Friday, May 23, 2014

Waiting to Die on the Government’s Watch

By Ilana Mercer

Why would a talented, dedicated cardiologist choose to be coffined in a medical gulag, weighed down by incompetents, his wages capped; his rewards incommensurate with his drive and dedication? He wouldn’t. Surprising as this seems to some, the best and brightest do not work for the state. Increasingly, government workers are carefully selected for
the color of their complexion, for their sex and sexual or political orientation, not for their competence.

In a policy statement, the VA commissioner for Connecticut, a woman of course, crowed that applicants to her department are screened to ascertain “minimum qualifications.” “Maximum qualifications” are not required in this killer of a system. “Applicants who meet the essential level of preparation,” writes the woman, “are not excluded. The Human Resources Administrator must work to bring as many protected members into the system.” Her words. Once recruited, the needs of these precious, “protected-group members” are jealously guarded.

If “diversity” trumps talent in government hiring; so too is job security a legislated article of faith. In order to set in motion a termination or two—pursuant to public outrage over the scandal in the Phoenix Veterans Affairs facility, where as many as 40 gravely ill veterans died while waiting to be treated—Congress has had to convene to pass “The VA Accountability Bill.” In the unlikely event of a layoff, seniority is given priority over the quality of the worker. A good healthcare provider will be terminated before a tenured provider.

Layoffs are as scarce as hen's teeth. A man has to commit mass murder before he is sacked. I wager that Maj. Nidal Malik Hasan—the Jihadi who committed fratricide at Fort Hood—is still on the government’s payroll. Courtesy of The Immigration and Naturalization Service, the 9/11 assassins retained valid student visas, long after their demise. For his part, Hasan worked at Walter Reed Army Medical Center, where he terrified the patients entrusted to his care. By necessity, a private hospital (to the extent that such a thing still exists in post-Obamacare America) would have done its utmost to fire problematic personnel for fear of litigation.

It is becoming crystal clear that the rot pervades the “1,700 hospitals, clinics and other facilities” operated by the command-and-control federal government. “A common language of bureaucratic corruption” is how The Daily Beast described the routine exchanges between VA staff in several states, so far, in the course of conspiring to lie to the auditing VA inspector general, to “forge appointment records,” and to secrete away lists of soldiers who believed they were waiting for care, but were in fact waiting to die.

Given the hiring process at play in the VA, can you picture how this could come about? I can.

No leap of logic is needed to predict that the culpable will not be named, shamed or jailed. The department will not be dissolved or declared bankrupt, morally or financially. If anything, expect budgetary increases. As we are lectured, the offenders were merely “overwhelmed and under-resourced”; encumbered by “a lack of funding." That’s how Democrats are framing root-and-brunch rot in the lumbering VA bureaucracy. Such special pleading is standard in explaining murder and mismanagement across the $63.4 billion-dollar government agency, whose discretionary budget Obama has only increased.

This too is a lie.

According to Investor's Business Daily, “The VA's budget has been exploding, even as the number of veterans steadily declines. From 2000 to 2013, outlays nearly tripled, while the population of veterans declined by 4.3 million. From 2008 to 2012 alone, per-patient spending at the VA climbed 27 percent. To put that in perspective, per capita health spending nationwide rose just 13 percent during those years.” Driving these costs, moreover, are not Iraq and Afghan vets, who “account for 7 percent of those treated,” and “were responsible for only 4 percent of its health costs.”

The Beast accretes reflexively. Not unlike Obamacare, which has compelled insurers to cover an extensive and exotic list of services, the VA under Bill Clinton—he signed the Veterans' Health Care Eligibility Reform Act of 1996—expanded the sort of services and coverage eligibility to many more categories of veteran, among them high-income enrollees.

As expressed in its output and input, the efficiency of the VA healthcare system should tell a fighting man all he needs to know about his fighting chance within the belly of the beast. According to The Daily Beast, the Albuquerque VA houses “eight physicians in the cardiology department. But at any given time, only three are working in the clinic, where they see fewer than two patients a day.” On average, that’s only 36 veterans per week. The average single private-practice cardiologist sees more patients in a week than the Albuquerque VA’s entire eight-person cardiology department. Surveyed, 60 percent of cardiologists in private practice “reported seeing between 50 and 124 patients per week. In the course of two days, a single cardiologist in private practice sees as many patients as the entire eight-person Albuquerque team sees in a week.

All the same, these government workers trust that their identities and salaries are shielded: taxpayers will pick up the legal tab for the deaths they caused through deliberate delays, medical and criminal malfeasance. When workers’ pay is untethered to performance; when people are hired for the wrong reasons and seldom fired—they will, at the very best, produce less and less.

It is in the nature of The Beast.

 Ilana Mercer is author of Into the Cannibal's Pot: Lessons for America from Post-Apartheid South Africa


  1. Any medical student or Resident who has worked in a VA hospital can attest to what a joke these places are. Not to mention that a substantial amount of the work is done by the essentially indentured servents that are medical students and residents.

  2. 2 patients a day is joke. I see 15-30/day. But that's because I am incentivized, by being a private practitioner, to be helpful, efficient and pleasant. On the other hand, if I had a cushy job with a guaranteed salary, I would see as few patients as possible, like two a day. The more patients you see equals more responsibility and more liability.

  3. Although my experiences with the VA have been positive, I have not put the system under any serious treatment pressures. My PC doc hails from India. Her resident from the same location, even though he attends a local medical school. Maybe their idea of quality medical care is what they see in their own countries?!?