Dog's death in flight is another tragic wake-up call
The VA's woes cannot be pinned on any singular administration
Actions express priorities. Unfortunately, for the nation's veterans, the current priorities of the U.S. Department of Veterans Affairs have not changed much in the Trump era.
As much as blaming Trump's populist policies or rousing rhetoric is an easy answer for any problem currently facing the nation, in the interest of fairness, it is important to note that the VA's woes cannot be pinned on any singular administration or political party, including the Trump administration.
Entrenched accountability issues such as those that are plaguing the VA take time to resolve. But, it appears that, thus far, the Trump administration may have over-promised and under-delivered.
Trump campaigned on a platform of overhauling the VA, and despite a robust legislative agenda aimed at following through on those campaign promises, the VA's priorities over the last several months have included gallivanting through Europe, defending questionable research programs, and delaying the release of a much-needed strategic plan on the future of the Veterans Choice program.
Wasting taxpayer funding seems to be at the route of many of the VA's problems. As explained by Avik Roy, a health care policy advisor and president of the Foundation for Research on Equal Opportunity, "[i]f you look at the budget of the VA and simply divide it by the number of people enrolled . . . there's more than enough money to fund veterans' healthcare. The problem is too much of the money is being spent not on veterans' healthcare, but on other institutional priorities."
The first institutional priority distracting top VA officials from veterans' healthcare relates to splurging on travel. Although VA Secretary David Shulkin's travel indiscretions pale in comparison to other members of the Trump cabinet, such as recently-resigned Health and Human Services Secretary Tom Price who spent over $1 million of taxpayer funds on charter flights, a Washington Post investigation into Shulkin's travel revealed that, while veterans continued to struggle with the improved access to care promised by the Trump administration, he attended Wimbledon, toured Westminster Abbey, and took a cruise along the Thames at taxpayer expense. The VA's Office of the Inspector General is now conducting its own investigation into the propriety of these travel expenses.
The revelations regarding Shulkin's travel were particularly egregious in light of the fact that, less than two weeks prior, Shulkin signed a memo instructing VA staff to curtail travel in order to "generate savings" within the department. Ironically, the memo went on to state that providing clearly documented rationale on the necessity of official travel was required to promote "accountability in determining whether employee travel in their organization is essential."
Assuming that leadership starts from the top, Shulkin has failed to provide the type of leadership necessary to promote the type of accountability and cost savings that are essential to reforming the department he oversees.
The second institutional priority distracting the VA from veterans' healthcare is in regard to the department's controversial canine research program. Many in the veterans community found it bizarre that, during the month of September, which is National Suicide Prevention Awareness Month, the only public opinion authored by Shulkin for a major media outlet was an opinion piece defending this program in USA Today, while he remained relatively silent publicly on internal data released the same week on the high rates of veteran suicide in rural states and among female veterans, until the Senate Committee on Veterans' Affairs scheduled a hearing on the topic at the end of the month.
As noted by Ben Krause, disabled veteran and founder of the website Disabledveters.org in a San Diego Tribune article discussing this topic, "I'm not going to say canine research should or shouldn't be done at all, I just don't think the VA should do it. VA has a hard enough time not withholding healthcare from veterans on a regular basis." If VA could redirect its zealousness in defending this program to providing better access to care, veterans would certainly be better off.
Finally, the third institutional priority distracting VA from veterans' healthcare is its inability to effectively implement the Veterans Choice Program. Although the Choice Program is relatively new, having been first signed in to law in 2014, VA has consistently struggled with the role of private sector care in conjunction with VA-care, with some equating the Choice Program with the demise of the department and full-scale privatization of the VA.
As VA continues to find a balance between its own existence and the role of private sector care, it nonetheless asked Congress for an emergency increase in funding for the program due to increased demand.
Despite legislation in August that provided the program with an additional $2.1 billion in funding, the money continues to be spent faster than expected because of a combination of the popularity of the program and VA's inability to properly account for the money. As a result, VA has slowed down veterans' referrals for medical appointments outside the VA, thus causing additional delays in needed care.
In requesting additional funding, Shulkin acknowledged to a Senate subcommittee in charge of VA funding that "we do not want to see veterans impacted at all because of our inability to manage budgets." However, this is exactly what is continuing to happen.
"On June 21 of this year, I joined several of my colleagues in writing to you to express our serious concerns about reports of financial mismanagement at the VA. We said at the time that it was essential, given the growing demand for care under the Choice program, that the VA immediately correct the failures that created such a serious shortfall. It appears as if you have not done so."
It should go without saying that VA's top priority should be veterans, but as the current administration's actions have demonstrated to date, this is not always the case. Only when the VA embraces a culture of veterans first, rather than entrenched bureaucracy first, can they overcome the many institutional detriments distracting them from effectively using its taxpayer funded budget to provide veterans with first class care.
Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation's veterans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans' Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs, and can be reached on Twitter @RileyTopping.