Lawmakers, advocates and bystanders alike have proclaimed myriad reasons to explain the Veterans Affairs Department’s delays in health care and ensuing cover up scandal.
Poor management, lazy bureaucrats and a general complacency toward veterans have been popular pabulums voiced by the outraged-at-large.
Another prevailing explanation is even simpler: money.
VA critics have said performance awards, or bonuses, were granted to those who kept wait lists down. This implicitly encouraged agency employees to alter wait time data, or keep them secret altogether.
“As the reports [into the VA scandal] make painfully obvious, the environment in today’s Veterans Health Administration is one in which some VA health officials are so driven in their quest for performance bonuses, promotions and power that they are willing to lie, cheat and put the health of the veterans they were hired to serve at risk,” wrote Rep. Jeff Miller, R-Fla., chairman of the House Veterans’ Affairs Committee, in an op-ed earlier this week.
The VA itself supported this notion, finding in its “phase one” audit that a measurable, outcome-driven performance management system created an incentive for deceptions.
“When tied to rewards” internal agency auditors wrote, “measurement of system performance runs the risk of engendering a culture where the appearance of success becomes the driving force.”
Miller and investigators may have a point: At the Phoenix VA facility alone -- the epicenter of the agency’s debacle -- Veterans Health Administration employees earned more than $186,000 in bonuses in 2013, according to a federal salary database.
The report suggested, as part of its “immediate action” recommendations, the agency “review and modify performance plans for wait time accountabilities.”
Of course, this only solves part of the problem. Disincentivizing the illusion of success is not the same as guaranteeing real achievement. In fact, removal of bonuses -- which former VA Secretary Eric Shinseki announced just moments before his resignation he would suspend in 2014 for all Veterans Health Administration senior executives -- could end up hurting veterans more than agency workers.
Federal employee advocates say punishing an entire group because of a few “bad apples” is no way to run a large entity like the federal government.
“Taking bonuses away from all top performers in order to punish the guilty has never been a plan embraced by successful companies,” said Todd Wells, executive director of the Federal Managers Association. “Many Members of Congress like to tout how if government ran like private companies all would be better. They need to learn that they are in effect the federal government’s Board of Directors. As such, I would ask that they learn the lessons of the private sector and empower their employees rather than constantly tear them down.”
Others have argued bonuses are only awarded after rigorous review, and play a critical role in boosting recruitment, retention and morale.
While Congress is debating the need to suspend VA bonuses in the short term -- or for as long as five years -- some are starting to turn their attention to more comprehensive, long-term personnel solutions.
The House Republican leadership wrote a letter on Wednesday to President Obama, criticizing his lack of a plan for dealing with VA’s systemic problems. Speaker John Boehner, R-Ohio, and his team questioned Obama’s willingness to implement the significant civil service reforms they view as necessary.
“It is imperative that you lay out for the American people your vision for reforming what is clearly a broken system,” the leadership wrote. “Are you willing to do whatever it takes, pending the results of the investigations that are under way, to ensure our veterans get the care we owe them, even if it means shaking up the current bureaucracy and rethinking the entire system?”
This change in rhetoric could mark a deviation from the standard knee-jerk, sound bite driven reactions such as “fire more people!” and “cut bonuses!” Sen. Bernie Sanders, I-Vt., introduced a bill that would provide more funding for the expedited hiring of additional medical personnel at VA, as well as create more facilities.
“There must be a culture of honesty and accountability within the VA and people who have lied or manipulated data must be punished,” Sanders said. “But we also have to get to the root causes of the problems that have been exposed. The simple truth is that with 2 million more veterans coming into the system in recent years there are many facilities within the VA that do not have the doctors, nurses and other personnel that they need to provide quality care in a timely way.”
Republicans have conveyed apprehension toward the approach, saying funding is not the issue, but also offered a more refined and thoughtful examination into the issue. Sens. John McCain, R-Ariz., Richard Burr, R-N.C., Tom Coburn, R-Okla., and Jeff Flake, R-Ariz., put forward the Veterans Choice Act on Tuesday.
In addition to giving vets more access to private care, the bill would remove wait time metrics as factors in determining bonuses. It would also reform the performance evaluations for senior leadership at VA medical centers and the Veterans Integrated Service Network to “ensure they are based on overall quality of care that veterans receive.”
While the two sides remain divided on the best path forward, Sanders and McCain have agreed to work together to reach a bipartisan solution. There may be hope yet for real, non-reactionary reform.