06/03/2014 12:53 pm ET Updated Aug 03, 2014

Following Up on Shinseki as a Hero

On June 2, I wrote a blog titled "Shinseki is a Hero" and was encouraged by the vigorous discussion on social media. I was also surprised at the number of people who are blaming the former Secretary of the VA for Congress' inability to do their job outside of partisan bickering and exchanging political favors for VA funding in their home districts. However, I figured it might make sense to highlight and respond to a few general issues people brought up in the conversation.

The Black Beret. I was not a fan of the black beret, but that had nothing to do with Shinseki's time as the Secretary of the VA.

Bureaucracy. Shinseki, when he was Chief of Staff of the Army, issued an order that powerpoints were to be only in black and white with no unnecessary color or graphics. As a junior officer, reminding my senior officers of this directive generally led me to the front leaning rest. While Shinseki hated unnecessary bureaucracy, few battalion commanders heeded his directive and their individual failures or successes at the unit level were rarely attributed to the General, despite him trying to set a more favorable climate for the rest of us. Do you see the parallel?

Hiding Patients. What drove the 'hiding of patients' at the Phoenix VA and elsewhere, was a 1995 rule that incentivized pay if wait times were decreased and patients more quickly moved through the system. Difficult patients are then simply moved out of the system. This system for tracking incentives was made electronic for the first time in 2002.

This is a market solution to a decidedly non-market problem. Imagine Shinseki trying to change this rule in the given Congress. It would not happen. We have not incentivized health, we have incentivized performance over people and this is happening nationwide on a host of issues from education, energy, the economy, and certainly our veterans. Thankfully, our country still at least pays lip service to the unnecessary deaths and critical mental and physical health issues of veterans but sadly, little is said about the unnecessary deaths or critical mental and physical health issues of those who did not have the privilege to serve. Shinseki would not have been able to know this was happening at the individual location by location level of VA management. These managers, not Shinseki, are who should shoulder the blame along with the rule itself.

Funding. A few people felt my blog post was overly focused on the funding of the VA, because in comparison to other parts of the budget, the VA is well funded. I don't disagree with this necessarily. Part of the challenge with the VA is that it is both overfunded and underfunded at the same time. Bureaucratic inefficiency, challenges in hiring and firing, and an unfortunate commitment to specific medications as the primary solution and treatment tool for all kinds of trauma, physical, mental, and post-traumatic, lead to unnecessary bloat in parts of the system. Why? Because it is easier to medicate and move on to the next patient when the lines are so long.

In other areas, specifically more holistic approaches, alternative medications and treatments, intense research into the brain, flexible treatment options, etc. are not funded enough. Part of the challenge is that any time a veteran has a problem with mental health, we call it PTS(D) with no look at the diverse happenings in combat that can affect transitioning from war zone to home. PTSD has been the dominant signifier without looking at war-related adjustment disorder as an apt diagnosis for clinicians to utilize in war trauma therapy.

Finally, no matter how high the budget is in relation to other programs in the country, we can't say we have enough money when we can handle all of the veterans coming in from just Iraq and Afghanistan. The VA exists to serve all veterans, not just the most recent war. Shinseki understood this as his moral duty. Unfortunately, Congress, or the American people, did not understand this as a moral, let alone practical reality.