The Senate confirmed Robert Wilkie as the nation's new secretary of veterans affairs on Monday. He now faces the task of implementing the VA Mission Act, a half-baked quasi-market reform aimed at transforming an infamously inefficient government bureaucracy.
The Department of Veterans Affairs is still recoving from a major scandal that broke in 2014, when the world learned that the VA had been keeping secret wait lists to avoid cuts to hospital bonuses. The operation may have killed more than 1,000 veterans, but only eight employees were reprimanded for their roles in the mess.
"The VA is so astonishingly bad it makes the DMV look competent," says Adrian Moore, vice president of policy at the Reason Foundation (which publishes this blog) and a veteran himself.
The VA has had constant problems managing transactions with private health care providers. Private care already exists in abundance, but the VA is unable, most of the time, to connect the provider with the veteran and to execute the necessary transactions. Moore says the agency should focus on "improving the operation of the interface between the veteran, the VA, and the health care provider."
That's the aim of the Mission Act, a bill passed this year to expand veterans' access to private care providers. Among other things, the law authorizes the VA to enter into contracts with some community health care providers. That will help more veterans gain access to the health care they need, and it will also help cut costs.
The Mission Act is a wobbly step in the right direction, but more serious structural reform is necessary if the VA is "to care for him who shall have borne the battle and for his widow, and his orphan," the agency's motto since its inception. "There has to be high pressure, top-down, well thought-out reform to the management structure of the VA," says Moore. At the very least, that means more transparency, more willingness to fire incompetent bureaucrats, and more willingness to transfer services to the private sector.
That last item will be the toughest one. While the White House says that David Shulkin, Wilkie's predecessor, resigned, he maintains that he was fired for his opposition to privatization. Yet Wilkie has pledged not to privatize the agency either. Whether he'll privatize parts of it remains to be seen.
In his capacity at the VA, Wilkie has the ability to affect serious reform, independent of Congress. But his track record shows little willingness to do much more than toe the party line. He's not likely to go much further than the mandate extended to him by the Mission Act.