Rebuilding the VA One Bureaucrat at a Time

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“There are no two words more harmful in the English language than ‘good job,'” according to J. K. Simmons in his riveting role as a jazz instructor in Whiplash.

President Obama and the VAWith all due respect, “good job” now must take back seat to “chipping away,” as President Obama declared in a recent visit to a VA facility in Phoenix. According to an article published in the Columbus Dispatch, President Obama declared that his new VA leadership is “chipping away at those problems.” Certainly the Government Accountability Office “GAO” and President Obama don’t seem to be reading from the same script as earlier reported by SFTT on veterans with severe depression:

10% of vets treated by VA have major depressive disorder and 94% of those are prescribed anti-depressants
86% of audited files of vets on anti-depressants did not receive a follow up evaluation within the required 4-6 weeks
40% of the same group of veterans on anti-depressants did not receive follow up care within the recommended time frame
63% of suicide cases were inaccurately processed

This means 500,000 veterans have major depressive disorder and 470,000 of those are prescribed anti-depressants. This means it is possible that 404,200 veterans on anti-depressants are not receiving timely follow up assessments.

Frankly, Mr. President “chipping away” at the problems of the VA is simply no where near a “good job,” let alone “mission accomplished.”

Simplified Model to Fix the VA

While I have no intention of engaging in partisan “gotcha” games, some problems are simply too big to fix with a bureaucratic house-cleaning.  With 340,000 employees, the  VA seems managerially adrift and totally unresponsive to the needs of our brave Veterans.   Can it be “fixed” from within?  I doubt it.   Responsiveness to address the needs of our Veterans clearly seems to have taken backseat to a bureaucratic structure that is both self-serving and adrift from the needs of the constituents it is mandated to serve.

In these situations, it is generally best to segregate the organization into activities or functions that “work” from those that have manifest problems.  Sure, some Veteran support functions may not be “broken” and in those cases it might well to determine what resources are required to fix the problem – and, if adequate resources are allocated to borderline cases, will the desired outcome be acceptable.

These need not be a complicated exercise, but is certainly one which VA bureaucratic insiders will sabotage.  The following decision tree results:

  1. VA Functions that “Work”:  Staff appropriately and allocate resources to either enhance or maintain capabilities;
  2. VA Functions that “May be Viable”:   Determine what problematic functions are viable and invest, or eliminate;
  3. VA Functions that are “Not Viable as Presently Administered”:   Current VA activities that are not viable or cannot be fixed within the current VA structure should be eliminated and/or outsourced to the private sector.

Simply throwing more taxpayer money at an institution with a stunted bureaucratic hierarchy  makes absolutely no sense.   I can sense President Obama’s frustration, but sadly the chronic neglect of our brave Veterans requires more that “chipping away” political soundbites.

The “Choice Card” Thwarted by VA Bureaucrats

Lat summer with great fanfare, Congress passed emergency legislation designed to provide Veterans with emergency healthcare in the private sector if adequate service was not available from the VA.   In general, the “Choice Card” was provided to Veterans who were more than 40 miles from a VA facility, however, it now appears that the VA disqualified some 80% of those Veterans who applied for medical help from the private sector.

It is no wonder that the entrenched bureaucracy at the VA is fighting tooth-and-nail to avoid letting Veterans determine the care they wish to receive.   James Tuchschmidt of Concerned Veterans argues that:

“We are now entering a realm where we, quite frankly, are running a health plan, where the veteran, the patient, decides what happens to them, and where they go, and how they get care, and what care they get. And this is a huge cultural shake-up, quite frankly, for us as an organization.”

Will the VA allow this initiative to succeed?  I doubt it, unless both the President and Congress insist on VA leaders who are prepared to effect “real” change rather than administer the status quo which is largely broken and ineffective in dealing with the needs of our Veterans.

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