Wednesday, May 21, 2014

A Broken Promise: Failures of Bureaucracy


Veterans Affairs Secretary Eric Shinseki is under fire on Capitol Hill today over the ineffectiveness and breakdown in common integrity within the department.  Records and revelations now indicate that the following events have occurred:
-       Off the record lists were kept of veterans waiting for excessive periods of time for care.
-       Up to 40 veterans died while waiting to get an appointment.
-       Staff at the medical care facility in Ft. Collins, Colorado was urged to falsify records to cover up the lengthy wait periods that fell outside of the department’s goal of 14 days.
-       Screenings for colon cancer were delayed resulting in 50 patients receiving a delayed diagnosis of colon cancer.

I’m certain that this short list is not exhaustive of the mismanagement within the Department of Veterans Affairs.  Nor does it reflect on all of the quality medical care that is provided to veterans on a daily basis, the timely payment of pensions, and the management of the national cemeteries.

Instead, I would prefer to pursue a different set of questions. 

First, let’s look at the size and scope of the Department of Veterans Affairs.  A quick check of the Department’s website reveals the Secretary Shinseki is responsible for the following organizations and facilities:
-       820 outpatient clinics
-       300 veterans centers
-       150 hospitals
-       131 national cemeteries
-       56 regional offices
-       3 different administrations
-       Over 275,000 employees (as of 2009)

With multiple responsibilities and facilities throughout the United States, the scope of the Department is massive.

Now to the questions:

-       At what point does a bureaucracy become too large to manage effectively?
-       At what point does a bureaucracy become so large that change becomes unlikely?
-       At what point does a bureaucracy become so large that it is foolishness to think that we can hold one person accountable for everything that is happening?

Government bureaucracies are interesting things.  Originally they are created to solve or address a specific problem or need.  Once a bureaucracy is in place it is a simple matter to give it increased responsibility in different areas rather than set up a new bureaucracy.  Government bureaucracies, like some banks, reach a point in size and scope, where they no longer have to justify their existence based on the need for their services or their effectiveness.  Rather, they justify their existence by the fact that they exist and employ and impact thousands or millions of people. 

Bureaucrats in large bureaucracies begin to lose sight of the original purpose of the organization.  Partly this stems from the fact that their ability to control events diminishes as the bureaucracy grows.  Focus shifts from problem solving and rendering services to ensuring the continued existence and growth of the organization.  This mentality begins to exist on its own within the abstract structures of the institutions.  Individuals with seeming authority speak out against the uncontrollable nature of the beast but recognize they are powerless to stop it.

At the end of the day, Eric Shinseki is not fully accountable for what happened at the VA.  His ability to see what was happening and to affect it is minimal.  He happened to be the person in charge when this set of unfortunate news came to light.  He or his replacement may be able to make some real changes after in the aftermath of this process, changes that may improve care and resurrect integrity.  Those changes will be temporary.  The changes will result in new bureaucrats, new rules, and new organizations that will continue to push the department beyond the scope of human control and understanding.

Accountability for this fiasco lies with the American people.  We have accepted as fact that a large, non-personal, non-accountable public entity will do what we created it to do.  We fail to see that at some point government agencies begin to exist for themselves.  Effectiveness, efficiency, and honesty are the casualties of gargantuan government agencies.

The promise that government in such a size can take care of us effectively has yet to be proven.  Some will say, “Well, the good outweighs the bad.  By and large these agencies do a good thing.”

What do we do when the good no longer outweighs the bad?  What do we do when the agency is no longer within the control of the taxpayer, the voter, the politician, or even the bureaucrat?

Here’s what we do, at least in the case of the Department of Veterans Affairs: We allow people who served our country to suffer and die needlessly. 

Of course, not all government mismanagement results directly in death.  Targeting and political agendas in the IRS, whatever the scope, probably didn’t kill anyone directly. 

One more question: As we look at what has happened within the Department of Veterans Affairs, what do we think is going to happen with the full implementation of the Affordable Care Act or if we go to a single payer system administered by the government?

Like Secretary Shinseki, I’m “mad as hell” to find out that our veterans have suffered and died needlessly.  Also like Shinseki, I’m largely powerless, by myself, to do anything to have prevented it.


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