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Christopher Holshek Headshot

Not Your Daddy's VA

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A lot of times something bad has to happen before a greater good can. Churchill once observed about Americans that you can "always count on them to do the right thing -- after they've tried everything else." What's happening now with the Veterans Administration now may be such a case. Perhaps the media and politics swirl will result in the right national attention to more than what the House Speaker identified as "a systemic management issue throughout the VA that needs to be addressed."

Some of his colleagues on the Hill are not so sanguine, the all-too-familiar mixture of Chicken Little and Alice in Wonderland -- "the sky is falling; so, off with their heads!" It's too bad so many in that institution are so quick to point out the ineffectiveness of other government organizations. Retired General Eric Shinseki, for six years the Secretary of Veterans Affairs, stayed behind for hours after his hearing before the Senate to talk with numerous representatives of veterans groups, including those who criticize him. Most of those who had grilled him had long left the room, apparently to grandstand on another issue.

Shinseki, who acknowledged that the organization under his charge has some serious systemic shortfalls, is no stranger to telling the truth or to housecleaning that sometimes requires, in the words of one VA executive, "shooting a cocker spaniel in the face." Already some 3,000 of a staff of over 300,000 have been removed from service due to poor performance or misconduct in the last year. More will come, as some already have. But it's neither about Shinseki nor his managers. It's about taking care of veterans, and on that score there is better news than many of us may think.

First, however, it's important to understand the enormity of the task. The VA services nearly 10 million veterans -- larger than the population of nearly half the states in the Union, spread all over this and dozens of other countries. It runs the nation's largest integrated medical and health care system. Each day, the VA conducts 236,000 outpatient appointments, 1,100 medical surgeries, and nearly 50,000 mental health outpatient appointments alone.

That's not all, as the Marine Corps League Board of Trustees noted:

Everyone seems to forget that we have been at war for the past 13 years and that a large number of those military men and women who have done anywhere from one to six tours in Iraq and/or Afghanistan and have now completed their tour in the military, are now registered on the rolls of the VA. And yet with all the claims from the Vietnam era and Korean War era military men and women added to the hundreds of thousands of new claims, General Shinseki's Department of Veterans Affairs has reduced the back-log from some 600,000 when he took over (that later ballooned to roughly 900,000) down to somewhere near 320,000.

At the same time, the VA has been transitioning from a largely paper to an automated system of records keeping and patient service management, while continuously negotiating with the Department of Defense to craft compatible systems. To this day, the VA cannot gain direct access to a veteran's military medical file -- it has to be hand-transferred or in some cases created from scratch, a huge handicap to either claims processing or diagnosing or anticipating medical issues for which the VA (and no longer DoD) is held responsible.

In spite of all that, the VA's performance in its core mission is better than any time in its history. Besides building new facilities and upgrading older ones at a faster pace in decades, it is extending its outreach network to sparsely populated areas to improve access to treatment for those far from major treatment facilities. In addition to reducing the disability claims backlog by nearly 50 percent, it has reduced veterans' homelessness by 24 percent and tripled the number of VetSuccess on Campus chapters. At the same time, the VA has paid out more than $40 billion in tuition and benefits to nearly 1.2 million veterans, service members and their families since the Post-9/11 GI Bill went into effect in 2009.

And for those convinced things are always done better outside government, quality care reports for the last three years indicated the VA has out-performed private sector benchmarks on several widely accepted measures of effective care, such as provision of preventive care, management of chronic conditions, prevention of hospital associated infections, and several aspects of hospital care. It's a record enviable enough for the RAND Corporation to suggest the VA may have something to teach us about managed health care.

Most veterans, including yours truly, understand: This is not your daddy's VA.

Many things still are a work in progress. In 2011, the VA set an ambitious wait time goal of 14 days for both primary and specialty care appointments. It has a long way to go, which accounts for much of the bad press of late. But it has already narrowed much of that gap -- those having to wait one to two months to see a health care professional are now in a minority.

We need not go back too far to consider the rampant horror stories about the treatment of Vietnam veterans far more forgotten then than now. As a nation, we have more than once too often overlooked what Senator Bernie Sanders from Vermont reminded us we should never neglect to consider: "If you can't afford to take care of your veterans, then don't go to war."

Unless the investigative process comes up with clear evidence of malfeasance at more than middle management, as Rep. Boehner said, "just changing someone at the top is not going to actually get to the solutions that many of us are looking for."

The VA's troubles are only part of larger government dysfunction. The now-defunct Project on National Security Reform, looking at the entire foreign and national security apparatus, recognized years ago that "...no leader, no matter how strategically farsighted and talented as a manager, could have handled these issues without being hampered by the weaknesses of the current system."

There's work to do at more than the VA, however, closer to home than in Washington. Despite how much we say we "support the troops," unemployment rates for recently discharged active-duty veterans remain stubbornly higher than for everyone else, even with the efforts of the VA, veterans' organizations, and initiatives like Joining Forces, headed by Michelle Obama and Jill Biden. Regardless of the Uniformed Services Employment and Reemployment Rights Act of 1994, it is almost twice as high for Reservists. To any business leaders reading this: These guys have taken chances on your behalf -- the least you can do is take a chance on theirs.

We have to get beyond all the feel-good sentimentality about soldiers, as West Point professor Elizabeth Samet explained in Foreign Policy, and integrate them into our communities. Soldiers don't need to be idolized; they need to be socialized.

Veterans are an example that patriotism isn't something you say or feel, it's something you do. What happened on the Hill last week and what will happen there in the coming weeks can turn out to be a very good thing, if we seize the moment.

Perhaps it will give us all a chance, and not just the VA, to answer to the fullest measure Lincoln's call "to care for him who shall have borne the battle."

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