Ed's Blog

"Some people know everything, but that's all they know."



Why is it that no matter how much national media attention problems at the Veterans Administration receive, serious problems affecting the care of millions of veteran’s health care persist?

Most recently, while long delays in wait times for veterans at VA health care facilities continue, problems mount with the Choice Card, intended to allow veterans to seek private medical care if VA is unable to provide it within a month of being requested, or if there is no VA facility near their homes. The program, opposed by senior people at the VA because they believed it undercut their reputation, is under siege because the VA has not paid millions of dollars to doctors. The result is the hounding of veterans who have used the card by bill collectors.

According to investigative reporter Like Rosiak writing in the Daily Caller, citing the Miami Herald, “A survey of non-VA hospitals in Florida, for example, found VA owed more than $100 million in unpaid claims for services provided to veterans under the Choice Card program. Sixty percent of the hospitals described the problems in getting paid as inexplicable, with their claims mysteriously getting lost. A growing number of doctors across the country are refusing to treat patients using the Choice Card for fear of never being paid.”

What will it take to give veterans the health care they deserve?

They way I see it, three problems are at the root of this scandal. First, is the nature of the federal bureaucracy. Firing incompetent or simply lazy federal employees is an enormous challenge. As a former senior executive in the Department of Defense I can tell you that the time and effort it takes to fire these employees is such a disincentive that most supervisors simply transfer the employee or ignore the problem. The result is a level of incompetence exists in the federal government that is not tolerated in private industry.

Even so, the VA has made progress on this front. According to Government Executive magazine, “The VA has fired 400 more employees this year so far than in 2014, according to Secretary Bob McDonald. McDonald said VA has fired 1,500 employees this calendar year compared to 1,100 people last year – a 36 percent increase. The former head of Procter and Gamble added that 2,280 employees have been terminated since his confirmation as VA secretary in July, and that the department has proposed disciplinary action against 300 workers for ‘manipulating scheduling.’” The VA has a workforce of roughly 330,000 employees. The question is, is this enough?

Second, health care, in and of itself, in the United States is fraught with difficulty. Costs are out of control. The demand for health care is on the rise while the number of doctors available is rapidly decreasing. In the case of the VA, 14 years of war has created a large number of physically and mentally disabled veterans. This compounds the increase in the demand for healthcare by a greying American population. Obamacare has only exacerbated this for Americans in general and driven some veterans to the VA system who otherwise may not have needed VA care.

Third is gross mismanagement by the VA leadership. Even after Congress gave the Secretary of Veterans Affairs the power to fire underperforming senior executives, very few, if any, have been fired. The VA has approximately 400 Senior Executive Service employees, but firing SESs has been difficult. In January and February of 2016, the VA lost three successive personnel decisions under this new authority, leading the VA Secretary to propose shifting the employment jurisdiction governing all VA SESs from Title 5 (Government Organization and Employees) to Title 38 (Veterans Benefits) of the United States Code.

What is the solution? Until all three of these problems are adequately addressed, veteran’s healthcare at the VA will not substantially improve. Perhaps with a new administration more progress is possible. A new National Security Management System introduced by the Bush administration to better rate employees on performance was quickly junked under federal employee union pressure when Obama came to office. Congress and the new president have their work cut out for them.




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