DOGE Files #1: VA Dental Care

President-elect Trump announced the establishment of the Department of Government Efficiency (DOGE), led by Elon Musk and Vivek Ramaswamy, seeking public input for improved government efficiency. A traveling veteran shared a frustrating experience navigating VA dental care, proposing recommendations to streamline access to medical benefits and enhance customer service for veterans.

The VA 500, Image by Grok 2 mini Beta.

Earlier this week, President-elect Trump announced the creation of the Department of Government Efficiency (DOGE) to be headed by Elon Musk and Vivek Ramaswamy. Both Elon and Vivek have publicly called for citizen input on ways we might make the government more efficiently serve we, the people. This short blog is my first input to the DOGE files…

Last week, while traveling away from home, a crown on one of my teeth rather inconveniently fell off. On a Saturday night, of course. My dental care is normally provided through the Department of Veterans Affairs (Hampton, Virginia location), who has managed this care through its Community Care program, which refers care to civilian providers who are reimbursed by the VA. I have generally found this care to be both good quality and responsive.

On Monday afternoon, I called the local (Boise, Idaho) VA Community Care office to seek a provider to cement the crown back on. The representative at Community Care (Biose) informed me that because I am a traveling veteran, that I needed to speak to the Traveling Veteran Coordinator and connected me to that office. I described the problem and desired resolution to the Traveling Veteran Coordinator (Boise), who then informed me that I must speak to the Traveling Veteran Coordinator (Hampton), since that is my VA Primary Care Provider’s location. I described the problem and desired resolution to the Traveling Veteran Coordinator (Hampton), who informed me that because I receive care through the Community Care program, I must speak to the Community Care Coordinator (Hampton) for a referral. I described the problem and desired resolution to the Community Care Coordinator (Hampton), who informed me that because I am traveling in Boise, I must speak to the Community Care Coordinator (Boise). I had completed a full lap of the Boise/Hampton – Community Care/Traveling Veteran matrix!

I informed the representative that I had now completed a complete lap of the VA500 and asked how we might break out of this infinite loop. Somewhere along the way I had been directed to use the VA Community Care provider look-up tool (which I had already done) and found that of the three dental providers listed, one had a link to an SEO-aggregator website and call center that put me in a do-loop of trying to get back to the locally listed office (no luck), and the others could not schedule care without first receiving a Community Care authorization from the VA.

Luckily, I ended up on the line with a kind southern woman (from the Traveling Veteran (Boise) office, I believe, but I was a bit dizzy by now) who took responsibility for my case and told me that the solution required that I send an “e-mail” through the MyHealth secure messaging portal to my PCM in Hampton (but not the Dental Office in Hampton) requesting that she complete a Traveling Veteran referral form and forward it to Boise for action. The kind representative called me back at each step in the process that followed: PCM submits the form, Traveling Veteran (Boise) receives and endorses the form, Community Care (Boise) receives and endorses the form, and Dental (Boise) receives and endorses the form.

At this point (Tuesday midday), my VA Valkyrie kindly informed me that the next call I would receive would come from the VA Dental (Boise) scheduler and that I should take care not to miss the call because they would only call once. VA Dental (Boise) called Tuesday afternoon and scheduled me for an appointment the following morning. Bob’s your uncle, I got my tooth fixed. Easy peasy lemon squeezy.

Recommendations for DOGE consideration:

  • Any Veteran who is entitled to medical and dental benefits carries a VA ID card. For any Veteran who is in a community care program, this card should act functionally like an insurance card and be accepted on a walk-in/call-in basis to get an appointment with a community care provider.
  • The list of community care providers on the VA website must be updated and must be purged of listings of 3rd party SEO-aggregator websites that don’t belong to or connect with a participating provider.
  • Any Veteran who is entitled to medical and dental benefits should be able to call any VA facility and be provided with the needed appointment or referral in one phone call, with no more than one transfer.
  • Any Veteran who is entitled to benefits should be able to walk into any VA facility nationwide and either be seen on a walk-in basis if available, be triaged and provided an appointment, or be provided a community care appointment, in one conversation with one representative.
  • Any Veteran who is entitled to medical and dental benefits should be able to call any community care provider directly and schedule needed care using the VA ID card as proof-of-benefit, and without needing a prior referral from the VA.
  • All of these recommendations support a governing principle: design the VA customer service process(es) to be maximally efficient and friendly to the Veteran, rather than the VA Organizational Chart. A combination of technology solutions and organizational and training solutions to provide single points of entry and service to coordinate the Veteran’s seamless access to all of their benefits is suggested.
  • A broader governing principle recommended to the DOGE: If a citizen is entitled to benefits, the Government, who already possesses the data to determine eligibility and complete enrollment, should determine eligibility and complete the enrollment automatically for the citizen, and provide them with an easy-to-understand statement of the benefits for which they have been enrolled, and both a web site and a single point of (human) contact for access, scheduling, assistance, questions, and appeals.

Story of Civilization: Vol. 1.6

Elam
The Sumerians

The “Little” Gudea
Ruler of Lagash, c. 2144-2124 BC.
Louvre

The City of Susa, in ancient Elam, east of the lower Tigris, shows signs of having been occupied for 20,000 years and evidence of advanced culture in at least 4500 BC. The Elamites had copper tools and weapons, mirrors and jewelry, writing and trade at least as far as Egypt and India (which of course implies the contemporary existence of trading cultures in those places also). Susa itself survived over 6000 years of empire and conquest: Sumeria, Babylon, Egypt, Assyria, Persia, Greece, Rome and into the 14th century AD.

We don’t know where the Sumerians, west of the lower Euphrates and including Ur, Uruk, Eridu, Larsa, Lgash, Nippur, and Nisin, came from. And perhaps the question itself is meaningless in a world where the places we occupy have mostly been occupied for tens of thousands of years. We do know that when Sumeria was already old, around 2300BC, their poets attempted to recreate their own history. In so doing, they traced their kings back over 400,000 years, recounting a golden age before a great flood; one of these legendary kings was Gilgamesh. An 8-foot layer of silt at Ur, discovered by Woolley in 1929, gives reality to legend, and below it lie the remains of a pre-diluvian culture. One of the earliest known poems mourns the sacking of Lagash and the rape of her patron goddess by Lugal-zaggisi. It was customary to steal the statues of the patron gods of a city when sacking it; the city could not be properly re-established without them. **

The Stele of Naram-sin (third son of Sargon I, “The Great”)
c. 2254-2218 BC, Akkadian Empire

The Stele commemorates the victory of Naram-sin over the Lullubi people of the Zagros mountains.

The Stele was taken out of Mesopotamia in the 12 century BC by the Elamite King Shutruk-Nakhunte and was found in 1898 at the site of Susa. Shutruk-Nakhunte added his own inscription to the Stele:

“I am Shutruk-Nahkunte, son of Hallutush-Inshushinak, beloved servant of the god Inshushinak, king of Anshan and Susa, who has enlarged the kingdom, who takes care of the lands of Elam, the lord of the land of Elam. When the god Inshusinak gave me the order, I defeated Sippar. I took the stele of Naram-Sin and carried it off, bringing it to the land of Elam. For Inshushinak, my god, I set it as an offering.”

Not long after the sack of Lagash, a king of Akkad named Sargon I, the non-royal son of a prostitute left in a basket of rushes, earned the title ‘the Great’ by sacking many cities and killing many men. Among those was Lugal-zaggisi. Sargon ruled for 45 years, conquering east, west, and south, including the kingdom of Elam and the lands all the way to the Persian Gulf. The wheel of history continues to turn, and eventually Elam and Amor ruled Sumeria for 200 years, before Hammurabi came from Babylon in the north, eventually capturing Elam and its king, ending the rule of the Sumerians and establishing the rule of the Semites that lasted until the rise of Persia.

The Sumerian City-States were ruled by patesi, or priest-kings, in palaces constructed with only two entrances and narrow passages guarded closely to prevent intruders. The Patesi took great pains not to lose power the way they had themselves gained it. Kings led their armies from the front, and wages war for practical purposes, without the veil of nationalistic language of modern times. “King Manish-tusu of Akkad announced frankly that he was invading Elam to get control of its silver mines, and to secure diorite stone to immortalize himself with statuary – the only instance known of a war fought for the sake of art.” (SoC 126)

Soon, trade and proximity led to consolidation of the city-states under powerful regional rulers. Societal order was maintained through feudal relationships and codified in a rich body of law. The first known code of laws was proclaimed by King Ur-engur in the name of the god Shamash. Government already knew the utility of religion. Each God had his or her temple, with staff, sacrifices, and rituals. Even Sin was a god – of the moon – and represented with a crescent around his head, a motif later used in Christianity to indicate saintliness. Originally the gods preferred human sacrifice, but as human morality developed, animals became preferred. Reads a tablet from a Sumerian ruin: “The lamb is the substitute for humanity; he hath given up a lamb for his life.”

Women enjoyed equal rights with their husbands over children. Women were permitted to own property, slaves, and businesses, and in the absence (or death) of husband and adult son, to administer the estate. In rare instances, Queens ruled after the death of the King. Women served in temples as domestics or concubines to the Gods or their representatives. Wealthy women wore expensive and fine jewelry and make-up.

In Sumeria also, we find the transition from writing as record-keeping to writing as literature. By 2700BC, great libraries had been built. At Tello, we have found over 30,000 volumes organized into a neat system.

The first architectural vaults belong to the Sumerians, having probably evolved from reed walls bent to join above in a naturally curved, vaulted roof. Wealthy citizens built mansions on hills, decorated them extravagantly with terracotta and tile, and had fine furniture with gold or ivory inlays. Temples were even more ornate, topped with 3, 4, or 7-story Ziggurats.

Strangely, pottery was not as advanced as the rest of Sumerian art. (Although, perhaps we just haven’t discovered any fine examples.)

Sumerian civilization may be summed up in this contrast between crude pottery and consummate jewelry; it was a synthesis of rough beginnings and occasional but brilliant mastery. Here, within the limits of our present knowledge, are the first states and empires, the first irrigation, the first use of gold and silver as standards of value, the first business contracts, the first credit system, the first code of law, the first extensive development of writing, the first stories of the Creation and the Flood, the first libraries and schools, the first literature and poetry, the first cosmetics and jewelry, the first sculpture and bas-relief, the first palaces and temples, the first ornamental metal and decorative themes, the first arch, column, vault and domes. Here, for the first known time on a large scale, appears some of the sins of civilization: slavery, despotism, ecclesiasticism, and imperialistic war, It was a life differentiated and subtle, abundant and complex. Already the natural inequality of men was producing a new degree of comfort and luxury for the strong, and a new routine of hard and disciplined labor for the rest. The theme was struck on which history would strum its myriad variations.

SoC 134

“Within the limits of our knowledge…” Certainly some of the paragraph quoted above requires revision. But only for attribution and timing; not for theme and content. Perhaps Sumeria is the first time we know of. At the same time, it is entirely possible that a lost civilization had created all the same patterns.

** Note: for a fun and very interesting look at this period, I recommend the podcast series Kings of Kings by Dan Carlin, part of his Hardcore History series.

Story of Civilization: Vol. 1.5

Chapter 6: The Prehistoric Beginnings of Civilization
– Paleolithic Culture
– Neolithic Culture
– The Transition to History

In this section, we are reminded by how many discoveries of the past 90 or so years have revised our understanding of our ancient past. The family tree of Homo Sapiens has likewise undergone much revision. Also, Durant acknowledges that he is only skimming the surface on prehistoric man – the necessary cost of such a broad endeavor is the simplification that opens one to criticism by more narrow experts. So it goes.

Durant again suggests a ‘heartbeat’ of history, this time in our prehistory, and he hints at bursts of progress between the four ice ages of the past 500,000 years, and implies some contraction and stagnation during them. And he cautions against the conclusion that the evidence transmitted to us through the millennia is representative of those ancient civilizations. “Like the Neanderthals, Cro-Magnon men are known to us as “cave-men,” because their remains are found in caves; but there is no proof that these were their sole dwelling place; it may be again but a jest of time that only those of them who lived in caves, or died in them, have transmitted their bones to archeologists.” (SoC, 92)

All the elements of civilization, save writing and the state, are present in our evidence of the old stone age (characterized by unpolished stone tools). And it appeared, even in Durant’s time, that tools, fire, painting, and sculpture were created not just by Sapiens, but by Neanderthal and Cro-Magnon as well. Those who discovered old stone age cave paintings in the 19th century were routinely accused of hoax or worse, their discoveries only being verified after their own passing. The paintings themselves, dating to around 16,000 BC, appear to be of mature and refined technique, evidence that art was not new, but was well-developed at the time. And that is just the paintings we have found, and the strokes that survived the ages. “Will Leonardo’s Last Supper, or El Greco’s Assumption, bear up as well as these Cro-Magnon paintings after twenty thousand years?” (SoC, 97).

The whole interpretation of history as progress falters when we consider that these statues, bas-reliefs, and paintings, numerous though they are, may be but an infinitesimal fraction of the art that expressed or adorned the life of primeval man. What remains is found in caves, where the elements were in some measure kept at bay; it does not follow that prehistoric men were artists only when they were in caves. They may have carved as sedulously and ubiquitously as the Japanese, and may have fashioned statuary as abundantly as the Greeks… They may have created masterpieces far superior to the fragments that survive.

SoC 97

Polished stone tools mark the transition to the Neolithic age around 10,000 BC in Asia and 5,000 BC in Europe. First discovered in trash mounds throughout Europe, they were accompanied by evidence of a thriving culture. Discovered first in Switzerland and later throughout the world, including modern civilizations, lake-dwellers, living on pile-dwellings, ate over 120 kinds of fruit. Appearing around the same time is a rock-carving depicting a plow pulled by two oxen. The new stone age marked one of the two most significant transitions in our history – from hunting to agriculture. It also shows the first evidence of domestication of animals, starting with our most faithful companion, the dog (around 8000 BC), then sheep, pigs, cows, and finally the horse.

The Neolithic also provides the first evidence of large-scale building and mining: pulleys, levers, grindstones, awls, pincers, axes, ladders, hinges. 10,000 years ago in Belgium, a miner was crushed by a falling rock; his pick remained clasped in his hands 100 centuries later. The Lake-dwellers used mortise and tenon joinery. Semi-precious stones were traded across long distances.

The coming of metals, copper, bronze, and iron, accompanied writing as we transition to recorded history. Here, the old terms copper-age, bronze-age, and iron-age have little meaning in terms of time, as they were ushered in (and sometimes skipped altogether) at different times in different locations. Writing progressed from pictorial representation of thoughts, to symbolic representation of syllables, and finally to symbols representing the first sound of the syllable. The Semitic names of the first two symbols gave us the word alphabet; the Phoenicians didn’t invent it, but did market it to the Mediterranean world and established a brand that has lasted perhaps 5000 years.

In undertaking a Story of Civilization, Durant recognized that his Story likely includes only a small minority of civilizations that have existed. Stories of lost civilizations abound in every culture and mythology. Some of them were certainly different and probably exceeded those we have discovered.

As Durant was writing, there was vigorous debate about where to locate the ‘cradle of civilization.’ Since Napoleon’s time, it had been assumed to be Egypt. In Durant’s the case was being made for Mesopotamia. One hundred years from now, it may very well be different, and older. Time conceals; and time may or may not tell.

Story of Civilization: Vol 1.3

Venus of Hohle Fels, 35,000–40,000 B.C. Image via Wikimedia Commons.

Chapter 4 (cont): The Moral Elements of Civilization
– Sexual Morality
– Social Morality

Faithful readers (there are a few)… I’ve been married to 28 years. There is little good that can come of me describing the varying sexual morals through history – lots of sex, young and old, with lots of partners; marriage variously non-existent, short, serial, and polygamous; virginity proof of unworthiness or infertility; and monogamy arising only recently, as a form of slavery and production of offspring to work the fields. So I won’t.

Every vice was once a virtue, necessary in the struggle for existence; it became a vice only when it survived the conditions that made it indispensable; a vice, therefore, is not an advanced for of behavior, but usually an atavistic throwback to ancient and superseded ways. It is one purpose of a moral code to adjust the unchanged – or slowly changing – impulses of human nature to the changing needs and circumstances of social life.

SoC, p. 51

Durant, who studied philosophy deeply before writing history, seems to come down on a version of moral relativism. However, his is more grounded than the moral relativism that sometimes pervades public discourse today – that which holds that the fact of many different moral systems means that none of them can be correct, and that as a result all are equally valid (a view that I do not hold). Durant’s version is more practical, grounded in the influences of environment and the stages of development of civilization. Morals serve to guide behavior in ways that are advantageous first to survival, and probably only incidentally, to the development of civilization. And in fact, that development serves to disrupt the morals that helped it along, until gradually they are supplanted by a new set, no less true than the old, but due to changing circumstance, environment, and experience, more useful. As the state emerges and the size of a culture grows, morals (as a commonly understood part of life) require additional weight, and law and religion provided that structure.

Morals, then, are soon endowed with religious sanctions, because mystery and supernaturalism lend a weight which can never attach to things empirically known and genetically understood; men are more easily ruled by imagination than by science.

SoC, p. 56

Story of Civilization: Vol 1.2

Chapter 3: The Political Elements of Civilization
– The Origins of Government
– The State
– Law
– The Family

If the average man had had his way, there would probably never have been any state. Even today he resents it, classes death with taxes, and yearns for that government which governs least. If he asks for many laws it is only because he is sure that his neighbor needs them; privately he is an unphilosophical anarchist, and thinks laws in his own case superfluous.

SoC, p. 21

In primitive societies, all governance was local: the province of the family patriarch; ad-hoc councils of elders in larger groups when specific events demanded such organization. If war was waged between tribes, a war-time Chief might emerge. In peace, he usually went back to the role of patriarch of his own family; the tribe needed little central leadership.

War acted as Darwin’s agent of natural selection, raising the level of competition and selecting for those who excelled in “courage, violence, cruelty, intelligence, and skill.” As in our time, it was a driver of innovation, and introduced new concepts of organization. Insofar as agriculture created property, war (frequently over property rights) created the state. As agriculture led to trade, and trade to writing, the state barely precedes the written word. In its creation, we mark the transition from kinship to domination.

Every state begins in compulsion; but the habits of obedience become the content of conscience, and soon every citizen thrills with loyalty to the flag.

SoC, p. 24

Wouldn’t it be interesting to ask Will Durant about these words during these interesting times, when so many (or at least so few, loudly) are decrying as unjust the very land upon which many of our monuments stand, and when so many attack those very monuments. Is this a natural part of the ebb and flow of history, the result of too long a time spent in affluence and peace? Whither the end of the unrolling of rights of conquest, as every piece of land on our globe has changed hands untold times amongst cultures extinct, revived, decaying, or thriving?

The state grows to consume authority over more and more of life, as men decide that they’d rather one unjust authority than many. The insatiable appetite of the state, in its early form almost universally authoritarian and autocratic, soon creates the need for law.

Law, which arises from property, trade, marriage, and government, grows out of the primitive concept of vengeance that each person was entitled to exact whatever revenge they could enforce through their personal power and influence. Early legal systems, such as the Code of Hammurabi, gave structure to, and by so doing, preserved the right of retribution, which can still be found in our modern legal systems. As the law grew, it substituted compensatory damages for retribution for lesser crimes. Some societies instituted ordeals between the aggrieved parties, less for determination of guilt perhaps than in the hope that the contest would end the dispute in such as way as to stop the chain of revenge. The growth of law led next to courts, originally elders tasked with hearing disputes and determining the justice required. From here, it was another short step to the concept of law and court as a means to prevent wrongs first, and to punish when necessary. Paradoxically, Durant concludes that laws increased our freedom:

Rights do not come to us from nature, which knows no rights except cunning and strength; they are privileges assured to individuals by the community as advantageous to the common good. Liberty is a luxury or security; the free individual is a product and a mark of civilization.

SoC, P. 29

If this sounds strange to modern ears (and it assuredly did to mine), we must recall that in primitive society, the individual existed only as a member of clan. Few individual rights were recognized, rather the individual was governed strictly by environment and custom. Expected to contribute freely to the clan; expecting to draw freely from it as well. Survival was a team sport. Few rugged individualists survived long enough to express their freedom.

As family groups appear to have been too small for success in the harsh environment of our past, we believe that the clan was the normal group. Upon the emergence of the state, the clan was superceded from above by the government, from below by the family. While the family could hardly be called matriarchal, as that implies female rule, it was usually organized around the mother, her children, frequently her brother, with the males as only passing companions. As men had always to be ready for battle or the hunt, women did most of the work in the clan, most likely including the invention of pottery, sewing, weaving, domestication of animals, and horticulture. As agriculture grew, only with the attendant security of the primitive state did men begin to take up more of the work. As the concept of property grew, the desire to pass that property to the next generation drove a shift to a fully patriarchal society.

Chapter 4: The Moral Elements of Civilization
– Marriage

Marriage as we know it is a very recent concept, indeed in some parts of the world it is perhaps less than a century old, and in others retains much of its more normal historical purpose. Durant traces the concept of marriage with some difficulty through pre-history and into early history, during which time, every conceivable approach has been tried, has served well for a time, and has ultimately transformed as environment and the development of civilization itself steered it.

Durant holds marriage as the first step in the moral development of civilization. Early primitive societies seem to have lacked much concept of marriage altogether; as with land rights, all was communal, in some cultures to the extent that marriage, sex, and procreation were not believed to be connected. When men were primarily hunters and warriors, they tended to die early, leaving a surplus of women, and as a result monogamy was not yet seen as practical alternative to celibacy. As agriculture created the need for cheep labor (slaves), and simultaneously led to the patriarchal inheritance of land and property, marriage to one, or frequently several women allowed a man to have children to work and inherit the land. Universal also was the concept of exogamy – of marrying from outside the clan. Today we understand the genetic advantages of exogamy; primative people’s motivations are unclear. Over time, exogamy evolved from capture, to capture with later payment, to purchase and parental arrangement, which survive in some cultures to this day. Curiously, this evolution seems to parallel in concept (if unsure in time) with the evolution of law from revenge to compensatory damages.

The concept of romantic love as part of the marriage institution is even more recent. Over most of our history, marriage has existed as an economic arrangement. The distance and longing of adolescence that lead to courtship and romance having not existed in the freer communal societies over the vast majority of our history. As Durant closes, “Wherever, in the history of civilization, woman has ceased to be an economic asset in marriage, marriage has decayed; and sometimes civilization has decayed with it.” I can imagine the outrage if Durant were to post that sentence to Twitter in 2020. And I wonder if the outrage we would see is, in the broader historical context, evidence in support of his conclusion.

Designing for Longevity – the 10,000 Year Clock

Report on a talk given by Alexander Rose, Executive Director of the Long Now Foundation

This past Tuesday, I was fortunate to be hear Alexander Rose, Executive Director of the Long Now Foundation, speak at the Virginia Air and Space Museum on the concept, design, and current progress of the 10,000-year Clock. The clock is designed to be a monument-sized project that represents today as the middle of a 20,000 year epoch of human history. The goal is to inspire us to Continue reading “Designing for Longevity – the 10,000 Year Clock”