Hi, I'm Mark Flatten. I've been reporting on problems at Veterans Affairs for over a year. I can explain why Eric Shinseki resigned and why people are so mad.

1. Why did Eric Shinseki resign?

2. Why are people so mad?

The problems at VA have been building for years. First there was the wasteful spending, then the long backlogs in processing disability claims, undeserved bonuses and finally the reports that patients were dying because of long delays in receiving medical care. Through it all, Shinseki either denied there was a problem, claimed it was overblown and being fixed, or tried to dismiss it as isolated incidents. Eventually the series of scandals and Shinseki's inability to acknowledge and deal with them effectively caused a loss of faith in his ability to fix the problems.

People are mad because this bureaucracy is unable to deliver on what was earned by the veterans who risked their lives to serve our country, whether it be disability benefits or quality health care. Veterans dying needlessly makes people mad.

I've had several family members at the mercy of the VA's. The care has always been substandard and the wait times are ridiculous. Do you think that this latest shake-up will actually change anything or once the news calms down about it, will it go back to business as usual?

The attention span in Washington DC is notoriously short. I know I will stay on this story and I'm confident others will too. Unfortunately, the consequence of failure at VA is that people die. And so to the degree preventable deaths keep happening this needs to remain a top-tier issue. To answer directly, simply shaking up a few top managers will not solve the problem.

How can the VA attract better doctors and nurses when they have no way of matching the salaries and benefits of hospitals and private practices?

Medical professionals often go to work at the VA because they want to work with veterans. However, many have complained that caring for patients becomes a secondary concern to meeting the needs of the bureaucracy. This puts them into a difficult position in which standing up for the patient's needs makes them a troublemaker within the system. We have seen repeatedly that VA administrators will try to discredit whistleblowers who try to report wrongdoing. The mechanism for protecting whistleblowers is not very effective. So again, the culture at VA is one that punishes the very kind of medical professionals that our veterans need. Here's a recent story along those lines: http://washingtonexaminer.com/veterans-affairs-whistleblowers-face-long-slog-in-fighting-retaliation/article/2548763

Who are three other people we should be following for reporting on the VA scandal?

First and foremost Aaron Glantz at Center for Investigative Reporting. CNN and Fox News have both broken big pieces of the VA story at various points. Both have teams of reporters on the story. Some of the best reporting has come from local and regional papers, notably the Arizona Republic, which had the first detailed account of what went on in Phoenix; The Pittsburgh Post-Gazette, which exposed patient deaths from Legionnaires Disease; and the Atlanta Journal-Constitution, which reported extensively on patient deaths in Georgia.

What happens now that Shinseki is gone in terms of the media's appetite and the public attention for the problems at the VA? will the public spotlight turn to the next thing now, which could allow the problems to go unfixed? Are you still digging on this story, for instance?

I will definitely continue digging into this story, which does not end with Shinseki's resignation. As I said earlier, there is a widespread culture at VA that did not start or end with Shinseki. Some of the national media coverage is likely to taper off. As for me, I want to know who within the bureaucracy is responsible for the mission failures and why they are still drawing their government paychecks.

What is the root cause of these long wait times and delays? Is it mismanagement, understaffing, or something else?

There are multiple problems at the VA, and the ones you mentioned are no doubt factors to one degree of another. But even those who have defended Secretary Shinseki acknowledge now that the main problem is a culture that does not hold people accountable for failure, that rewards managers for making their numbers look good rather than delivering quality care and services, and seeks to silence and punish the whistleblowers who speak out about the problems. As even the President suggested Friday, simply throwing money at a broken system is not likely to fix it.

If you've been reporting on this issue since 2013, why do you think the issue has only come to a head in the last few months?

Some of it is just Washington's way of doing business. Wasted money and long, bureaucratic delays in processing disability claims are more the norm than the exception. But as we started seeing more evidence that long delays in medical care were being tied directly to patient deaths, the problems in the agency became far more ominous. Many of the practices that I've been reporting on for more than a year, such as cooking the books to make numbers look good, have far more dire consequences when patients' lives are at stake. Eventually a consistent pattern emerged in agency practices. It became clear that these were not isolated incidents, but, as the IG put it, systemic problems rooted in agency practices and policies. Local and national media began reporting across the country about similar incidents of patient death and care delays that were consistent with what was being reported elsewhere. This made it more difficult for agency officials to write it off as a few isolated incidents.

Can you give an example of "cooking the books?"

The most obvious example is what happened in Phoenix. VA had performance goals for delivering patient care, 14 days. To make it look like they were delivering the care within that time frame, when a patient came in his or her name was placed on a paper waiting list. That patient might wait months to see a doctor. Then, when the available appointment was 14 days away, the patient was added to the official waiting list. So even though the patient waited months to see the doctor, the official records only showed the patient waiting 14 days. I wrote about some of these scams on Friday in this story: http://washingtonexaminer.com/decade-of-reports-show-shinseki-was-in-denial-not-in-dark-at-va/article/2549151

What have been the most reasonable long term solutions that have been suggested to resolve these problems?

There is not just one problem at VA. It is a culture, as the president alluded to on Friday. Top administrators have a perverse incentive to falsify their statistics. If their numbers match VA policies on things like wait times, then they qualify for five-figure bonuses. So meeting the numbers became more important than delivering the care. That is why we have seen so many instances of cooking the books, as it has been repeatedly called. One interesting note across the board at VA is a failed manager is far more likely to receive a large bonus than face any type of discipline. The legislation that goes most directly to the accountability issue is a proposal that would allow the Secretary to fire, demote or otherwise discipline ineffective top managers. Shinseki complained during a recent Senate hearing about the difficulty in disciplining top managers. And yet at that time he opposed a bill by Rep. Miller to give him more authority to impose discipline. He indicated a change of position on Friday, just before his resignation was accepted. The Miller bill is stuck in the Senate. Sen. Sanders has come up with his own version, but it would leave in place many of the civil service protections that are problematic. The other major push legislatively is to give veterans the option of seeking VA-paid care from private providers if the agency cannot deliver it in a timely manner. There are different bills with different nuances. But in concept some form of those two bills would seem to be the most likely short-term result.

What is the likelihood of either of these bills becoming law?

Some iteration of these two proposals seems inevitable. The House passed its accountability bill with virtually no opposition. Now Sen. Sanders, chairman of the Senate veterans committee, has his own version. Both Republicans and Democrats talk about the need for reforming the bureaucracy and giving veterans better options for private care. However they do differ on details. For instance, Miller's House bill would give the secretary broad power to fire or demote incompetent managers. The Sanders accountability bill leaves in place many of the civil service protections that many view as the problem. The law already allows outside referrals, but that is meaningless if as a practical matter there is so much red tape that it becomes all but impossible in the real world. So just passing a "reform" bill does not necessarily fix the problems.

How about changing or removing the offending incentives - is that being done?

It's hard to tell with VA. The agency's history is to first deny there is a problem, then to claim there are a few isolated incidents if the problem can no longer be denied. Finally, the last resort is to claim the problem is already being fixed and they just need a little more time. We heard testimony last week from Thomas Lynch, a top VA official, that what he called performance measures improperly were elevated to goals. I'm not sure what that kind of bureaucrat-speak means. So it's hard to know whether VA officials are ready to accept the depth of the problem, or if they see it just as a public relations challenge.

Do you think it makes sense for the VA to be separate from the rest of the healthcare system? Whatever the reasons we have set it up this way, would it not ultimately make more sense for veterans who have private insurance to use the regular system?

That's an interesting policy question that has come up. I don't know the answer. The beauty of being an investigative reporter is that my job is to identify the problem. It's up to people smarter than I am to figure out how to solve it.

My husband is an injured veteran and he will be applying for disability through the VA very soon. He is taking his time as he is very skeptical of the VA, as they once charged us thousands of dollars for their mistake of mismanaging the GI Bill tuition benefit.

Do you have any advice for injured vets who are trying to navigate the system?

Many of the major veterans' service organizations have trained people to assist people filing claims without charge. The VA system is a complex bureaucracy and these groups can often help navigate the system. I've heard mixed reviews of the different organizations. So if you do opt to have one of these groups assist you, understand that you will always be your own best advocate.

How would you characterize the overall quality of care at VA hospitals, waiting times and gaming of backlogs aside? My impression is VA hospitals generally score pretty high in terms of the quality of care and cost containment relative to the private sector. Is that true? How do veterans rate the quality of care they receive?

Generally the feedback from veterans, veterans service groups and people who have contacted me is that once they get the care they need they are generally happy with their front-line providers. The problem is getting access to the care. If there is nothing seriously wrong with you, the delays in care may not have a lasting impact on your health and you will be fine. But if you have to wait six months for a colonoscopy, your Stage 1 treatable colon cancer may now be a Stage 4 terminal cancer. VA has already admitted to 23 patient deaths from gastrointestinal cancers linked to delays in diagnostic care. Getting a first-rate colonoscopy at that point is a lot like the old line, "other than that how did you like the play Mrs. Lincoln?"

Who will replace Shinseki? Is former Sen. Jim Webb a realistic candidate? And does it really even matter who is at the top?

I have no idea who the president will select to replace Shinseki. But the clear message from both Republicans and Democrats is that simply replacing the secretary will not solve the problems until some accountability and transparency is brought to the agency. If the new secretary is brought it to oversee the same broken bureaucracy, nothing is likely to change. That seems to be the universal assessment.

Hey Mark,

What do you think will be changed? Will veterans be allowed to use private care?

Again, this will require a change in the culture at VA. The law already allows patients to be referred to private providers to get care if necessary. However, the culture is such at VA that agency officials are reluctant to make those referrals, for whatever reason. As a result, patients in places like Columbia, S.C., had to wait months for something as simple as a colonoscopy which could have been delivered in a week had a referral been made to an outside provider.

Is it true that republicans are screwing over the veterans, or is it democratic bluster?

Both Republicans and Democrats have been trying to get answers from VA on these issues. This is DC and there will always be partisan finger-pointing. But if there is an issue that is bipartisan in this town it is caring for veterans. It's important to sort out the talking points and the political rhetoric from the reality of what's going on at VA. A good example of the bipartisanship was this Senate committee hearing last month: http://washingtonexaminer.com/eric-shinseki-deflects-senate-panels-tough-questions-on-veterans-affairs-scandals/article/2548507