The news that the Phoenix Veterans Affairs hospital system had a secret waiting list on which some vets waited for years to get an appointment — leading to dozens of deaths — has two lessons. The first is that it is immensely risky to trust the government with something as important as health care. The second is that government will inevitably be intertwined with veterans’ health care, and we do not pay nearly enough attention to how it is performing.
The VA’s health system is not a total failure: It works along the lines of private managed-care systems, and satisfaction rates are high. But as a government program, it is fundamentally unresponsive to the consumer. Bureaucrats are encouraged to conceal failure and inflate outcomes, and rarely suffer consequences for it. Wait times are too long, and the backlog for veterans applying to receive benefits is massive.
How scandalous can the mismanagement get? In Phoenix, more than a thousand veterans were placed on a special waiting list, kept secret from the outside and from higher-ups, where they often waited for more than a year to get care. At least 40 veterans died while waiting on that list for basic care. The VA requires its hospitals to provide appointments within a month or so, and Phoenix VA officials used the secret list to pretend they were meeting that standard while vets died by the dozens on their watch. This problem isn’t isolated: In Los Angeles in 2012, for instance, more than 40,000 requests for diagnoses were “administratively closed” — i.e., struck from the books — so reported wait times would drop.
In other words, the mandates issued for the VA about access to care are repeatedly gamed, without consequence. Senator Marco Rubio and Representative Jeff Miller, both Florida Republicans, have introduced a bill to impose some fundamental accountability, by giving the veterans-affairs secretary the power to fire senior VA officials. As it stands, bureaucrats who manipulate their numbers get massive bonuses for meeting standards, rather than an investigation and the threat of a pink slip. The House Veterans Affairs Committee points out that empowering the VA secretary to fire senior officials would give him the same control over his top employees that members of Congress have over theirs — wouldn’t that be nice? Such a system would probably be welcome across the entire federal bureaucracy, but the VA’s sorry state and perverse incentives particularly demand it.
Beyond the problems with access to care, many veterans have trouble registering with the VA system in the first place. The backlog for disability applications has exploded under the Obama administration, and while it is starting to come down, it remains enormous: 700,000 veterans are waiting to begin receiving their benefits, with 400,000 of them having waited more than 125 days. The agency was underprepared to handle the surge of veterans returning from Iraq and Afghanistan — and apparently still is. But there is also a systemic problem: Filing claims is vastly more complicated than it ought to be, and vets are essentially required to be conversant in the medical language used to adjudicate their cases. They can turn to veterans’ organizations for help, but ultimately, it’s the VA that should be making registration more convenient.
These are problems endemic to government-run health care. Access is throttled to hold down costs, and bureaucrats lie to keep their jobs and reputations. This is why many veterans end up getting most of their care from sources outside the systm, which makes the VA look a lot better at keeping them healthy than it really is.
Still in all, the challenges facing veterans — combat injuries, unemployment, mental illness, etc. — are such that it probably does make sense to provide their health care through a government-run system.
It just had better be the best government-run program in America. Too few politicians seem interested in ensuring this is the case.