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The VA was born from scandal: How its latest failure offers hope for reform

U.S. President Barack Obama walks across Lafayette Park back to the White House on June 30, 2014.
Kevin Lamarque | Reuters
U.S. President Barack Obama walks across Lafayette Park back to the White House on June 30, 2014.
Posted July 22, 2014, at 12:19 p.m.

Scandal is nothing new to the U.S. Department of Veterans Affairs. General Eric Shinseki’s resignation adds another chapter to the beleaguered agency’s long history of mismanagement. Although Maine’s 150,000 veterans were largely spared from the problems that plagued other parts of the country, the reports of shameful waiting list manipulations and systemic failures to deliver promised benefits are enough to make anyone fear for the future of veterans’ health care.

Yet my research on the history of the VA leaves me hopeful that this most recent debacle will lead to meaningful reforms. During the last 90 years, the VA’s failures have focused attention on this often-neglected agency, leading Congress and VA officials to make dramatic improvements in the quality of veterans’ health care.

The modern-day VA was born from scandal. In the 1920s, Col. Charles Forbes, the agency’s first director, was thrown in jail for devising ingenious ways to steal millions of dollars from the federal government. Under his direction, the VA purchased huge quantities of hospital supplies — including a 100-year supply of floor wax — that were resold as government “surplus.” The loss to taxpayers came in at well over $2 billion in today’s dollars, and the VA medical system began its life under a cloud of corruption.

But, fortunately, the story doesn’t end there. After years of neglect, the agency’s inability to accommodate millions of returning World War II veterans led it to develop a unique partnership with medical schools in 1946. Medical school professors agreed to work as VA staff physicians in exchange for access to VA hospitals and training for their medical students. This partnership — one that is still in place today — led to a marked increase in the quality of veterans’ medicine and is the reason why many VA hospitals are built in close proximity to medical schools.

During the 1970s, the VA again faced criticism for its substandard facilities — troubles made famous by Ron Kovic’s memoir, “Born on the Fourth of July,” which detailed his own experiences at a dilapidated VA hospital. The larger problem, however, stemmed from the VA’s inability to adapt to changes in the delivery of medical care. Unlike the private sector, which began to focus on primary and preventative care, the VA remained committed to its outdated model of intensive, inpatient health care throughout this period. This made it difficult for veterans to receive needed primary care at local facilities, particularly in less populous states, and led some to question whether the VA could still deliver high-quality care.

Yet again, however, these failures created the political will to invest in veterans’ health care. With the adoption of the 1996 Veterans’ Health Care Eligibility Reform Act, the VA transformed itself into an integrated health care system. These reforms increased access by opening hundreds of veterans’ outpatient clinics across America — developments that were particularly important in rural states like Maine — and dramatically improved health outcomes for millions of veterans.

Unfortunately, recent expansions of the VA health care system were not accompanied by sufficient money from Congress to pay for them. During the past decade, an aging population of veterans combined with the return of wounded soldiers from Iraq and Afghanistan overwhelmed the VA system. Yet members of Congress, who now so easily express their shock at the agency’s failures, did little to prevent this perfect storm until it became impossible to ignore.

The VA’s current failures are shameful, but there is reason for optimism. If the agency’s long history tells us anything, it is that this most recent outrage will lead to meaningful changes. Now Congress can no longer neglect its oversight duties and VA administrators can no longer pretend that management gimmicks are enough to cope with dramatically increased demand for VA medical care.

The current bipartisan proposal to provide billions more to hire new doctors and nurses and build several new VA facilities is a good start. But these reforms will not work in the long run unless we all hold Congress accountable for making good on the promises we have made to our veterans. Only that level of vigilance will guarantee that this most recent scandal is the last one.

Colin Moore is an assistant professor of political science at the University of Hawaii. He is the co-director of the Hawaii Regional Network, part of the Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.

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