The recent resignation of Eric Shinseki, Secretary of the Department of Veterans Affairs (VA), puts an intense spotlight on problems in the VA. However, many observers do not believe that the problems were entirely of Shinseki's creation. After all, the retired general implemented policies that significantly reduced the backlog of disability claims. Nevertheless, many veterans' claims for disability benefits are still stuck in the backlog. This, combined with recently revealed problems at the Phoenix VA medical center, created an untenable situation that would have required the resignation of anyone in Shinseki's position.
There have been many criticisms and calls for Shinseki's resignation in the past few years, prompted especially by the backlog in disability claims that reached over 600, 000 pending claims as recently as March of 2013, according to VA reports. However, because of the steady progress made by the VA in reducing the backlog, reported to be 283,762 claims at the end of May, 2014, Shinseki successfully fended off calls for his resignation.
The improvement was the result of both internal and external factors. Changes within the VA that included mandatory overtime for claims processors, and a gradual reduction in claims as the wars in Afghanistan and Iraq wound down, helped improve the situation. Additionally, the flood of Vietnam-era vets who were able to submit new claims for Agent Orange-related illnesses and conditions began to decline, reducing still further the number of active claims.
So why did General Shinseki resign? The tipping point was reached when the Inspector General's office released a report detailing a scheme at the Phoenix VA medical center that hid the long wait times endured by veterans seeking treatment. The Veterans Health Administration requires that clinics and hospitals give veterans appointments in a timely way, usually about two weeks after requesting an appointment. However, the Phoenix VA developed a shadow scheduling system that hid the real waiting times for vets seeking appointments. Many veterans waited for more than a year for an appointment with a physician, and it is possible that at least 40 veterans died while waiting for appointments at the Phoenix facility.
It turns out that problems at the Phoenix VA medical center may be only the tip of the iceberg. NBC News reported that at least 10 other facilities in eight states and Washington, D.C., forced veterans to wait so long that some may have died. For example, a 2013 Inspector General's report showed what it referred to as a "disturbing set of events" at the medical center in Columbia, South Carolina. Apparently over 50 veterans had a delayed diagnosis of colon cancer and some died as a result.
Problems at VA medical centers did not begin in 2013, nor were the problems unknown until then. For example, in 2012 the General Accountability Office (GAO) studied patient care at four VA hospitals around the country, in Los Angeles, Washington, D.C., Dayton, Ohio and Fort Harrison, Montana. The agency determined that the facilities studied had "inadequate oversight of the outpatient scheduling processes" that resulted in problems with scheduling timely appointments. In addition to lax oversight, the GAO noted that the problem was exacerbated by poor training, inconsistent procedures, outdated software and high levels of employee turnover.
Because scheduling problems were hidden by some medical centers' secret lists, the credibility of the VA self-reporting has been compromised, creating doubt in the minds of many Congressional funders that the department has the ability to address problems and reform itself. For example, the chairman of the House Committee on Veterans' Affairs, Jeff Miller, R-Fla., noted, "...I have no confidence that the department's recently announced Nationwide Access Review will yield results that are either accurate or useful. Given the fact that the department now stands accused of cooking appointment wait time books in multiple locations, an independent review of VA's entire system for ensuring veterans receive timely care is clearly warranted."
Given the lack of confidence in the agency's ability to police itself, Eric Shinsheki's resignation makes sense. However, whether his departure will actually change anything remains to be seen. The basic facts have not changed: The VA is ill-equipped to deal with problems resulting from increased demand and insufficient resources. An external issue, a lack of primary care physicians, simply adds to the agency's problems in some regions of the country, according to observers.
While many in Congress who call for VA reform are sincere, a few observers have noted that some members have opportunistically used the problems of the VA to criticize government-run health care in general. And even congressional leaders who are thought to be supportive of the VA and enthusiastic about government-run health care have suggested that the immediate difficulties of the agency could be solved by allowing vets seeking health care to use private medical facilities at the VA's expense.
Sen. Bernie Sanders, I-Vermont, has co-sponsored a bill that would do just that. His bill would also provide emergency funding to hire doctors and nurses and would forgive student loans for health-care providers who go to work for the VA. Sanders noted that while those who falsified information should be punished, their failings should not be allowed to hide systemic problems within the Department of Veterans Affairs and its health-care system.
Whether a change at the VA comes from solutions such as these or from a gradual decline in the number of veterans seeking health care and other services remains to be seen. What is certain is that the VA now has the full attention not only of Congress, but of the public at large.