What appears overlooked in most reports covering the present VA scandal is how the VA mission has morphed over its long history. Initially, the VA provided domiciliary accommodations and treatment for veterans injured during combat. After World War II, the VA was flooded with veterans. It was decentralized, leading to field offices that administered benefits expanded to include educational assistance, life insurance, pensions and home loans, among others.
About two decades ago, the Veterans Health Administration began providing primary care. This coincided with substantial reductions in inpatient facilities and employees, while the patient population doubled in size. Over the same time frame, the costs of VA services began to outstrip its annual budget.
These statistics almost have a bearing on the present sad state of affairs, penalizing the many patients who depend almost entirely on the VA for their care. Shinseki cannot be blamed directly for all the problems revealed to date, as many clearly predate his appointment. However, it is not clear that any single individual can do the heavy lifting required without getting the VA’s complete buy-in to a systemic overhaul.
Former VA Secretary Anthony Principi has suggested that formal integration of the VHA and Department of Defense health systems could achieve significant savings by economies of scale and benefit the same patients at different stages of their lives (The Wall Street Journal, May 30). This might be a good start but will not happen overnight.
As a Vietnam veteran who served in the Army Medical Corps, I would suggest that the very first step in changing the VA culture should be wholesale punishment of all staff involved in these unthinkable acts that resulted in the unnecessary deaths of those who proudly served our country during war.