The Department of Veterans Affairs can’t provide adequate care or manage itself
by MATTHEW GAULT
The Department of Veterans Affairs is the largest health care provider in the United States. The V.A. runs more than 1,700 locations, provides care to nine million vets and spends an annual budget of around $200 billion. It runs 163 hospitals and employs more than 200,000 people. By contrast, the next largest health care company employs just over 100,000.
That’s a lot of people, a lot of buildings and a lot of cash for what is — by all accounts — a substandard level of care for American veterans. Everyone agrees that the V.A. is broken and everyone seems to think that the best option for fixing it is to pour more money into the broken system.
But it won’t. No amount of money will fix the problem. Digging deep into government reports on the V.A. paints a picture of a systemically broken system, one that can’t build new facilities let alone care for wounded warriors.
Wars create soldiers, and soldiers come home and become veterans. In payment for their service, veterans should be able to walk into a V.A. clinic and receive care. That’s part of the deal and the dream we have about the way we care — or at least should — for the people who fought for us.
In practice, vets often wait in long lines lasting months and sometimes years. They receive a level of care from the V.A. so awful that those who can afford to avoid the V.A. clinics do so. And thanks to the wars in Iraq, Afghanistan and all the other battlefields associated with America’s 21st century wars, the V.A. has around five million more veterans entering the system.
That number will grow. To accommodate them, the V.A. has gone on a building spree to both replace old facilities and construct new ones.
They’re screwing it up. Back in 2013, Congress discovered that the V.A. had cost overruns to the tune of $1.5 billion in its four biggest construction projects. Worse, the V.A. couldn’t explain how or why those cost overruns happened. The problem was so bad that Congress passed several laws that forced fiscal responsibility on the V.A. and required the department to turn over control of construction projects costing more than $100 million to the U.S. Army Corps of Engineers.
According to a new report from the Government Accountability Office, the V.A. has 23 ongoing construction projects that cost more than $100 million. Of those, it has turned over control of 12 of them to the Corps — but the Corps is having difficulties sorting through the V.A.’s shoddy records.
One recurring problem are “change orders,” something every construction project deals with. When you’re building something large and complicated, plans change. Designers change their minds, the needs of the project may change during construction, or a bureaucrat may decide to tack on a few extra rooms.
It happens … but the V.A. does a terrible job of tracking them.
Relatedly, the V.A. is facing large cost overruns regarding a large hospital currently under construction in Aurora, Colorado. “V.A.’s activation cost increased from $272 million in 2012 to $341 million currently. However, the current estimate is not reliable; V.A. officials could not provide information on how they developed it.”
That’s right, the V.A. knows it’s paying more but — because of those awful record keeping practices — it can’t explain why. This is a department-wide problem that should sound awfully familiar to any veteran who’s waited on secret lists to receive care. When it comes to records, the V.A. often just wings it. Change orders are no exception.
“[The V.A.] does not currently track reasons for change orders, [our emphasis] such as whether V.A. medical staff requested them,” the GAO report explained.
The V.A. makes note of change orders and adjusts its budget when they come in, but it doesn’t track why they happen. Which is a huge problem and a huge potential for waste, fraud and abuse. And that lack of information has the Corps scratching its head.
“It is not yet clear how the V.A. plans to use new information it collects to oversee change orders because V.A. lacks a mechanism to oversee and monitor changes to a facility’s design as a project progresses.”
Which might go a long way to explaining why the V.A. is going upwards of 100 percent over budget on projects then can’t explain why. “Without such a mechanism, V.A. cannot determine how processing timeframes and design changes affect costs and schedules and thus is at risk for unexpected cost increases and schedule delays.”
This is infuriating for a few reasons. First, it reveals — yet again — that the V.A. is incompetent. It can’t build a hospital in a reasonable manner, let alone care for all its patients. Second, it’s yet another story about the Pentagon’s inability to manage real-estate holdings.
As War Is Boring previously reported, the Pentagon owns so much property that it can’t even keep track of it all. The V.A. itself is worse, because it often rents out its property … then forgets to collect rent.
In California, the ACLU is suing the V.A. on behalf of homeless veterans in the area. Over 100 years ago, wealthy Californians donated a swath of land to the V.A. for the specific purpose of housing homeless veterans. Instead, the V.A. rented out the land to private companies. One of them built a golf course on the land. Homeless vets often sleep along the gate that keeps the golf course private.
That’s just another example of a bleak fact — the V.A. is busted and no amount of money will fix it.