Skip to comments.The VA Bureaucracy on Trial
Posted on 06/09/2014 5:36:57 AM PDT by Servant of the Cross
When Woodward and Bernstein did their groundbreaking reporting in the 1970s, they uncovered abuse of power and corruption that led to the resignation of the nations highest elected official. It was what a free press can and should do: keep government honest.
But Watergate was ultimately a story about one man and one administration. The VA story is about something much larger: systemic corruption at one of our biggest federal agencies. The Department of Veterans Affairs employs more than 300,000 people and has an annual budget thats increased from $98 billion in 2009 to more than $153 billion today. Of those 300,000-plus workers, a stunningly low number are primary-care doctors 5,100. And though the VAs budget has increased almost 60 percent in the past three years to keep up with an increase of almost 50 percent in patients, the number of VA doctors has increased by only 9 percent.
Small wonder that there are long waits; bureaucrats and administrators dont treat patients.
Thats why this story is so much bigger than one mans fall by way of Watergate. This story is not about what departed VA secretary General Eric Shinseki knew and when he knew it, or about what President Obama knew or should have known. Its about federal bureaucracies and how they too often serve themselves instead of their customers.
No one person can be blamed for what is happening at the VA, because no one person caused the problem. No one person can fix it. General Patton himself, who wore down the Nazis and their menacing panzer divisions, would have been beaten down by the immense VA bureaucracy.
The man who runs the world-renowned Cleveland Clinic, Delos Toby Cosgrove, turned down an offer from President Obama to run the VA, citing his commitment to his current job. We all know the real reason he said no.
As President Obamas chief adviser David Axelrod admitted in a rare moment of candor, the federal government is so sprawling that its almost impossible for anyone even our chief executive officer to keep track of it. In the early days of the IRS scandal, Axelrod told MSNBC: Part of being president is theres so much beneath you that you cant know because the government is so vast. Forget too big to fail. The VA and most other federal agencies are too big to manage. And theyre certainly too big to change.
If an army of Woodwards and Bernsteins were unleashed on the VA, can you imagine what they might find? If 1,000 FBI agents used state-of-the-art forensics and software to ferret out corrupt practices, can you imagine what they might unearth?
Already, the inspector generals report has revealed that those waiting lists and wait times in that one Arizona VA hospital were not the exception but the norm. We now know that those secret waiting lists were not the work of only one or two bad managers; they were at the heart of a system that incentivized such corruption. Worst of all, we learned that whistleblowers were afraid to expose such practices for fear of reprisal from their bosses.
According to the New York Times, Representative Jeff Miller (R., Fla.), chairman of the House Veterans Affairs Committee, said that whistleblowers at several veterans hospitals had told his staff members that they would be threatened if they failed to alter data to make patient-access numbers look good for their supervisors. Miller has rightfully called for a criminal investigation.
Fear was instilled in lower-level employees by their superiors, and those superiors did not want long wait times, Mr. Miller said. Bonuses are tied directly to the waiting times of the veterans, and anybody that showed long wait times was less likely to receive a favorable review.
To some Americans, the VA scandal, though outrageous, stands as an outlier. To those of us who worry about what can happen when unelected bureaucrats have no check on their power, the VA horror is predictable. We know that it represents only the tip of the federal-agency iceberg.
Can you imagine what a team of hardworking (or even halfway diligent) journalists might uncover if they spent a lot of time investigating the VA, or HUD, or the waste and fraud in Medicare, or the abuse in our skyrocketing disability programs, or the scams and fraud in food stamps?
Regrettably, there is less journalism being practiced in our country than ever before, at a time when we need it most. Indeed, many of our journalists are clearly doing the public-relations work of the executive branch of our government.
When Jay Carney left his post as Washington bureau chief of Time magazine to become Joe Bidens press secretary and eventually President Obamas conservatives werent surprised. The job title changed, but the job to promote the cause of the Left and attack the Right didnt.
There is a great opportunity for free-marketeers to make their case to America not through more investments in think-tank research but via bona fide journalism. Imagine the windfall if we were to train up a small army of journalists and recruit some exFBI agents and private investigators who already do this kind of gumshoe work for insurance companies and the private sector. Imagine the bounties, not to mention the savings to U.S. taxpayers.
Great journalism would undoubtedly expose a universe of dysfunction in many of our federal agencies, and the ugly picture would permanently alter how Americans view their government. Wed be motivated at last to make an all-out effort to find practical solutions, derived from experience in the private sector.
For an example of how the private sector leaves government in the dust, look at FedEx or UPS, which can track a package in real time, in flight, and get that package anywhere in this country, affordably and within 24 hours. And a veteran cant get in to see a doctor in weeks or even months? The VAs inefficiency is an outrage, but its also the obvious outcome when the customers cant walk and the employees know theyll keep their jobs no matter how poor their work. In the private sector, the specter of competition keeps business honest. FedEx and UPS are behemoths, but they got big precisely because they were so good at delivering packages on time.
Big-government bureaucracies are petri dishes of corruption. And only a robust fourth estate can unearth the true depths of corruption and inefficiency that plague them.
Hal Scherz, a doctor from Georgia, wrote a piece in the Wall Street Journal last week about the VA medical system. Many of our nations private-practice doctors, he notes, have worked as medical residents and interns in VA hospitals because most of the 153 VA hospitals are affiliated with the countrys 155 medical schools. Scherz cited story after story from friends who had had terrible experiences while working at the VA. He concludes:
The VA health-care system is a disaster. Throwing more money at the system, or demanding the scalps of top bureaucrats Washingtons reflexive response to any problem of this sort wont repair the mess. Whats needed is a fundamental rethinking of how to provide medical care for Americas veterans. . . . The VA health-care system is run by a centrally controlled federal bureaucracy. Ultimately, that is the source of the poor care veterans receive.
Thomas Lifson at the American Thinker blog seconds Scherzs conclusion:
It is important that Americans understand the fundamental point about the incompatibility of monopolistic medical bureaucracies and high-quality medical care. It is not a matter of incompetent management and employees (though such no doubt exist). The problem will not be solved by adding dedicated leaders and staff; they also no doubt exist in the VA health-care system. People who cant be fired and who know that no matter what they do, their organization will continue to exist inevitably become self-serving. This is the moral hazard of government-funded bureaucracies.
Thats the real crux of the VA crisis. Thats the story thats not really being told, because we dont have the storytellers the journalists who are interested in telling it. Nor do we have the storytelling platforms to frame and distribute it.
If NPR gave that a shot, it would make a hell of a ten-week series, dont you think?
As Ronald Reagan said so memorably ...
The VA is a disaster top to bottom. It is based on an upside-down system of incentives, i.e. people are positively incentivized to try to go to categories of increasing disfunction rather than try to reconstruct their lives.
Let’s assume for a minute that all the people working in the VA were perfect people. Their only motivation was to take care of Veterans. They would not lie, cheat or steal. Every day, they gave eight full hours of work. There was no interpersonal conflicts or rivalries. Everyone worked to improve the efficiency and effectiveness of the VA. Would we have these problems in the VA?
The problem with the VA isn’t that it is an imperfect bureaucracy. The problem with the VA is that it is staffed by imperfect people. All organizations are staffed by imperfect people. 100% of our citizens are imperfect. The best that you can do is try to provide “controls” that find and punish the really bad imperfect behavior.
The one truly effective management theory is THE LAW OF EFFECT. Generally, you will receive more of the behavior that is rewarded and less of the behavior that is punished. The trick is in making sure this actually happens.
The executives at the VA were told that they would receive bonuses for keeping patient scheduling times within a certain timeframe. They are imperfect people and they wanted bonuses. Without some means of monitoring and correcting, imperfect people will take the easy way to get what they want. In this case, they falsified records. How do we stop this?
THE LAW OF EFFECT PROVIDES the answer.
Citizens are required, by threat of imprisonment, to provide a portion of their wages to the government in the form of taxes. A portion of this tax money is then provided to the VA. The express purpose of this money is to provide care to Veterans. The bonus system was a means to improve this care. VA executives taking this money without providing improved service is theft. We punish thieves with prison time. This punishes the behavior of stealing. The VA executives who stole money by faking records need to be imprisoned, not merely fired. We control imperfect behavior by imperfect people by punishing the improper behavior.
The "fourth estate" isn't interested in exposing corruption because it too is corrupt. It has a symbiotic relationship with the liberals controlling government.
The only thing you got right in the above is that 100% of people are "imperfect".
However, 'imperfect' people CAN regularly deliver SUPERIOR service and products ... in a competitive, for-profit, free market environment.
The problem with the VA, and with all government organizations, IS that it is a bureaucracy, which will ALWAYS be 100% inefficient, delivering horrible service and doing the same old same old tired processes, without any sense of urgency or pride. It has NO incentive, or leadership, to do better.
The VA is just the tip of the iceberg. Yes, it is a very large and impactful department, but other agencies suffer from the same problems, corruption and inefficiencies that plague the VA. You are right about the upside-down system of incentives, but another problem is that, in general, there is a total absence of accountability in the government. This culture needs to dramatically change.
The entire government needs a massive overhaul IMO. I’ve worked inside a number of agencies and you always see the same systemic problems. There is a lot of room for improvement. Just saying.
Computer science at the VA is basically in a state of anarchy and many of the jobs the call center people are asked to do are basically impossible. It would have to be less espensive and much more efficient to simply provide veterans with cards (picture IDs of course) which allowed them to seek treatment for pretty much anything at their own discretion.
Computer science at the VA is basically in a state of anarchy
I don’t disagree. While harmful to veterans, this perpetual state of disarray and inefficiency is very lucrative for beltway bandits and the conga line of VA “managers” passing through the department.
Supporting veterans is, unfortunately, not the priority.
‘The VA executives who stole money by faking records need to be imprisoned, not merely fired’
Yes, that is the proper answer but it will never happen because the goal of the VA’s was to let vets whose treatment might cost a bunch, die. They did it with the full knowledge and permission of the WH. I can not prove it but it fits the pattern of this administration. Coming soon to a hospital near you, truth be told I think it is already happening.