Eric Shinseki's fate aside, the VA debate is about government competence

 
Eric Shinseki speaks at a conference in Washington, DC on 30 May, 2014. Conservatives argue the problems at the VA are bigger than just Secretary Eric Shinseki

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Update: President Barack Obama announced on Friday morning that Secretary of Veterans Affairs Eric Shinseki has resigned.

Now that the former Army general is exiting the picture, expect the focus to shift even more than it has already toward what the Veterans Affairs story says about the larger issue of government competence.

***

Pressure continues to mount on Department of Veterans Affairs Secretary Eric Shinseki, as investigation into delays in treating patients has found "systemic problems" in the department.

At this point, nearly two dozen members of Congress on both sides of the political divide have called for the secretary's resignation. The White House has offered tepid support for the embattled former general, with press secretary Jay Carney saying that President Barack Obama will wait to determine accountability "once we establish all the facts".

Behind the headlines about Mr Shinseki's fate, however, lies a larger debate over what the Veterans Affairs (VA) scandal says about the government's ability to manage a large-scale healthcare programme. In many ways it's a rehash of the ongoing political tug-of-war over healthcare reform.

Start Quote

For the left, the Department of Veterans Affairs is how healthcare is ideally supposed to work”

End Quote Rich Lowry Politico

The healthcare debate has died down a bit, as enrolment in the programme surged this spring and problems with the healthcare.gov website were fixed. The VA story has given critics on the right another chance to air their objections, however.

This time they're targeting a VA system that can accurately be characterised as full-fledged socialised medicine, since the facilities are owned by the government and the doctors are government employees.

During debate over passage of the Affordable Care Act, some supporters pointed to the VA as a successful model for a more extensive government involvement in management of healthcare. Congress opted for a scaled back reform relying on private insurance companies and medical providers, but the praise of the VA has been repeatedly thrown back at those advocates by conservative critics in recent days.

One conservative commentator, neurosurgeon-turned-Republican-pundit Ben Carson, went so far as to say on a Fox News show that the VA scandal was a "gift from God to show us what happens when you take layers and layers of bureaucracy and place them between patients and the healthcare provider".

"If we can't get it right with the relatively small number of veterans, how in the world are you going to do it with the entire population?" he asked.

Townhall's Guy Benson thinks Carson's comments were "terribly unhelpful", but that he is correct that the scandal "presents a relevant and pressing opportunity for opponents of government healthcare".

The VA's troubles expose the department's inability to understand that modern healthcare can't be done both fast and on the cheap, writes Reason magazine's JD Tuccille.

"To the increasingly limited extent that it's allowed, American private medicine recognises the compromises that have to be made and offers a variety of coverage at different price points," he writes.

He continues:

Start Quote

Conservatives are treating this not as a fixable problem but as an exercise in building a narrative”

End Quote Brian Beutler The New Republic

The VA has tried to pretend that compromises don't have to be made; that it can, somehow, deliver care to everybody without worrying about cost. But it faces the same lack of infinite resources as everybody else. If the VA won't charge more for quick access to better care, fast will have to give. So we end up with secret waiting lists.

National Review editor Rich Lowry writes in Politico that the VA is "an island of socialism in American healthcare".

"For the left, the Department of Veterans Affairs is how healthcare is ideally supposed to work," he says. "No insurance companies, no private doctors, no competition - just the government and the patient."

According to Lowry, however, "it is perhaps the worst bureaucracy in the federal government".

PJ Media's Roger L Simon says that even maligned-by-the-left government contractor Halliburton could have handled veterans' care better than the VA.

"Probably almost any business would have," he writes. "There at least would have been some accountability."

The VA should be privatised, argues Avik Roy in Forbes.

"There is only one way to truly reform the VA, to truly ensure that veterans get the care they need," he says. "And that is to give vets the ability to take the money that the government spends on them and use it to buy high-quality, private insurance."

The apparent scope of the problems at the VA and the rapidly escalating level of rhetoric from critics on the right have put liberals who believe in government's ability to take on complex public issues on the defensive.

The New Republic's Brian Beutler points out that conservatives don't really have veterans' best interests in mind as they ramp up their attacks.

"Conservatives are treating this not as a fixable problem but as an exercise in building a narrative that will help them devolve, cut and/or privatise veterans health services and other government programmes," he writes.

He says President Barack Obama and his fellow Democrats shouldn't cede ground to their Republican critics:

Quality of management isn't a function of a system's relative degree of privatisation. Just ask the airlines, Wall Street, your electricity company and Target. Likewise being a good manager doesn't just mean avoiding problems, but fixing things - not dissolving the managed entities when things go wrong.

Despite all the criticism of the VA, writes syndicated columnist Froma Harrop, it's important to note that veterans generally are happy with their level of care from the government-run programme.

"You see, getting medical care can be rougher outside government-run programs than inside them, as contented veterans and Medicare beneficiaries repeatedly tell pollsters," she writes.

She also notes that many of the charges levelled against the VA are still just allegations, including the reports that 40 or more veterans died while waiting for medical services in Phoenix, Arizona. At least 17 of those deaths, according to the interim government investigation, have been found to be unrelated to wait times.

Privatising would be the worst possible answer to the VA's current problems, writes Daily Kos's Jon Perr:

Sending millions of older, sicker Americans - many of them requiring specialised care for rare and complex health problems - into the waiting arms of private insurers, private doctors and private pharmaceutical firms - is a recipe for chaos and de facto rationing on a grand scale.

Whether Mr Shinseki stays or goes - and, based on the current trajectory of this scandal, his job is hanging by a thread - the VA story is far from over. Investigations into the delays and possible cover-ups and criminal wrongdoing will continue well into the summer.

It will all be rolled into the ongoing debate over the role and effectiveness of government in healthcare - and, for that matter, everywhere else - which will continue unabated.

 

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  • rate this
    0

    Comment number 23.

    22. Republicans follow the creed 'always ensure a bud is in the loop for a piece' hence the egregious abuse on every Federal dollar spent, period. Its wearing thin in my view as evidenced by the VA and many other public money scams that have continued for the last decade or so.

  • rate this
    0

    Comment number 22.

    Interesting to see the Obama-haters here who have no experience with the VA, yet have plenty of political prejudice of which to inform us.

    I am a Vietnam Vet who gets great service when I can get in, and want the Republicans to FUND US!!

  • rate this
    +2

    Comment number 21.

    Iowa Neanderthals seeking a Senate seat targeted in on Obama and the VA scandal: http://theiowarepublican.com/2014/iowa-gop-senate-candidates-sound-off-on-va-scandal/ They ran Paul Ryan's nonsense up the pole: "... the Republican candidates suggested other ways of providing better care to our veterans, including voucher systems and private, out-of-market options." The never, never quit folks!

  • rate this
    +1

    Comment number 20.

    With US casualties dropping: Obama pulled the US out of Iraq, and the Afghanistan war (sic) winding down this year, there is light at the end of the VA tunnel now as the House is finally forced to address the litany of abuses by the civilian VA administration 'on their watch.' Obama's next two years should result in ever reducing casualties: http://www.bbc.com/news/world-us-canada-27606536

  • rate this
    0

    Comment number 19.

    "The VA's troubles expose the department's inability to understand that modern healthcare can't be done both fast and on the cheap, writes Reason magazine's JD Tuccille"

    Spiegel (German)

    Ambulance(around the corner) $1800

    Overnight observation in hospital -- $4000

    Allergy test -- doctor and laboratory --$2500

    Tablet-- $1.5 (Amazon for 100!)

    Diabetes strips - each $18 (amazon each 55 cents)

  • rate this
    +1

    Comment number 18.

    17. You have to be kidding - Obama obstruction from day one in 2009 was the plan and completed by McConnell (Senate filibusters) and Boehner/Cantor's House (sequester). Such redirection to Obama, the most hapless lame duck the White House has ever housed, is disingenuous.
    16. Yes, with a budget as large as the US, handling the admin. of an NHS style service for a few should be a cake walk?

  • rate this
    -1

    Comment number 17.

    Truly unbelievable how the libbie lemmings attempt to blame the "rabid right" when obama and his cronies have been in total control of things since 2008...

  • rate this
    +1

    Comment number 16.

    You missed the boat on this one. It's not about the government's ability to manage a large-scale healthcare programme (the UK and most other developed countries do a pretty good job of it), but about why the US government cannot do so. Most likely explanation: an out-of-control civil service.

  • rate this
    +1

    Comment number 15.

    It's disappointing that President Obama doesn't accept responsibility as head of the executive branch for the problems at the VA and take decisive action to fix them instead of offering up Shinseki as a scapegoat. He doesn't have to face re-election so why not agressively tackle this issue using the full power of his office? Do our veterans deserve anything less?

  • rate this
    +1

    Comment number 14.

    Although I wasn’t too surprised by Gen. Shinseki’s resignation, I was deeply saddened by the news. For almost fifty years Eric Shinseki was a good soldier, one of America’s best, and as such he fell on his sword for his commanding officer. Shinseki attempted to carry out his mission at the VA with the resources provided. The failure was due more to the system than Shinseki’s leadership.

  • rate this
    +2

    Comment number 13.

    I receive my health care through VA as my father did before me and my son will after me. I have always received excellent care as did my dad. I see the health care that my husband and other children receive with private insurance (through their employers) with high premiums, high deductibles, and high copays & 30-60 day waits for appointments for a physicals or med checks REALLY?

  • rate this
    -1

    Comment number 12.

    I have to say I agree with the right on this one. This for me confirms my belief that setting up a single payer healthcare system in the U.S. would be a disaster. The feds are hopeless at running this type of program.

    However, unlike the right I do think a solution in the future is to use the ACA to take care of our vets. The People would pick up the tab, naturally.

  • rate this
    +3

    Comment number 11.

    So the bureaucrats who ran the VA were taking money they hadn't earned and cooking the books to disguise fiscal hanky-panky: no wonder Congress is upset, you're supposed to win an election before you behave like that in govenment.

    Shinseki is being offered up as a scapegoat. No way the politicians were going to admit their part in promising more than they could deliver.

  • rate this
    +3

    Comment number 10.

    The fact that many Vets are dead and many more hurting because of this fraud is the issue. The VA bosses took large bonuses to 'pretend' they were doing their jobs. The 'cooked the books' and now the people ordered to do so are telling it on the news. This is fraud on a grand scale. We should expect large fines and jail sentences for grand larceny and gov't. fraud. Elections are coming soon.

  • rate this
    +2

    Comment number 9.

    How about - the VA debate is about middle management incompetency (or complacency). Too bad for Shinseki he didn't act on this the real problem sooner.

  • rate this
    +2

    Comment number 8.

    @5.Curt Carpenter,
    The issue of care of veterans is as old as our nation & shouldn't be used as fodder for politics.That in itself disrespects veterans.Every administration has had underserved veterans of current or former wars.We need to address that w/out attempting to score political points .Whether a war is justified or not is separate discussion.

  • rate this
    +2

    Comment number 7.

    Do you know how long this problem has been going on? It has been going on since the Nam. This isn't anything that is new and if those in charge of the VA say it is they are telling tales. This started before Bush I or Bush II, it was before Clinton and Before Obama. Where was Congress when it all started. They were getting their pockets lined with some of the money that's where. Now they can't.

  • rate this
    +1

    Comment number 6.

    Why would any person accept the job as VA secretary, given the massive mess caused by illegal wars and congressional underfunding of the VA. There is only one group responsible for the VA's shame - that would be Congressional Republicans. They love to send "the troops" to imperial wars but refuse to support the services they need on their return.

  • rate this
    0

    Comment number 5.

    Shouldn't the debate about "government competence" have started with George W. Bush and his administration as he led the country into two pointless wars -- that coincidentally created a large number of VA patients?

    Where were our friends on the right then?

  • rate this
    +1

    Comment number 4.

    There are really several parts of VA.
    The Hospital part is always underfunded. The Disabled American veterans organization publishes an annual independent budget that covers the costs of keeping the promises. It is always presented to Congress.

    I am a satisfied patient of my local VA. Your luck there varies by state.

    The Veterans Benefit Administration is a nightmare.
    The Cemeteries work fine.

 

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