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The VA’s Bureaucracy Always Wins—Until Now

Veterans Affairs Secretary Eric Shinseki has been forced to resign. This bizarre solution to the VA scandal fires the Senate-confirmed cabinet chief so that the career staffers responsible for the mess can run the organization for the year or so it would take to find, confirm, and educate a new secretary, just before a new president would choose someone else. The Washington bureaucrats always seem one step ahead of the politicians.

President Barack Obama was reportedly “madder than hell” about the VA scandal. Before Shinseki’s auto-da-fé, ultra-liberal WashingtonPost columnists Dana Milbank and Eugene Robinson actually criticized the formerly sacrosanct president for not taking charge. Even the Democratic Senate Veterans Affairs Committee held investigative hearings finding that 40 patients at a Phoenix VA hospital reportedly died while waiting to be treated. Its VA leaders reported patients only had to wait 26 days for an initial appointment, when the Inspector General later found the wait to be 115 days. An April memo by a deputy undersecretary disclosed “gaming strategies” to hide the delays that the IG confirmed were “a systematic problem nationwide.”

Congressmen from both parties expressed shock and demanded Shinseki’s head, ignoring the numerous Government Accountability Office and IG reports going back decades that warned against such shenanigans, currently gathering dust in Congressional back offices. In fact, irregularities and poor service have been reported since VA’s inception. Shortages in primary and other medical care are offered as excuses for failure, but such shortages are not due to a lack of funds. The VA is popular with voters, and its military “service” organizations are such powerful lobbyists that its budget increased from $27 billion in 2003 to $57 billion in 2013, a 106 percent increase. Even with such funding, the IG found that 84 percent of veterans had to wait two weeks or longer to be treated.

Congress demanded reforms for many years, but nothing much changed. After many requests, the VA announced in 2000 that it would finally overhaul its decrepit, quarter-century-old scheduling process. After $127 million and nine years, the VA gave up the project without adopting any improvements. Implementing a medical records system that would integrate military and veteran systems was abandoned after almost $1 billion in spending. The bureaucracy cites a RAND study claiming that the VA is actually superior to private medicine, but that study was based on VA records the GAO and IG findings now undermine. Clearly no one in the private sector has such long wait times (although the government’s Medicaid comes close).

The real test is that only 16 percent of veterans identify the free services of VA as their primary source of medical care, and only one-third more even use it in emergencies. They know what they are doing. The best estimate finds that veteran suits against the VA yielded $845 million in malpractice payments over the past decade. The New England Journal of Medicine found that private practice pays about 20 percent of malpractice suits brought against them, compared to 25 percent for VA, a rate one-quarter higher. The decorated and wounded Army General Shinseki did not know what he was up against: “I can’t explain the lack of integrity among some of the leaders of our healthcare facilities,” he said. “This is something I rarely encountered during my 38 years in uniform. I cannot defend it because it is indefensible.” House Veterans Affairs Committee chairman Jeff Miller had warned “his people were not telling him the truth” even as Shinseki visited more facilities than any previous secretary, an absolutely corrupt bureaucracy lying right to his face.

Senate Veterans Affairs Chairman Bernard Sanders introduced the Democratic solution, to invest billions more and even open 27 new facilities, albeit allowing veterans to seek private care if they were delayed 30 days. But this counting of waiting periods is precisely what the VA careerists gamed, and 30 days is too long as it is. The system is beyond fixing, and certainly can’t be fixed by those who created the problems in the first place, or adhere to the same discredited ideology. As recently as 2011, New York Times columnist Paul Krugman praised the VA as a model of “success,” as an American “socialized medicine” free of “the perverse incentives” of market capitalism, a mode of centralized administration that allowed the VA to make effective, objective medical decisions. If Obamacare was as socialized as VA, he argued, it would have been more successful.

The problem with the VA is not poor administrators, but just what Krugman found so attractive, the fact that it is socialized medicine. Government programs must be given a budget to spend as its experts think best. Yet, no matter how generous, there must always be more demand for free services than can be supplied. So managers must create waiting lists. Back in the 1980s the Reagan administration tried to rationalize the VA, proposing to take the money supporting medical services and give vouchers directly to veterans to spend at any medical facility they chose, VA or not. The proposal, similar to the emergency chit the Obama administration offered to temporarily solve the current crisis, was defeated primarily by the veteran service organizations concerned that their special relationship at VA and the government-supported services they offered at its facilities would be eliminated by such a program. When Senate Veterans Affairs Republican Richard Burr challenged them during the current crisis, he was immediately silenced by claims that criticism of the service organizations was an attack on all veterans. As a result, the top legislator was isolated, left to fend for himself, showing who really has the power to determine VA policy.

There is a need for an organization supporting veterans, but not one with hundreds of thousands of employees who know that their unions and managers will protect them from getting fired or disciplined. There is only one way to cut through Washington’s unaccountable bureaucrats, nests of special interests and self-promoters, and business as usual attitudes, and that is to get the programs out of government by issuing vouchers. An advocate leader and a few auditors and program analysts are all the government needs. At least initially, existing VA medical facilities could compete against private ones to see if they could survive. Obamacare was a program to reform one-sixth of the whole economy. Such an enormous program would naturally run into difficulties. But the almost century-old Veterans Affairs with a much smaller population to cover and fat budgets year after year, that is something else.

Unaccountable bureaucracy is the worst solution for humane health care, whether it’s for veterans or the public at large. Many who still support Obamacare seem truly upset at the enormity of the VA abuses. This is a teachable moment for them. The problem must not be allowed to be written off as both Democrats and Republicans would prefer, by firing one former war hero, perhaps above his head administratively but not primarily responsible for the problem, and shoveling in more money. That response only allows the politicians to ignore the real problem and escape the wrath of the powerful veteran service organizations who are wedded to the status quo.

The fact that the Obama administration even temporarily and partially adopted a semi-voucher process that would allow veterans forced to wait for VA care to use private medical services is enormously significant both intellectually and morally, and it must be used as a wedge to privatize every bit of it to resolve the fundamental problem once and for all. Then adopt the same solution for Obamacare, veterans, and everyone else too. Problem solved.

Donald Devine is senior scholar at the Fund for American Studies, the author of America’s Way Back: Reconciling Freedom, Tradition and Constitution, and was Ronald Reagan’s director of the Office of Personnel Management during his first term.

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