I don’t know. From what I hear on the news there are two main problems with the VA: a huge backlog of new veterans who have applied for VA medical care but who have not yet been enrolled, and cheating by VA hospital administrators to hide long waits for medical appointments. There are even allegations some VA patients died while waiting for care that may have kept them alive.
I worked for the Tucson VA Hospital a few years ago. I was a low level wage scale employee, not civil service, but during that time I worked with literally hundreds of patients. I heard the occasional gripe, but overall they loved the VA. I’m on the outside now, but many of my friends go to the VA hospital, where they believe they get better care than they would anywhere else.
Of course these are all veterans already in the system. I don’t know about the hundreds of thousands of vets who are waiting to get in … and how would I? I think I have a little insight into part of the problem, though, the part that has to with paper versus electronic records.
One of my jobs at the VA was to transport applicant records from Tucson to the VA Regional Center offices in Phoenix. Every day there’d be between six and twenty heavy cardboard boxes stuffed with the complete military medical histories of new applicants. Applicants would submit their records and fill out forms at the hospital in Tucson; I’d transport the files to Phoenix; VA regional office administrators would evaluate the records and applications and eventually enroll new patients in the system.
Every morning, as I loaded those boxes into the back of my van, I’d think of this once-ubiquitous bit of office humor, endlessly Xeroxed and pinned to bulletin boards:
I worked for the VA from December 2005 to October 2008. During those years there was supposedly a push on to transition from paper to electronic records, but I never saw any evidence of it. Shortly before I left, I asked the guys in patient records how the transition was going. Their reaction? It was the old “You Want It When?” cartoon come to life. After they quit laughing, they told me it would never happen and not to worry my pretty little head about it.
Realistically, someone at the regional office is still going to have to read and evaluate records and applications before enrolling new vets in the VA health care system. Whether that someone reads paper or electronic records probably won’t have a major impact on how long it takes to approve new enrollees (yes, being able to enter search terms to sift through mountains of text will speed things up, but I think the bigger problem with paper records is storage).
It’s the civil service mentality I worry about. Standing between every new vet and enrollment in the VA health care system is a bureaucracy of old-school civil service administrators, and when I think of that lot all I see is that cartoon. You want it when? By “old-school civil service,” I mean “can’t be fired.” Complicating things, disabled military vets get hiring preference for VA civil service jobs. All the guys in the patient records office at Tucson were disabled vets. They’re the sacred cows in the system. You think it’s impossible to fire a regular civil servant, wait till you try to fire a disabled vet!
I don’t know what can be done to change things. When I retired from the military, I chose not to enroll in the VA health care system. Neither my wife nor I have any special health issues, so we opted for Tricare medical insurance and civilian doctors, as do many vets. Now that we’re of Social Security age, we have a combination of Tricare and Medicare, and that should see us through the rest of our lives. So if insurance and civilian care work for us, would it work for all vets? Could we shut down the VA hospitals and put all the vets on Medicare or Medicaid?
Many of the patients I worked with at the VA were in really bad shape, with multiple medical issues: amputations, diabetes, cancer, PTSD, chronic lung diseases, cardiovascular problems. Would they get the same level and quality of treatment through Medicare? One of my friends on the outside has had not one but three hip replacements through the VA. Would she have gotten more than one from Medicare? The VA provides mental health care, and they do it in a big way, since so many veterans have stress-related mental health problems. Does Medicare cover mental health treatment? Can the typical vet afford private supplemental insurance to help cover the things Medicare doesn’t?
I don’t know, but I suspect the VA provides services and a level of care many veterans need and won’t be able to get in a privatized system. We need to fix the enrollment problem, but that’ll require hiring more administrators to catch up with the backlog. How can that possibly happen with the current congress and the budget constraints they’ve put on government service?
If Veteran Affairs Secretary Shinseki is to be believed, although the enrollment backlog still numbers in the hundreds of thousands, it’s coming down. Presumably once the spike of Iraq/Afghanistan war veteran applicants have been enrolled, providing we don’t start any new wars, the problem will be solved. But it’s still going to take years and years, and what are these vets supposed to do until then? Most of them are too young for Medicare, but perhaps they can be enrolled in state Medicaid programs until they finally get into the VA system.
If Shinseki can be believed. And that brings me to the second issue, cheating by VA hospital administrators to hide long waits for medical appointments. I don’t know about patients dying. Patients died all the time while I worked for the VA in Tucson, but then again those patients were, as previously noted, in terrible shape and in many cases were being kept alive by the care they got at the VA hospital. I suspect we’ll eventually learn that most patients who died while waiting for medical appointments would have died anyway, as harsh as that sounds, and doesn’t the exact same thing happen in the civilian health care system? All the time?
No, the problem is the lying and cheating, and given how widespread it is, how do we know Shinseki is telling the truth about reducing the backlog of new applicants? Maybe he thinks he’s telling the truth, but the numbers he’s been shown in staff meetings were cooked. How would he even know?
I don’t know how to fix that either. All I know is this: if our job security and promotions depend on meeting percentages and numbers, we’ll try, but when our best efforts fall short we’ll find ways to disguise our failure. Tell VA hospital administrators all appointments must be scheduled within 14 days, they’ll try to make it happen, but when it doesn’t they’ll find ways to make it look as if they met the goal. It’s human nature to measure job performance with numbers; it’s human nature to do whatever’s necessary to measure up … or appear to. How can that be changed? Damned if I know.
I want to believe Secretary Shinseki. When he was General Shinseki, chief of staff of the US Army, he told Defense Secretary Rumsfeld an unpleasant truth and got fired for it. I was happy when President Obama righted that wrong by appointing him to the VA post. But he’s barely made a dent in the backlog problem, and as a former military commander and leader he should have been more savvy about the possibility of underlings fudging performance measurements. He should have fired some VA hospital administrators before now. Maybe he’s not the right man for the job. It’s up to President Obama now.