In the first two blogs on this meme I looked at the accusation of treason as well as the claim that bribery played a role in the Uranium One decision. I also looked at some traits shared by those who believe this conspiracy. On my third blog I looked at “Politicized DOJ, FBI” and also “Weaponized Intelligence Communities”, and after finding out that the evidence for these claims are listed in incidents further within the coils of this snake decided to deal with each separately, starting with the “IRS Targeting Conservatives”. Then I slithered along to Fast and Furious and found that it, like the others is the result of a true scandal that was then inflated by ignoring facts, making up facts, and twisting facts. Now, I slide on to the Veterans Affairs scandal.
I find it interesting how the Veteran Affairs scandal was labelled on this meme: “abuse of veterans”. It gives the impression that President Obama and his administration were going out and purposely and deliberately abusing veterans. It brings up visions of Biden and Obama ambushing a veteran after he leaves the theater and beating him or her up. By the way, this labelling here is a good example of the power of words to slant a story.
Beginnings
In 2014 it came out that there were not just a few instances of negligence within the VA hospitals, but a pattern of negligence. Military patients were supposed to be able to get an appointment within 14 days. This was not happening. Worse, in some of these hospitals staff falsified records so it looked as if they were meeting the 14 day requirement. And even worse, some patients died while still on the waiting list.
A CNN report from April 30, 2014 showed that at least 40 veterans died waiting for care at the Phoenix branch. The VA internal investigation showed that 35 individuals had died while waiting for care at the Phoenix branch. In expanding the investigation to cover all the VA, several other VA centers across the US were found to have the same problems as the Phoenix branch. Over 120,000 veterans were left waiting or never received care. Also, falsification or other ways to fudge the waits times were found.
In addition to the news investigation and the VA internal investigation, the FBI also investigated as did the White House, the House Veterans Affairs Committee, and the United States Office of Special Counsel. In addition the Republican Congress commissioned the RAND Corporation to study the VA.
A Slight But Relevant Digression
I am about to write about the findings of these investigations and discuss root causes and possible solutions. Many view this sort of analysis as nothing more than “making excuses”, especially when the issue is one they have weaponized and used against their foes.
However, without a root cause investigation nothing can get fixed or be improved. Failures are going to happen. No matter how well made a car is, it is going to break down at some point. I wonder if those who think this way then view the diagnostics required to figure out what is wrong with the car as being making excuses for the car breaking down?
Most of the time those who weaponized this issue want to use it to show that governments, especially large governments are incompetent and cannot be trusted with anything important such as healthcare for the nation. Instead, large government needs to be reduced to very small government with most of our current departments being eliminated. I am not sure on this specific issue they would advocate for eliminating the VA. I have never asked those making this argument that question before.
However, I think their claim of governmental incompetence is overstated in this case (I’ll go into why further down). Sometimes a car is so bad off that it cannot be repaired. However, most of the time a fix can be found that is at least marginally affordable. However, it requires a good look at what went wrong, something those who take this position argue strongly against. It was on a different topic, but I once tried to explain to someone who had this sort of view why a prediction I had made was wrong, but he quickly said “I don’t care. You’re wrong.” Boom.
To my mind, this sort of thought, or lack of thought, process is indicative of someone who would rather destroy systems instead of fix and improve them, even if such destruction would result in literally millions of people being harmed.
Tidbit and Investigative Results
The results? Well, just to build suspense a bit let me first mention one number that some have tossed out to show how big and terrible a problem this was. Many extreme conservatives and most recently Trump, have said that 300,000 veterans died because of the excessive wait times. However, while this was unacceptable and a terrible problem, it was not as terrible as 300,000 deaths.
The claim that 300,000 veterans died waiting for service is based upon September 2, 2015 VA Inspector General report. In this report the IG stated “that pending records included entries for over 307,000 individuals reported as deceased by the Social Security Administration.”
At first glance it sounds as if this does support the claim that 300,000 died as a result of VA waits. However, look at it again. It never said that it was due to the waits. In fact, just after this sentence the same report states the limitations of this sentence:
- The VA’s record keeping was so poor that it makes it impossible to determine how many of these deaths were due to waits for healthcare or for other reasons.
- This information was pulled from the VA enrollment database created in 1998. Some of the individuals listed as deceased died before the creation of the database.
- The VA provides a great many other services than healthcare; home loans and disability payments for example. In 2013 those records and information were added to this database. This consisted of millions of records. Due to glitches in the software it is impossible to determine how many of those who died were actually seeking healthcare or were seeking one of these other services.
- Some of these files pertained to those asking about services, not applying for them. Again, per the report, the VA “does not have a reliable method to distinguish which enrollment records were created in response to an enrollment application or records entered into (the database) by actions other than enrollment.
The Inspector General concluded that “Most of the pending records are old and inactive and many of them misclassified”
To sum this bit up – no, 300,000 veterans did not die due to incompetency at the VA.
And actually, the above was actually a good part of the findings of the Veterans Affairs Office of Inspector General.
As for the results of the multiple investigations. It basically came down to two issues. The first if that given the resources setting a 14 day timeline for getting in was unrealistic and created pressures to fudge the reality in reports. The second is management failures in several areas. Although providing a bit more detail, this sentence nicely summarizes that failure – “…This backlog developed because the HEC (Health Eligibility Center) did not adequately monitor and manage its workload and lacked controls to ensure entry of WRAP (Workload Reporting and Productivity) workload into ES (Enrollment Systems).”
In fact, these two issues – unrealistic timeline and management failures in tracking how the system was doing both in terms of wait times and provision of services afterwards – were two of the main root causes. Another is not having the financial resources to deal adequately with their mandate.
Actions
- Both Veterans Affairs Secretary Eric Shinsek and the Veterans Health Administration’s top health official, Dr. Robert Petzel retired early. Shinksek retired after publicly accepting responsibility for the scandal.
- VA General Counsel Will Gunn and VA Acting Undersecretary for Health Robert Jesse stepped down
- Three other top officials were reprimanded.
- Several senior managers were removed from the Phoenix VA system.
- More than $390 million were moved inside the VA budget to fund care for veterans outside the VA system;
- Mobile VA medical units were deployed;
- The goal of providing appointments within the 14-day window that Nabors criticized as unrealistic and said may have “incentivized inappropriate actions” was ended;
- Twice-monthly public updates of VA wait times were posted;
- Performance bonuses were banned;
- Some senior managers from the Phoenix VA system were removed;
- Leadership emphasis on protecting whistleblowers from retaliation.
In addition to the above, several pieces of legislation were passed to try to correct this problem.
- The Veteran’s Choice Act was passed in 2014. Despite what he says, Trump did not create this. This happened during President Obama’s watch and was signed by him. Senator McCain and Senator Sanders were co-sponsors of this bill and shepherded it through Congress. Trump did expand the program, which Senator McCain was also pushing through before he died.
- One interesting thing to note here, and something I alluded to earlier, it is not being used as much as expected. There are two reasons for this, one of which I will be going into soon. The other though is that the wait times in the private sector are, in general, worse than those in the VA system.
And Now for the Surprise – VA Care is actually Good
Earlier I mentioned a study done on the VA system by the RAND corporation at the request of the Republican Congress. Its findings were interesting. Let me note that it did not look at wait times, and, instead, focused on quality of care.
The VA health care system performs similar to or better than non-VA systems on most measures of inpatient and outpatient care quality, although there is high variation in quality across individual VA facilities, according to a new RAND Corporation study.
Examining a wide array of commonly used measures of health care quality, researchers found that VA hospitals generally provided better quality care than non-VA hospitals and the VA’s outpatient services were better quality when compared to commercial HMOs, Medicaid HMOs and Medicare HMOs. The findings are published online by the Journal of General Internal Medicine.
“Consistent with previous studies, our analysis found that the VA health care system generally provides care that is higher in quality than what is offered elsewhere in communities across the nation,” said Rebeccas Anhand Price, lead author of the study and senior policy researcher at RAND, a nonprofit research organization.
While the study found wide variation in the quality of care provided across the VA health system, the variation is smaller than what researchers observed among non-VA health providers.
When all is said and done we wind up in an interesting place. The wait times did not meet VA standards, but that wait time was unrealistically set, and one that most private healthcare providers did not meet. However, the quality of care was as good as or better than most private healthcare providers. As I said earlier, the scandal was caused by unrealistic wait time goals, a poorly developed and used management and computers systems, and attempts to cover up these problems.
Final Thoughts and Lessons
While acknowledging the very real and serious problems at the VA, (ones it still has under Trump by the way), these problems do not mean that the VA system is worthless. Far from it in fact. When evaluating how well an organization is doing (or machine or anything else for that matter), especially organizations as large and varied as the VA system, there are two criteria that need to be used.
The first is comparing it against perfection. It is a good and needed standard. However, we need to remember that perfection is an impossibility. This is true for individuals and even more true for large organizations. Which is why we also need to compare against how other, similar organizations are doing.
Keep in mind that very large organizations are, well, large. Which means they have several departments providing various different services and engaged in many different tasks. A large organization can fail in one area but still be very good in other areas. This is the situation with the VA. In one area, wait times, they do poorly, although keeping in mind in looking how they do compared to other similar organizations they appear to be doing OK. However, in providing quality care for our veterans they do better than most private healthcare groups.
Which now brings me back to my main point. I mentioned earlier that there are those who like to weaponize problems such as this, and refuse to look at anything over than what they want to see. They see this as supporting evidence that large government is inefficient and incompetent. Further, in this particular case, they use the VA Scandal as evidence that a Medicare for all will not work, that it will be a flop.
However, when you look at this beyond just the problems, you see that the VA actually is evidence that the government can provide quality care. When you add in the other two large government healthcare providers, Medicaid and Medicare, there is ample evidence that the government can deliver this service.
Will it be perfect. Hell no. But, it will be better than what we have now. And, if instead of calling everything excuse making we do a true root cause analysis and act upon its findings, we can bring them closer to perfect.