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Soldiers Face Neglect, Frustration At US Army's Top Medical Facility

New post to deal with problems at Walter Reed

http://www.cnn.com/2007/POLITICS/03/08/walter.reed/index.html


WASHINGTON (CNN) -- The Army has created a new post to help address problems at the Walter Reed Army Medical Center, the Army's vice chief of staff announced Thursday.

Gen. Richard Cody said Brig. Gen. Michael Tucker will become the deputy commanding general of the hospital, acting as Walter Reed's "bureaucratic buster."

"Basically, there should be an 'easy-button' for our soldiers and families to go to where someone welcomes them and says 'what is your problem, what are your issues,' " and help them quickly, Cody said.

Tucker, currently stationed at Fort Knox, will work with soldiers recovering from war wounds to help them cut through government red tape.

"He understands soldiers, he understands leading and combat, he understands how to run large organizations," Cody said of Tucker at a round-table meeting.

The appointment of Tucker is part of an action plan for Walter Reed and other Army medical facilities requested by Defense Secretary Robert Gates and Army Chief of Staff Gen. Peter Schoomaker, in response to complaints about the treatment of veterans.

In addition to Tucker's new position, Cody said a 24-hour wounded warrior and family hotline, with a 1-800 number linked directly to the Army Operations Center at the Pentagon, will be available soon.
 
Investigators investigating, again, and again, and again.....

Oh yeah - this military certainly knows that story.
 
I have been to WRMAC several times on visits but I never went to any of the med hold facilities.I am sorry that I never did.While I agree with S-Baker as to the quality of the medical staff,but I have long had problems with how the Medical Corps handles administration and this story is all about poor management/administration. I think my feeling is borne out by the decision to bring in combat arms officers/NCO's to run the med hold side of the house.

http://www.armytimes.com/news/2007/03/TNSwoundedbrigade070308/

New brigade to help soldiers at Walter Reed
By Kelly Kennedy - Staff writer
Posted : Friday Mar 9, 2007 14:04:13 EST

The Army’s vice chief of staff announced a new brigade and a new general officer position to help solve problems at Walter Reed Army Medical Center.

All of the new positions, including 122 new platoon sergeants in the medical hold units, who will form the backbone of a new Wounded Warrior Transition Brigade, have been filled by combat arms soldiers.

“We’re an Army at war and we demand an awful lot of our medical professionals,” Army Vice Chief of Staff Gen. Richard Cody said during a media roundtable at Walter Reed. “We need to let them concentrate on the medical thing.”

Combat arms soldiers, Cody said, have the right level of leadership to take charge of the new brigade.

Cody also announced a new position: deputy commanding general of Walter Reed. That officer will be specifically assigned to help soldiers make it through the outpatient process at Walter Reed. Brig. Gen. Michael Tucker, who most recently served as deputy commander of the U.S. Army Armor Center at Fort Knox, Ky., will be the first to fill that position.

The Wounded Warrior Transition Brigade will replace the medical command overseeing the medical hold and holdover units at Walter Reed. Col. Terrence McKenrick will head the new brigade, with Command Sgt. Major Jeffrey Hartless serving as McKenrick’s senior enlisted soldier.
 
The latest casualty of this tale.


Army Surgeon General Forced To Retire
http://news.yahoo.com/s/ap/20070312/ap_on_go_ca_st_pe/walter_reed

By PAULINE JELINEK, Associated Press Writer March 12, 2007

The Army forced its surgeon general, Lt. Gen. Kevin C. Kiley, to retire, officials said Monday, the third high-level official to lose his job over poor outpatient treatment of wounded soldiers at Walter Reed Army Medical Center.

Kiley, who headed Walter Reed from 2002 to 2004, has been a lightning rod for criticism over conditions at the Army's premier medical facility, including during congressional hearings last week. Soldiers and their families have complained about substandard living conditions and bureaucratic delays at the hospital overwhelmed with wounded from the wars in Iraq and Afghanistan.

Kiley submitted his retirement request on Sunday, the Army said in a statement.

"We must move quickly to fill this position — this leader will have a key role in moving the way forward in meeting the needs of our wounded warriors," Acting Secretary of the Army Pete Geren said in an Army statement.

Geren asked Kiley to retire, said a senior defense official speaking on condition of anonymity because he was not authorized to speak on the record. Defense Secretary Robert Gates was not involved in the decision to ask Kiley to retire, the official said.

Kiley's removal underscored how the fallout over Walter Reed's shoddy conditions has yet to subside. Instead, the controversy has mushroomed into questions about how wounded soldiers and veterans are treated throughout the medical systems run by the military and the Department of Veterans Affairs and has become a major preoccupation of a Bush administration already struggling to defend the unpopular war in Iraq.

"I submitted my retirement because I think it is in the best interest of the Army," Kiley said in Monday's Army statement. He said he wanted to allow officials to "focus completely on the way ahead."

Amid the focus on Walter Reed, Veterans Affairs Secretary Jim Nicholson on Monday ordered his department's clinics to provide details about their physical condition by next week to determine if squalid conditions found at Walter Reed exist elsewhere.

Nicholson has been under pressure to reduce claims backlogs and improve coordination at the VA's vast network of 1,400 hospitals and clinics, which provide supplemental care and rehabilitation to 5.8 million veterans.

The conditions at Walter Reed were detailed last month by The Washington Post. Since then, Gates has forced Army Secretary Francis Harvey to resign and Maj. Gen. George W. Weightman, who was in charge of Walter Reed since August 2006, was ousted from his post.

A number of investigations have been ordered.

President Bush appointed a bipartisan commission to investigate problems at the nation's military and veteran hospitals, and separate reviews are under way by the Pentagon, the Army and an interagency task force led by Nicholson.

In a briefing Thursday for reporters at the medical center, top Army officials said they have moved to fix some of the problems at Walter Reed.

Army Vice Chief of Staff Gen. Richard Cody said that officials have added caseworkers, financial specialists and others to work with soldiers' families on problems they have related to the injuries such as getting loans or help with income taxes.



 
Top Army medic quits over troop care problems
Mon Mar 12, 2007 2:08PM EDT
http://www.asia.reuters.com/article/domesticNews/idUSN1236106420070312
A senior U.S. defense official said surgeon general Lt. Gen. Kevin Kiley had been asked to request retirement by acting Army Secretary Pete Geren. Kiley made the request on Sunday and was immediately replaced by his deputy, Maj. Gen. Gale Pollock, the Army said.

"I submitted my retirement because I think it is in the best interest of the Army," Kiley said in a statement. "We are an Army Medical Department at war, supporting an Army at war -- it shouldn't be and it isn't about one doctor
."

If MG Pollack is confirmed as the new US Army Surgeon General, she will be the first non-doctor to hold that position (she is a nurse).  http://www.armymedicine.army.mil/leaders/pollock.html

 
blackadder1916 said:
Top Army medic quits over troop care problems
Mon Mar 12, 2007 2:08PM EDT
http://www.asia.reuters.com/article/domesticNews/idUSN1236106420070312
If MG Pollack is confirmed as the new US Army Surgeon General, she will be the first non-doctor to hold that position (she is a nurse).  http://www.armymedicine.army.mil/leaders/pollock.html

And probably someone beter inclined to understand soldier care VS detached clinical approach.
 
geo said:
And probably someone beter inclined to understand soldier care VS detached clinical approach.
In agreement here, but it looks like "wait and shoot".

http://www.army.mil/-news/2007/03/12/2225-army-surgeon-general-to-retire/
WASHINGTON (Army News Service, March 12, 2007) - Yesterday, Lt. Gen. Kevin C. Kiley, Army Surgeon General and commanding general of Army Medical Command, submitted his request to retire from the U.S. Army to Acting Secretary of the Army Pete Geren. Maj. Gen. Gale Pollock, current Deputy Surgeon General, assumed Kiley's duties until a successor is named.

Geren further directed immediate convening of the required advisory board who will recommend a slate of candidates from among officers in the Army medical department for consideration as the next Surgeon General. The officer ultimately selected must be approved by the president and confirmed by the Senate.

"We must move quickly to fill this position - this leader will have a key role in moving the way forward in meeting the needs of our wounded warriors," Geren said. "We have an Army action plan underway under the leadership of the Vice Chief of Staff of the Army, General Dick Cody, and the Surgeon General has a critical role in the execution of that plan. I am confident Maj. Gen. Pollock will ably lead the Army Medical Department during this transition period." ..............
 
Interesting follow-up from USA Today: http://www.usatoday.com/news/washington/2007-03-15-walter-reed-vip_N.htm  (More info and photos in article)

VIP ward at Walter Reed gets scrutiny By Gregg Zoroya, USA TODAY

Disclosures of substandard housing for troops treated at Walter Reed Army Medical Center are prompting Congress to investigate whether the Army is running a plush ward at the complex for VIPs at the expense of ordinary war casualties.
House investigators are asking "if the allocations of resources is in any way adversely impacting the treatment of the troops," Rep. John Tierney, D-Mass., told USA TODAY in response to inquiries about the six-suite ward. Tierney leads a House subcommittee investigating allegations of poor care at Walter Reed. "Our nation's military, our returning heroes, are the true VIPs," he said.
The large, comfortable suites on the hospital's top floor are reserved for the president, the vice president, federal judges, members of Congress and the Cabinet, high-ranking military officials and even foreign dignitaries and their spouses. The only enlisted members of the military who are eligible to stay there are recipients of the Medal of Honor.

The suites have carpeted floors, antique furniture and fine china in the dining rooms. That's a stark contrast to mold- and mice-ridden housing that some wounded troops had been found to be living in.

The Washington Post disclosed complaints about housing conditions for war wounded at Walter Reed last month, triggering some immediate repairs by the Army and investigations by Congress, the White House and the Pentagon. The secretary of the Army, Army surgeon general and the hospital commander have been fired or forced to leave office.

The ward is staffed by 21 nurses, doctors and clinicians. It averages 72 inpatients and 2,600 outpatients a year, said administrator Frances Cheever.

Cheever said the staff-to-patient ratio is the same in the rest of Walter Reed as in the special ward.

The Eisenhower Executive Nursing Suite, also known as Ward 72, features heightened security, including bullet-proof windows and secure telephone lines. Among the other touches are flat-panel televisions and curio cabinets filled with gifts from foreign leaders. The ward is named for former president Dwight Eisenhower, who died at Walter Reed in 1969.

Army spokeswoman Cynthia Vaughan said it costs $950,000 a year to run the ward, or less than two-tenths of 1% of Walter Reed's annual expenses. But she acknowledged that salaries for nurses and other medical personnel come out of the general budget.



http://www.washingtonpost.com/wp-dyn/content/article/2007/03/12/AR2007031200544.html (More details in article)

Surgeon General Of Army Steps Down
By Josh White
Washington Post Staff Writer
Tuesday, March 13, 2007; Page A01
Lt. Gen. Kevin C. Kiley, the Army's surgeon general, agreed to step down from his position after weeks of intense public criticism stemming from revelations about poor conditions at Walter Reed Army Medical Center, defense officials said yesterday.
Though there had been repeated calls for Kiley to resign as the Army's top doctor during hearings on Capitol Hill, he refused to step aside even as he was grilled about horrid living conditions and a tangled bureaucracy at the Army's flagship hospital. Kiley at first played down reports of problems at Walter Reed-- where he had served as commander from 2002 to 2004 -- but later was far more contrite.

Kiley submitted his retirement request on Sunday, according to an Army news release. Defense officials said Pete Geren, the acting secretary of the Army, had sought Kiley's removal in recent days. Geren has been in his new role only since last week, when he was tapped to replace Francis Harvey, who resigned as Army Secretary as the scandal began to unfold.
The Army's inspector general reported yesterday that the service is lacking in critical staff and formalized training in caring for soldiers. The inspector general also found that the Army's system for determining disability benefits is overwhelmed by the number of wounded.Army officials quickly named a temporary replacement for Kiley -- his current deputy, Maj. Gen. Gale S. Pollock. She will serve until an advisory board recommends a new surgeon general.

Personal Note: Lt. Gen. Kiley was an impressive speaker and leader, he will be missed by their Army.

 
Personal Note: Lt. Gen. Kiley was an impressive speaker and leader, he will be missed by their Army.

Have to differ with you. He wont be missed and he was hardly a leader. When the crap hit the fan a leader would have stepped up and taken full responsibility, rather than relieving MG Weightman who had only been in command for 6 months.
 
Maj. Gen. Weightman was fired by then-Army Sec. Francis Harvey.  I met him on several occasions and beg to differ.
 
this news story broke out just before i baught my ticket when i decided to leave my stint in australia.

i was going to go to america, and try to get into iraq.  part of my decision in coming to canada instead.  i have heard some horror stories with my time here.  but this all comes from long hair flat footers.  all antiwar crap.

is there any truth to canadians being mistreated?
 
Weightman Takes Blame For Reed Scandal
Declining Support For War May Lower Tolerance For Bureaucracy, He Says
http://www.armytimes.com/news/2007/03/gns_weightman_032007/
By Tom Philpott - The Honolulu Advertiser    Posted : Tuesday Mar 20, 2007 10:22:55 EDT

"We didn't deliver what they needed and we didn't hear their cries for help," said Maj. Gen. George W. Weightman, who was fired March 1 as commander of Walter Reed Army Medical Center. "I'm not here to let down patients. I'm here to take care of them."

Weightman was recalling how he felt listening to testimony last week of two severely injured Walter Reed outpatients, and the distraught wife of another, describing episodes of institutional neglect that occurred after they moved from inpatient status to join hundreds of outpatients housed on or near the Walter Reed campus, usually for months, sometimes for years.

"I'll tell you what affected me the most," Weightman said of their testimony. "It's the frustration I heard from these patients and their families with our system. And I'm responsible for all that."

Weightman explained what he thought went wrong at the Army's premier hospital in an hourlong interview. There were breakdowns in leadership; a support staff too small to handle needs of a large outpatient population; hiring challenges tied to the closure of Walter Reed in 2011; a medical and physical disability board maze designed for a draft-era army, not for wounded volunteers fighting to stay in service.

Weightman also cited what he perceives as a sharp decline in support for the war among military families. That can raise a family's anger at terrible injuries to loved ones and lower tolerance for bureaucratic hassles as they seek proper care and support.

Weightman's shouldering of blame for all problems at Walter Reed surprised some because many of the incidents of neglect and bureaucratic inertia occurred before he took command Aug. 25.

Reports last month described some outpatients as stuck in Building 18 just off the main campus, in rooms with holes in the wall, mold and mouse droppings. They described a lack of staff supervision to help schedule and escort patients to appointment, a particular problem for brain-injured patients. They referred to a bog of forms to fill out.

Weightman said he visited four of five buildings for outpatients but not that one. In September, residents had complained about rodents and cockroaches. Weightman sent a preventive medicine team which traced the problem to unsanitary conditions including food in the rooms.

He received no more complaints about the building until the Washington Post article, he said. Weightman said he didn't know about the leaky roof that had left mold growing in two of 54 rooms and in five bathrooms. He learned 26 rooms needed some repair.

"Quite frankly, if relieving me allows the Army and the nation to move forward at a faster pace to improve the care of these soldiers and their families, then I think it will serve a purpose," Weightman said.

He expects to retire when investigations are completed
.

 
Quite the burden
but, with a nation at war and dissabled soldiers rolling in by the busload, there should have been more resources asked for & provided.  Where was the fella that was looking after the infrastructure.

............ Or, wasn't there one?  did they expect an MD to manage all aspects of running a hospital?
 
Is this just an Army problem or is it service wide ? I bring this up as I was a patient in the US Naval Regional Medical Center at Camp Penaldton and the treatment there was state of the art. In addition discussing this with a few others who have had 'hands on' experience covering quite a number of years our cumulative opinions seem to be the same. No complaints but absolute praise for the US Navy from the corpsman to cutters and hence onward to the rehabilitation experts.
 
Bush Apologizes For Walter Reed Woes
http://news.yahoo.com/s/ap/20070330/ap_on_go_pr_wh/bush
By JENNIFER LOVEN, Associated Press Writer 30 March 2007

President Bush apologized Friday for the shoddy conditions at Walter Reed Army Medical Center and promised during a visit to the facility for war veterans that "we're going to fix the problem."

Critics questioned the timing of Bush's visit six weeks after poor conditions and neglect of veterans were exposed there.

Bush toured the main hospital and Abrams Hall, where soldiers were transferred after they were vacated from the facility's Building 18, the site of moldy walls, rodent infestation and other problems that went unchecked until reported by the media. He said his conversations with those who had been in Building 18 left him "disturbed by their accounts."

"The problems at Walter Reed were caused by bureaucratic and administrative failures," the president told about 100 medical workers and patients at the hospital. "The system failed you and it failed our troops and we're going to fix it."

Among the areas of the hospital that Bush toured were a typical — but empty — patient room in Abrams Hall that featured a large wide-screen television and a Macintosh computer, and the physical therapy unit of the main hospital. Along the way, he awarded 10 Purple Hearts to soldiers recovering from serious wounds suffered in Afghanistan and Iraq.

"It is not right to have someone volunteer to wear the uniform and not get the best possible care," the president said at the end of his more than two-hour visit, cut short from its planned length by almost an hour. "I apologize for what they went through and we're going to fix the problem."

He said important steps, including the replacement of military leadership in charge of the hospital and the establishment of several commissions to study the facility and the broader military health care system, have been taken already.

But, Bush added: "We're not going to be satisfied until everyone gets the kind of care that their folks and families expect."

The president devoted much of his brief statement to praising the medical care that members of the military and veterans receive at Walter Reed.

"The soldiers and Marines stay here only for a few months, but the compassion they receive here stays with them for a lifetime," Bush said. "Americans must understand that the problems recently uncovered at Walter Reed were not the problems of medical care. The quality of care at this fantastic facility is great and it needs to remain that way."

Retired Maj. Gen. Paul Eaton, among retired military officers who took part in a conference call before Bush's visit, praised the president for seeing wounded soldiers. But, he added: "I'm convinced he would honor them more if he would refrain from using soldiers as props in political theater."

"I would be very happy to see him do the Walter Reed visit more like the commander and secondarily as an inspector general, rather than as a politician," he said.

Bobby Muller, president of Veterans for America, said Bush wasn't seeing areas of the hospital most in need of change. He cited Ward 54, where soldiers are suffering from acute mental health conditions, and outpatient holding facilities where soldiers see long waits to get processed out of the Army.

"Walter Reed is not a photo-op," Muller said. "Walter Reed is still broken. The DOD health care system is still broken. ... Our troops need their commander in chief to start working harder for them."


White House spokeswoman Dana Perino called it "an unfortunate characterization" to say Bush was using Walter Reed as merely a picture-taking opportunity. She said it took some time to clear enough room on the president's schedule to spend an afternoon with patients and staff at Walter Reed.

"There is no more personal moment that he has, and it's one of the memories that I cherish the most of working for the president, because you see his gratitude, and they share hugs, and they share laughter, they share tears," she said.

Perino also said that when the situation at Walter Reed first came to light, "the president immediately took action."

Walter Reed is considered one of the Army's premier facilities for treating the wounded. The revelations in mid-February of poor treatment and neglect of those wounded in war was an embarrassment to Bush, who routinely speaks of the need to support the troops and praises the care they receive back home.

Troops and veterans say many of the issues have been well-known for a while, and have long been in need of greater attention.

In the wake of reports of problems at Walter Reed, three high-level Pentagon officials were forced to step down and lawmakers on Capitol Hill were outraged. This week, the House voted to create a coterie of case managers, advocates and counselors for injured troops. The bill also establishes a hot line for medical patients to report problems in their treatment.
 
Military conflict : Are warnings of the health of the Army falling on deaf ears?

General Richard A. Cody graduated from West Point in 1972, flew helicopters, ascended to command the storied 101st Airborne Division, and then, toward the end of his career, settled into management; now, at fifty-seven, he wears four stars as the Army Vice-Chief of Staff. This summer, he will retire from military service.

In 2004, in a little-noted speech, Cody described the Army’s efforts to adapt to its new commitments. (It was attempting to fight terrorism, quell the Taliban, invade and pacify Iraq, and, at the same time, prepare for future strategic challenges, whether in China or Korea or Africa.) The endeavor was, Cody said, like “building an airplane in flight.”

Last week, the General appeared before the Senate Armed Services Committee and testified that this method of engineering has failed. “Today’s Army is out of balance,” Cody said. He continued: "The current demand for our forces in Iraq and Afghanistan exceeds the sustainable supply, and limits our ability to provide ready forces for other contingencies. . . . Soldiers, families, support systems and equipment are stretched and stressed. . . . Overall, our readiness is being consumed as fast as we build it. If unaddressed, this lack of balance poses a significant risk to the all-volunteer force and degrades the Army’s ability to make a timely response to other contingencies."

In 2006, the Army granted eight thousand three hundred and thirty “moral waivers” to new recruits, meaning that it had accepted that number of volunteers with past criminal charges or convictions. The percentage of high-school graduates willing to serve is falling sharply from year to year; so are the aptitude-exam scores of new enlistees. To persuade soldiers and young officers to reënlist after overlong combat tours, the Army’s spending on retention bonuses increased almost ninefold from 2003 to 2006.

In normal times, when an active four-star general implies in public that the Army is under such strain that it might flounder if an unexpected war broke out, or might require a draft to muster adequate troop levels, he could expect to provoke concern and comment from, say, the President of the United States. Some time ago, however, George W. Bush absolved himself of responsibility for his Iraq policy and its consequences by turning the war over to General David H. Petraeus, Cody’s four-star peer, and the champion of the “surge” policy, who will testify before the Senate Armed Services Committee this week.

Petraeus, too, is a loyal Army man, but he has distinctive views about military doctrine; he has long advocated a change in orientation by the Army, away from preparations for formal warfare between governments and toward the challenges of counter-insurgency and nation building. (“Learning to Eat Soup with a Knife” is the title of a book co-written by one of Petraeus’s advisers, Lieutenant Colonel John A. Nagl.) To buy time in Iraq, Petraeus has lately argued within the Pentagon that the Army must buck up and accommodate his need for heavy troop deployments, despite the strains they are creating, and he has publicly fostered an unedifying debate about how to most accurately assess failure and success in Iraq, as if such an opaque and intractable civil conflict could be measured scientifically, like monetary supply or atmospheric pressure.

There is, of course, empirical evidence of declining violence in Iraq, which has coincided with Petraeus’s command. The additional troops he requested have certainly been a factor, but not even Petraeus can say how much of one. At best, during the past year he has helped to piece together a stalemate of heavily armed, bloodstained, conspiracy-minded, ambiguously motivated Iraqi militias. Nobody knows how long this gridlock will hold.

A war born in spin has now reached its Lewis Carroll period. (“Now here, you see, it takes all the running you can do, to keep in the same place.”) Last week, it proved necessary for the Bush Administration to claim that an obvious failure—Iraqi Prime Minister Nuri Kamal al-Maliki’s ill-prepared raid on rival Shiite gangs in Basra, which was aborted after mass desertions within Maliki’s own ranks—was actually a success in disguise, because it demonstrated the Iraqi government’s independence of mind.

In this environment, it is perhaps unsurprising that General Cody’s plainspoken, valedictory dissent about the Army’s health attracted little attention. His testimony marked a rare public surfacing of the contentious debates at the Pentagon over the strategic costs of the surge. These debates involve overlapping disagreements about doctrine (particularly the importance of counter-insurgency), global priorities (Iraq versus Afghanistan, for instance), and resources. At their core, however, lies Cody’s essential observation: the Army is running on fumes, but Petraeus and his fellow surge advocates are driving flat out in Iraq, with no destination in sight. It hardly matters whether Petraeus would recommend keeping a hundred and thirty thousand or more combat troops in Iraq for a hundred years, or only ten. Neither scenario is plausible—at least, not without a draft or a radical change in incentives for volunteers. Flag officers in the Bush Administration’s military have learned that they can be marginalized or retired if they speak out too boldly. The Administration does not romanticize the role of the loyal opposition. Last month, Admiral William J. Fallon, the commander of U.S. forces in the Middle East, announced his early retirement, under pressure from the White House, after he argued privately for a faster drawdown from Iraq, to bolster efforts in Afghanistan and to restore a more balanced global military posture. Publicly, Fallon also described the “drumbeat of conflict” against Iran as “not helpful.”

The suppression of professional military dissent helped to create the disaster in Iraq; now it is depriving American voters of an election-year debate about the defense issues that matter most. These include the nature and the location of the country’s global adversaries and interests, the challenge of a revitalizing Al Qaeda in Pakistan, the conundrum of Iran, the failing health of the nuclear nonproliferation regime, and, to address all this, the need for a sustainable strategy that restores the Army’s vitality and makes rational use of America’s finite military resources. To implement such a strategy, it would not be necessary to rashly abandon Iraq to its fate, but it would be essential, at a minimum, to reduce American troop levels to well below a hundred thousand as soon as possible. In the long run, success or failure for the United States in Iraq will not hinge on who wins the argument about the surge; it will depend on whether it proves possible to change the subject.


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