Friday, April 08, 2005

The Department of Vicious Assmasters (Screw You, Taxpayer!)

Democracy Arsenal attempts to blast the Republican party for cutting funding to Veterans Health and Benefits. They rail that this is how one can denigrate the Republicans from their position as the party of the military. I'm sympathetic to what they're saying, and I'm extremely sympathetic to the plight of veterans. But, at the same time, defending the VA is not the best strategy if you want to help Veterans. Demanding higher premiums and more money for non-formulary prescription drugs is a sad course of action, but simply giving the department more money from Congress is a recipe for disaster. Why? Veterans Affairs is by all accounts an arrogant and politically unaccountable bureaucracy that rarely puts the Veterans first. I know this from working for VA. The one benefit to making people pay some of their healthcare tab is that it will start to shift some accountability into VA from the actual customers, and cost recovery.

I'll agree with Democracy Arsenal that $250 is steep, it should probably be a lower amount, but it's the only way anyone's ever going to get VA to do anything about its problems. First, the VA attitude can be summarized thus: "No one is ever going to cut our funding, because no one ever wants to be seen as hurting the Veterans. So we can do what we want, and we don't have to worry." There are good people at VA, but I worked with dozens of program managers and probably 75% of them had that attitude. In the corporate world, people perform because it means earning more profit, so you cut costs and try to boost sales. In government, the incentives are different. You cut costs and perform better because you are afraid that if you do a poor job, your funding will be cut. That's the accountability. Politics actually sometimes destroys this accountability. For instance, EPA will have its budget cut even if it does a good job, or maybe BECAUSE it does a good job, because people are hostile to the work it does. Therefore there is no incentive. VA will have its budget raised, because politicians are desperate to seem kind to Veterans, and cutting it is political suicide. This leads to incentives, as I've seen at VA, to waste money and to care very little about performance. Accountability for outcomes and performance is thus undermined. The GAO has it here. No matter how much they waste, no one calls them to task for it.

The Bush Administration is the first Administration to really put the fear of God in VA, which I regret to say is a good thing. This premium issue will be another. With all of the money coming in through Congress as if like mana from heaven, with more every year, there's no accountability. If they have to collect at least some of the money from the veterans and can't just blackmail Congress for more every year, THEN we'll have real accountability. It's the same reason why poor people should always pay at least some taxes, otherwise they won't care what is done with the money that goes into public services.

That's why I have to part ways with Democracy Arsenal. . .perhaps making Veterans pay some of the premiums will force accountability in VA, and make them actually spend the money well and do their job better. This can only be better for the Veterans in the long run. But 250 is still a little steep to pay for VA's CRAPPY healthcare.