A couple of days ago, I was listening to the (then) latest discussion about the problems associated with treatment of veterans at VA hospitals. The commenter at the time was opining that thorough investigation was needed to get to the root causes of the problems at the VA before meaningful fixes could be done. Given that this is Memorial Day weekend, and the high regard that we should (mostly do) hold for our veterans, I thought that the least that was owed to those currently having problems getting treatment and their families was an honest assessment. And any honest assessment must acknowledge the following: We know the root causes.
Our veterans, and indeed veterans of other countries around the world, cannot and will not receive the care that they were promised in anything approaching a timely or efficient manner. The root cause of this is that their care is being administered by an organization that does not place primary emphasis on timely and efficient care. It cannot.
The Veterans Administration is a government bureaucracy. As such, it responds to government and political directives. That is not an insult or accusation. It is simply a statement of fact. Its options are set by the government. Its actions are limited by the government. It responds not primarily to the needs of its clients, but to the laws and regulations enacted by government. The government pays its salaries, establishes the rules, and provides the means. As such, no matter how well or poorly the needs of the veterans are being met, the response will always be limited by law and policy set by those with little or no stake in the outcomes of the medicine. Under these conditions, efficient and effective medical treatment is all but impossible.
The government set policies and time tables requiring timely treatment of veterans, but provided no means of quickly adapting to changes in demand or adjusting to the needs of an aging veteran population. At the same time, the use of targets and bonuses for quick treatment of veterans, combined with extraordinary protections against firing or discipline, gave great incentives to "cook the books" with unpublished waiting lists that allowed staff and supervisors to make it appear as though the system was working smoothly even as veterans were dying for lack of care.
I am not interested in assigning blame or responsibility at this point. I would like to think that will happen some day, but entrenched politicians on both sides make it unlikely that few people will be disciplined, and those who are may be far removed from those who actually bear any real responsibility. I am far more concerned right now with replacing a system that cannot work with a system that at least has the possibility of working. And whatever form that system might take, it won't be achieved with a government bureaucracy controlling the health care for veterans. The sooner we admit that, the sooner we can actually begin to fix the problem. Unfortunately, since such a large number of Americans seem determined to place themselves and the rest of us under a similar care system, I fear it will be a long time in coming.
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