Disarray at the VA

June 11, 2014
By Christina Pazzanese, Harvard Gazette

Amid public furor over revelations that employees at a U.S. Department of Veterans Affairs (VA) hospital in Phoenix concealed a massive backlog of patients waiting up to a year for treatment, VA Secretary Eric Shinseki resigned. The hospital reportedly placed patients on a secret list to evade scrutiny by federal regulators who grant bonuses for maintaining short patient wait times. Whistleblowers have alleged treatment delays are to blame for the deaths of at least 40 veterans at the facility.

Linda Bilmes, Daniel Patrick Moynihan Senior Lecturer in Public Policy, is a leading national authority on veterans and defense costs, as well as public finance and U.S. budgeting. Bilmes has written extensively about veterans issues and co-authored “The Three Trillion Dollar War: The True Cost of the Iraq Conflict” (2008) with Joseph E. Stiglitz, a Nobel laureate in economics. Bilmes spoke with the Gazette from England, where she is teaching at Oxford University, about Shinseki’s departure and the systemic challenges facing the troubled agency.

Q: Was Shinseki’s resignation appropriate given the findings of the VA Inspector General’s May 28 report and the May 30 audit summary, or was it a symbolic move designed to contain a political embarrassment before it did further harm to the Obama administration?
Bilmes: I don’t think it was appropriate. My opinion is that General Shinseki did a very good job as the head of the VA. The fact that the VA has continued to have so many problems over the past few years, despite very strong leadership, confirms my view that the fundamental system at the VA is simply broken. The job of a VA secretary is to try to make the existing system work well, but in this case what we need is to overhaul the system itself.

Q: Beyond the scheduling delays, what are the most significant deficiencies at the VA today?
Bilmes: The system is ill-suited to the needs of today’s returning veteran population. This VA system was set up a long time ago in a different era, pre-Internet, pre-all-volunteer force, and at a time when far fewer troops survived injuries. The wars in Iraq and Afghanistan have been fought by a small percentage of the population, many of whom have served multiple tours of combat. Fortunately, a much higher percentage of those who are wounded or injured can survive, but there is heavy demand on the VA because nearly half of the troops who are returning today are applying for disability benefits.

Q: Some blame the VA’s problems on chronic mismanagement, while others say they’re the result of inadequate funding which has led to a shortage of physicians to provide care. What is at the root of this current scandal, and what steps does the next secretary need to take to begin to fix the department?

Bilmes: One of the root problems is the lack of coordination between the Department of Defense [DoD] and the VA when troops come home. Returning service members are still within the military, and it is only after they are discharged that they can apply to become “service-connected” to the VA. But to date, more than one million returning troops have been treated in VA medical facilities. And if they want to continue to receive care from the VA, in most cases they need to apply for disability benefits from the VA. However, if they received medical treatment during their years in military service, quite often those records are not being shared with the VA, or not in a form that is translatable to the VA system.

There is a limit to how much the VA secretary can do without the Pentagon. Despite the fact that General Shinseki was a four-star general and he was able to improve the relationship between the VA and DoD compared with previous eras, it’s still not possible [for] a VA secretary to force the Defense Department to change its way of doing things. No VA secretary is going to have the authority to harmonize these systems. The lack of coordination has been a problem for every VA secretary for decades. But the scale of demand right now has pushed the whole thing into crisis, which may get worse, because there are hundreds of thousands of troops who will be discharged in the next few years. I believe that President Obama needs to take the lead. The president should establish a commission to consider major reforms to the structure of how military members receive medical care and disability compensation during and after their service, which seeks to streamline the transition and to radically simplify the VA disability claims process. read more

Linda Bilmes, Daniel Patrick Moynihan Senior Lecturer in Public Policy

Linda Bilmes, Daniel Patrick Moynihan Senior Lecturer in Public Policy
Photo Credit: Harvard Gazette

"The fact that the VA has continued to have so many problems over the past few years, despite very strong leadership, confirms my view that the fundamental system at the VA is simply broken."

 


John F. Kennedy School of Government 79 John F. Kennedy Street
Cambridge, MA 02138
617-495-1100 Get Directions Visit Contact Page