[fblike]

Since the war on terrorism began in 2001, questions about veterans’ issues have played a role in military and national defense rounds.  The wars in Iraq and Afghanistan added thousands of injured veterans to the list of those receiving care at Veterans Affairs (VA) hospitals throughout the country.  The Veterans Health Administration (VHA) current provides cares to nearly 10,000,000 American veterans across 1,700 sites.  The VHA has been heralded as a healthcare success among other elements of bureaucratic dysfunction that are sometimes associated with the federal government, but a recent scandal has called into question the care that veterans are receiving.  Allegations from a Phoenix VA facility that medical professionals there “cooked the books” to hide long waiting times for veterans in need of care have placed Veterans Affairs Secretary Eric Shinseki under fire and Republicans and Democrats are calling for answers from the Obama administration.

This topic brief will give some background on the Department of Veterans Affairs and its functions, detail what is behind the current scandal, and note some issues that extempers should follow as the VA scandal unfolds in the coming weeks and months.

Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.

The Department of Veterans Affairs

The care of military veterans has always been a national priority dating back to the American Revolution, when the Continental Congress had to debate the length of pensions provided to disabled soldiers.  Following the Civil War, a network of state-run hospitals were established for the veterans of the war since the sheer number of casualties in that conflict overwhelmed the nation’s existing medical infrastructure.  In 1930, Congress authorized the establishment of a Veterans Administration (VA), which was tasked with coordinating the federal government’s activities toward veterans.  This bureaucratic body was not a cabinet department.  Instead, it functioned as an independent bureau.  By 1988, though, the bureau was upgraded to cabinet status by an act of Congress and it acquired the name of the Department of Veterans Affairs.  The reason for the upgrade was the growing demand for veterans’ services by those who served in the Second World War, Korea, and Vietnam.  Republican lawmakers, who were skeptical of growing the federal bureaucracy, were persuaded to create the new cabinet department due to the fact that the change was simply in name and that the new department would not strengthen the power of the federal government.  The Department of Veterans Affairs would be the most recent cabinet department until the creation of the Department of Homeland Security in 2002.

The Department of Veterans Affairs present responsibilities include the oversight and running of veterans’ medical facilities, veterans’ benefit programs (e.g. mortgage assistance, pensions, job training), handling veterans’ burial and memorial sites, and dealing with other issues that face American veterans, such as homelessness.  It is the second largest department in the presidential cabinet, trumped only by the Department of Defense.  The department currently employs more than 250,000 people.  The Chicago Tribune on May 22nd adds that the VA currently serves 6.5 million people and handles 230,000 patients a day.  Its current secretary is Eric Shinseki, a four-star general and former Army chief of staff, who was also wounded twice in Vietnam.  Shinseki has been President Obama’s only VA secretary during his tenure in the White House.

Before going into the current scandal, extempers should be aware that the VA has had a troubled history of mishandling veterans care.  A long list of these scandals is provided by CNN on May 26th.  The first Veterans Bureau established by Congress in 1921 was rife with corruption, which was why the VA was established in 1930.  In 1945, there were reports of bad care at VA hospitals, which led to the resignation of VA Administrator Frank Hines.  Reports of mismanagement continued during the 1940s and 1950s.  In 1976, the General Accounting Office (GAO) found shortcomings in the care of VA facilities in Denver and New Orleans and Vietnam veterans throughout the 1970s claimed that they were receiving sub-par care at some VA hospitals.  In 2003, a commission appointed by President George W. Bush found that more than 200,000 veterans were waiting six months or more for medical visits and reports of more backlogs continued to trouble the administration.  In a speech about the VA scandal, extempers would be wise to include a few of the examples in the CNN article because it would help to illustrate that the VA problems that are being reported on are not new and might be endemic of a poorly functioning federal bureaucracy as opposed to the poor bureaucratic management of Shinseki.

The Current VA Scandal

Politico on May 21st provides an overview of the existing VA scandal.  The Obama administration was reportedly aware of shortcomings in VA facilities as it began its presidential transition after the 2008 elections.  Accusations of mismanagement began to grow in 2012, when reports emerged that veterans were dying while waiting for care at a VA hospital in Columbia, South Carolina.  In December 2013, Sam Foote, director of internal medicine at the Phoenix VA hospital, retired and alleged that the Phoenix hospital was keeping false records of how long veterans were waiting for treatment.  Foote told The Arizona Republic and members of Congress that medical professionals were keeping two waiting lists.  One list was an accurate list of veterans awaiting care, but this was hidden because it exposed waiting times in excess of two weeks, which was the standard waiting time that the Department of Veterans Affairs had asked local hospitals to adhere to.  To hide the list, doctors kept a separate list, which was officially transmitted to federal officials, that showed waiting times aligning with the two week standard and when spots opened for veterans to receive care, they were moved from the accurate, hidden list to the official one.  This “cooking of the books” matters because doctors and VA hospital administrators receive financial bonuses for being efficient with veterans’ care and The Chicago Tribune article previously cited reports that the VA paid annual bonuses of $8,000 to these professionals, including those who have been accused of falsifying records.  Foote’s allegations went national when Representative Jeff Miller (R-AZ), who is the chairman of the House Committee on Veterans’ Affairs, began holding hearings on the issue and CNN aired a story on the Phoenix VA on April 23rd.  Reports are now emerging that VA facilities in South Carolina, Florida, Pennsylvania, Georgia, Texas, New Mexico, and Illinois were also falsifying records and Al-Jazeera on May 15th writes that VA facilities at Fort Collins (Colorado), San Antonio, Austin, St. Louis, Chicago, Cheyenne (Wyoming), and Durham (North Carolina) may have been using the same scheme that the Phoenix VA was using to deceive high-ranking government officials.

The issue of improper care is not only explosive because it reeks of federal mismanagement, but it is alleged that the poor care provided by the Phoenix VA led to the deaths of at least forty veterans.  The Wall Street Journal reports on May 21st that the VA’s inspector general is looking into the allegations at Phoenix, but has not found any cases where veterans’ deaths can be linked to wait times.  However, CNN reports on May 23rd that the VA has acknowledged at least twenty-three deaths nationwide that were due to delayed care, which is twenty-three too many in the eyes of many Americans.

Aside from President Obama, the official that has taken the most heat for the recent scandal is Shinseki and the American Legion, the nation’s oldest and arguably most influential veterans group, has called for his resignation.  This is the first time in thirty-five years that the American Legion has called for the resignation of a public official.  Republicans have yet to present a unified front calling for Shinseki to step down, as minor Republicans in the House who lack leadership status are agitating for his dismissal, while Speaker of the House John Boehner has stopped short of calling for Shinseki’s ouster.  Shinseki has thus far refused to tender his resignation to President Obama and there is no evidence that President Obama has asked for it.  In fact, when President Obama addressed the media about the scandal last week, he backed Shinseki in his present role.  For his part, Shinseki has defended the VA as an effective institution, noting that the VA has launched an effective campaign against homelessness for veterans (down 24% according to government estimates) and reducing the government’s benefits backlog by half.  The Christian Science Monitor on May 15th reports that Shinseki also points to the American Customer Satisfaction Index, which found that customer satisfaction with the VA is “among the best in the nation” and that satisfaction scores on appointment schedules and medical providers are in excess of 90%.  Shinseki’s supporters claim that the operations in Phoenix do not illustrate a nationwide trend and that he has been a competent manager of the VA during his tenure.  The New York Daily News on May 22nd writes that Bernie Sanders, Vermont’s self-proclaimed socialist senator, has defended Shinseki and points to his ability to computerize VA records, as well as his navigation of other elements of the federal bureaucracy, as reasons not to dismiss him from his job.

When testifying before the Senate Committee on Veterans Affairs two weeks ago, Shinseki was loathe to fire anyone until a full accounting of what went wrong in Phoenix and other VA facilities was done, but shortly after testifying, he fired Dr. Robert A. Petzel, the department’s under secretary for health.  However, political observers criticized this firing because, as The New York Times explained on May 16th, Petzel has already announced his retirement from the department back in September and President Obama had already nominated his replacement.  The Iraq and Afghanistan Veterans of American criticized the move as a cynical public relations ploy.  The Hill on May 16th reports that Shinseki also did himself no favors in the eyes of some Congressional leaders by claiming that he did not know of the problems at the Phoenix VA and elsewhere, which seems to feed the narrative that he was giving his subordinates too much control.

A preliminary report from Shinseki to the Obama administration is expected this week and The New York Times reports on May 21st that president Obama has dispatched his deputy chief of staff Rob Nabors to do a complete evaluation of the VA’s health facilities.  The Nabors report is due within the next month.  Working alongside these investigations is the VA’s Office of the Inspector General (OIG), which is looking into the claims from Phoenix (the OIG’s findings will likely factor into Shinseki’s preliminary report), and federal prosecutors are looking into the possibility of criminal activity by VA officials.  If these investigations uncover a cover up, Shinseki could be in big trouble, but extempers should keep in mind that these investigations will also take a lot of time, with the OIG’s report not due until August and Congress likely to hold hearings when these reports are released, which means that they could be talking about the VA scandal at the beginning of the 2014-2015 season.

The Fallout of the Scandal and What Lies Ahead

With the 2014 midterms approaching, the VA scandal is an unwelcome event for the Obama administration.  Opponents of the administration have charged that the VA scandal illustrates that the president is a poor manager.  The Wall Street Journal on May 16th charges that one could lump the VA scandal with other Obama missteps, which include the lack of “shovel-ready” jobs in the 2009 stimulus, the flawed rollout of healthcare.gov, the “red line” erasure in Syria, and the mishandling of America’s foreign relations with Russia and Egypt.  The Washington Post on May 16th reports that an April 2010 memo by the deputy under secretary for health at the VA described the “gaming strategies” used by VA facilities like Phoenix and that the U.S. Office of Special Counsel described abuses in the VA system and sent a report to President Obama in September.  This would suggest that the administration was aware of the problem, but did very little to fix it.  Additionally, the Republican attack on the administration has actually focused more on bureaucratic dysfunction than firing Shinseki, which Politico notes on May 22nd is in contrast to its handling of the healthcare.gov rollout when it demanded the dismissal of Health and Human Services Secretary Kathleen Sebelius.  The administration has countered these charges by noting the enrollment successes on healthcare.gov, the way it handled the BP oil spill in the Gulf several years ago, and improving the federal contract process for green energy grants after the Solyndra debacle.  Regardless of your political persuasion, though, the fact that the administration is dealing with another scandal is bad news for Democrats in the 2014 midterms.  Second-term presidencies tend to get bogged down in scandals and the Obama administration is proving that it is no exception.  The real damage from the VA scandal is not necessarily tied to President Obama’s approval rating, but the fact that it inhibits the president and his party from getting a narrative out about their other domestic priorities regarding climate change and immigration reform.  President Obama declared that 2014 would be the “year of action,” but controversies over the Internal Revenue Service (IRS), Benghazi, and the VA have weakened the ability of the president to push his agenda.

As far as Shinseki’s long-term prospects, it is likely that he will not ride out the storm.  One of the reasons is that the American Legion has demanded his dismissal.  This is a vote of no confidence toward Shinseki and the Department of Veterans Affairs and they want someone to be held accountable for the poor treatment of veterans in Phoenix.  A second reason is that if Shinseki stays on and no one loses their job, it ties into the Republican narrative that President Obama never wants to hold anyone accountable.  Republicans point to Sebelius getting to stay on in the months immediately following the botched rollout of healthcare.gov and that few officials in the State Department were held accountable for the Benghazi situation.  They note that Obama standing by Shinzeki shows that he does not want to take immediate action when things go wrong, so fixing this perception may cause Shinseki to lose his job at some point.  Another reason that Shinseki may be dismissed by the end of the summer is that Democratic Senate candidates are calling for his head.  Politico on May 23rd writes that three Democratic Senate candidates – Natalie Tennant (West Virginia), Michelle Nunn (Georgia), and Alison Lundergan Grimes (Kentucky) – have called for Shinseki’s ouster.  This is an attempt by these Democrats to distance themselves from the White House and if President Obama wants to do some favors for Democratic candidates in red states for the coming election cycle, he may consider dismissing Shinseki sooner rather than later.  Therefore, even if Shinseki is not found directly responsible for the VA’s problems (and if he is found to be an innocent bystander in this situation he may be able to retain his position, albeit with damage to his reputation as a competent VA manager), he may still be the fall guy because of the political considerations engulfing the VA issue for both sides (and extempers should observe that this is not a simple left-right political issue as politicians on both sides are calling for answers).

The problems at the VA may also have an impact on the debate over healthcare reform.  The Washington Examiner of May 22nd writes that the VA has been praised by liberals and an example of how single-payer healthcare models, which are administered by the government, reduce costs and offer a higher quality of care than what exists in the private sector.  It is true that the VA has high customer satisfaction ratings, but the conservative narrative of attack is that when the government is in charge of healthcare costs and you have bad people administering the system, bad outcomes result.  I think it would be a stretch for extempers to argue that the VA scandal will doom the chances of a single payer system ever coming to the United States, but it could to be used as an example of why some Americans are skittish about adopting such a healthcare model.  As a result, elements of the VA scandal could help extempers analyze the different facets of healthcare reform.

In the immediate term, it looks as if Congress may enact some stopgap measures meant to improve the performance of the VA and deal with veterans that are experiencing long waiting periods to receive care.  Roll Call on May 23rd writes that Jeff Miller has asked the VA to allow veterans to receive private healthcare if VA facilities cannot accommodate them.  U.S. News & World Report adds on May 21st that Congress is considering legislation that would make it easier for Shinseki to fire VA employees who are not doing their job.  This would strengthen the powers of the VA secretary to handle the bureaucracy beneath them.  According to Slate on May 20th, former Defense Secretary Robert Gates once argued that the VA was a more difficult bureaucracy to navigate than the Pentagon, so the VA scandal, like those before it, may involve a sizable bureaucratic shakeup that consolidates more authority in Washington and/or gives more powers to the VA secretary.  Extempers should pay attention to the proposals made to fix the VA problem and what they might mean for the powers of the department.  Any reforms that call for greater accountability, streamline paperwork, and provide more oversight of local VA facilities would be a step in the right direction to ensure that veterans receive the care that they deserve for their dedication and service to the nation.