Posted on | May 28, 2014 | 35 Comments
While this could be a descriptor of many offices, bureaux, agencies and possibly even entire departments of the Federal Government, I’m addressing the problems at the Department of Veterans Affairs, which is still referred to by many as the Veterans Administration or simply VA. As CNN points out in this excellent article (apparently they do still have good reporters, they just don’t let them on the air) the VA has been a disastrous pile of fail ever since 1921, when Congress formed the Veterans Bureau only to see it collapse into a slough of corruption so bad that it had to be abolished in 1930 and replaced with the Veterans Administration, which also took over pensions from the Interior Department and the National Home For Disabled Veterans, this last actually comprising a number of Federally operated homes for destitute and disabled veterans.
Trouble could have been foreseen from the beginning at the VA, since its first head was retired Brigadier General Frank Hines, who had headed the scandal-plagued Veterans Bureau for seven years; he would be sacked by President Truman in 1945 after a series of news reports on shoddy care in VA hospitals*. He was replaced by General Omar Bradley, but even Bradley could make little headway with the over-centralized VA bureaucracy, and by 1946 the American Legion was calling for his head. Two years later, a government reform commission found massive waste, fraud and inefficiency in the VA, some of which was cured by decentralizing the bureaucracy; another reform commission in 1955 noted that waste and poor care persisted. The problems continued on through the 1970s, 80s, 90s, and continue to persist today.
Part of the problem is that while theoretically the VA is supposed to provide care for all veterans, in practice, it triages veterans based on whether their injuries/illnesses are combat-related (this was at the root of the Agent Orange brouhaha) and whether they can afford to pay for their own care. Another part of the problem is that the VA has arguably never had the assets to properly do its job, and while the VA budget has increased since 2008, it hasn’t kept up with the surge of elderly veterans from the Greatest Generation and the Baby Boom who now comprise most of the patient load. This is also the reason why you’re seeing most of the “dying in line” cases coming out of the VA medical centers in Arizona and Florida – those states are very attractive to retirees, and so retired vets tend to flock there. You don’t hear about problems like this in Minneapolis, Washington DC and Boston, for example, because most retired vets either aren’t interested in living in climatic hellholes or simply can’t afford to live in the latter two areas due to their high costs of living. The number of Iraq/Afghanistan vets trying to fight their way through the paperwork to get their benefits is relatively small by comparison.
Megan McArdle posted a pessimistic essay yesterday which I linked to this morning, whose basic thrust is that the Obama Administration thought they could solve the VA’s ongoing problems by just throwing more money at the problem and hiring some more people, only to find that the solution just wasn’t that simple – people need to be fired and processes need to be changed, and both of these are a hell of a lot harder in the Federal government than they are on Wall Street or Silicon Valley. Instead, thanks to the executive decision to make it easier for vets to get help for PTSD and Agent Orange, the claims ratcheted up faster than the agency could deal with them (McArdle quotes a National Journal article that says Agent Orange claims ate up 37% of the VA’s claims processing resources from 2010 to 2012), so things wound up even worse off than they were before. The obvious solution, which is allowing the private sector to take some of the load off, has been fought by the American Federation of Government Employees, which has been fighting a new $9.3 billion program that encourages Medicare-eligible vets (about half the patient population) to seek care from civilian hospitals.**
Stacy’s Crazy Cousin John is often wrong, but as far as the VA is concerned, he’s right – the Veterans Health Administration needs to be stripped down to the things it does best, and hand off other medical care to private physicians. Given the current administration’s sinister ineptitude, though, I think we’ll continue seeing more veterans die in line while waiting for the VA bureaucracy to get them what they need.