And they’ve been waiting a long time, too. The Associated Press reports on an internal audit from more than 700 VA facilities shows that 57,000 veterans have waited 90 or more days for their initial medical appointment, let alone for any advanced care that might be needed. Another 64,000 have been enrolled in the VA health-care system for more than ten years without ever getting to see a doctor:

The Veterans Affairs Department says more than 57,000 patients are still waiting for initial medical appointments at VA hospitals and clinics 90 days or more after requesting them. An additional 64,000 who enrolled in the VA health care system over the past 10 years have never had appointments.

The audit confirms that 13% of scheduling staff received instruction in how to fraudulently cover up the horrendous wait times and access issues. The rest of the wait-list issue gets chalked up to a “complicated” appointment scheduling process and “confusion” among staff on how to manage it.

Will anyone buy that? It’s important to remember that this is the result of an internal audit run by the VA on orders from Eric Shinseki before he resigned under an avalanche of public pressure on the VA scandal. No one has yet conducted an outside audit, although the Inspector General is conducting an independent investigation of the Phoenix facilities which became the epicenter of the scandal. For an idea of why an internal audit may not produce the whole truth and nothing but the truth, read Lindsay Wise’s McClatchy report on the internal culture of the VA and the complete lack of effort at reform over the last several years:

It has a management culture marred by cronyism, intimidation and poor oversight from the Department of Veterans Affairs central office. It has a performance-based bonus system that rewards those who falsify records to meet unrealistic quotas. And it simultaneously penalizes supervisors who don’t push their employees to “cook the books.”

“If you weren’t going to crack people’s heads, if you didn’t put people’s feet to the fire, they didn’t want you around,” said Charleston Ausby, a Marine Corps veteran from Sugar Land, Texas, who worked as a VA veterans service representative from 2002 to 2012.

Ausby said he and his co-workers routinely came under pressure to reduce the VA’s record disability-claims backlog by misfiling or mislabeling old claims that had been pending for years to make them appear in the computer system as though they were new claims.

Like “cooking the books” at VA hospitals to conceal delays in medical care, the practice of manipulating claims data made it seem as though veterans weren’t waiting as long for decisions on their benefits as they really were, Ausby said.

The solution to this problem isn’t more money. The VA budget is 78% larger than in FY2008, the fastest-growing Cabinet agency by percentage in the Obama era, which received $235 billion in extra funding over the FY2008 baseline budget since then. The extra resources appear to have simply evaporated in the bureaucracy. Nor is the answer just more effective political appointees all by itself. Shinseki was a highly-regarded four-star general who got blindsided by the scandal. He later claimed that he trusted the organization too much, which is a bit absurd since both Shinseki and Obama made a point in 2008 and 2009 to criticize the VA for its long wait times and bureaucratic inertia in dealing with the issues.

The problem with the VA is that it’s bureaucracy-focused, not customer-focused, because they have a captive customer base. The only real solution is introducing competition for non-service-related medical issues, but even then the proposed reforms only provide conditional access to private-sector care — and makes the same bureaucracy that produced fraudulent wait-list metrics the gatekeeper on the basis of the same wait-list metrics. Only in Washington does that get called reform.