Can Eric Shinseki save his job after the publication of a damning Inspector General report about systemic fraud on his watch over the last five years? Yesterday, Democrats in the House and Senate shifted from defending Shinseki to joining Republicans in demanding his resignation, and the impotent White House response of Shinseki being on “probation” after five-plus years on the job didn’t do much to stem the tide. The embattled VA Secretary penned a column for USA Today in which he pledged to “restore integrity” to his agency — which calls into question what he’s been doing since January 2009:

The findings of the interim report of VA’s Office of Inspector General on the Phoenix VA Health Care System are reprehensible to me and to this department, and we are not waiting to set things straight. …

We are doing all we can to accelerate access to care throughout our system and in communities where veterans reside. I’ve challenged our leadership to ensure we are doing everything possible to schedule veterans for their appointments. We, at the Department of Veterans Affairs, are redoubling our efforts, with commitment and compassion, to restore integrity to our processes to earn veterans’ trust.

Read through the whole essay to discover just how little Shinseki has to say on this subject. It’s mostly a regurgitation of what Shinseki has done over the past month after the scandal erupted, such as demanding a nationwide audit, and getting an independent assessment of what happened in Phoenix while placing the management team on (paid) leave a month ago.

What’s missing? Accountability. There isn’t one word of explanation about what Shinseki has done over the last five and a half years since taking over the Department of Veteran Affairs to prevent this kind of systemic fraud and widespread collapse, even after having his budget increased by 78% during his tenure by Congress. In the past six budget cycles, Shinseki has received $235 billion in extra funding over the FY2008 baseline for the VA budget. Where did the money go? What has Shinseki been doing for the past five-plus years? He writes this essay as if he’d just landed on the job, not as if he’d been in charge all along.

Not coincidentally, his management team took the same approach to their testimony before the House Veterans Affairs Committee, where that approach succeeded in angering everyone.  Freshman House Republican Jackie Walorski teed off on three VA witnesses who tried using the Shinseki Defense — now they’re working hard, so talking about the past is somehow off-limits. One witness, Assistant Secretary for Congressional and Legislative Affairs Joan Mooney, called the facts “reprehensible” but refused to answer whether she should be held responsible for them:

http://www.youtube.com/watch?v=_9xHcmdW_3I&feature=youtu.be

Walorski wasn’t alone in going after Mooney and assistant deputy undersecretary for health Thomas Lynch:

Tennessee Republican Rep. Phil Roe, a physician and veteran of the Army Medical Corps, summed up the mood on Capitol Hill when he addressed Dr. Thomas Lynch, the VA’s assistant deputy undersecretary for health.

Noting that the three officials at the witness table are well-paid but presided over a system that ignored the needs of cash-strapped veterans who are locked into the VA health system, he leveled a sledgehammer at Lynch.

‘What I don’t understand is, as a veteran – as a doctor, as a practitioner – I don’t understand how you can stand at a mirror and look at yourself in the mirror, and shave in the morning, and not throw up,’ he said, ‘knowing that you’ve got people out there … how in the world?’ …

‘Why have you not told this committee yet who was disciplined in Augusta, Georgia and Columbia, South Carolina, where nine veterans died because they were on a waiting list for colonoscopies?’ [Rep. Jeff] Miller asked [Mooney].

Mooney deflected the question, saying that her office had ‘responded to more than 100,000 requests for information,’  but Miller was unimpressed.

‘Ma’am! Ma’am! Ma’am! Ma’am!’ he exclaimed. ‘Veterans died! Get us the answers, please!’

‘I understand that, Mr. Chairman,’ Mooney replied, and I will look —’

‘That’s what you said three months ago!’ Miller boomed. ‘This has been going on since January. Since January.’

This entire episode demonstrates what happens in systems with no competitive pressure and no real accountability to its customers. In my column at The Fiscal Times, I argue that the issue is really the single-payer system of the VA that incentivizes opacity and fraud while leaving veterans with no other choices for medical care, and that the VA isn’t the only example of the problem in the federal government:

Even as Congress launched the effort to pass the Affordable Health Care Act in mid-2009, the Associated Press reported that IHS spent only two-thirds per capita on health care for Native Americans than federal prisons did on felons. “On some reservations,” the AP noted, “the oft-quoted refrain is ‘don’t get sick after June,’ when the federal dollars run out.” Congress did nothing to fix IHS while pushing the ACA to approval despite popular opposition to the proposal.

The Department of Defense system came under heavy criticism during the final two years of the Bush administration. The Washington Post ran an expose´ in February 2007 on the crown jewel of the network, Walter Reed National Military Medical Center, citing patient neglect and poor living conditions. The scandal cost one general his job, and once again highlighted the lack of accountability in the single-payer systems run by government. …

In no other organizational structure except a government-run single-payer system would this take place. If these veterans had a choice of where to seek medical care, they would not have abided average wait times of 115 days to see a doctor, let alone waiting months just to show up on a wait list in the first place. Only the lack of all other options kept these veterans trapped in the nightmare of VA systems, in Phoenix and around the country.

Only in a government-run system like this would fraud have gone undetected by executive management, because customers would have walked out long before circumstances reached the extremis discovered by the IG.

Let’s not forget, too, that VA executives in the Obama administration have been repeatedly warned – in the transition in 2008, and in writing in 2010, and 2012 – of wait-list fraud, and did nothing about it. Even now, no one has been held accountable for the massive failure and fraud that may have costs the lives of dozens of veterans.

Eric Shinseki and the entire management structure that allowed this fraud to flourish need to get fired, and the sooner the better. However, the problems at the VA go deeper than personnel. We need to provide our veterans with the widest range possible of choices for their medical care so that they are never again trapped in a bureaucracy filled with cover-your-butt managers and executives who would rather hide their failure than treat our veterans. It’s long past time to end the single-payer system at the VA.

Update: Add Virginia Senate Democrat Mark Warner to the list of those calling for his resignation:

Gen Shinseki has served US w/distinction, but shld step aside now to allow focus to be on making critically needed changes to fix VA

— Mark Warner (@MarkWarner) May 29, 2014

Warner faces a challenge from Ed Gillespie this November, but hasn’t been considered particularly vulnerable. Either Warner’s more worried about the midterms than conventional wisdom would suggest, or Obama’s support for keeping Shinseki on the job is almost completely evaporating.

Update: For some reason, I thought Rep. Walorski was a Democrat — even though I interviewed her at CPAC a few years ago, and wrote about her race. Talk about brain fade. Anyway, I’ve fixed it above.