The Department of Veterans Affairs hospital system is such a behemoth that it can simultaneously represent the best and worst of health care in America. It serves 9 million enrollees, who account for 90 million outpatient visits a year. The VA system, the closest thing the United States has to the single-payer systems of Canada and Europe, inspires some customer loyalty: An American Customer Satisfaction Index report in March found that 84 percent of veterans were satisfied with their inpatient care, edging past the 80 percent satisfaction index for the hospital industry. At the time, the American Legion’s deputy director for health care, Jacob Gadd, praised those ratings to The Washington Post, saying they reflect “pride among veterans that there’s a system for them that understands their unique needs.”
But no one can take pride in what has gone wrong recently. Secretary Eric Shinseki suspended the director and associate director of the VA’s system in Phoenix amid allegations that 40 veterans had died while awaiting care and that secret lists were drawn up to hide the wait times. Other accusations of falsified wait times have been reported in several other VA facilities around the nation. The department acknowledged last month that delayed cancer screenings played a role in the deaths of 23 other patients. The Center for Investigative Reporting found that the VA has paid out $210 million in wrongful death settlements to about 1,000 families since 2001, for botched treatment, falls, suicides, and disease outbreaks.
The sudden cascade of scandals caused the American Legion to do an about face, with national commander Daniel Dellinger calling for Shinseki to step down for “poor oversight and failed leadership.” Shinseki did himself little favor at a recent congressional hearing, claiming he is “mad as hell” about the incidents —
Yet as with most complex, deep-rooted problems in government, many of the VA’s woes are longstanding —
The VA bureaucracy, to be sure, has hardly proved nimble. As National Journal recently reported, the agency was slow to adopt an electronic claims system and used a paper system until last year. A House bill would, at the least, enhance the secretary’s ability to fire senior employees who are obstructing progress. Shinseki should accept such authority. But there’s no reason to think that a few high-profile firings will solve systematic problems. The VA needs a broader analysis of its capabilities and goals. If Shinseki himself simply takes the fall, it doesn’t mean the agency’s deeper problems will be properly addressed.