Eric Shinseki is out: 3 big ideas for his successor to fix the VA

Eric Shinseki resigned Friday as Veterans Affairs chief after a report found systemic abuses in VA facilities across the US, including 'secret' lists that delayed patient care and hid the scope of the problem. What to do to make the VA better?

President Obama accepted the resignation of Department of Veterans Affairs (VA) chief Eric Shinseki Friday, after a follow-up Inspector General report found that misconduct involving creating “secret” waiting lists grossly delaying veterans' care is not limited “to a few VA facilities,” Mr. Obama said, “but many across the country.” These are charges that remain under investigation, but have already resulted in the elimination of any performance bonuses for senior VA officials this year.

The president said he made the move “with considerable regret.” Shinseki himself is a veteran, a former four-star general “who left part of himself on the battlefield.” Shinseki rocketed to US notice in the early days of the Iraq war, when he warned that winning would require more troops than then-Defense Secretary Donald Rumsfeld had claimed. “He’s never been afraid to speak truth to power,” Obama said. “His commitment to veterans is unquestioned; his service to our country is exemplary.”

A majority of Americans may be pleased with Shinseki's departure. Preliminary results from a Christian Science Monitor/TIPP poll, started Tuesday, indicated that 54 percent of respondents who were following the story said the VA chief should resign. 

The interim report from the VA Inspector General released earlier this week found “serious” misconduct at a Phoenix, Ariz., VA hospital, which one whistleblower says led to the deaths of 40 veterans. The IG conclusions – that more than 1,700 veterans waiting for primary care were put on a “secret” list that delayed their care and allowed hospital officials to “significantly understate” the VA’s average wait time for new patients – did not yield good news for Mr. Shinseki, who Friday called the findings “totally unacceptable” and a “breach of trust” before offering the president his resignation.

Lawmakers and veterans groups who want more accountability are proposing their own fixes for the VA. Here are their top three suggestions:

New leadership at the VA

It looks as if they'll have their way on this point, at least at the very top. Calls throughout the week had increased for the VA chief to step down. Sen. John McCain (R) of Arizona – who once lauded Shinseki’s willingness to speak truth to power – joined that chorus “with some reluctance,” adding that if Shinseki did not step down voluntarily, the president should “fire him.”

Along with the Republican chairmen of the House Armed Services and Intelligence committees, Democrats had also begun to call for Shinseki to step down. Sen. Al Franken of Minnesota, up for reelection this year, pointed to a “systemic problem that this leadership has not been addressing.” Rep. Tammy Duckworth (D) of Illinois, who lost both legs in the Iraq war and who served as a VA official, said Friday it was time for her former boss to resign.

Although Shinseki’s resignation serves to “create a political climax for the story, I think the problem runs a lot deeper than the secretary,” says Philip Carter, director of the Military, Veterans, and Society Program at the Center for a New American Security in Washington. The VA chief has had to contend with antiquated computer systems and the “accumulated weight of 10 years of problems,” he added – one that a resignation alone will not solve.

Obama acknowledged, too, that the decision had political considerations, and that Shinseki had become a “distraction” – a point that Shinseki acknowledged in offering his resignation, the president said.

“I want someone who’s spending every minute of every day figuring out, ‘Have we called every single veteran that’s waiting? Have we fixed the system? Do we have all the technology we need?’ ”

In the meantime, Sloan Gibson, a former infantryman and president of the USO who has been deputy secretary at the VA for three months, will serve as acting head of the VA during the search for a new chief. 

Offer private health care for veterans

US lawmakers are now proposing legislation to let veterans waiting more than 30 days for an appointment to seek private care, paid for by the VA.

Rep. Jeff Miller (R) of Florida, who chairs the House Veterans Affairs committee, said the legislation is designed as an “emergency step to ensure veterans who may have fallen victim to appointment wait-time schemes or delays in care get the medical treatment they need.”

Senator McCain, too, is working with three other GOP senators to draft legislation to allow vets access to care outside the traditional VA system. “Let’s let our veterans choose the health care that they need and want the most, and not have to be bound to just going to the VA.”

The VA already offers access to private care for some rural veterans, but the problem with these bills, Mr. Carter says, is that the VA provides “really good care unmatched in the private sector.” 

Veterans overwhelming say that once they are in the VA system, they are exceedingly satisfied with the care. “It’s not clear the private sector has the capacity or the capability to provide the care the VA does – or that vets will get better or faster care on the private market,” Carter says. 

There is also the issue of consistency and coordination. In the VA system, the treating physicians and therapists can see the notes and prescriptions of every other doctor seen by the veteran, he notes. “When you start sending vets out on an a la carte basis,” Carter adds, “there is not that continuity of care.”

Abolish the VA

Perhaps, some vets say, the VA cannot be fixed at all. One group would like to eliminate the VA altogether and instead place responsibility for caring for veterans under the Affordable Care Act. 

Veterans Against the Veterans Administration (VAVA) founder Jerome Almond says the $160 billion annual VA budget could be better used to accomplish the VA’s primary mission of serving the vets, calling the VA a “medical gulag system.” 

The VAVA’s proposals are bold, but lacking in details. The group calls on tech companies like Apple and Google to work with private insurance companies “to create an efficient compensation apparatus” and for all education benefits, including the GI Bill, “to be handled by the colleges and universities instead of the VA.”  

It’s not likely to happen. “The VA represents the nation’s brick and mortar commitment to its vets,” Carter says. “There’s no chance it’ll ever make it through Congress.”