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Veterans Affairs scandal: Why Shinseki's resignation wasn't enough

Finding someone to blame is the preferred act of misdirection. Meanwhile, the problems remain unresolved.
Veterans addresses Sen. John McCain at a forum in Phoenix, Arizona to discuss mismanagement of Veterans Affairs, May 9, 2014.
Veterans addresses Sen. John McCain at a forum in Phoenix, Arizona to discuss mismanagement of Veterans Affairs, May 9, 2014.

The Veterans Affairs scandal is turning out to be a classic example of what Charles Peters, in his book “How Washington Really Works,” calls “Washington make believe.” In Washington, Peters wrote, “bureaucrats confer, the president proclaims, and Congress legislates, but the effect on reality is usually negligible.” That’s because the overriding imperative is not to solve the problem, nor even to get an especially accurate fix on what the problem is. Rather, the goal is to create a popular impression of decisive action.

Finding someone — anyone — to blame is the preferred act of misdirection, with that person’s firing or resignation usually sufficient to create a false impression that the problem has been solved. So it has proved with the May 30 resignation of VA Secretary Eric Shinseki. Practically overnight, the press stopped treating the VA’s shortcomings as an intolerable disgrace and reverted to its usual stance, which is to view them as a tedious bore.

Meanwhile, three truths emerge from a June 9 report by the VA on the problem of intolerably long wait times to see a VA doctor. The first is that the extent of this problem appears to be greatly exaggerated. The second is that the problem has not been solved. And the third is that the VA’s real challenge in providing adequate access to health care has yet to receive much attention at all.

Ever since stories first broke documenting long waits and scandalous efforts to cover them up at VA facilities in Phoenix, Ariz. and a few other places, a central question has been, "How many veterans, nationwide, are affected?" Now we have at least a preliminary answer: 4%. That’s the proportion of veterans waiting, as of May 15, longer than 30 days for their next medical appointment.

Another way of saying that is that of the six million American veterans who were waiting to see a doctor on May 15, 96% will have seen that doctor within 30 days. True, regulations stipulate that they aren’t supposed to wait more than 14 days. But 14 days is an unrealistic goal. In the private sector, the average wait is 18.5 days, and for various reasons, that’s probably a lowball estimate.

The new VA report doesn’t provide a comparable average, but a VA source has informed me the VA’s average wait time is 21 days, a mere two-and-a-half days longer than in the private sector. If that estimate holds up — and it’s important to note that, given the type of data entry deceptions exposed thus far, it may not — then the problem of long VA wait times is not, as is widely assumed, system-wide. Two other data points tend to support this conclusion. One is that the VA doctor shortage that’s widely seen as the ultimate cause of the long wait times is not national, but rather limited to certain locales (including the Southwest). The other data point is that a 2013 customer-satisfaction survey (not conducted by the VA itself) rated VA’s favorability at a bafflingly high 82%, or only one percentage point below that for private industry -- and, specifically with regard to “accessibility,” 81%. Such findings will be easier to understand if long wait times are confirmed not to be the VA norm.

Even so, 4% of six million people is still 240,000 people waiting longer than 30 days to see a VA doctor. Fifty-seven thousand are waiting longer than 90 days, and another 64,000 requested care but never got it.

Did Shinseki’s resignation do anything to shorten that wait? Of course not. Somewhat maddeningly, the VA audit doesn’t quantify how frequently VA employees engaged in illegal behavior in the course of scheduling (or not scheduling) medical appointments. But there appears reason at least to suspect fraud in three-quarters of all VA facilities, according to the report. The impact of that possible fraud is not quantified.

A logical place to start prosecuting will be Phoenix, where 11% of all veterans waited more than 30 days for an appointment. Extensive abuses have already been documented there, but Phoenix’s wait times were not the worst, at least according to the statistics in the new VA report. That distinction goes to Fayetteville, N.C., where 17% of all veterans waited more than 30 days. Meanwhile, Phoenix’s 11% was matched by Reno, Nev. and Fresno, Calif. Just behind, at 10%, were Columbia, SC, and Boise, ID.

Meanwhile, are wait times even the best metric? Remember that what finally put the VA scandal on page one was a series of ever-changing estimates as to the number of veterans who may have died because of the delay. (Last week, Acting VA Secretary Sloan Gibson said 18 people died waiting to see a VA doctor in Arizona, but that he didn’t know whether the deaths can be attributed to wait times.) What really matters isn’t the wait time for all patients to see a doctor, but rather, the wait time for certain patients whose specific ailments require them to see a doctor right away.

If Veteran Joe is making an appointment to assess whether he should fix his deviated septum, that probably isn’t an emergency. Weep no tears if he has to wait a few months. If Joe is making an appointment to evaluate a potentially cancerous lump, then that may be an emergency. Any wait longer than a month would be unacceptable. And if Joe is making an appointment to have a specialist evaluate a potentially cancerous lump that already worries his general practitioner, then that’s definitely an emergency. To wait more than a week would be intolerable.

Making such distinctions is difficult and messy, but there’s no practical alternative. If the VA system can’t always move quickly for someone who urgently needs medical care — and there’s already much anecdotal evidence that it can’t — then that is a serious problem. That the private health care system often has the same problem moving quickly for those whose health is at serious risk is no excuse. Private health care is less directly the nation’s collective responsibility. Public health care for veterans, on the other hand, is something we’re all responsible for. Finding a scapegoat to blame is a very poor substitute for fixing the problem.