Bad-to-Worse

Remember the outrage that accompanied last year's scandal at the Veteran's Administration.  Everyone from President Obama was in high dungeon over revelations that dozens of vets died while waiting for appointments at VA medical centers around the country.  Meanwhile, scores of administrators were secretly cooking the books, creating phony lists to make it look like veterans were being seen in a timely manner, to protect their jobs and annual performance bonuses.

At the time, Mr. Obama said such conduct was intolerable:

"When I hear allegations of misconduct, any misconduct -- whether its allegations of VA staff covering up long wait times, or cooking the books - I will not stand for it. Not as commander in chief but also not as an American. None of us should. If these allegations prove to be true it is dishonorable, it is disgraceful, and I will not tolerate it, period."

Of course, it actually depends on your definition of tolerance.  His feckless VA Secretary, retired Army General Eric Shinseki, was left moldering in the post for almost two months, as details of the long (and deadly) wait times emerged.  Various media organizations--led by CNN--also discovered that the VA had known about such practices for years, but did nothing to stop them.  Administrators kept submitting phony documentation claiming that vets received health care within prescribed time lines--and kept collecting their bonuses.  Meanwhile, more than 40 veterans died awaiting treatment at the Phoenix VA hospital alone--a stunning revelation that proved to be the tip of the proverbial ice berg.  Corrupt practices in Arizona were duplicated at virtually every VA facility around the nation, with the same deadly results.

After Shinseki finally stepped down, President Obama turned to Robert McDonald, the former CEO of Proctor and Gamble.  Mr. McDonald was given a mandate to reform the VA and as Job #1, fix the appointment problem, once and for all.  McDonald, who knows a little about marketing from his days at P&G, said all the right things before Congress and the media, and headlined some carefully-staged events to convey an image of "change."

But, like so many things associated with the Obama Administration, reform at the VA has proven illusory.  As Mr. McDonald ends his first year on the job, the number of veterans awaiting care at the agency's clinics and hospitals has actually increased.  From the Washington Post: 

One year after an explosive Veterans Affairs scandal sparked national outrage, the number of veterans on wait lists to be treated for everything from Hepatitis C to post-traumatic stress is 50 percent higher than at the same time last year, according to VA data.

VA’s leadership attributed the growing wait times to soaring demand from veterans for medical services, brought on by the opening of new centers and a combination of aging Vietnam veterans seeking care, the return of younger veterans from Iraq and Afghanistan and the exploding demand for new and costly treatments for Hepatitis C.

Ahead of the House Committee on Veterans Affairs budget hearing scheduled for Thursday, VA leaders also warned that they are facing a $2.6 billion budget shortfall. They said they may have to start a hiring freeze or furloughs unless funding is reallocated for the federal government’s second-largest department.

The VA says the continued backlog can be partly blamed on an increase in the number of veterans using the system.  So far this year, the agency has logged 2.7 million more appointments than in 2014, and has increased its capacity to handle an additional seven million patients a year.  Those increases are roughly double what the VA anticipated.  

To provide more care, the VA has also been on a hiring binge, adding thousands of new doctors, nurses and other staffers.  But the waiting lists continue to swell, despite the infusion of new personnel and $15 billion in additional funding the VA received last year.  

And yet, the agency recently notified Congress that it is now facing a $2.6 billion dollar shortfall, unless funds are re-allocated.  

One reason for the budget crunch (according to the agency) is the billions allocated for a new program that allows vets to receive care at private health care facilities if they're facing an extended wait time at the VA, or the agency doesn't provide the type of service they need.  But the "choice card" has proven less-popular than anticipated--in part because the VA has done little to promote it, and secondly, because the agency takes months to reimburse veterans for their out-of-pocket expenses under the program.  

None of this is surprising.  While there are thousands of physicians, nurses and other VA personnel who provide exceptional service to veterans, the agency's leadership culture is rotten to the core.  Facing genuine competition to their system, VA senior management (and their friends in Congress) made sure the choice cards would be a flop, keeping vets in the failing system.   And, if the VA can illustrate increased patient demand (and improvements in delivering service), they can extract more budget money from Congress, and keep the bonuses/other perks to which they've grown accustomed.

Earlier this year, Secretary McDonald went on a p.r. offensive, claiming his reform efforts were taking hold.  As proof, he reported that 900 VA employees had been fired, including 60 with direct ties to the appointment scandal.  But as the Washington Post discovered, McDonald's figures were greatly distorted, and presented completely out-of-context.  A VA spokesman later admitted
that the agency had only proposed disciplinary action against the 60 workers connected to the scandal.  Most of those employees are still on the job.  As for the 900 forced out at the agency, Polifact learned that more than half were probationary employees, who were terminated at the end of their first year on the job. 

In others words, the overwhelming majority of VA employees involved in the appointment scandal are still on the federal payroll, and most will remain there until they die, retire, or move on to something more lucrative.  And that "house-cleaning" cited by Mr. McDonald?  It involved less than one percent of the VA's 340,000 personnel.  

Just one more reason the agency will never change.  And our veterans will pay the price for its incompetence and bureaucratic lethargy.