Skip to main content

Gingrich: The VA's real problem

By Newt Gingrich and Ali Meshkin
May 15, 2014 -- Updated 0232 GMT (1032 HKT)
STORY HIGHLIGHTS
  • Newt Gingrich: VA secretary should quit, but replacing him isn't the solution
  • He says the VA is so enormous and so inadequate that it requires a systems change
  • All efforts to integrate its systems with the Defense Dept. have failed, he says

Editor's note: Newt Gingrich is a co-host of CNN's "Crossfire," which airs at 6:30 p.m. ET weekdays, and author of a new book, "Breakout: Pioneers of the Future, Prison Guards of the Past, and the Epic Battle That Will Decide America's Fate." A former speaker of the House, he was a candidate in the 2012 Republican presidential primaries. Ali Meshkin is a researcher for Gingrich. The opinions expressed in this commentary are solely those of the authors.

(CNN) -- In the current nationwide series of Veterans Administration scandals, the real focus has to be on rethinking the system that is failing to serve our veterans and their families.

I strongly favor Secretary Eric Shinseki resigning or being fired. He has clearly failed to lead and manage this vast bureaucracy. There are too many problems in too many places for him to remain as secretary. No one should believe, however, that simply replacing the secretary with a new person will solve the Veterans Administration's problems.

Scapegoating one or even a team of senior leaders will produce only marginal results and ultimately be drowned out by an enormous bureaucracy.

Newt Gingrich
Newt Gingrich

The real challenges in developing a 21st century Veterans Administration are challenges of systemic reform that go far beyond any single person or even a new senior leadership team.

The VA is a classic example of the principle W. Edwards Deming, the father of the quality movement, was trying to communicate with his red bead experiment. Deming had a bin full of mixed red and white beads. The goal was for workers to obtain only white beads, but he required them to scoop a random assortment blindly from the bin. Of course, they always came up with red beads as well as white beads. The experiment illustrated the point that organizations fail when the systems are bad, even if the workers are willing.

Trying to fix the VA by replacing the secretary but not the whole system is like trying to obtain white beads by replacing the person dipping blindly into the bin.

V.A. Groups call for Chief to Step Down
Email: VA hospital was gaming the system
Shinseki: We will end the backlog in 2015

In private industry, businesses have used information and communications technologies to create highly reliable, efficient, personalized, and instantaneous new systems. The ATM is a good example. Anywhere in the world you can walk up to an ATM, stick in your card, and within seconds get cash from your bank account. There is no bank teller involved. There are no business hours involved. At most banks even deposit slips are a thing of the past.

Government bureaucracies like the VA have seen little innovation. In many cases they have gotten worse as more layers of bureaucracy grow on top of the existing systems.

The VA may be the best place to start applying breakout thinking because of the scale of its bureaucracy and the scale of its problems.

The VA workforce is larger than the Marine Corps. More than 314,000 work full time for the VA compared to 202,000 in the Marine Corps (potentially shrinking to 150,000--at which point there would be half as many Marines as VA bureaucrats).

The VA treats some six million veterans a year at more than 1,400 different sites including hospitals, clinics, nursing homes, etc. In 2013 there were nearly nine million veterans enrolled -- or better than one out of every three veterans in the United States.

Just the size of the VA training system is enormous. According to the VA, it helps train 90,000 health professionals every year in its medical centers. Over 50 percent of all American physicians have had some training in the VA system.

The scale of VA bureaucracy has grown dramatically. Between 2006 and 2013, the number of full-time employees jumped more than 40 percent, from 220,000 to 314,000. Yet with 94,000 additional government employees, the system has not been able to match the private sector's standard of care.

Consider the issue of waiting times for treatments. The national average waiting time in an emergency room is 26 minutes. At VA facilities, veterans wait twice that time on average and that understates the problem in especially mismanaged sites.

The Washington Times reports:

"A recent inspector general investigation of a VA facility in Las Vegas found that up to 25 percent of patients experienced a length of stay of more than six hours on all but one of the days in a week monitored...

"During a 2011 investigation, the watchdog found that a majority of ER patients had an average length of stay exceeding nine hours at a facility in Memphis, Tennessee, and roughly 27 percent of veterans spent over six hours in the emergency room."

This means that one out of four veterans in those sites was experiencing a wait more than 12 times longer than the national average. That is a systems problem, not a scapegoat problem. Simply firing a couple of managers without replacing systems, structures and culture will not solve systemic problems.

Waiting times are just the tip of an extraordinarily large iceberg. This map shows the serious problems at VA centers around the country. We are finding new issues to add to the map every day.

Compounding the VA challenge is the fact that it has to be considered in combination with the Department of Defense's Military Health System, which serves nearly 10 million people at a cost of more than $50 billion a year.

Every effort to integrate Department of Defense and VA medical record systems has failed. The result has been an absurd process of transitioning from active duty health services to VA health services.

At a time when you can instantly make airline and hotel reservations or get money from an ATM worldwide in seconds, it takes 175 days to transition a veteran's care from the Defense Department to the Department of Veterans Affairs.

The DoD and VA spent $1.3 billion to build a joint electronic medical record system for their health care services before the two secretaries announced in February that they were abandoning the effort. This is on top of the over $2 billion the Defense Department has spent on a failed upgrade to its own electronic medical system.

In other words, even though military health costs are growing rapidly and taking up more and more of the DoD budget, the Department is failing to modernize its system and to integrate it with the VA. But this is where the solution for the MHS and the VA must begin.

Sadly, this dysfunction is not new. Anyone upset at today's Veterans Administration should consider the founding of the Veterans Bureau in 1921 and take comfort that the admittedly appalling corruption or mismanagement we see today pales in comparison to that which marked the first two years of the original Veterans Bureau.

The first director, Charles Forbes, hired tens of thousands of bureaucrats. Many were cronies or patronage positions. They did such a bad job that fewer than 50,000 veterans were getting help out of more than 200,000 wounded veterans from World War I. Forbes stole hundreds of thousands of dollars of taxpayer money

As the scandal broke, President Harding summoned Forbes to the White House and "took him by the neck and shook Forbes 'as a dog would a rat,'" as Amity Shlaes writes in her book "Coolidge," ending the tenure of the first director of the modern Veterans Administration. Appropriately, Forbes wound up in jail for this corruption.

We can take some comfort that for all its current problems the system is vastly more honest and accountable than it was in 1921.

Now we have to have the courage to develop a system worthy of our veterans, our active duty military and their families for 2021 and beyond.

Follow us on Twitter @CNNOpinion.

Join us on Facebook.com/CNNOpinion.

ADVERTISEMENT
Part of complete coverage on
October 28, 2014 -- Updated 1237 GMT (2037 HKT)
Errol Louis says forced to choose between narrow political advantage and the public good, the governors showed they are willing to take the easy way out over Ebola.
October 27, 2014 -- Updated 1803 GMT (0203 HKT)
Eric Liu says with our family and friends and neighbors, each one of us must decide what kind of civilization we expect in the United States. It's our responsibility to set tone and standards, with our laws and norms
October 27, 2014 -- Updated 1145 GMT (1945 HKT)
Sally Kohn says the UNC report highlights how some colleges exploit student athletes while offering little in return
October 26, 2014 -- Updated 1904 GMT (0304 HKT)
Terrorists don't represent Islam, but Muslims must step up efforts to counter some of the bigotry within the world of Islam, says Fareed Zakaria
October 24, 2014 -- Updated 1302 GMT (2102 HKT)
Scott Yates says extending Daylight Saving Time could save energy, reduce heart attacks and get you more sleep
October 27, 2014 -- Updated 0032 GMT (0832 HKT)
Reza Aslan says the interplay between beliefs and actions is a lot more complicated than critics of Islam portray
October 27, 2014 -- Updated 1119 GMT (1919 HKT)
Julian Zelizer says control of the Senate will be decided by a few close contests
October 24, 2014 -- Updated 1212 GMT (2012 HKT)
The response of some U.S. institutions that should know better to Ebola has been anything but inspiring, writes Idris Ayodeji Bello.
October 22, 2014 -- Updated 2101 GMT (0501 HKT)
Paul Callan says the grand jury is the right process to use to decide if charges should be brought against the police officer
October 23, 2014 -- Updated 1619 GMT (0019 HKT)
Theresa Brown says the Ebola crisis brought nurses into the national conversation on health care. They need to stay there.
October 21, 2014 -- Updated 2235 GMT (0635 HKT)
Patrick Hornbeck says don't buy the hype: The arguments the Vatican used in its interim report would have virtually guaranteed that same-sex couples remained second class citizens
October 24, 2014 -- Updated 1630 GMT (0030 HKT)
The Swedes will find sitting on the fence to be increasingly uncomfortable with Putin as next door neighbor, writes Gary Schmitt
October 24, 2014 -- Updated 1632 GMT (0032 HKT)
The Ottawa shooting pre-empted Malala's appearances in Canada, but her message to young people needs to be spread, writes Frida Ghitis
October 26, 2014 -- Updated 0148 GMT (0948 HKT)
Paul Begala says Iowa's U.S. Senate candidate, Joni Ernst, told NRA she has right to use gun to defend herself--even from the government. But shooting at officials is not what the Founders had in mind
October 23, 2014 -- Updated 2208 GMT (0608 HKT)
John Sutter: Why are we so surprised the head of a major international corporation learned another language?
October 23, 2014 -- Updated 2154 GMT (0554 HKT)
Jason Johnson says Ferguson isn't a downtrodden community rising up against the white oppressor, but it is looking for justice
October 24, 2014 -- Updated 1621 GMT (0021 HKT)
Sally Kohn says a video of little girls dressed as princesses using the F-word very loudly to condemn sexism is provocative. But is it exploitative?
October 21, 2014 -- Updated 2006 GMT (0406 HKT)
Timothy Stanley says Lewinsky is shamelessly playing the victim in her affair with Bill Clinton, humiliating Hillary Clinton again and aiding her critics
October 23, 2014 -- Updated 1414 GMT (2214 HKT)
Imagine being rescued from modern slavery, only to be charged with a crime, writes John Sutter
October 21, 2014 -- Updated 1600 GMT (0000 HKT)
Tidal flooding used to be a relatively rare occurrence along the East Coast. Not anymore, write Melanie Fitzpatrick and Erika Spanger-Siegfried.
October 21, 2014 -- Updated 1135 GMT (1935 HKT)
Carol Costello says activists, writers, politicians have begun discussing their abortions. But will that new approach make a difference on an old battleground?
October 21, 2014 -- Updated 1312 GMT (2112 HKT)
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
ADVERTISEMENT