Saturday, May 17, 2014

VA  Hospitals -  A Necessary Bureaucracy with All of Its Faults

Government is a poor manager.  It is, of necessity, concerned with procedure, for it is also, of necessity, large and cumbersome.  It must administer public funds and must account for every penny. It has no choice but to become “bureaucratic.”  The moment government undertakes anything, it is entrenched and permanent.  Every beneficiary of every government program immediately becomes a “constituent.” .. The best we get from government is competent mediocrity.  What is impressive is the administrative incompetence.

Peter F. Drucker (1909-2006), social critic and father of modern management.

1.      The current VA “scandal” over manipulation of waiting lists at VA hospitals should come as no surprise.   The VA hospital system  is a sprawling bureaucracy,  the largest hospital system in the world,  serving  8.76 million veterans, at 1700 different sites. The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health that implements the medical assistance program of the VA through the administration and operation of numerous VA Medical Centers (VAMC), Outpatient Clinics (OPC), Community Based Outpatient Clinics (CBOC), and VA Community Living Centers (VA Nursing Home) Programs.

The VA is a necessary bureaucracy,  since the primary purpose of government is to protect national security and veterans are essential for that security.   If the VA did not exist, we would have to invent it.   It is what we owe our nation’s veterans – all 8.76 million of them who signed on with the promise we  would protect their health and welfare.

Veterans are a powerful constituency.    When they  protest,  both parties listen.  That is the reason, the current VA “scandal, which consists of revelations that VA officials,  including physicians in charge,  manipulated waiting lists and from which veterans died while waiting, is so potent a political  issue.        In Phoenix, it is charged. 1,400 to 16,00 sick veterans, waited for months to see a doctor, and 40 of them died during the wait.  VA administrators, it is said, tried to cover up the problems by establishing secret waiting lists and falsifying reports. Bureaucracy, by its various nature, requires waiting,  for government can never meet demands its promises generate. 

I have no idea if these “scandal”reports are true.   But it is important to put certain things in context.
·         If one offers government services for free, or such things at $7 prescriptions for expensive drugs,  demand escalates.

·         Demand was up by 76% ($24 billion) from 2007 to 2012, 13%, as a consequence of Iraq and Afghanistan,  aging veterans, women veterans, sexual assault and emotional trauma issues   and the backlog of case-processing due in part to the VA 9% error rate in processing  claims.
It is important to understand that the VA serves useful purposes,   Not only does the VA  strive to care for the nation’s veterans,  but it:
·         serves as teaching and training  grounds for more than half of the nation’s doctors.   Many of the VA hospitals are affiliated with academic medical centers.

·         Is  useful  testing ground for evaluating the utility of a nation-wide  electronic heath record system linking all hospitals and clinics.

·         represents a model for testing the validity  and viability of whether a government-run health system  will work in the United States and whether promising more health care means delivering  on the promise of delivering more health care in the real world.
Tweet:  The  government-run VA hospital system is inherently bureaucratic, as it has to be, but it is also necessary for veterans’ health care.

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