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06/03/2014

The VA Scandal: Ask First, “What is the Mission?”

Since last week’s first post on the VA scandal Secretary Shinseki resigned, surprising no one. The hue and cry for action made his forced departure the simplest and most visible means of giving the appearance of change. The VA itself however, remains fundamentally the same. While the debate rages on about how to fix this massive machine, we are failing to take the very first step upon which the whole endeavor depends. We are failing to answer the very first question: What do we want this machine to do?

The origin of veterans care is commonly traced back to President Lincoln’s directive, “To care for him who shall have borne the battle, and for his widow and his orphan.” Once formally established in 1930, the mission of the VA itself expanded to provide services to all veterans, who are defined as, “individuals who have served in one of the seven uniformed services who meet the length of service and character of discharge requirements prescribed by law.” This alone was not problematic until, as we might now see as quite predictable, Congress acted repeatedly to expand benefits. As the VA’s own Strategic Plan states, “[t]he responsibilities and benefits programs of the Veterans Administration grew enormously.”

But if the mission of the VA is now to serve all veterans, what exactly does this nation want to serve? For example, amidst the great clamor regarding wait times for screening tests such as colonoscopies, not one article I’ve read raised the question: Why is the VA even doing them? Is this what American citizens envisioned was the purpose of the VA, to deliver comprehensive healthcare including preventive services for all veterans?

Now this country could certainly decide to do so, should we determine that comprehensive healthcare is an appropriate benefit of one short enlistment. That would be at least a direct and honest approach. The problem is that we have an awfully hard time saying aloud what we should and should not do for veterans because that would force us to recognize the costs and limits of our capabilities, and even the appropriateness of the benefits themselves. We might then have to make hard decisions, and tell someone “no.”

Unfortunately, the lack of clarity of mission, purpose, and even raison d’être of the VA clouds the actions of the entire system as it swells to provide more and more benefits. Instead of following a clear model driven by a clear mission, each VA facility evolves based on available funding and local initiatives and peculiarities. An oft-repeated phrase is, “If you’ve been to one VA, you’ve been to one VA.” When the demand expands beyond a medical facility’s design and resources, its leaders are forced to decide between admitting failure to accomplish the mission or lying about success.

We now know too well how many decided. But I believe that this is deeper than just a problem in individual integrity. Lack of integrity is built into the very system of disability benefits administered by the VA. The VA provides benefits for conditions not caused by military service ( such as hypertension), increases benefits for worsening that is attributable to normal aging, and assigns “disability” for conditions that are not actually disabling. The net effect is that veterans capable of gainful employment are deemed “disabled” and then receive vast benefits paid for by working taxpayers, many of whom are even worse off physically. A vast apparatus has arisen to grind out benefits, and it is a magnet for abuse. We need to draw a line for what earns benefits, and for what those benefits are. We need the courage to say “no.”

However, to criticize the system that delivers benefits to veterans is anathema (and certainly political suicide), for not one article I have seen amidst the recent flood has called into question what really is going on within the VA. As if on cue, an article appeared in my local paper with the underlying theme of the veteran as victim battling against a harsh and uncaring bureaucracy. I urge you to read this article carefully, and see if you agree with the subsequent observations posted by readers.

We have produced a system that has lost integrity, all on the notion that those who serve have earned unlimited compassion. Perhaps that is a result of so few people having served, so that this compassion is a compensatory response for guilt or thankfulness. Whatever the cause, there is an extreme reluctance to call into question what the veterans are getting, because it would appear unpatriotic. It certainly would make it impossible to win an election, which I now never expect to do. But let this veteran raise a call for caution. Not only can this country not support such demand, it is unseemly and in fact dishonest. It is into this very culture that we then received news of dishonest behavior by the organization’s employees. We ought not be surprised.

President Obama himself said, “there is a need for a change in culture within the VHA, and perhaps the VHA as a whole — or the VA as a whole that makes sure that bad news gets surfaced quickly so that things can be fixed.” But if the underlying problem is a lack of integrity in the very purpose and mission of the VA, don’t expect that simply reporting waiting times honestly will resolve the problems. It will take those willing to receive criticism and political disfavor to scrutinize the system and call it for what it is—an excessive and highly manipulated system that spawns dishonesty. This country ought to expect an honest appraisal from those very people who should embody its highest ideals, including courage and integrity. And this honest appraisal must include clear-eyed and unflinching calls for what we can and cannot afford, and what we should and should not do for our veterans. Does this nation have such people ready to deliver bad news?

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