After Shinseki: How to Cure the VA’s Dysfunctional Health Care System

Image: Dana Valle and Stacy Acevedo hold pictures of their father Cecil Valle at a forum at the Burton Barr Central Library on May 9, 2014 in Phoenix, Arizona.

Dana Valle, 37, of Avondale, Arizona, left, and Stacy Acevedo, 35, of Youngtown, Arizona hold pictures of their father Cecil Valle at a forum at the Burton Barr Central Library on May 9 in Phoenix, Arizona. Cecil Valle was a patient at the Phoenix VA when he died on April 2014. Sen. John McCain (R-AZ) met with Arizona Veterans to discuss mismanagement of Veterans Affairs in Phoenix, Arizona. Laura Segall / Getty Images

Fixing the Department of Veteran Affairs mangled health care system and ravaged image is attainable but will require a profound and painful housecleaning — perhaps including mass firings and partially privatizing the agency’s medical arm, several top veterans said Friday.

Political leaders and combat veterans alike hailed the resignation Friday of VA Secretary Eric Shinseki as merely the beginning of a wholesale rebuild of the department.

But under a new leader — ideally a younger combat veteran, tech-savvy and someone who can foster a culture in which criticism is welcome and veterans are treated as partners rather than adversaries — that mammoth restoration project could be completed in one year, said Tom Tarantino, policy director of Iraq and Afghanistan Veterans of America (IAVA).

VA Shakeup Brings Veterans Mix of Relief, Worry 4:25

“It is epic but achievable,” said Tarantino, a retired Army captain who served in Iraq. IAVA represents nearly 300,000 members.

“We need somebody from the Iraq or Afghanistan wars who can be a dynamic, public face of a 21st-century VA, who can communicate to veterans, who can bring the public along, and who can let everyone around the country know the VA has got our backs,” added Tarantino, 36, who uses a VA hospital to treat shoulder injuries and arthritis.

But following the release Friday of a White House-ordered audit showing that hospital staff imposed unnecessary waits at 64 percent of 216 surveyed VA facilities, that new public face must also swing a heavy hand, Tarantino said.

Image: Connie Olberg
Connie Olberg sits in her home in Sammamish, Washington, on May 21, holding a photo of her brother, Donald Douglass (at left), taken in the mid 1970s when he was serving in Germany in the U.S. Army. Douglass had a small spot on his forehead diagnosed as cancerous at the Seattle Veterans Affairs hospital in 2011, but according to his lawyer, the hospital's delay in removing it contributed to his death in 2012. Ted S. Warren / AP

“Senior leaders at the VA must know that if you lie, if you are lying to your country, if you’re lying to your patients, you’re going to go,” Tarantino said.

Fellow Iraq veteran David Curry, a retired Marine wounded by an improvised explosive device, said indifferent employees infesting the VA’s medical system pose greater problems for frustrated veterans than the department’s top brass.

“It’s time for the Jack Welch approach of firing the bottom 10 percent,” said Curry, 32, referring to the ex-chief of General Electric who endorsed the sweeping terminations of GE’s lowest performers.

“In my interaction with the VA over the years, there were many employees who outright didn’t care, who are there for the paycheck,” Curry said. “Getting rid of them would send a bigger message than just Shinseki.

U.S. Sen. Richard Blumenthal, D-Conn., who sits on the Senate Committee on Veterans’ Affairs, on Friday called for the swift hiring of more doctors and an improved patient information system to track veterans as they negotiate VA bureaucracy.

But others in Congress are pushing for the partial or even complete privatization of the department’s medical model.

Sen. John McCain, R-Ariz., a Vietnam veteran, has suggested that veterans be offered a voucher system that allows them to seek care from private doctors yet with government-paid visits.

Partially privatizing medical care for veterans could drastically reduce appointment-wait times and improve service at the VA by forcing it to compete with other providers, proponents say

“The President must join with Congress to support legislation we will introduce next week to … give far greater flexibility to veterans to get the care they need and deserve, where and when they want it,” McCain said in a statement released Friday.

Other critics have called for the VA to simply exit the medical business and focus on other pieces of its core mission, like providing wounded warriors with disability compensation and paying for the college educations of ex-service members.

That suggestion was blasted by the Student Veterans of America (SVA), a nonprofit advocacy group representing ex-military members on college campuses across the country.

“The holistic wellbeing of veterans is very important. If you look at student veterans who are having problems with their health care, they are not going to do well in school. So we think that holistic approach that VA provides (medicine plus education) is important to maintain,” said Will Hubbard, SVA spokesman.

Removing medical care from the VA’s duties would also cut large-scale research projects currently conducted by the department, creating a void the private sector is unlikely to fill, argued Curry, the retired Marine, who is diagnosed with post-traumatic stress and a traumatic brain injury.

Curry was also concerned that sending millions of veterans into the private sector for medicine would swamp an already overwhelmed U.S. health-care infrastructure. He does, however, back McCain’s voucher idea.

“This is all fixable,” Curry said. “But we’ve got to be able to endure the pain of fixing it. Repairing the VA will require some unpopular decisions and it might require some political capital, like challenging (VA) employee unions, which are a large voter bloc.

“But if we’re willing to endure the pain – like many veterans have had to endure the pain of injury – if the government and the nation can follow that as a testament, I believe we can fix this.”