Wednesday, July 16, 2014

The Veterans Affairs Crisis: Is It About The Money?

Thirty years ago, President Ronald Reagan gave America a good chuckle during one of his debates with Democratic presidential nominee Walter Mondale when the president  said with mild exasperation, "Well... there you go again!” That's undoubtedly what many Republican pols are thinking again today in response to the Senate testimony of Sloan Gibson, acting chief at the Department of Veterans Affairs:

"Well, VA... there you go again!"

Gibson, who in May replaced VA Sec. Eric Shinseki, who was forced to resign amid the exploding scandal at the department over falsified wait times for ailing veterans at hospitals across the country, boldy told the Senate Veterans’ Affairs Committee that VA needs a whopping $17.6 billion in additional funds over the next three years to effectively address the agency's problems.

Gibson said the funding would address improvements and additions in clinical staff, space, information technology, and benefits processing "necessary to provide timely, high-quality care and benefits." Specifically, the money would be used to hire 10,000 healthcare providers over the next three and ½ years, including 1,500 physicians, and would also be used to expand capacity at community clinics and other healthcare facilities and lease an additional 77 facilities.

"I am convinced we are going to see some productivity enhancement but it also means we have some investments to make," Gibson said. 

Not surprisingly, Gibson's pitch got mixed reviews from the Committee. Democrat Sen. Jon Tester from Montana supported the idea, while Republican Sen. Mike Johanns from Nebraska was unimpressed, saying that it "sounds so similar to what we heard over the years. 'I need more money. I need to be bigger, faster, grander. I need a bigger bureaucracy. I need to hire more people’ and on, and on and on. I think what you need personally is competition. If you can’t clean up your act, guess what. You lost out.... I don’t think you need billions and billions of dollars.”  

Rep. Jeff Miller (R-Fl), who chairs the House Veterans Affairs Committee, had this more characteristically thoughtful, if still critical response to Gibson's request.

"“I am committed to giving VA the resources it needs to provide our veterans with the care and benefits they have earned. But if there’s one thing we’ve learned over the last few months, it’s that we can’t trust VA’s numbers," Miller said today in a statement. "That includes the $17.6 billion in additional funding Acting Secretary Sloan Gibson asked for today. Given that this figure seems to have magically fallen out of the sky today – after years of assertions from VA leaders at all levels that they had nearly every dollar and every person necessary to accomplish VA’s mission – it would be an act of budgetary malpractice to blindly sign off on this request." 

Miller added that VA has had "hundreds of millions more in medical care funding than it could spend every fiscal year since 2010. So if VA truly needs this additional $17.6 billion, that would mean the VA administrators involved in past department resource allocation decisions are either incompetent, disingenuous or both.” 
Miller makes some very valid points. It is virtually impossible to trust anything that comes from a VA executive these days. But while Gibson’s formula, which represents a 20 percent increase from the $78 billion Congress already allocated for the department, sounds inflated, it's actually more palatable than the $35 billion over ten years that the Congressional Budget Office reportedly said would be needed to allow veterans who are suffering from long waits to see private doctors. 
The House and Senate have reportedly both passed bills to address this and other VA needs, but the CBO's numbers have some members of Congress shaking their heads in disbelief.

It’s fairly easy to predict how this will all play out. I don’t think even Gibson expects stingy House Republicans like Paul Ryan and Michele Bachman, who as I've reported here have called for reductions in veteran benefits in recent years, to fully support the plan. But there will likely be some additional funding for VA as a result of all this. Just how much is anyone's guess.

Some Republicans, even those like Miller of Florida who generally support veterans, will agree to some budget increases, I suspect, but will also point to this proposal from Gibson as just another misguided expenditure by the Obama administration. And some Democrats who are locked in re-election battles with Republican up-and-comers may also take issue with the largesse -- if only to appear fiscally frugal and to not appear too liberal or too supportive of the agency or the president.

Given the depth and breadth of the VA scandal, though, it's hard to blame any pol for his or her reluctance to spend billions more on a department that has a "corrosive culture," as Gibson recently acknowledged. But some of my most trusted sources insist that the wait times and many of the embattled agency's other ills are indeed the result of the lack of resources needed to hire enough doctors and other quality healthcare staff. 

It isn't a popular sentiment these days. But there may be something to it.

"It really is about money,” insisted Dr. Sam Foote, the physician and whistleblower who worked at the Phoenix VA for 23 years. He was the one who first brought the wait times scandal into the light. 

“The story here, the most important point, is that there is a horrible mismatch between demand for care in Phoenix and VA's ability to provide it,” said Foote. “That is what is driving all the shenanigans. People are dying while waiting for care at the Phoenix VA, and rather than admit that they can not provide for the demand, they are playing games."

Foote, who for the record is a staunch critic of Obamacare, said these "games," which include the falsification of wait times, are common throughout the VA system, not just in Phoenix.

"This all started in the mid-90s when the World War II population was going away, and VA predicted that by 2005, there would only be about 3.5 million veterans to take care of," he said. "They closed clinics and operating rooms in the late 1990s, and then the war came and the floodgates were opened. VA has been behind and trying to catch up ever since."

One respected veterans advocate, who asked for anonymity because the advocate works regularly with Congress, agreed with Foote. The advocate took it a step further, saying that said Congressional leaders don’t provide enough appropriations to VA. 

“No one in Congress wants to raise taxes to pay for the rest of the war,” the advocate said. “That is, our wounded, injured, ill, and disabled veterans.”

The advocate added that Congressional leaders "don’t hire enough professional staff to provide long-term, thorough oversight of VA. Even though VA is the government’s second largest department, most individual Hill offices lack a full-time subject matter expert to brief Senators and Representatives so VA has adequate funding to meet increasing demand for healthcare and disability benefits. In the worst case, some Hill professional staff are too busy defending VA to provide oversight of VA".

The advocate also suggested that VA leaders in Washington DC don’t provide enough oversight of local facilities. "There are so few oversight visits from DC that they are swatted away like pesky flies," the advocate said. "The end results are autonomous kingdoms at VA hospitals and regional offices with little to no accountability."

It will be interesting to see what Congress does from this point on. After the Senate hearing today, SVAC Chair Bernie Sanders (I-Vt) said the House and Senate have been making "significant progress in the last month” on their respective bills to fix a broken VA system, and that there will be an agreement very soon. 

“Millions of veterans are counting on us to do so,” Sanders said. “We can’t afford to make them wait any longer for the care and services they have earned and deserve."


  1. I am a Desert Storm veteran and a retiree of the USAF, I see two things at a glance without going too deep into the scandals of the VA. The systemic problems of the VA, both benefits and healthcare, are twofold one is the leadership and one that is not mentioned much is mismanagement at the highest level. This starts not at the government but at the directors locally and VISN's.

    Set aside my military education of management the civilian community states that to manage successfully you need to know your employees and rely on the information you gather from them for correct decisions, too include corrective action for successful operations. Second, a manager needs to know the money allocated to getting the job done. I have heard this saying and stand by the premise, "if there is a problem and it is not visible, follow the money for answers." Budgets are there for even the lowest households in the U. S. for sustainability and comfortable lifestyle disregard the budget and you become complacent in real management.

    A manager who disregards the budget and conditions of the workplace will have a poor customer satisfaction and less than successful outcomes in their area of responsibility. It is so incomprehensible that government seems to think we as American citizens cannot see the real issue of the VA scandal. Pouring more money into an already disingenuous administration would be like burning money in the back yard.

    I would say we may need better resources requiring more money but until the real issues of mismanagement is resolved, money would be inappropriate at this time.

  2. What about the Vietnam War Veterans? When we returned home many received little or no treatment. Many have endured a myriad of problems caused by their service. When will we be recognized for our sacrifices? Once again the Vietnam veterans are overlooked.