Accountability, prominently including an executive personnel system that fires miscreants instead of shuffling them from job to job. is essential if one is serious about reforming the Department of Veterans Affairs (VA).
I’d like to suggest the thought, however, that the problem with VA goes deeper than the problem of the people running it.
The system is dysfunctional.
The system is focused on itself, on the “integrity” of the structure of VA—the institutions, the buildings, the workers—not on veterans and their families.
Protecting the status quo is an “Iron Triangle” of bureaucrats, veterans organizations and congressional figures that serves to decentralize power and responsibility and resist transformative change.
It begins with a towering, hardened steel superstructure that’s so stove-piped that people who work for the Veterans Health Administration (VHA) don’t recognize the FACT that there are other parts of VA.
They think they are the VA.
They’re so out of touch that half of them still answer the phone “Veterans Administration” (an entity that ceased to exist in 1988). They send out letters from the “Veterans Administration.”
They don’t have the slightest idea who the Veterans Benefits Administration (VBA) is and what they do (and VBA likes it that way).
They think the “Cemetery Service” is a part of the hospital, like the janitors.
VA spent millions back in the ‘90s on a smoke screen called “One VA” that required tens of thousands of high-priced managers and executives to travel to gigantic conferences around the country and hear stories about the various parts of VA and how they existed in their alternate universes.
A guy I worked with summed it up: “I’m one VA and you’re another.”
Why is it so dysfunctional?
There are three basic reasons for its failure.
One: The rugged steel skeleton of the VA edifice is based on a model that is 72 years old.
The GI Bill of 1944 was based on the need to craft a system that would help 16 million WWII veterans readjust to a civilian society that was booming economically, still based largely on manual labor on the farm and in the factory, and politically united as never before and never since.
The decades since have seen the classic art deco style of the VA skyscraper become festooned with antennas, exposed wiring, computers hanging in cages, diverse bric-a-brac added to keep up with the times, etc.
As written in law and regulation, the system is simply too complicated and opaque to be reformed.
Two: Ever since the aftermath of the Vietnam War, VA has become more and more partisan and less and less focused on veterans.
Meeting the needs of veterans has become another problem like the deficit, immigration, security from terrorists, an education system that teaches the best and the brightest to burn the flag, etc., etc.
Like defense itself, veterans affairs has become just one more government program like building sewage treatment plants.
It goes on and on devoid of purpose except spending money.
It’s part of the vast, muddy swamp that is the federal government.
Three: Neither Republican nor Democrat administrations can get a handle on the problem because they each fear the other side will excoriate them for “not serving veterans.”
So, they add another ornament on the Christmas Tree, send out a news release about how wonderful they are, and pretty soon you’ve got a system that is so thick and impenetrable that you can cut that baloney any way you want to.
The bureaucrats love it because they have ALL the power in a system that makes no sense.
Here are some principles for fixing VA.
Force DOD and VA to talk to each other or send people packing.
Not next year, but next month. DOD’s exit physicals should be good for VA purposes and the computers should talk to each other.
If it makes the most sense—FOR THE VETERAN—to keep him in uniform but in a desk job or something like that, KEEP HIM (or her).
Serve the veteran first.
The system now is adversarial.
The system assumes the veteran is a crook and a four-flusher. Serve the veteran first and then adjust if you find out that the veteran is a crook. (Over the history of VA, the crooks have almost overwhelmingly been the bureaucrats, not the veterans.)
Eliminate the lawyerly, adversarial nature of the process. Abolish the Board of Veterans Appeals and the “U.S. Court of Appeals for Veterans Claims.”
Eliminate both VHA and VBA.
That is, abolish the stovepipes.
Essentially, make them one organization.
Build a new structure based on the medical centers that includes offices that provide veterans the non-medical help they need, whether it’s educational, employment, adaptive housing, monetary, family assistance, whatever is needed.
Some VA specialties such as insurance, home loans and cemetery and memorial services can remain as individual organizations, sort of like the coffee shop, lunch counter and bar on the ground floor of the skyscraper.
Focus on the individual veteran and his family.
Families need help working with the bureaucracy on behalf of the veteran, especially when it comes to serving young, seriously disabled veterans and elderly veterans with limited means.
Maintain veterans’ healthcare delivery separate from civilian hospitals.
Civilian doctors, administrators and patients don’t understand the veteran milieu, and veterans function best around other veterans.
Get a handle on the problem of being all things to all people.
VA needs to focus on the bullseye, which is the severely service-connected disabled veteran.
VA should expend every effort on operating and maintaining hospitals that are world-class in terms of treating the worst disabilities such as amputations, burns, blindness, psychological trauma and environmental diseases, for example. The big thing, however, is that most veterans have proudly served the country without suffering crushing loss.
Yet, all veterans are now eligible for health care but their access is limited by a priority system that, supposedly, pushes the least affected to the back of the line. When the current framework was adopted in the 1990’s, then VA Secretary Jesse Brown told Congress that VA couldn’t provide medical service to every veteran without a lot more money.
Politicians and bureaucrats sang the siren song of directing third party reimbursements to VA to pay for serving veterans without service-connected disabilities who also had the means to pay for their own health care. It was another typical act of budgetary slight-of-hand.
The country needs to focus on this problem and decide (through its elected representatives) whether it can stand the wailing and gnashing of teeth it will cause if they tell veterans to take care of themselves if they have the means and are not damaged by their service to the nation.
Some may need to be “grandfathered” in and one size may not fit all when it comes to this problem. The delivery of health care is much different in different parts of the country: urban vs. rural, for example.
At the same time, VA needs to own up to its responsibility to serve elderly veterans who have nowhere else to go, whether they are service-connected or not.
It needs to be acknowledged, too, that some disabilities—such as hearing loss—become progressively worse and may not be a problem until long after the veteran has left active duty.
By and large, however, the system has foisted the mission of taking care of elderly veterans on to the states but done it in such a way that lots of cronies get rich running veterans homes that VA should have been running to begin with.
One last thought: The election of Donald Trump is so far out of the box as far as American politics is concerned, that maybe this is the time to go for a complete house cleaning of VA.
Don’t stop at firing the bad actors, drain the swamp!
Get rid of the manure piles!
Tip over the outhouse!
Bill Jayne, was Marine infantryman wounded at Khe Sanh who who was given “the great opportunity to make a career of serving his fellow veterans and their families.”
Bill: You got it! Thank you, Ken
Well said Bill. My claims have languished in the VA System for years. I’ll be dead before they are reviewed. You are right on that the System is too adversarial. The claims officers and medical personnel think you are cheating the VA for unearned benefits.Maybe these should get wounded and/or be exposed to Agent Orange.
Maybe Trump is exactly what the VA needs.
” Drain the Swamp”
Rather than maintaining the VA Healthcare system, why not use civilian healthcare services. WW11 veterans are now civilians and the majority have the same health problems as other civilians, why not use local, well equipped and staffed facilities that are not bogged down by a bureaucracy!
Furthermore, why not take Dr.Ben Carson’s suggestion and equip DOD to take care of retirees until they are able to return to civilian life, rather than transferring them to VA where they get “lost”!!
THE VA HEALTHCARE SYYTEM IS ANTIQUATED, DISFUNCTIONAL AND TOTALLY UNNECESSARY!!!