Does The Veterans Affairs Scandal Prove That Governments Do Not Know How To Deliver Quality Services? Is the VA Department an isolated case, or is it just another piece of evidence indicating that only the private sector creates systems that can guarantee competence and accountability?

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WASHINGTON – The unfolding scandal affecting more than 20 medical facilities run by the Department of Veterans Affairs, (false records, lies about waiting time, veterans dead because of lack of service), is great news for the Republicans.

Obama promised VA efficiency

Improved care for all US veterans was and is yet another high profile Obama issue on which the administration failed to deliver –in a most spectacular way, it seems.

Way back in 2008, candidate Obama attacked the Bush administration for its poor record on delivering necessary medical assistance to US veterans. Obama promised that his administration would do a lot better. Every veteran would get all the medical care he or she needed. As President, Obama continued to give speeches on this topic.

A disaster

Well, more than 5 years later, it turns out that the Obama administration did not improve anything at all. In fact now the picture looks a lot worse.

The biggest headlines are about the recently discovered willful manipulation of records at many VA medical facilities, so that the actual wait time for doctors visits and procedures would look much better. This by itself is egregious. VA medical and administrative directors conspired to hide poor services at their facilities by falsifying records.

Veterans died while waiting for needed appointments

But it gets worse. Actual wait time for appointments and sometimes critical procedures in many instances is so long (several months) that it makes a mockery of any theoretical promise to deliver care.

On account of this, there are plenty of horror stories, still to be verified, of several veterans who died while on a waiting list for appointments to see doctors.

Bad service

And there is more. Mundane services like transferring medical records from one facility to another may take weeks or months. Unresponsive and uninterested VA staff react slowly or not at all to routine requests.

Furthermore, there are credible allegations that theft of expensive medications and of medical equipment happens frequently at many VA medical facilities, while internal policing is minimal.

Money not the main issue

And money is not the main issue. While it is true that the Department of Veterans Affairs is dealing now with a huge surge of demand for medical services on account of the large increase in the number of veterans who came back from Iraq and Afghanistan, budgets have also been increased substantially in recent years.

In other words, some of the dysfunctions can be attributed to the strain on the system caused by so many new customers arriving all at the same time. But it would appear that the problems run deeper. They are systemic.

Political fallout

Looking for a moment at the political consequences of this VA scandal, this is yet another black eye for Obama. Again, do keep in mind that candidate and then President Obama promised to improve upon the poor record of George W. Bush.The President frequently talks about the supreme obligation to care for all returning soldiers.

In the light of this, ensuring appropriate medical care for all veterans should have been a high priority. Someone, starting with VA Secretary Eric Shinseki, (a retired General, therefore himself a veteran), should have been looking at all this and fix any problems way before any disservice could develop into a crisis resulting in a huge embarrassment.

Well, no wonder –say Obama’s political enemies– this is all about incompetence.

And they add that for those who would love to have a truly national, government-run health care system for all Americans, they should look at the Department of Veteran Affairs to see how well the government delivers health care.

Public policy questions

Aside from partisan politics, from a public policy analysis stand point, these are some of the questions stemming from this egregious example of public service failure:

–Is the government simply incapable of delivering quality services to the general public at a reasonable cost? 

–Is it just impossible to set up proper checks and accountability systems within large, national bureaucracies?

–Is it simply out of the question that the government will be able to recruit dedicated and capable people who will work just as hard as their colleagues in the private sector?

In other words, is the VA scandal now unfolding an exceptionally bad case due to bad leadership? (By the way, for the moment VA Secretary Shinseki –the man in charge– has no intention to offer his resignation). Or is it yet another piece of evidence indicating that governments just do not know how to run complex services?

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