Lessons From the VA Scandal

Suppose you’re Eric Shinseki (Veterans Administration head).

Actual VA photo

Actual VA photo

You learn of huge problems – a vast backlog of unprocessed paperwork (partly because it is literally paper, mountains of it, not computerized) – and now this scandal of delayed medical attention and resulting horror stories and even deaths – compounded by widespread cover-ups of those treatment delays via fraudulent record keeping.images

So you snap your fingers and order it all fixed. Right? Wrong. The VA is a vast organization, but these scandals tell us it’s not actually vast enough. The paperwork piled up because the VA lacked the manpower to deal with it, let alone take steps to computerize it. Likewise, appointments were delayed because there weren’t enough doctors and other resources to meet patient needs.

Unknown-2No snap of the fingers could have fixed this. It required money. Shinseki should have been shouting from the rooftops, “Houston, we have a problem,” pre-emptively telling Congress and the president the VA is in trouble and needs more money.

But wait, you’ll say: isn’t that what bureaucrats are always whining? That they could do wonderful things if only their budgets were increased? Was there ever a bureaucrat who said, “My budget is quite adequate, thank you very much”?

We’re told the VA scandal shows what a lousy manager President Obama is. I’m loath to dispute that; but I take a bigger lesson. It shows what a lousy manager government is. Especially big government.

Unknown-1It’s actually probably unfair to imagine Obama should somehow have seen and fixed the VA problem. The VA isn’t exactly all he has to worry about. The government is a monster with a million tentacles and a very small brain – the president and his administration – to minutely direct those tentacles’ behavior. Good luck.

Yet the essence of American liberalism is the faith that government, because it is the avatar of disinterested public spiritedness, of the wish to do good – in contrast to a (selfish, grubby, greedy) quest for private profit – will do good, if given our trust (and money). images-5But the fly in the ointment is that government is comprised of human beings, not angels, and while they may indeed be motivated for good, they are also subject to all the other personal motives that govern human behavior in any context. And when those motives conflict with the disinterested desire to do good, it’s a rare person who will sacrifice the former for the latter.

VA staffers are probably mostly altruistic people who sincerely want to help veterans. But caring also for their own asses, in the situation, has made many of them perpetrate a great crime. Performance incentives, great in theory, merely incentivized VA personnel to cook the books to earn the rewards despite screwing patients. (And it’s not obvious how Shinseki might have avoided bamboozlement.)

At least in the private sector, the (selfish, grubby, greedy) profit motive – and competition – impose a certain discipline that’s lacking in the public sphere. Unknown-3That’s a fundamental reason why government is so problematic. No private sector organization could survive in a competitive marketplace treating customers as badly as the VA.

More broadly, the VA scandal shows that we, as a society, have gone way overboard in what we ask of government – greatly outstripping the money to pay for it. It’s not as though we’re miserly with the VA; its budget is huge; yet still evidently insufficient for its ever expanding mission, as more and more veterans survive better and live longer, with ever more and costlier medical advances to help them do so. This story is emblematic of so much of what government does, and why spending outgrows what we can afford. We borrow the difference, but as I keep saying, there’s a limit to how far we can stretch that without triggering economic disaster.

Unknown-4I’m not suggesting shutting down the VA. We must honor our commitment to veterans. But we, as a nation, must get serious about the overall gap between what we ask of government and what is affordable. This is the great problem of the age, which Obama is sweeping under the rug.



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2 Responses to “Lessons From the VA Scandal”

  1. ramblingdon Says:

    In part, I ave to agree with you. The country’s “commitment to Veterans” is far larger than what the VA can ever meet.
    You see, as a Veteran myself (Vietnam Era) I have watched this organization go through the standard waves of “promises and failures” that it has always gone through with veterans.
    Look back at our history. Our politicians stand on the curbs of their hometowns, waving flags, smiling and promising to take care of our young people as they march to war.
    But as the veterans return, some physically OK but mentally as wounded as the ones who come back in wheelchairs, the politicians quickly forget.
    They forget their promises and start looking at the costs of healthcare.
    They forget that those numbers being treated are people.
    They forget that families are involved.
    So, they start cutting back on what they promised. And this time, they found a way to cut costs by letting a certain number of veterans just die!
    You see, thats what happens to a sick person. If you don’t treaty them and quickly, they will either get treatment some other place, or they magically heal on their own, or THEY DIE!
    And a dead veteran doesn’t cost much, at all. Hell, at a vetrans funeral even the flag and the tribute is done by volunteer veterans, so, no cost to the budget there.
    Just go back, and look. Th has been the fact after WWI, WWII, Korea, and Vietnam.
    What else should veterans expect after the Iraq/Afghanistan debacles?
    Take care of the poor bastards that can live with the constantly lowering of the standards of care, and bury the others.
    Five, ten more years and we will have another generation of young and patriotic young people to throw at some stupid international calamity and screw their returning wounded also.
    It’s funny really. In WWI, if you were badly wounded, you probably died and were buried “over there”.
    In WWII, sanitation and surgical capabilities were better and more soldiers died, but still many were just buried over there.
    In Korea, we had highly improved medical treatment and surgical facilities behind the lines and saved enormous numbers of the wounded, more than ever before.
    In Vietnam, not only had battlefield medical care taken a giant leap in efficiency, but everyone wounded were flown immediately to centralized care facilities in places like Japan, Australia, etc and there they would go through multiple surgical procedures to keep them alive and at least semi-functional.
    In Iraq and Afghanistan, our military field medical system was second to none in the world. They had tent hospital capabilities that many local hospitals did not have.
    I mention this because if one reason.
    The Military itself became better at saving and at least partially repairing our wounded, and keeping them alive.
    The VA always tried to react after the fact to the growing numbers of survivors or veterans that were flooding their facilities,and the politicians always had their hands tightly controlling the purse strings.
    In summary, the problem that needs to be solved is not that more veterans are dying, but they are dying in front of the American public than ever before. At least in years past they had the decency to die on the battlefield, out of sight and out of mind.

    Don Bobbitt

  2. rationaloptimist Says:

    Thanks for your perspective. One comment: much though one wants to blame “politicians,” that’s hardly fair here. They were not knowingly skimping on VA funding. The problem is that needs outran means faster than anybody was realizing. VA personnel knew they were behind, but did the human thing: they covered it up, to get their performance bonuses regardless. The human thing: that’s the real problem with big government. It’s full of humans.

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