WSJ: “How to Fix the Veterans Affairs Mess” … say, what?

Last week, the WSJ ran an opinion piece How to Fix the Veterans Affairs Mess by Anthony Principi who served as secretary of Veterans Affairs from 2001-05.

I expected a practical roadmap for attacking the current problems.

Instead, the author delivered a potpourri of declarations … some of which surprised me, and many of which made me sigh “oh my”.



Here are some of the points that caught my attention.



Fewer veterans to serve

Much has been said about how to fix the VA’s problems. Some say the department is underfunded. I disagree.

The VA’s budget has more than tripled, to $154 billion in 2014 from $49 billion in 2001, the year I became secretary.

In that time, the veteran population has declined to 21.9 million from 25.5 million.

The decline will accelerate with the passing of the World War II, Korean War and Vietnam War veteran populations.

The prevailing story line from the Administration is that the huge influx from the Iraq & Afghanistan wars have swelled the population of veterans beyond the VA’s capacity.

A declining population of veterans is certainly new news to me.


Mission creep

Veterans’ benefits have clearly multiplied far beyond President Lincoln’s post-Civil War promise to “care for him who shall have borne the battle, and for his widow, and his orphan.” It’s time for a return to original principles (of serving veterans) with disabilities incurred while in service—especially in combat or while training for combat.

Today, the country actually compensates a significant number of veterans for the expected and ordinary effects of aging….  more than 40 years after their military service for ailments such as heart disease or prostate cancer where there is no medical evidence of service-related cause.

I dare say this was not what Lincoln had in mind.

I’m officially confused regarding the VA’s mission.

I assumed that VA Hospitals provided lifetime care for veterans … this narrower scope surprised me.

Perhaps a starting point for fixing the mess is to clarify the mission’


Infrastructure & EMRs

The U.S. government operates two separate Veterans Affairs and Defense Department health-care systems. , both caring for the same people at different points in their lives.

Shared infrastructure alone would save billions in construction costs over the long term, and help in treating more veterans closer to their homes.

Realignment would also end the long-running battle between the VA and the Pentagon regarding electronic medical records.

Nearly $1 billion has been wasted in a failed attempt to move the departments to a joint operating platform.

First, I didn’t realize that the Feds were, in fact, operating 2 separate hospital systems.

But, what really caught my eye was the EMR observation.

A key part of ObamaCare is homogenizing thousands of idiosyncratic hospital record keeping systems.

If the Feds can’t do it for 2 systems that they directly control, why should anyone expect success linking thousands of disparate systems?


Monopoly protection

The VA and the White House recently announced plans to make it easier for some veterans to receive medical treatment outside of the VA system.

While this may have value in areas with long waiting lists, it raises serious questions.

The VA system is valuable because it is able to provide specialized health care for the unique medical issues that veterans face, such as prosthetic care, spinal-cord injury and mental-health care.

If there is too great a clamor for vouchers to be used in outside hospitals and clinics, the VA system will fail for lack of patients and funds, and the nation would lose a unique health-care asset.

Oh, my.

The implicit logic: VA Hospitals provide better care than private hospitals and – if given a choice – patients will choose private hospitals that provide worse care … and the better (government run hospitals) will lose market share.

Isn’t that the same argument used to protect the much maligned public school system?


Civil Service protection

Vouchers are not necessary to ensure high-quality health care, nor is the removal of civil-service protections for senior VA leaders, as has also been proposed.

What can I say?

I was surprised when Shinseki said that he didn’t want more authority to fire underperformers.

This continues that theme.

Protect managers from political whims (yeah, right) … and protecting them from a need-to-perform … and the result will be a high performance system.

I’m betting the under on that one.


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