Veterans care report favors VA, special interests, not vets

How badly does a federal agency have to fail before it can be fixed? The answer is not reassuring, based upon obstacles to reform at the Department of Veterans Affairs (VA), which has been plagued by management scandals and performance problems. The result has been inferior health care for veterans.

As longtime advocates for veterans’ interests, we were urging VA reform even before the most recent scandals were exposed. Last year, we were each appointed to the Commission on Care, an independent 15-member expert body charged with reforming the Veterans Health Administration (VHA), which provides health care services to approximately 6 million veterans each year [DU1] .

{mosads}The commission was established by Congress in 2014 and charged with developing a plan to reform and improve veterans’ health care and VHA. Our mission was to transform the VHA to ensure prompt access and quality care for veterans now and in the future.

Unfortunately, the commission’s final report, published July 6, while well meaning, mostly offers a hodgepodge of small-scale and incomplete fixes to veterans’ care, which will result in propping up the failing status quo rather than the total transformation VHA needs. There are exceptions — improvements to the VHA’s governance structure and Choice Program and an independent commission to close unneeded facilities are positive — but even those are incomplete.

As a roadmap for bold transformation, the commission’s final recommendations are VA-centric rather than veteran-centric, and will make it difficult for Congress to take action. That’s a catastrophically missed opportunity for veterans.

The Commission on Care differed from most federal commissions. By Congressional mandate, the executive branch would be required to implement our recommendations where feasible, advisable and seek legislative action where necessary. Commissioners knew our recommendations could be historic.

Unfortunately, a powerful array of forces aligned to limit our ability to pursue discussion of reforms anytime it threatened the status quo. A closer look at the commission’s dysfunction is a case study in how to forestall government reform.

Rule out items for discussion to ensure a preordained conclusion.The commission chairperson and executive director met with veteran service organizations (VSOs) and White House officials throughout the process to receive their policy preferences.

Commissioners were then warned White House officials would not accept as feasible or advisable any reform proposals which they deemed as “privatization,” and that VSOs would have to approve our recommendations. This pre-emption thwarted the commission’s independence, ruled out discussion of viable options and preordained the conclusion from the start.

Ignore the policy process and control the flow of information. The commission’s executive director, Susan Webman, a longtime labor lawyer, was unresponsive to research requests and disregarded agreed-upon work processes and timelines. Meeting agendas were provided at the last minute, making preparation difficult if not impossible. She interjected herself into commission proceedings and rewrote key documents to reflect preferences of the VA and White House. Dedicated staff members found a toxic working environment that was hostile to careful fact-finding and sound policymaking.

Defer to the status quo incumbents. The commission was unusually deferential to the preferences of VA leadership and government labor unions — that is, the very people who ran the veterans health care system off the tracks. Limited meeting time was given over to VA and selected VSO leaders, led by the Disabled American Veterans organization, to argue for protecting the status quo. Notably, a comprehensive survey of veterans’ preferences about their health care was never performed. These steps ensured a truly veteran-centric approach to reform would never be heard.

Create an echo chamber to ensure message discipline. These same selected VSOs known for unquestioning support of VA positions met privately with White House and VA officials to coordinate messaging and ensure the commission’s recommendations would not rock the boat. Meanwhile, progressive media outlets and government labor unions published misleading propaganda denying the existence of any problems at the VA and attacking the commission by deploying scare tactics about alleging sinister schemes to “privatize” the VA — something no commissioners had proposed.

Ultimate blame for this failure lies with the Obama White House, which worked closely with the department bureaucracy and government labor unions in a campaign to shelter the VA’s government-run health care apparatus from significant change.

Their efforts were aided and approved by the commission chair, Nancy Schlicting, an accomplished health care executive and management expert. She literally wrote the book on how disruption and innovation in existing business models can drive improved performance. Unfortunately, that mindset was absent from commission proceedings; instead she readily deferred to the wishes of the VA bureaucracy and the White House, while threatening to deny commissioners a vote or dissenting opinions to be published in the report. 

Notably, members of Congress, both Republicans and Democrats, respected the integrity of the policy process, making no attempt to sway or direct the commission. Had the White House taken a similar hands-off approach and respected the commission’s independence, a real transformation plan would have been possible.

Instead, we can expect continued media reports about VA health care failures, even after the commission’s recommendations are implemented. Within a few years, we expect a future Congress or White House administration to call for yet another blue ribbon commission to deal with the problem of fixing veterans health care.

The Commission on Care’s failure is an unfortunate win for the special interests—the VA bureaucracy and government labor unions, backed by a compliant White House, favored VSOs and media complex—that worked together to strangle meaningful reform. Our nation’s veterans deserve better.

Selnick is a U.S. Air Force veteran and served as special assistant to the Secretary of Veterans Affairs from 2001-2009. Hickey, a U.S. Marine Corps veteran, served as national executive director of AMVETS from 2011-2015. Both served as members of the Commission on Care. The opinions published here are their own.