VA Reform: Nearly-Impossible and Absolutely-Necessary
The U.S. Department of Veterans Affairs has had a rough few years. The effects of Operations Enduring Freedom and Iraqi Freedom are many and complex, but one effect is fairly simple: the VA must now care for a new generation of veterans with needs often unlike those of previous generations. Under this increased strain, the VA has both succeeded and struggled. The public has been much more aware of the latter, witnessing a series of VA scandals through a sometimes sensationalist media. From patients being infected with HIV with improperly sterilized equipment, to the controversial denial of claims, to a massive scandal about appointment delays, to continued difficulty providing sufficient mental health services.
Increasingly, high-ranking public officials are suggesting that more fundamental change may be needed at the U.S. Department of Veterans Affairs. Similar concerns have been voiced by the VA Inspector General, the Government Accountability Office, Congress, the media, veterans' advocacy groups, and others. Perhaps most notably, the "Commission on Care" recently found in its final report that "America’s veterans deserve much better, that many profound deficiencies in VHA operations require urgent reform, and that America’s veterans deserve a better organized, high-performing health care system." The Commission went so far as to say that the VA needs "fundamental change."
What is "fundamental change" anyway? Does it mean a change in leadership? In some form, that is probably a component. But there's a problem: the Secretary of the VA doesn't have as much power as you might think. It is an influential position, no doubt. But the Department of Veterans Affairs is a government agency -- a behemoth of a government agency with a $182 billion budget, approximately 300,000 employees, and about 1,550 sites throughout the country. One person, no wonder how visionary or charismatic, cannot transform a government agency that massive with anything resembling haste, or even reasonable speed.
This leaves the VA -- and the country at large -- with an incredibly important and vexing question: If fundamental change really is needed to reform the VA, but it is nearly impossible to transform a government institution as massively entrenched as the VA, what can we really hope to do?
My current research at the MIT Institute for Data, Systems, and Society examines this very question, in a narrow defined (and hopefully therefore narrowly achievable) way. I'm studying ways to potentially reform not only the thousands of policy documents that govern VA operations, but also the inefficient and ineffective policy management process that has produced an increasingly unsustainable foundation for the VA. Further posts will explain my methods in greater detail, and I hope to discuss findings when possible.