Government Bureaucracy Fails Veterans
Alas, corrupt government is host to many ironies, but three are paramount: success is a liability, failure is an asset, and as long as the intentions are pure in the public mind, better funding follows failure, not success. Once established, bigger civic programs have few measures of effectiveness. The end game is there is no end.
The logic is pragmatic. No politician makes a career by defunding or eliminating failed programs. Think of effectiveness as you might Fitzgerald’s receding green light, a flash on the horizon not a destination.
Failure has a permanent constituency: passive taxpayers, venal politicians, and rent seekers who are smart enough to manipulate the first two. Contrary to the conventional wisdom, when it comes to public management and/or results, good intentions are more than enough.
The Veterans Administration (VA) and the Affordable Care Act (ACA) illustrate these phenomena.
The Veterans Administration, like a deer in the headlights, is again in the headlines -- this time for fatal wait times. Seems the VA, like some criminal enterprise, is cooking the books; one set of books for incentive pay and bonuses and another set for the real world where former soldiers may be wasting in waiting rooms or dying on waiting lists. Medical apparatchiks apparently are reporting care statistics and/or mortality rates that do not comport with patient experience. “Do no harm” seems to have been an early casualty at the VA.
The VA is the largest single payer, state sponsored, health care system in the country. Think of the VA as a prototype of the ACA. The VA has been around since 1930, a cabinet department since the end of the Gulf Wars. You might also stop wondering why, in the run-up to ACA, veterans care wasn’t held up as a role model, an exemplar for the federal health mecca to come.
The culture of deception evident at the VA is a federal, not a Phoenix problem. Indeed, when terms like “public servant” are deployed to defend apparatchiks, only half that phrase is likely to be true. In addition to six figure salaries, VA administrators are awarded bonuses or incentive pay to do a lousy job.
Fraudulent bookkeeping is necessary because true merit is lacking. Like T-Ball; everyone gets a good report card and everyone gets a dollar trophy. Deadbeats flourish where there are no meaningful measures of effectiveness, especially at the federal level where most real work is done by contractors and camp followers anyway. Phony statistics thus become a stand-in for employee achievement. Reform at the VA is unimaginable without fundamental Civil Service reform.
Frankly, neither political party thinks much about places like the VA unless there’s a scandal. Republicans don’t complain, or respond to complaints, because it might offend public unions. And Democrats don’t want to publicize any incompetence that might screw the single payer pooch, nee total socialization.
With both, the political nomenclatura, even former military mandarins, will never subject themselves to the same indignities as the proletariat. Rest assured that John McCain, Harry Reid, Colin Powell, and Eric Shinseki, like Congress and staff, will never have to wait in line for three months for a colonoscopy or a prostate biopsy.
You could do worse than think of the Affordable Care Act as a kind of doubling down on Veterans health care; another federal bailout for failure, if you will. The VA and the ACA are not exactly comparable at the moment, but you don’t have to be a clairvoyant to see the specter of single-payer and an even bigger federal role in medicine on the horizon.
You might also wonder what a soldier like Eric Shinseki is doing in the health care or social services business. Shinseki is the longest-serving VA secretary. He owns the fraud problem. Clearly, the retired general knows as much about medical good practice as David Petraeus did about good Intelligence. Giving an infantry officer control of a health care system is a little like giving a proctologist command of an amphibious landing.
To be fair, we should note that minor cabinet sinecures like the VA are usually more about politics; in Shinseki’s case, a reward for very public pushback against the Bush/Rumsfeld Iraq strategy.
And let’s not let organized veterans off the hook here. Most groups like the American Legion, the Veteran of Foreign Wars, and the Disabled American Veterans are social clubs. Most organized veterans willingly pose with any nitwit running for office before succumbing to promissory dementia. Truth is few politicians give a damn.
Given the half-life of Media interest in all things military, least of all veterans care, the net effects from the latest VA scandal are fairly predictable.
Barack and Michelle Obama will make all the appropriate noises of indignation. Mrs. Obama might even pose with a sign, and a pouty face, as she did when Boko Haram kidnapped nearly 300 school girls for forced conversion to Islam and the sex slave trade.
Congress will do what it always does; throw more money at the VA, another failed federal institution. The answer is always more funding -- never mind that more is never enough. Few federal bureaucrats will get fired! Unionized apparatchiks, like unionized teachers might be moved, but seldom removed.
Any congressional reform will probably do more to protect civil servants, contactors, and rent seekers than it will improve the lives of aged or injured former soldiers. Unlike veterans, camp followers have real power inside the Beltway.
General Shinseki probably tarnished what was heretofore a distinguished military career by not falling on his sword earlier. Alas, he was at the VA long enough to get the lay of the land. Generals who dabble in politics are vulnerable and dispensable anyway. Shinseki, like Patraeus, will be just another sorry footnote to the Obama era.
Studs Terkel (1912-2008) hurled brickbats from Chicago for decades. Never mind that the Windy City, if not Illinois, are two of the most corrupt polities in North America. Social inequalities and Capitalism were Terkel’s favored targets.
His most effective analytical tool was the interview where he artfully allowed victims to bare their souls – and sometimes self-destruct. Terkel’s social criticism was often spot on - brutal and humorous, simultaneously. Unfortunately, he gave more thought to criticism than solutions. Diagnosis and remedy, like good will and achievement, are worlds apart.
With Studs you got blunt and often amusing analysis undone by flaccid, if not shopworn, urban bromides. For Terkel, bigger government at any level was better.
But government solutions are never as real as problems. Studs Terkel, as usual, is half right. Hope might hang in there, but esperanza never outlasts funding. Money and institutional self-interest eats hope and good intentions for lunch. Federal crime not only pays; indeed, there are incentives and bonuses for fraud!
G. Murphy Donovan, a combat veteran, served in USAF Intelligence for 25 years. He has never seen the inside of a VA waiting room or an American Legion hall.