The call for cabinet officers' heads to roll in response to bad news is a predictable and often wearying Washington tradition. Generally, serious problems are far deeper and more complicated than the actions or inactions of any one leader. And watching the din of posturing around the VA health care scandal it's easy to tune out ands fall back on basic partisan assumptions.
But while it's clearly true that the biggest sins committed here came from deep within the bureaucracy rather than the top of the Obama administration, wrongdoing by high officials really does seem relevant in this case. Veterans Affairs Secretary Eric Shinseki was right to step down. But it's unfortunate that Obama framed this as something he did reluctantly in order to help quell a political controversy.
"A few minutes ago Sec Shinseki offered me his own resignation," Obama said. "With considerable regret, I accepted."
He should have fired him.
The damning facts go back to Debra Draper's December 2012 Government Accountability Office report into the waiting times situation at VA facilities. The GAO went in to investigate the fact that anecdotal complaints from VA patients about delays in scheduling appointments were hard to square with the VA's official claims about wait times. She found that this was happening because "VHA's scheduling policy and training documents for recording desired date are unclear and do not ensure consistent use of the desired date."
Staffers were, at times, fudging the numbers.
"Three schedulers changed the desired date based on appointment availability," she wrote. "This would have resulted in a reported wait time that was shorter than the patient actually experienced."
Draper did not succeed in uncovering anything close to the extent of what we now know happened. But in essence, these scheduling problems were no coincidence. Congress attempted to improve the timeliness with which veterans could get Veterans Health Administration affair by offering bonuses to facilities that hit timeliness targets. At the same time, and influx of new war veterans undermined VHA's ability to treat everyone. Rather than admit that they were having trouble and trying to find a solution, VHA personnel responded to the incentive program by lying about what was happening.
It's not Shinseki's fault that people were lying. But it really is his fault that he didn't respond to the GAO's earlier reporting by looking into the situation.
As German Lopez has previously reported for Vox, "The VA could, in theory, audit these facilities, but it rarely does — largely because the issues were out of the public spotlight until now."
And indeed they were. But cabinet secretaries are supposed to pay attention to what's happening in their area of responsibility even when it isn't in the public eye. Veterans were complaining that wait times weren't as they seemed. The GAO was reporting that the complaints were correct, and facilities were not handing the situation appropriate. The VA knew what incentive programs it was running. They should have looked into it. They didn't. Needless suffering happened as a result.
The Obama administration has a well-known disinclination to fire officials who come under fire. And I understand where they're coming from. But the President also has a laudable streak running through his policymaking where he's trying to get public institutions to focus more on outcomes and outputs and less on inputs. He's trying, in other words, to get financing more tied to performance. Not just in veterans health care but in Medicare, in K-12 education, in college tuition, and all across the board.
This is great, but performance incentive programs only work if there's independent verification of outcomes. Leaders who oversee programs like that need incentives of their own.
Losing your job for screwing up is a pretty good incentive.
Heads should roll on this one.