Shinseki’s resignation: Rearranging Titanic deck chairs at the VA

As the VA scandal unfolds, with continued revelations of secret waitlists and delayed or denied medical care, calls have been building Veterans Affairs Secretary Eric Shinseki to resign. He did just that, resigning because, “He had become a distraction as the department struggles.”

President Obama, eager to show America that he was being proactive about the scandal, regretfully accepted the General’s resignation. But other than allowing the president to show that he is doing something about the problem, what will Shinseki’s departure actually accomplish or fix?

The VA health care system is an example of integrated health care or one-stop shopping for all medical care under one large government umbrella. Many have advocated for such a system of single payer healthcare for America writ large. Phillip Longman, a senior fellow at the Washington Monthly and the New America Foundation, wrote a book, “Best Care Anywhere: Why VA Health Care Would Work Better For Everyone,” praising the same system currently undergoing a massive crisis.

The fundamental problem at the VA is not that Shinseki is in charge, but that the VA is a form of government-run health care, which leads to high costs and shortages. Stories abound over long wait lists in the British NHS, with over a hundred thousand patients waiting more than 18 weeks to see a specialist. Or in New Zealand, where patients are simply removed from the wait list when the list gets too long.

The VA system represents government bureaucracy and inefficiency at its finest. At the Edward Hines VA Hospital, in the president’s home town of Chicago, only one-fourth of their 4,230 employees are actually providing primary medical care. What are the other 75 percent of employees doing? Shuffling papers, creating secret wait lists, or holding meetings?

The VA’s problems are not for lack of money. Their budget has doubled over the past decade with only a one-third increase in their patient load. So they are spending more money per patient with little to show for it — except for the bureaucrats and administrators who have been generously rewarded. The VA awarded more than $400 million in bonuses in 2011, according to Military.com. At the Phoenix VA, where this scandal first surfaced, one in five employees received bonuses in 2013, with a total payout of $337,885.

How will any of this change with General Shinseki’s resignation? The secretary already tried to fix the problem by firing the VA undersecretary of health, Dr. Robert Petzel, who was already due to retire this year. He was replaced by Dr. Jeffrey Murawsky, the director of VA’s Great Lakes Health Care System which includes Hines VA where most of the staff is busy administrating. This makes perfect sense within government bureaucracy: Find someone responsible for overseeing an inefficient and bloated regional morass, and promote them to oversee the entire system.

With General Shinseki’s resignation, who wants to bet he will be replaced by a Dr. Petzel or Dr. Murawsky, well steeped in the VA bureaucratic traditions that are the cause of this current scandal and General Shinseki’s departure? This may allow the president and members of Congress to feel good about fixing the problem, but in reality they are only rearranging the deck chairs on the Titanic.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.  This article originally appeared in The Daily Caller.

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  • buzzkillerjsmith

    I’m not scouring the AFP for ads to work at the VA. I suspect other docs here might feel the same way.

    Working at the VA is a spike in the brain–every day. Deck chairs is right.

    • Eric Strong

      I choose to work at a VA hospital because it provides great care, compensates physicians fairly, and serves a population that most Americans (and Congress) take for granted. Its bureaucratic problems are no greater than those in any other large health care system.

      • buzzkillerjsmith

        Bully for you.

      • Suzi Q 38

        I agree.

        I would take their care in 1991 for my FIL over the care I received from my ivory tower teaching hospital (with my PPO insurance, no less) for my care in 2011.

  • guest

    What the VA needs is Lean Management! Oh, right, lean only refers to the workers doing the actual work of the organization. Bloat and waste at the administrative level is to be celebrated.

    • Eric Strong

      The Palo Alto VA hospital has been employing Lean principles for years. Google “Rapid Process Improvement Workshop” and check out the top search result.

  • SteveCaley

    If the Obama Administration wishes to get to the heart of the terrible riddle of the VA and improve services, it needs to see the discordance between what the Federal VA headquarters perceives that it accomplishes for veterans; and what it ACTUALLY drives and directs in the actual service delivery on care sites.
    One of the best means to understand why the VA is so terrible in care of Veterans can be powerfully understood in considering why the Federal Government has been so terrible to Native Americans. Much of their history has been told of genocide by gun; that is actually not the worst part. The BIA and “Indian Affairs” has caused the cultural and societal damage that bullets could not. Bullets only tend to kill individuals; the habits of the Federal Government in 250 years of Indian Affairs has caused tremendous social wreckage.
    Pause and review the story of Mrs. Elouise Cobell, (Yellow Bird Woman in the Blackfeet Tribe) one of my true American heroes, and of her actions on the Individual Indian Trust Fund. The story of the Individual Indian Trust Fund (and of the Tribal Trust Fund, which is not yet resolved) is one of individual American bravery in addressing centuries of injustice and indifference. If you can understand Mrs. Cobell’s extensive litigation on this matter, and her ultimate, although partial, victory in remediation of this matter, then the toxic and corrosive nature of the Veterans’ Administration healthcare system will become amazingly clear to you. (see http://www.cobellsettlement.com/)
    The riddle of the VA is that of blindness. How can so many people, who seem to be decent and not cruel, run a system that effects horrible mismanagement and cruelty? How can a Veteran die in a hospital cafeteria, and yet go to the undertaker with the reassurance that “all VA procedures were strictly followed?”
    Bureaucratic evil, systemic evil is not a hothouse plant – it is not a fragile orchid. It does not need a farmer to become established. It thrives in a climate of indifference; nobody has to cultivate it. It is a weed – it only needs neglect to flourish. And it must be labeled evil; other names cause misunderstanding.
    Over fifty years ago, a serious scrutiny of one of the greatest perpetrators of evil, Adolf Eichmann, showed to chronicler Hannah Arendt no notable brilliance in his technique; rather his dull indifference to human morality, and a willingness to do things by the books. Eichmann did not need to invent new and wicked procedures; these were already in the policies of the BIA decades before the European final solution was detailed. What Eichmann did can be seen here at home, if one is attuned to it – less horrific because it is less liberally applied, not because it is any more benign. Zyklon B is a chemical without moral value; it is the humans that make it horrific.
    How different is the Nazi’s “Final Solution” from the deaths and neglect at the VA? At first, that question seems hyperbolic and insulting – for nobody intends Veterans to die. But when one considers that in both cases, nobody is particularly bothered to help them live, one begins to see a narrowing of lines, like perspective on railroad tracks stretching off into the distance. They may never touch – but they get so damn close, you can’t really tell, after a while.

  • QQQ

    One sure way to “fix” the VA healthcare problem would be to make all of
    the congress and White House staff go to a VA hospital for their health
    care needs. If they had to use it, the damn sure would be sure it works.
    We could fix social security the same way, eliminating congresses
    pension plan and make them go under social security. Take away their
    super platinum type taxpayer funded plans and make them use the same
    systems they impose on the vets and the public.

    • May Wright

      Exactly right.

    • Suzi Q 38

      Good idea.
      Problem is that the private hospitals have much of the same problems, too.
      If you want examples, read some of my whining posts.
      I would go to the VA if I could.

  • Eric Strong

    I am so tired of ignorant people piling on the anti-VA bandwagon. I’ve got news for you. Whatever medical care system you work for, it
    does not provide better care at lower cost than the VA. There are 2 reasons why there appears to be so many problems with the VA.

    First and foremost is politics. 99% of commentators in the media and physicians on blogs like this who have awful things to say about the VA (most of which is based on hearsay, and is not fact-checked) are clearly anti-Obama, and are happy to bring unwarranted and disproportionate levels of attention to any deficiency for the sake of pointing out what a terrible job Obama is doing with running our country. (Choosing to publish this fictional opinion piece on the Daily Caller is a bit of a giveaway…)

    Second, the VA is under a constant microscope by the media. Problems that fly completely under the radar at other institutions become national headlines when they occur at the VA. I’ve worked or
    been a student at 8 different hospitals (2 VAs, 2 large private academic centers, 2 county public hospitals, 2 smaller private community hospitals), and the most egregious examples of privacy violations, ethics violations, malpractice, illegal activity, and overall poor care that I’ve personally witnessed have all occurred somewhere other than a VA hospital. Is the current VA scheduling/waitlist scandal
    horrible? Absolutely. However, guess what…there are equally
    horrible things going on in other hospitals across the country all of the time – including yours. But no one cares – apparently including you.

    For example Dr. Joondeph, do you think anyone cares that
    your own Colorado Retina Associates apparently submitted fraudulent insurance
    claims to the government in 2012? (https://oig.hhs.gov/fraud/enforcement/cmp/false_claims.asp#2013)

    For every 1 patient who actually has been to my VA hospital and who complains about the care there, I have 10 who state they are very happy and would never consider moving to a different hospital. And for every 1 patient I transfer to a different hospital because we are unable to accommodate their needs, I accept 25 transfers in because we provide care that other hospitals don’t. To commentators who state that the VA problems would be fixed if we made members of Congress go to a VA hospital for their care, they would be lucky to receive our care. If I personally became ill, I would rather be a patient at my VA hospital than any other hospital in the country.

    Dr. Joondeph and others on here: You simply do not know what
    you are talking about. This is not a matter of a difference of opinion. It is a matter of you speaking without facts, and because you are more interested in satisfying your own anti-government tendencies and in deflecting attention away from the deficiencies in your own medical practices.

  • Suzi Q 38

    My father in law was an Army veteran in 1991 who went to the VA after 3 major strokes. First, he was at the hospital, who told us there was nothing they could do. I didn’t believe that, so I “pushed” harder for rehabilitative care. They wanted me to approve a transfer for him to a horrible nursing home. We pushed harder to get him to his own home.

    Sadly, his new wife, did not want him there and neglected him by not feeding him regular meals. The only food he got was Ensure. WE didn’t realize how bad he was until we visited him a month later and he looked like a concentration camp victim from WWII.

    The wife went ahead and transferred him to a nursing home. We could not fight this and realized that it would be preferable than someone who did not want him. She was living in his major asset (his house), so we could not sell it for his care.

    After a few months of legal issues, we were awarded custody and was able to get him some much needed care.

    The first place he went for post stroke rehab as a first rate hospital specializing in such. This took 6 weeks and was covered by his senior insurance and medicare. Getting the insurance company to authorize this high level of care was not easy.

    My father in-law did well at the private rehab hospital, but still could not walk.

    I was tipped off by a neurologist who had helped us legally with a competency case concerning my father-in-law.
    He told me that my FIL might qualify for benefits at the Loma Linda VA in California.

    To make a long story short, he did even better there. The VA hospital’s rehab “team” not only taught my FIL how to make transfers, but taught him how to walk again, albeit with a claw cane. They also told us about my FIL’s Army service, which was in Alaska in the “Pacific theater” of WWII.

    I have only praise for the job they did, and my FIL could live at home with us and a part-time CNA because of their assistance.

    Is it that bad at every VA hospital? Have things changed that much since the 1990′s when my FIL received his care?

    I have nothing but praise for all physicians at the VA involved in my father’s case.
    They helped him when other doctors did not have the courage to do so.

    • Eric Strong

      Thanks for sharing!

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