Veterans Administration Reform: Place Your Bets

BY MICHAEL S. JOHNSON

My Dad used to complain about the Veteran’s Administration (VA). He was a Marine, but didn’t like to go there so he didn’t. My Mom had similar views if I recall correctly. She was a Marine, too, when they met during World War II. Neither of them saw action during the war, coming home with only cuts and bruises, my Dad’s from a still that blew up. The war took its toll on them and their marriage, but there’s no VA fix for that kind of thing.

I grew up remembering my parents’ distaste for the VA and after long careers in journalism, government, and the private sector, my/their view of the VA as a government bureaucracy with incredibly good intentions but mediocre service at best never changed. I always wondered in all that time, why the VA—at least the health care divisionwas not transformed into a private-public sector partnership in which the government specialized in care unique or particular to military service.

The answer may be that the United States, tragically, has been at war through most of the 80-year history of the VA and maintaining special full-service health care service for our military men and women just seemed the right course practically, patriotically, and philosophically.

Now, however, faced with another burgeoning VA scandal, it is time to reassess. The VA health service may have been the right answer after World War I ended, but it’s time to seriously question whether it is the right course now. Maybe our veterans are not getting the timely care they deserve because government bureaucracy is no longer capable of delivering it well, particularly in times of heightened military conflict when our warriors, two million of them, have been coming home in droves with every wound – physical and mental – imaginable.

Maybe the bureaucracy (the operable word here) can’t meet the needs, because it’s also burdened by its own maladies, Booz Allen Hamilton described years ago as “the current shortage of nurses, nurse practitioners, primary care providers, and specialty physicians.” The VA is currently staffed with 5,100 primary care physicians. It sounds like a lot but they need 400 more and can’t find them. There is a critical need for more nurses, as well. Add to that the shortage of facilities. The VA has 150 medical centers and 800 outpatient clinics, but it is not enough (Senator Bernie Sanders, chairman of the Veterans Committee in the Senate has proposed legislation to lease 27 new health facilities in 18 states). And even though Congress has done much to maintain the VA budget, doubling the budget in the last 8 years to $154 billion, there is need for more funding. The infrastructure of technology in the VA dates back to a time when computer geeks still wore bow ties and worked at IBM. Then, there’s the 12-layered command structure that doesn’t seem to work from the top down or the bottom up.

What’s needed is a prescription for change. But writing that prescription requires a thorough examination and a proper diagnosis. The latest scandal has a lot of layers and we have only peeled away a few.

The White House, for example, is conducting an investigation. So are the VA and the General Accountability Office. The House and Senate Veterans Committees have already conducted more than a dozen hearings in the last year alone and they will do more, not necessarily with the cooperation of the VA. They have both produced bills, but they only address immediate concerns, not long-range strategic thinking. The Senate bill is a good start and raises the issue of more public-private partnership.

Once those layers have been peeled away; once the Administration can say definitively what happened and why, and what the President thinks the future holds, and once Congress engages in the oversight necessary to affirm or disprove what the Administration has found, the two branches must come together on the diagnosis and the prescription, short-term and long-term. They will need help from the media and veterans organizations. The Administration and Congress can’t succeed in fixing the problem without public support and confidence. So far, that isn’t there. Almost 60 percent of the public are unhappy with President Obama’s performance on the VA thus far.

But come together, they must. The VA isn’t a sandbox and our veterans are, as they have demonstrated over and over again, not children.

There’s scarcely little room here for partisanship, electioneering, ideological rigidity, or arbitrary attitude of some politicians who don’t want to be bothered by the facts because their minds are made up. There are 22 million American veterans and they all deserve better. Clearly a good number of them are getting far less, standing in line for treatment, waiting for decisions on their claims, waiting for benefits that never come, just waiting and waiting. Somewhere between 20-40 have died waiting. And don’t ever forget the reality that preceded this scandal, that up to 22 of them a day are committing suicide.

Again, the country may discover after we’ve plumbed the depths of this scandal that the VA structure may no longer be valid and needs to be even replaced.

The House Republican Leadership said as much in a somewhat pompous letter to the President, calling the Department an “abject failure” and the system “broken,” but I am not sure the leadership has taken the full measure of their words.

Once again, this is only the tip of the iceberg (if it hasn’t melted yet). The VA isn’t the only bureaucracy in trouble. The VA scandal reflects a failure of both branches of government. It reminds us of the obvious: The Federal Government has grown so large–a $3.7 trillion, massive, unmovable, impenetrable, unparalleled, monolith—that there isn’t a human being alive who can manage it, let alone control it or even understand it’s deceptive culture.

The scandals of our time – the rollout of Obamacare, the regulation of the finance industry after the crash, Benghazi, Fast and Furious, the IRS, Secret Service shenanigans, and countless others that stretch back decades – all are vivid reminders of the complexity and uncontrollability of the bureaucracies we, the citizenry, have allowed to be created to meet our needs. They are operated by millions of public employees – 320,000 in the VA alone – trying to earn a living, most of them honorable, but enough who are not, that disasters such as this one are inevitable. They exist in a culture of public service that for every intended consequence there is an unintended one and for every good intention there is power easily abused and values easily discarded.

The bureaucracies are not helped by an overbearing, righteous White House and a political infrastructure, cascading down from the President to lowly assistant secretaries in the departments, who hang certificates of appointment or election on their walls and look at them as though they certify greater intelligence, better judgment, epic enlightenment, and a franchise on being right.

Then, too is a Legislative Branch dominated by a few too many who don’t know how to govern and probably wouldn’t want to if they bothered to learn. It isn’t just the Veterans Administration that’s in trouble; it’s Transportation, Agriculture, Defense, State, and most of the others. Their dysfunction is perpetuated by members of Congress on the far right and the far left who complain, but do nothing, who believe that doing nothing is doing something.

Complaining does not solve problems, only consensus does, and those unwilling to engage in that process are as responsible for the VA as General Shinseki or President Obama.

Our political leaders are expected to think bigger, act wiser, and get things done. It is never easy for those who want to lead, especially in a negatively-charged environment where nasty is the norm and intransigence is the strategy of choice.

But the plight of veterans offers an opportunity to be wise, to be responsible, to act and to accomplish something good for them. They are, after all, our veterans. There is little downside. If you can resist the temptation to politicize and pander as the White House just did trying to shift the focus to housing homeless vets, then Congress and the Administration can do something rare in a contentious election year.

Okay, ladies and gentlemen, place your bets. Will they or won’t they?

Editors’s Note: Mike Johnson is a former journalist, who worked on the Ford White House staff and served as press secretary and chief of staff to House Republican Leader Bob Michel, prior to entering the private sector. He is co-author of a book, Surviving Congress, a guide for congressional staff.   He is currently a principal with the OB-C Group.