The best is enemy of the good.
The profoundest truths are paradoxical.
Friday, May 30, 2014
"Playing Politics With Veterans' Health." Sec. Shinseki :Good Man In A Neglected System
U.S. Secretary of Veterans Affairs Eric Shinseki in Washington on May 15
UPDATE ON MAY 30 | Veterans Affairs Secretary Eric Shinseki has resigned from his post. Read the full report here.
Buried beneath the outrage over an alleged coverup of long patient delays at the U.S. Department of Veterans Affairs in Phoenix is this bit of counterintuitive good news: When vets actually get in to see a VA doctor, they typically receive decent care. Asked how well their “physical health needs are being met today,” 85 percent of Iraq and Afghanistan war veterans responded “very well” or “somewhat well,” according to an April Washington Post-Kaiser Family Foundation survey. The response to a question about “mental or emotional health needs” was almost identical. The split on both sets of answers was roughly 50-50 between “very well” and “somewhat well.”
“Study after study now confirms the VA system as a whole outperforms the rest of the health-care system on just about every metric that health-care quality can devise,” Phillip Longman, a senior research fellow at the New America Foundation, told the Senate Committee on Veterans’ Affairs at a hearing on May 14. “These include adherence to the protocols of evidence-based medicine, investment in prevention and effective disease management, use of integrated electronic medical records, and, importantly, patient satisfaction,” said Longman, author of the 2012 book Best Care Anywhere: Why VA Health Care Would Work Better for Everyone.
Even Dr. Sam Foote, the former VA clinic director in Phoenix who blew the whistle on alleged secret waiting lists and preventable vet deaths in that city’s VA system, has said most kinds of care for former soldiers and sailors is adequate. “Today’s VA health care system in general does a good job at providing chronic care, and it excels at things like blood pressure and diabetes contro,” Foote wrote in a May 23 op-ed in theNew York Times. Where the VA system breaks down, Foote said, is in getting patients into clinics and hospitals in the first place and in providing emergency care. These are not minor shortcomings. In Phoenix, officials allegedly compounded the problem by concealing delays with phony record keeping. Foote blames a dysfunctional bureaucracy and “a mismatch between the VA’s mission and its resources.”
In Washington, politicians and senior officials have used the latest evidence of bad management at the VA as an occasion not to press cures but to point fingers. The man in charge of the VA, retired General Eric Shinseki, told the same Senate committee in mid-May that he’s “mad as hell” about allegations of lethal delays and coverups. President Obama likewise is “madder than hell” about the Phoenix fiasco, his chief of staff, Denis McDonough, said a few days later on CBS’s Face the Nation. And on Memorial Day, Obama, just back from a surprise visit to the troops in Afghanistan, said, “We must do more to keep faith with our veterans and their families to make sure they get the care and benefits … they’ve earned.”
Shinseki’s and Obama’s sentiments suggest they want to kick the butts of the people responsible for not doing right by vets. They need look no further than the head of the VA and the commander in chief of the U.S. armed forces. Shinseki has sat atop the agency for more than five years—the appalling misbehavior in Phoenix unfolded on his watch. Obama is not just now learning of the agency’s dysfunction. When he ran for the White House in 2008, he attacked George W. Bush for paying inadequate attention to vets and vowed to make VA reform a priority.
Republicans also have exploited the situation in Phoenix, now under investigation by the VA’s inspector general. Responding to a promise by the president to get to the bottom of the debacle, GOP Senator John McCain decried Obama’s declaration as “wholly insufficient in addressing the fundamental, systemic problems plaguing our veterans’ health-care system. … We need answers, leadership, and accountability, none of which we’ve seen from the Obama administration.” This level of indignation is odd from a legislator who, after all, represents Arizona, calls Phoenix his home, and has a skilled staff in that city available to look into complaints from local vets.
A more substantive discussion of what ails the VA begins with the data. The wars in Iraq and Afghanistan added vast numbers of cases to the agency’s backlogs. The VA received a record 1 million claims during Obama’s first year in office. The burden kept rising until it peaked in 2011, at 1.3 million, then fell to 1.04 million in 2013. Because of advances in battlefield medicine, many soldiers who would have died in the past now survive with difficult-to-treat injuries.
The bottom line: Five years after the president said he’d make veterans’ health a priority, the VA is still understaffed and overwhelmed.
Barrett is an assistant managing editor and senior writer at Bloomberg Businessweek. His new book, Law of the Jungle, which tells the story of the Chevron oil pollution case in Ecuador, will be published by Crown in September 2014. His most recent book is GLOCK: The Rise of America’s Gun.