19 May 2016

FUBAR:: The Shame of Our Veterans Adminstration

While the national media today devotes its pages and airtime to Donald Trump's twitter feeds, and our President is taking center stage issuing bathroom decrees, a huge scandal, the shame of our Democracy, is all but ignored.

An NPR program aired last night told the story:

Remember the Veterans Administration scandal of 2014? Veterans had earlier been induced to enlist in the Armed Forces by our government's promise that upon their honorable discharge they would receive, "all the necessary care... to promote, preserve, and restore your health." Then they were screwed over by their country. The wait for care: months and months-- was so long that some VA administrators cooked the books to hide the disgraceful delays.

When the matter became public, the finger pointing commenced. There was enough blame to go around. 

First, in the eight years of the Bush wars, the size of our military grew, as did the injuries to be treated after discharge. The Administration came up with the cash to acquire the guns and bullets, but failed to acquire the hospital beds and medical personnel  sure to be needed when the troops came home. While Bush and Cheney ignored the issue, Congress slept. 

Second, when the Harvard Law Professor and Community Organizer  Barack Obama, became President, he was full of policy ideas, and successfully crammed Obamacare down the throats of the Republicans in Congress.  Having napped for 8 years, the R's  were now awake and well rested, and instantly became such experts in health care, they could piss all over The Affordable Care Act. But neither the President nor the Congress looked out for the vets. Their care was left to the slumbering Veterans Administration, an agency that is almost a perfect model of what is wrong with Government.

So for each of the ten years after taking office, our head of The Executive Branch failed to do his duty, failed to monitor the V.A., failed to appoint supervisors who would supervise. And so the veterans got screwed again and again. 

When it was reported that not only were there unacceptable delays in the delivery of medical services, but local administrators were fraudulently covering them up, the head of the V.A., General Shinseki was forced out. Congress rushed through a bill providing $10 billion to fix the problem, but the legislation was wildly unrealistic: it gave the V.A. 90 days to patch up a system hosted by a crumbling infrastructure. 

The fix failed.The bill required the agency to create a whole new network of alternative health care providers.  The hospitals, doctors and other health care personnel would be paid by the V.A. But when the V.A. tried to put the pieces together, it failed, and hired an outside firm to do the job. The result was chaos. The heart of the fix was that vets could go to non-V.A. doctors when the wait at V.A. facilities was more than 30 days or they lived more than 40 miles away.   Not only did the V.A. need to enroll patients and doctors in the program, promulgate regulations, fashion a billing system, etc,  it then had to execute: it had to make sure the doctors and hospitals received timely payments for their services.  Asking the Veterans Administration bureaucracy to organize and administer such a plan was like asking pigs to fly. Duh, when the doctors and hospitals complained the government did not pay at all, or did not pay within 90 days, they dropped out of the program.  And we were back to GO.

The result, NPR reported, is that delays at V.A. hospitals are today as bad as they were before!

I know the President is busy. But so are lots of chief executives who run successful enterprises. They manage to succeed because they know that policy is only the first half: you must then administer the execution of the policy. (Cf. the famous Seinfeld scene when he is told the car rental agency does not have the car they reserved for him. He says to the attendant "Sure you know how to take a reservation, but the important part is to keep the reservation.")

In the few months left to his Presidency, is it too much to ask that Mr. Obama fix this--permanently?  Talk about the Obama legacy!

And Congress, they ain't about to sit down and draft a new complicated bill. One of the two sponsors of the defective bill (Senator  Bernie Sanders) is too busy now anyway.  

So here is my simplistic suggestion:  Do not try to reinvent the wheel. Why not just put all eligible vets into Medicare? And then appoint somebody like Mike Bloomberg as head of the V.A., with power to effect the regulations and attend to the details of the merger. The R's should love it because the government can probably fire thousands of ineffective clerks and managers whose jobs are duplicates of existing Medicare personnel.

Let's leave FUBAR back in the history of WWII, and not reimpose its consequences on today's veterans.

A bientot.

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