Friday, May 30, 2014

Shinseki Sacked, Sadly

This morning President Obama announced that he has accepted VA Secretary Eric Shinseki's resignation.  Shinseki will be replaced for now by Deputy Secretary Sloan Gibson.  In the wake of Wednesday's devastating report on the issue, I don't see how Shinseki could have survived the firestorm anyway.

Veterans Affairs Secretary Eric Shinseki has resigned amid widespread troubles in the VA health care system.

President Barack Obama says he accepted the resignation with "considerable regret." He and Shinseki met in the Oval Office on Friday morning.

Shinseki had faced mounting calls to step down from lawmakers in both parties.

Shinseki's resignation comes two days after a scathing internal report found broad and deep-seated problems in the sprawling health care system. The system provides care to about 6.5 million veterans annually.

I gave Alison Grimes a hard time about calling for Shinseki's head last week, but she's looking pretty shrewd right now.  I don't know if that's good or bad.

The report is pretty damning.

The report said 1,700 veterans using a Phoenix VA hospital were kept on unofficial wait lists, adding that “these veterans were and continue to be at risk of being forgotten or lost in Phoenix HCS’s convoluted scheduling process.”

Auditors determined that the hospital’s leadership “significantly understated the time new patients waited for their primary care appointment in their FY 2013 performance appraisal accomplishments, which is one of the factors considered for awards and salary increases.” 
Official VA data showed that 226 patients in a sampling from the Phoenix clinic had waited just 24 days on average for their first primary care appointments. But the inspector general’s office determined that those veterans had actually waited an average of 115 days
The unofficial wait lists may represent the “secret” list that whistleblowers claim the Phoenix clinic used to cover up treatment delays, according to the report.

In other words, this looks like a complete cover-up.  Yes, Republicans blocked the VA from getting the funding necessary to help correct this problem, but that doesn't absolve Shinseki's VA from lying about what was going on at the expense of veterans who needed health care, didn't get it, and suffered greatly because of it.

I'm hoping now that Shinseki is out of the way, that the problem can then be addressed.  A bill to fix the VA like the one Senate Democrats put forth in February will be tough to block.  I figure it'll just die a quiet death in the House instead.

Why would Republicans choose to fix a problem when they can do nothing and successfully blame Democrats for things not getting fixed?

That's been the story of the last six years, and it's worked for them to an extent.  But this is where Democrats need to make it clear that this was definitely a problem that Obama inherited from Bush.

But according to VA inspector general reports and other documents that have gone overlooked in the current firestorm, federal officials knew about the scheme at the heart of the scandal—falsifying VA records to cover up treatment delays—years before Obama became president. VA officials first learned of the problems in 2005, when George W. Bush was entering his second term, and the problems went unfixed for the duration of his presidency.

The underlying issues date back even further. In 1995, as part of a broader overhaul, the VA began pressing clinics to cut wait times for new patient appointments to 30 days. But there was no system for tracking which facilities were meeting this target until 2002, when the VA introduced electronic waiting lists to keep tabs on patients who couldn't be seen within a month. Managers who slashed wait times were given bonuses and other perks. This created an incentive to game the system, especially after veterans of the Iraq and Afghan wars began flooding into VA clinics and straining their already stretched resources.

Got this?  Good.  Shinseki's head will probably roll because, hey, politics. But following that Democrats need to kick some Republican ass for this. These problems go back to 2005, and that means all the Republican efforts to block legislation to fix the problem since then are part of the problem as well.

And finally, it's important to remember that firing Shinseki won't do anything to fix the VA.

The fundamental problems at the VA are systemic and not individual, though some individuals undoubtedly did very bad things. In large organizations, it is systems that drive behavior. No one individual, even a cabinet secretary, can dictate systemic behavior to such a degree.

In the case of the disinformation about waiting times at VA hospitals, there was a system in place that set a standard that no wait time should be longer than 14 days. There was also an individual performance review system that would be affected positively with more money or promotions for meeting the standard, and negatively for missing the standard.

There were other systems in place regarding resources – personnel, facilities, financial, and computing systems – that apparently made it impossible to meet this lofty wait time standard. If you don’t have enough psychologists to treat veterans with PTSD, for example, it is impossible to make an appointment for them when no service is available. There may also have been sheer incompetence at some facilities, but it is important to eliminate the systemic problems before assuming incompetence or malfeasance.

Once again, Democrats in the Senate intended to pass legislation to do this.  41 GOP senators blocked it.


aconservativeteacher said...

Of course it's always Nixon's fault! Or was it Hoover? Whatever, at some point far back in history a Republican voted against increased government spending on the problem, which is the same exact thing as voting in favor of making all problems worse. Obama has only been President for 5 years and the Democrats have only controlled the Senate for 7- that is far too short of a time to undo all the damage inflicted on America by President McKinley!

Zandar said...

Boring *and* unfunny.

Eric Lindholm said...

Spending on the VA has increased 50% since 2009, more than any other program in the Federal budget, but - gosh darn it - it's just not enough because Republicans.

Enjoy that rationalization while you consider that a President who ran on this very subject, along with a Secretary who swore he'd fix this problem, with the help of Senate Veterans Affairs Chairman Bernie Sanders did nothing at all.

Zandar said...

41 GOP Senators thought it was too expensive to care for vets, a system overloaded by Bush's trillion dollar wars.

Nothing you say changes that fact.

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