Lessons From the VA Scandal

Suppose you’re Eric Shinseki (Veterans Administration head).

Actual VA photo

You learn of huge problems – a vast backlog of unprocessed paperwork (partly because it is literally paper, mountains of it, not computerized) – and now this scandal of delayed medical attention and resulting horror stories and even deaths – compounded by widespread cover-ups of those treatment delays via fraudulent record keeping.

So you snap your fingers and order it all fixed. Right? Wrong. The VA is a vast organization, but these scandals tell us it’s not actually vast enough. The paperwork piled up because the VA lacked the manpower to deal with it, let alone take steps to computerize it. Likewise, appointments were delayed because there weren’t enough doctors and other resources to meet patient needs.

No snap of the fingers could have fixed this. It required money. Shinseki should have been shouting from the rooftops, “Houston, we have a problem,” pre-emptively telling Congress and the president the VA is in trouble and needs more money.

But wait, you’ll say: isn’t that what bureaucrats are always whining? That they could do wonderful things if only their budgets were increased? Was there ever a bureaucrat who said, “My budget is quite adequate, thank you very much”?

We’re told the VA scandal shows what a lousy manager President Obama is. I’m loath to dispute that; but I take a bigger lesson. It shows what a lousy manager government is. Especially big government.

It’s actually probably unfair to imagine Obama should somehow have seen and fixed the VA problem. The VA isn’t exactly all he has to worry about. The government is a monster with a million tentacles and a very small brain – the president and his administration – to minutely direct those tentacles’ behavior. Good luck.

Yet the essence of American liberalism is the faith that government, because it is the avatar of disinterested public spiritedness, of the wish to do good – in contrast to a (selfish, grubby, greedy) quest for private profit – will do good, if given our trust (and money).

But the fly in the ointment is that government is comprised of human beings, not angels, and while they may indeed be motivated for good, they are also subject to all the other personal motives that govern human behavior in any context. And when those motives conflict with the disinterested desire to do good, it’s a rare person who will sacrifice the former for the latter.

VA staffers are probably mostly altruistic people who sincerely want to help veterans. But caring also for their own asses, in the situation, has made many of them perpetrate a great crime. Performance incentives, great in theory, merely incentivized VA personnel to cook the books to earn the rewards despite screwing patients. (And it’s not obvious how Shinseki might have avoided bamboozlement.)

At least in the private sector, the (selfish, grubby, greedy) profit motive – and competition – impose a certain discipline that’s lacking in the public sphere.

That’s a fundamental reason why government is so problematic. No private sector organization could survive in a competitive marketplace treating customers as badly as the VA.

More broadly, the VA scandal shows that we, as a society, have gone way overboard in what we ask of government – greatly outstripping the money to pay for it. It’s not as though we’re miserly with the VA; its budget is huge; yet still evidently insufficient for its ever expanding mission, as more and more veterans survive better and live longer, with ever more and costlier medical advances to help them do so. This story is emblematic of so much of what government does, and why spending outgrows what we can afford. We borrow the difference, but as I keep saying, there’s a limit to how far we can stretch that without triggering economic disaster.

I’m not suggesting shutting down the VA. We must honor our commitment to veterans. But we, as a nation, must get serious about the overall gap between what we ask of government and what is affordable. This is the great problem of the age, which Obama is sweeping under the rug.