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
September 1, 2014 -- Updated 1221 GMT (2021 HKT)
Carlos Moreno says atheists, a sizable fraction of Americans, deserve representation in Congress.
August 31, 2014 -- Updated 1625 GMT (0025 HKT)
Julian Zelizer says Democrats and unions have a long history of mutual support that's on the decline. But in a time of income inequality they need each other more than ever
August 31, 2014 -- Updated 0423 GMT (1223 HKT)
William McRaven
Peter Bergen says Admiral William McRaven leaves the military with a legacy of strategic thinking about special operations
August 29, 2014 -- Updated 1611 GMT (0011 HKT)
Leon Aron says the U.S. and Europe can help get Russia out of Ukraine by helping Ukraine win its just war, sharing defense technologies and intelligence
August 29, 2014 -- Updated 1724 GMT (0124 HKT)
Timothy Stanley the report on widespread child abuse in a British town reveals an institutional betrayal by police, social services and politicians. Negligent officials must face justice
August 30, 2014 -- Updated 0106 GMT (0906 HKT)
Peter Bergen and David Sterman say a new video of an American suicide bomber shows how Turkey's militant networks are key to jihadists' movement into Syria and Iraq. Turkey must stem the flow
September 1, 2014 -- Updated 1554 GMT (2354 HKT)
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
August 29, 2014 -- Updated 1434 GMT (2234 HKT)
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
August 28, 2014 -- Updated 1432 GMT (2232 HKT)
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
August 29, 2014 -- Updated 0243 GMT (1043 HKT)
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
August 30, 2014 -- Updated 1722 GMT (0122 HKT)
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
August 29, 2014 -- Updated 1330 GMT (2130 HKT)
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
August 29, 2014 -- Updated 1849 GMT (0249 HKT)
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
August 26, 2014 -- Updated 2242 GMT (0642 HKT)
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
August 27, 2014 -- Updated 1321 GMT (2121 HKT)
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
August 27, 2014 -- Updated 1319 GMT (2119 HKT)
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
August 26, 2014 -- Updated 2335 GMT (0735 HKT)
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
August 26, 2014 -- Updated 2053 GMT (0453 HKT)
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
August 26, 2014 -- Updated 1919 GMT (0319 HKT)
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
August 26, 2014 -- Updated 1558 GMT (2358 HKT)
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
August 25, 2014 -- Updated 1950 GMT (0350 HKT)
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
August 25, 2014 -- Updated 2052 GMT (0452 HKT)
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
August 25, 2014 -- Updated 2104 GMT (0504 HKT)
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
August 22, 2014 -- Updated 2145 GMT (0545 HKT)
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
ADVERTISEMENT