Secretary of Veterans’ Affairs Eric Shinseki fought for his job until the end, but ultimately had to fall on his sword. Probably most fatal was his initial effort to portray the wait-time scandal as isolated in Phoenix. When the Inspector General report revealed that the problem was systemic, it pulled the rug out from Shinseki and left him with too few allies willing to give him the benefit of the doubt.
This is a story about resources, but it’s also a story about perverse incentives. By tying people’s annual reviews to their ability to create short wait-times, the VA gave folks a reason to game the reports. We all want accountability, but we have be careful about how we try to measure performance. I think we see some similar problems with our desire to measure how teachers and school districts are performing. Sometimes our efforts to measure performance are counterproductive or create weird or unethical responses.
When we create these systems, we create an atmosphere where people are incentivized to cheat, so dealing with that has to be built into the system from the beginning. It the VA’s case, they have already suspended the wait-time tie to performance reviews. If they are going to revive that standard, they will need an IT solution that is robust enough to forestall cheating.
Shinseki had to resign because our politicians are corrupt, amoral assholes. Plain and simple. Can someone tell me how things are going to be fixed by the end of Obama’s term in office?
They are not going to be fixed. Not by the end of anyone’s term in any office unless that person is willing to do some truly revolutionary things. Plus…the Government Media Complex will not allow anyone anywhere near he office of president who seriously threatens this massive criminal conspiracy that we laughingly call “Our Federal Government.”
Bet on it.
Non-personing first. If that doesn’t work? There are…other means.
Bet on that as well.
AG
So a major critic of the Bush-Rumsfeld rush into Iraq has been disgraced and all memory of the 2004 Shinseki report purged from the internet.
The President looking forward again. The Republicans burying the past with veterans complaints that they can’t get socialized medicine more promptly than private medicine. And bureaucratic gameplaying by people under the gun for performance without the resources to make that performance happen. (Or if you want to go all tin-foily about the locations of the VA organizations that were playing games, an election-year set-up by burrowed-in Republicans.)
This is first and foremost a GOP scandal. And another link in the chain of evidence of misleading and war crimes of the Bush administration weakened.
Following Obama’s lead, Shinseki didn’t clean house when he took on the assignment according to a career VA medical center contract administrator that I talked to.
Very true, but he of all people should have known Bush appointed crooks and audited the waitlist reports (long waitlists have always been a significant issue for the VA; this is not a side issue that shouldn’t necessarily get to his desk).
Hopefully those carrying out the coverups will get indicted for manslaughter, because that’s exactly what they are guilty of.
What I’m not yet clear on is when the manipulation – subverting the IT system – of wait lists began. IOW, were the official (system reported) wait list times during Bush/Cheney real or artificial? If the latter and it was a reduction in the wait time from an artificially low number that Obama/Shinseki initiated, the thing was bound to blow up. Absent routine, quality, and on-going audits during for the decade ending in 2008, and it’s a safe bet that didn’t occur during those years, or absent a whistle-blower or two, Shinseki had to accept the automated reports as accurate. Instituting verification audits would have been a good thing — but where was the funding to do that? Particularly absent sufficient or reasonable suspicion that the system reports were inaccurate?
In a saner world, these current reports are the original evidence of some rotten going on. And it’s appropriate that Shinseki and his senior staff be given the time to fix a problem that they couldn’t previously have been aware of.
Here we go: Documents Show the VA Debacle Began Under George W. Bush
Shinseki is too decent, honorable, and honest to have approved covering up this fraud. However, it appears that there was no shortage of VA employees that had reasons for continuing to engage in the fraud and hide it from disapproving higher ups.
Two years later, another inspector general audit found that the VA had failed to act on these recommendations and that schedulers were still using paper lists and other tactics to mask the backlogs. The report recommended that the VA “establish procedures to routinely test the accuracy of reported waiting times and the completeness of electronic waiting lists, and take corrective action when testing shows questionable differences.” At the time, the VA agreed to convene a work group to tackle the issue. A VA spokeswoman declined to comment on whether it had actually done so.
If there are multiple systems (as in each operating region had their own system which has avoided integration for decades because of different regional operating procedures), the subversion of the system comes with reporting the sub-unit performance. And the incentives come with the way the IT system ties wait times to personal job performance reviews. The politics of designing performance-tracking systems is really quite amazing. And “user satisfaction” is a key benchmark of IT contracts. Guess who the users are.
Your speculations wrt VistA are off the mark.
The only way to defeat it was for employees not to enter the data and maintain a manual second set of books. IOW fraud.
Again, Management By Objectives and a bonus system that pays for overall inefficiency.
It’s not the IT system, however, it’s the Management system at fault. I’ve neither seen nor heard of computer glitches.
Unfortunately, the whole Government system has become toxic with bonuses and contractors.
.
Quite damaging for Shinseki …
○ President Obama Meets with VA Secretary on System-Wide Problems
○ VA clinic in Phoenix just took the gaming system to another level
Your link to the Mother Jones: article gives excellent overview.
I’m conditionally going to disagree that this is damaging to Shinseki. The problem was recognized and compliance with VA SOP was appropriately delegated to the health directors. It was an order.
Failure to follow this order, including passing it along to subordinates, then became grounds for immediate termination for all those that engaged in the fraud. Better to leave Shinseki at the helm to crack the whip and complete the task of cleaning up this long-standing issue then bring in someone new. There’s plenty of existing goodwill for Shinseki at the VA, including the medical centers. A new Secretary wouldn’t have that — and bureaucracies can be quite effective at defeating a new head guy.
Also, it’s not so easy to fire career government employees absent solid evidence of serious incompetence or malfeasance.
The fundamental reason that Bush burrowed people in.
Faking reports is sufficient reason. Lieing on an official form is, in fact, the only reason that I personally have ever seen a civil servant fired for although I have heard of other felonies. No, I’m wrong. Recently we had a temp arrested for murder in Chicago. He was arrested by Postal Inspectors on a Cook County warrant and delivered to the Chicago Police just outside the building (the building is federal property). When his locker was searched they found a pistol. That’s what he was fired for, not the warrant, which legally is only an allegation.
Precisely.
Like father like son?
Up a notch.
Like boss like employee.
AG
It’s no longer a Republican scandal. Obama’s firing of Shinseki made it a Democratic scandal because of the implication that it’s Shinseki’s fault. Maybe it is, but I’d like to see an explanation other than “he was in charge”. If that’s the reason, Obama should have resigned because ultimately he was in charge. Or is it now “The Buck stops downstairs”?
Pardon me, but as I detailed in Socialized Medicine, the VA & Shinseki the VA has the best medical IT system in the freaking world. So good that other countries and private healthcare systems have borrowed it.
It was greedy, cowardly, incompetent and/or nefarious mid/senior level employees at the VA that engaged in the fraud. (A fraud that would likely have surfaced long ago if whistleblowers in this country weren’t treated like shit.) What should be junked entirely are government employee bonuses. Or so rare for extraordinary performance that can’t be rewarded with a promotion that the President would publicly award it.
What you have written makes me think that it is the management reporting system that ties individual personal performance to the “best medical IT system” or the system for rolling up individual and unit reports that is where the failures occurred.
Changing aggregate totals on manually produced spreadsheets supposedly generated by computers is not that difficult a fraud to commit and easy to overlook in assumptions that the system is totally automated.
What I smell is a political hit job on Shinseki for a variety of GOP reasons.
No. The appointment scheduling is automated. For Vets that utilized the user portal to schedule their own appointments, VA clerks and managers couldn’t manipulate that information. Those that called for appointments and relied on entry clerks were vulnerable to manipulation. Those clerks would have been ordered by local managers on how to handle this and in violation of SOP. Does “following orders” absolve them?
Confirmation that my read of the system is correct:
Snowden’s response to release of e-mail by US officials.
Perhaps when the truth is on one’s side, slam-dunks are easier. But this is more evidence that Snowden is a very smart cookie. Do read the whole thing — it’s short.
How many times does the current administration get exposed as liars before we the people demand “the whole truth and nothing but the truth?” Or do we prefer to smear Snowden and Greenwald with lies because we can’t handle the truth?
“Word like utterances” (h/t Charles Pierce) from Palin:
Unclear if she’s aware that the VA is the only socialized healthcare system in the US. Or exactly what her complaint is. Vets being deprived of the opportunity to seek medical care from the private sector that has a doctor/patient ratio of 1:300? Or that the VA doesn’t have a 1:1.5 doctor/patient ratio as she claims exists at Guantanamo.
Maybe McCain can propose Palin to head up the VA — she wouldn’t last long but it would be long enough to destroy it.
The GOP is going after the VA and seeking to privatize it. Not sure where the White House folks Jarrett and DeParle are on this. But there might be a bunch of Democrats wanting to dodge the “socialism is failing” mantra that is coming out around this.
Just another act in the GOP Theater of Cruelty.
Of course the GOP and neo-liberal Democrats would like to privatize the VA medical system. Big bucks in this one to pick off.
And who will the Vets have to complain to after the fact? heh.
It is about neither, Booman.
Not really.
It is about yet another massive Big Government bureaucracy that is too large to be policed properly. This is the main problem with our government right now. There will always be thieves. That’s a human fact. When they can find cover under layer after layer of clomp-clomp-clomping bureaucratic incompetence they will burrow in and thrive. Downsize on all levels, cut the fat, send responsibilities to the most local systems available and there be less room to hide. This is libertarianism 101 and it is exactly on the money.
AG
Shinseki Steps Down!!!???
Bullshit.
He was fired.
Why?
Because of the same kind of incompetence that we see in every federal system. Bigger gets worse. His bad luck? The results hit the headlines.
Parsing the truth of the matter won’t work anymore, Booman. May as well quit trying. Shorty of a truly herculean figure pissing clean the Augean stables of this government, the foul odor of Big Gov rot is just going to continue until people will not be able to hold their breath/suspend their disbelief any further. I hope that moment comes soon. I have very sensitive nostrils.
AG
Yes, he was fired. Why? The White House has admitted that it is because Democrats seeking re-election demanded it. IOW, he bowed to pressure and refused to support his hand picked man. Weak as water.
“Downsize on all levels, cut the fat, send responsibilities to the most local systems available and there be less room to hide.”
Questions/statements in response:
Ron Paul voted for the AUMF, and then voted for tax cuts. He refused to vote for the funding levels sought by the VA under the Obama Administration. Libertarianism, budget cuts and “states’ rights” will not fix the VA.
. . . they will need an IT solution that is robust enough to forestall cheating.
The problem is almost never about technology, it’s embedded in a system that rewards mediocrity. From earlier attempts at “change”: The National Performance Review, 1993:
“The National Performance Review is about change–historic change–in the way the government works. The Clinton administration believes it is time for a new customer service contract with the American people, a new guarantee of effective, efficient, and responsive government. As our title makes clear, the National Performance Review is about moving from red tape to results to create a government that works better and costs less.“
What’s changed? Nothing.
What changed is that they junked the employees and systems that performed oversight functions. Saved money. It also made it ever so much easier for team Bush/Cheney to steal from the federal coffers in countless ways — from Halliburton’s no-bid exorbitant contracts to fraudsters at VA medical centers to collect bonuses.
Loosen the regulations and can the regulators is why this country went from practically no bank failures in the decades after 1935 to massive failures in the aughts. The S&L debacle was a preview of the high cost “smaller government.” Or the low cost alternative that is “too bad suckers” to ordinary people that lose their savings when their banks fail.