Playing Politics With Veterans' Health

VA docs provide good care, but good luck getting in to see them
U.S. Secretary of Veterans Affairs Eric Shinseki in Washington on May 15 Photograph by Andrew Harrer/Bloomberg

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 control,” Foote wrote in a May 23 op-ed in the New 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.

In 2010 the Obama administration opened the door to yet more claims by making it easier for Vietnam-era vets to seek treatment for maladies linked to Agent Orange. The VA simultaneously reduced demands for documentation supporting claims of post-traumatic stress disorder, a syndrome commonly diagnosed in troops returning from Iraq and Afghanistan.

Despite the increased demands for care, the Obama administration says it has started to make progress on backlogged claims, cutting the number from 587,000 in 2012 to about 300,000 as of early May. VA critics, however, say those numbers are artificially deflated by excluding, for example, claims under dispute.

Whatever the accurate backlogs, there’s little doubt that, in the words of VA advocate Longman, vets face “excessive red tape,” which leads to “excessive waiting times.” Making matters worse, the agency displays the classic bureaucratic reflex of trying to hide its flaws. Foote has said that he went public about bogus wait lists only after the VA’s inspector general ignored letters of alarm he sent internally beginning last October. Now that same inspector general’s office bears responsibility for explaining what’s wrong.

The question is twofold: Will the agency come clean? And can Congress and the White House muster the political will to do what’s right for those who have served the nation? The VA doctors, for the most part, know how to do their jobs.


    The bottom line: Five years after the president said he’d make veterans’ health a priority, the VA is still understaffed and overwhelmed.

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