- - Wednesday, July 16, 2014


The latest report describing the breakdown of performance and service at the U.S. Department of Veterans Affairs (VA) was unsparing. The department suffers from a “corrosive culture,” “little transparency and accountability,” a “lack of responsiveness,” and is “resistant to reforms and change.” These conditions have led to “significant and chronic systemic failures.”

Those must be the criticisms of a staunchly conservative critic of government health care, right? Wrong. In fact, the tough assessment comes from a report on VA care compiled by President Obama’s deputy chief of staff, Rob Nabors.

Released on June 27 as a diagnosis of the patient-care scandal that has consumed the VA, the report offers a scathing look at the department’s dysfunction. As such, it reflects a candid, forthright assessment of what’s gone wrong at the VA.

That’s a dramatic step forward for the Obama administration, which until recently had been more likely to downplay criticisms of the VA as politically motivated or overblown. Perhaps the president finally recognized there is no political benefit to be gained from defending the indefensible.

The Nabors report proves the situation has become indefensible, as well as unsustainable and intolerable. For those of us who have been critical of the VA, the report is a vindication, confirming that our warnings about VA’s failures were prescient and on target.

However, while the Nabors report offers a realistic assessment of the VA’s status quo, it’s less useful as a blueprint for future action, since it lacks clear solutions and next steps for reform.

As members of the House-Senate conference committee work to reconcile competing reform proposals, the following are three steps the Obama administration should take to keep up the momentum:

First, show presidential leadership. Thus far, the president has been content to stand on the sidelines while Congress carries the banner of VA reform. That must change.

The president should make it clear that he supports the strongest accountability and patient-choice measures needed to set the department on the course to repair, and work in a bipartisan manner with members of Congress to ensure the reforms are not watered down. Change will face resistance from the VA bureaucracy, so the president’s leadership is essential to protect the reform package and see that it is implemented as intended.

Second, appoint reformers to lead the department. The president took a step in the right direction by nominating former Procter & Gamble CEO Robert McDonald as the next VA secretary. McDonald’s private-sector experience is promising, and he should be given the latitude and authority he needs to hold his team accountable for results.

It doesn’t end there, though. It will take more than one leadership change to turn this ailing department around. As a next step, the president should seek out an outside reformer to appoint as the next undersecretary to lead the Veterans Health Administration, which is perhaps the most troubled arm of the VA. Mr. Obama needs an open and transparent nationwide search for someone with health care expertise and organizational management skills to institute a culture of change.

Third, make a plan. The Nabors report offers a solid diagnosis of the VA’s symptoms, but what’s missing is a plan for treating the disease. As we all learned in the military, prior planning prevents poor performance. Reform requires a plan.

Mr. Obama should direct the VA leadership to prepare a concrete and actionable reform plan based on the findings of various studies of the department’s problem areas conducted by the Office of the Inspector General, the Government Accountability Office and Congress. This initial reform plan must have goals, objectives, evaluation, milestones and due dates. Everyone should be on the same page as to what’s expected, and VA senior executives should know they will be held accountable for success — and for failure.

This last component — accountability — is perhaps the most critical step to restoring the VA to its mission of service to veterans. As the current scandal illustrates, the VA has embraced a distorted ethic of caring for bureaucrats, rather than veterans. It’s critical that the new secretary be granted the strongest accountability tools, including the ability to fire poorly performing executives, to send a clear message of change.

In just a few short weeks, the debate on the VA has made a remarkable shift, as fixing the department has become a bipartisan priority. That’s a heartening development, and we should welcome the support for reform from both sides of the aisle.

At the same time, though, veterans and their advocates should watch the process closely to ensure that the principles of reform are honored with follow-through. Our nation’s veterans have too much at stake to simply stand back and hope for the best.

Darin Selnick, a U.S. Air Force veteran, is an independent consultant and a member of the Concerned Veterans for America organizing committee. He served as special assistant to the secretary of Veterans Affairs from 2001 to 2009.

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