Is the VA scandal a funding issue, or a leadership failure?

We’ll be doing deep dives into the scandal at the VA as the story progresses, but one particular canard has to get addressed directly as it tends to muddy understanding of the true causes of this deadly failure of leadership. Over the last few days, some have suggested that the issue at the VA has been a lack of resources, by which the US has shortchanged the VA in budgets and in patient spending. While one can argue whether resources within the VA have been adequately focused — which is a leadership issue — one cannot argue that the VA has lacked for resources from Congress in the form of budgets or per-patient spending.

OMB historical data on budget outlays by department are easily available at the White House website, and the spreadsheet tells a very interesting story.  Since 9/11, the VA budget has increased by 235%, from FY2001’s $45 billion annual budget to FY2014’s $150.7 billion. On a percentage basis, the only Cabinet agencies that had larger budget increases over that arc have been State (271%) and Homeland Security (245%), the latter of which barely existed at the start of that period. In the Bush era, comparing the final budget with his signature (FY08) to the final Clinton budget (FY01), VA spending rose 88.3% to $84.7 billion. Defense spending rose 104% in the same period.

Barack Obama ran in 2007-8 on failures at the VA, promising more resources and better management. In comparison to that final Bush budget — don’t forget that Obama signed the FY2009 budget in March 2009 with the omnibus spending bill after a Democrat-controlled Congress refused to deal with Bush — VA spending has risen dramatically as well. The annual budget rose 78% in six budget cycles, with double-digit increases in four of the six years — while Defense spending was flat. No other Cabinet agency had a larger budget increase by percentage during Obama’s tenure. The closest was Agriculture (64%), followed by State (59%, which tends to discredit the canard about the Benghazi failure being caused by a lack of resources). Only HHS had a larger annual budget increase in terms of dollars spent, but it amounts to a 37% increase in spending from the FY2008 baseline. The amount of increase in the VA’s budget in the Obama era, $65.9 billion, exceeds the entire VA budget in the FY2004 budget.

During this entire period, Eric Shinseki has been the man in charge of the VA and the recipient of this massive increase in resources. Despite all of the new resources and a supposed mandate for reform, Shinseki has utterly failed to improve the situation for America’s veterans. Instead of holding Shinseki accountable for this failure of leadership, Obama put him in charge of investigating his own failure. In my column for The Fiscal Times, I argue that this is a dereliction of leadership on Obama’s part as well as Shinseki’s, and a potential conflict of interest:

“Nobody cares about our veterans more than Ric Shinseki,” Obama assured reporters. “I want to know the full scope of this problem, and that’s why I ordered Secretary Shinseki to investigate.”

That’s absurd on at least two levels. First, as Obama also noted in his remarks, the Inspector General has an open investigation into the wait-list fraud. The IG should be independent of VA executives, including Shinseki himself, and that investigation may well end up making Shinseki’s performance a subject for the probe. Having Shinseki run his own investigation parallel to an IG probe is problematic at best, and potentially a conflict of interest. …

Eric Shinseki had more than five years and plenty of additional resources to solve this problem, or even to “investigate” it. Yet the White House claimed this week that it was so shocked by the scandal that it hadn’t heard anything about wait-list fraud until news media began reporting on dying veterans languishing on faked appointment schedules. In any other organization, that kind of executive incompetence would get a subordinate fired. In the Obama administration, it gets the subordinate a televised statement of confidence and control over the investigation into his own lack of action.

This time, though, Shinseki’s position and Obama’s shrug may prove untenable. Two House Democrats, Georgia Reps. David Scott and John Barrow, followed Obama’s breezy business-as-usual speech by demanding Shinseki’s resignation. Rep. Tammy Duckworth – herself a disabled veteran – demanded that Obama provide “his personal attention”rather than relying on Shinseki. CNN’s Drew Griffin summed up the disappointment from veterans groups to the non-action of the Commander in Chief by reporting that what “they did not want to hear is we’re going to wait for, yet again, another investigation, office of inspector general report, or some fact-finding mission.”

At the moment, though, Obama refuses to make his subordinates accountable for their own failures. A lot of incompetent bureaucrats will sleep easier tonight with this object lesson on accountability and leadership in the federal government from President Obama. Too bad our veterans won’t be able to join them.

Dana Milbank also slams Obama’s “passivity” in the face of excruciating reality:

“If these allegations prove to be true, it is dishonorable,” he said. “If there is misconduct, it will be punished.”

Obama spoke of only “the possibility that somebody was trying to manipulate the data” on appointment wait lists, and he suggested that “whatever is wrong” may be “just an episodic problem.”

But there are no “ifs” about it: Numerous inquiries and leaked memos over several years point to “gaming strategies” employed at VA facilities to make wait times for medical appointments seem shorter — and these clearly aren’t limited to those reported in Phoenix; AlbuquerqueFort Collins, Colo.; and elsewhere. Lawmakers in both parties have spoken of a systemic problem at the agency, and the American Legion, citing “poor oversight,” has called for Shinseki’s resignation — the first time it has made such a gesture in more than 70 years.

Obama said Wednesday that he doesn’t want the matter to become “another political football,” and that’s understandable. But his response to the scandal has created an inherent contradiction: He can’t be “madder than hell” about something if he won’t acknowledge that the thing actually occurred. This would be a good time for Obama to knock heads and to get in front of the story. But, frustratingly, he’s playing President Passive, insisting on waiting for the VA’s inspector general to complete yet another investigation, this one looking into the Phoenix deaths. …

Obama doesn’t need an IG to tell him “if” there has been mismanagement and misconduct. He needs only his eyes and ears.

The NRCC has a good video about President Passive and his detachment from reality that hit this morning:

The VA scandal is a leadership failure from top to bottom. That’s not a meme — it’s a deadly reality.

Update: John Merline has a great analysis of VA spending at Investors Business Daily, and takes a look at it from another angle:

Medical care spending — which consumes about 40% of the VA’s budget — has climbed 193% over those years, while the number of patients served by the VA each year went up just 68%, according to data from the VA.

From 2008 to 2012 alone, per-patient spending at the VA climbed 27%. To put that in perspective, per capita health spending nationwide rose just 13% during those years.

And per-enrollee spending for Medicare went up only 10%, government data show.

Some will argue that the increase in health spending was the direct result of all those wounded warriors coming back from Iraq and Afghanistan.

But these vets aren’t driving VA costs higher.

Congressional Budget Office report found that they cost $4,800, on average, in 2010 compared with $8,800 for other veterans who used the system.

It also found that while these Iraq and Afghan vets account for 7% of those treated, they were responsible for only 4% of its health costs.

I linked it in my TFT column, but it’s worth including here again.