well. If you have a person who is not as skilled, it probably wouldn't work so well. So what we need to get and arrive at is a consistent approach because I think you said that -- right? -- how do we know that this is working well? Ultimately part of how we know is going to come from the veterans. And Secretary [of VA]'s approach means that we are testing a variety of ways not only to use standard surveys because those are part of the healthcare landscape now but also trying to get more real time data. Believe it or not, like many other spheres of life, veterans have a lot to say on Twitter, in Facebook and so forth. And the really great news is we can learn a great deal from that if we're -- and translate what we're hearing into actions to address the problems.
Does anyone see the problem?
The VA's Dr. Clancy seems to think it's her meeting.
Throughout she tries to dominate.
To impart wisdom?
No, just to flap her gums.
She misunderstands what Heather says and yet goes on and on. Josh Rising nicely redirects her and she's still yammering away.
The VA needs to start coming to roundtables and hearings to listen.
It might be really great if officials were just instructed to listen.
In a roundtable, they could speak at the end.
But clearly Dr. Clancy isn't able to listen and pay attention.
ADDED 12/2/16 at 4:27 pm EST: A number of e-mails are expressing interest in the roundtable. I'm adding the video:
The following community sites updated:
Iraq
Glenn Greenwald 
Andy Hearn 
Will Black 
Neil Clark 
Brett McGurk 
