Friday, May 30, 2014

Cruising the Web

I don't think that getting rid of Eric Shenseki is the solution to the problems at the VA. The problems are much deeper than one man's incompetence in overseeing the bureaucracy. In fact, I think that focusing on Shinseki is distracting us from helping veterans immediately. All those veterans who did not receive appointments in a timely manner should be what everyone focuses on first. Since the VA was unable to do that, the government should give all of them vouchers to seek health care elsewhere from the VA. Don't make them wait while the folks in Washington duke it out.

However, there is still a political dimension to this. That seems to be first on the administration's mind as former White House communications official and Obama campaign veteran Bill Burton says that the reason Obama isn't keen on firing Shinseki is because the President doesn't want to give Senate Republicans will make too much of a big deal out of this scandal during confirmation hearings. Yeah, because politics is the most important thing right now.
Noting at the end that it was within the realm of imagination to suggest that those calling for Shinseki’s ouster may not be motivated by politics alone, Burton nevertheless said that the president trusts his own judgment and those around him.
Based on what evidence does he have such trust in his own judgment and those around him?

As vulnerable Senate Democrats rush to the microphone to call for Shinseki's ouster, one such Democrat facing a tough reelection campaign prefers to equivocate. Arkansas's Mark Pryor says that he wants to wait for more evidence of wrongdoing in Arkansas's VA hospitals. Remember that Pryor is running against a veteran, Tom Cotton, and both men are accusing each other over whether or not it is time for Shinseki to go. As Allahpundit writes,
He’s outraged, but … not quite outraged enough to give someone else a shot at reforming this Kafkaesque bureaucracy before other veterans die while waiting for treatment. This is the same guy who accused Tom Cotton of having a sense of political “entitlement” because he served in Iraq. (It’s an amazing show of balls by Pryor, who owes his own Senate seat to his father’s high name recognition in Arkansas, to accuse anyone else of entitlement.)
I imagine that Pryor's wait-and-see attitude isn't going to go over all that well in Arkansas.

The VA scandal adds meat to the arguments about Obamacare and serves as a counter to all those Democrats calling for a single-payer plan. As David Freddoso writes,
If our federal government is too negligent and malicious to deliver care to people like them, what will it do to you and me if it ever it controls our health care?
Peter Suderman expands on how the VA scandal refutes the call from liberals for a single-payer approach to health care.
Until recently, Democrats have not been particularly shy about expressing their feelings about the VA health care system. For years they have been telling us that it’s great—a model system from which the rest of the nation’s health care systems could learn a thing or two....

The ongoing VA scandal over falsified records, and the deadly long wait times for care that appear to have been the result, seems to suggest otherwise: Veterans are not safe and sound within the fully government-run system, its quality control leaves much to be desired, and its lengthy wait times are not a fictitious prediction but an all-too-grim reality.

In other words, it’s hardly a triumphant, model system. But even if there were no scandal at all, the VA wouldn’t be a system worth emulating.
Suderman goes on examine how parts of the stimulus were aimed at copying the VA's IT system.
The stimulus money was sent out to hospitals all over the country, and, with federal funding and a slew of incentives to act, new electronic records systems were rapidly installed. But the hoped-for savings never arrived. In fact, the health IT push may have helped drive federal health spending upwards, by making it easier and more efficient for hospitals to send bigger bills to Medicare.

The system-wide efficiency improvements never appeared either, because too many of the new health records systems couldn’t communicate with each other. The federal government’s health IT investment was supposed to make health care better and cheaper. Instead, it made it more expensive and worse....

The point is that even when and where the VA works well it’s not necessarily a system to emulate. That goes for the VA’s vaunted cost control methods too. Paul Krugman is right when he says that the system offers a real-life example of cost control; it really is cheaper than many competitors. But that’s only part of the story. It’s also necessary to account for how the system achieves its savings.

And one of the chief methods the VA uses to control spending is to organize its beneficiaries into eight "priority groups" that determine who gets the most care. The sickest and the poorest are at the top of the list, but everyone else gets shuffled into lower priority groups. And not all types of care are covered, which means veterans in most of the priority groups get the majority of their care outside the system. In 2007, the Congressional Budget Office reported that none of the eight priority groups received more than 50 percent of its care from the program. In 2010, the VA reported that just two of the priority groups—the two groups that have the highest cost per enrollee—had barely crept above 50 percent usage.

It’s not a full-featured system designed to handle the complete health care needs of the population it covers. But it is an example of how government controls costs in health care: through strictly defined prioritization systems and limitations on treatments.

And that's how the system is supposed to work. Add the systematic lies and manipulations that the recent scandal has brought to light, and you have an accurate enough picture of how government health care works in practice.

That’s the government system that Democrats and liberal advocates say they like, and that we should learn from. The scandal shows how bad a government-run system can get, but even the best-case scenario mostly provides lessons in what not to do.

Peggy Noonan also sees the VA scandal as an indictment of the progressive vision. And it further heightens skepticism over Obama's basic lack of management skills.
The scandal also prompts this thought: Barack Obama is killing the reputation of government. He is killing the thing he loves through insufficient oversight. He doesn't do the plodding, unshowy, unromantic work of making government work. In the old political formulation, he's a show horse, not a workhorse.

The president's inattention to management—his laxity, his failure to understand that government isn't magic, that it must be forced into working, clubbed each day into achieving adequacy, and watched like a hawk—is undercutting what he stands for, the progressive project that says the federal government is the primary answer to the nation's ills.

He is allowing the federal government to become what any large institution will become unless you stop it: a slobocracy.

The president and his staff don't seem to know that by the time things start bubbling up from the agencies and reach the Oval Office the scandal has already happened, even if it's not in the press yet, and the answer isn't to prepare proactive spin but to clean up the mess, end the scandal, fire people—a lot of people—establish accountability, change bad practices, and make the agency work again.

The administration's sharpest attention goes to public relations, not reality. This time even their spin has failed.
Kimberley Strassel reports on how Democrats have put union supporters before veterans.
We know with certainty that there is at least one person the Department of Veterans Affairs is serving well. That would be the president of local lodge 1798 of the National Federation of Federal Employees.

The Federal Labor Relations Authority, the agency that mediates federal labor disputes, earlier this month ruled in favor of this union president, in a dispute over whether she need bother to show up at her workplace—the Veterans Affairs Medical Center in Martinsburg, W.Va. According to FLRA documents, this particular VA employee is 100% "official time"—D.C. parlance for federal employees who work every hour of every work day for their union, at the taxpayer's expense.

In April 2012, this, ahem, VA "employee" broke her ankle and declared that she now wanted to do her nonwork for the VA entirely from the comfort of her home. Veterans Affairs attempted a compromise: Perhaps she could, pretty please, come in two days a week? She refused, and complained to the FLRA that the VA was interfering with her right to act as a union official. The VA failed to respond to the complaint in the required time (perhaps too busy caring for actual veterans) and so the union boss summarily won her case.
Oh, what a surprise that unions are making the problems at the VA worse.
As for patient-case backlogs, the unions have helped in their creation. Contract-negotiated work rules over job classifications and duties and seniorities are central to the "bureaucracy" that fails veterans. More damaging has been the union hostility to any VA attempt to give veterans access to alternative sources of care—which the unions consider a direct job threat. The American Federation of Government Employees puts out regular press releases blasting any "outsourcing" of VA work to non-VA-union members.

The VA scandal is now putting an excruciating spotlight on the most politically sensitive agency in D.C., and the unions are worried about where this is headed. They watched in alarm as an overwhelming 390 House members—including 160 Democrats—voted on May 21 to give the VA more power to fire senior executives, a shot over the rank-and-file's bow. They watched in greater alarm as Mr. Shinseki said the VA would be letting more veterans seek care at private facilities in areas where the department's capacity is limited.

One NBC reporter has had a wake-up call since he was so awe-struck by Barack Obama's prospective ability to bring better relations between the United States and the Islamic world. Now he can't name a single country where U.S. relations have improved since Obama became president. The VA is full of union workers who are working full-time on union business and being paid for by taxpayers.

Kay Hymowitz is puzzled about what feminism stands for today.