markflatten

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.

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

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.

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.

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.