The American Dilemma and How We Can Fix It

Archive for the ‘veterans’ Category


We all love a good news story.  And I’m going to be among the first to put one up if it should arrive on the scene.  So, you think I missed one – don’t you?  Juwannadoright, didn’t you notice that Congress just passed a bill that is going to reform the VA?  Well, sadly, I did notice – and the “reform” bill isn’t that promised good news story.  But it does look pretty good – as long as you don’t read it.  (Nancy Pelosi may her words be praised).

The bill comes on the heels of what might actually be some good news for the VA – the confirmation of Robert McDonald as its new Secretary.  The vote was unanimous in the Senate – which is perhaps the first sign of anything resembling bipartisanship in a coon’s age.  That’s a good thing.  Mr. McDonald has a great deal of management experience and, if permitted to do so, might actually bring some positive changes to the medical care of our sick and injured veterans.  But that is the question.  Will Secretary McDonald actually have the authority to reform this agency?

After a number of decades of watching politicians and how they generally act, I have reached a general conclusion (although there are some few but notable exceptions to this observation) that politicians are far less concerned about doing good than they are about looking good.  Unfortunately, the VA reform bill is just another example of that kind of legislation.

Let’s recap the VA problem for those of you who have been hiding in their bunker for the last several months in an effort to stay out of sight of any Obamadrones which might be in your neighborhood.

The VA, the largest medical provider in the U. S., has had problems for years in providing care to serve its large population of veterans who look to it for medical care.  In some respect the recent problems are the VA’s own fault because they set for themselves a mission goal of providing every veteran who requested an appointment a fourteen day window for that appointment.  That was an admirable goal – but unfortunately, one that simply wasn’t achievable.

The result was that in order to appear to be doing good, certain people in the VA developed a system that gave the appearance of looking good by creating multiple appointment lists which appeared to achieve that goal.  Sadly, at least fifty of our veterans died while being on one of these phony lists.  Now into this mix add the additional issue that employee bonuses were based on how closely to achieving this fourteen day goal each facility came.  This, of course, introduces the idea that it might have not been mere “face saving” but also greed which contributed to the problem.

Shortly after we realized that the creation of phony waiting lists was not something that was unique to the Phoenix VA, in fact the same system was in place in twenty-six VA facilities nationwide, one of the proposed solutions was that each veteran be given a voucher which he or she could take to any medical provider in the event that there was an inordinate delay in securing an appointment at a VA facility.  The bill that Congress passed attempts to address that.

The second issue that was raised was with reference to accountability within the VA and making it easier to fire employees who engaged in doubtful practices, such as developing or maintaining phony lists – among other issues.  The new law only peripherally addresses this issue – so one can only wonder how now Secretary McDonald will be able to implement any management changes he might develop to benefit our veterans.

Let’s look at what the bill actually says.  (Follow the bouncing ball Minority Leader Pelosi).

Should a veteran require medical attention. be unable to secure a VA appointment within fourteen days and live more than forty miles from a VA facility, he or she can request a letter from the VA. authorizing treatment at a private facility.  (There is no specificity in the law as to how long the VA has to provide that letter).  Now, armed with this authorization, the veteran may make an appointment with a non-VA doctor or facility.  But then that doctor or facility has to request a letter confirming the contents of the original confirmation before the veteran can receive treatment.  (Again, there is no specificity as to how long the VA has to respond to that second request).

As I read through this bureaucratese, I could see the loggers out in the Pacific Northwest, felling the giant redwoods to provide the pulp for all the paperwork that will be involved in this process.  No doubt we will have to add to the bureaucracy within the VA (much to the delight of the unions that represent its employees) to handle this new program.

As to the second point – enabling top VA management to fire incompetent or malfeasant employees more easily – the bill does absolutely nothing.  In its inimitable way the Congress did skirt the issue and address the question of bonuses which might have been one source of the problems.  It limited future bonuses to a mere $360 million – a moderate reduction from the amount that was handed out in the last fiscal year of $393 million.

How could the VA actually offer our veterans quality, timely care?  The answer is fairly straightforward.  It would require the VA to identify and classify its clients as being in need of “Urgent,” “Maintenance” or “Ordinary” care.  The most critical patients should get appointments within seven days; those who are going in for routine follow ups should get an appointment within thirty days; and those who need the VA’s services only occasionally should get vouchers to get treatment at private providers, thus freeing up the VA’s appointment calendar for those who have more critical needs – an area of medicine that the VA handles quite well.

How should we deal with employees who are less than fully competent since apparently outright firing is, at least for the moment, off the table?  If an employee is found to be less than fully competent, he or she should be ineligible either for a bonus or for any pay increase or COLA adjustment for a five year period.  That might encourage those who are not pulling their weight either to see the light and reform or seek employment elsewhere.

Who knows?  Someday there will be an act of Congress that passes that not only makes the legislators look good but actually does good.  I’ll keep you posted when I run across it.

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