The VA History and Issues

Veteran's Affairs According to VA.gov (2016), the Department of Veteran's Affairs has its roots in a policy passed in 1636 when soldiers at the Plymouth Colony who had fought on the war with the Pequot Indians were granted support by the colony. After independence, the policy was continued, and by 1811 the first hospital for veterans was built and funded by the federal government. The system of veteran's assistance was expanded numerous times over the course of the 19th century, and in 1917, further expansion occurred.

After World War One there were three agencies that were responsible for different aspects of veteran's benefits and so in 1921 these were merged to create the Veterans' Bureau, the precursor to the modern Department of Veteran's Affairs. The VA was formally created in 1930 by President Hoover, granting it more authority than it previously had, and absorbing more divisions (VA.gov, 2016). The medical side was the Veterans' Health Administration, which evolved from the earliest veterans' hospitals that were founded following the Civil War.

The system includes a variety of hospital and veterans' homes and is the largest component of Veteran's Affairs. It is also one of the largest health care systems in the world. There are 152 hospitals, 800 community-based outpatient clinics, 126 nursing homes and 35 domiciliaries (VA.gov, 2016). Managing this system is a complicated business, and this has led to some issues in the past. Prentice and Pizer (2007) note that the VA struggles with providing access to health care for veterans, as it appears to have capacity issues.

The VA receives its funding from Congress, and this funding must be approved. Budgetary pressures have resulted in there being challenges with respect to obtaining adequate funding, and these have then manifested in delays in receiving care, due to capacity issues at some VA facilities. This is a chronic issue, and the VA has been working towards reducing wait times since at least 2000, before the current conflicts in the Middle East.

The efforts to decrease wait times are important for the VA in terms of performance, because long wait times are positively correlated with negative outcomes, up to and including increased mortality rates. By 2014, the wait times problem had not been addressed effectively, and a report cited that a leadership crisis was responsible. Leaders at a number of VA hospitals were accused of falsifying reports regarding wait times, in an effort to conceal wait time problems (Kille, 2015).

At the House Veterans Committee, a $2.5 billion addition outlay was authorized to help bridge the funding gap at the organization (Kille, 2015), highlighting that at least some of the VA's challenges were financial in nature. There are also some structural factors.

For example, more soldiers are injured than killed now compared with 20th century conflicts, and their injuries are often more severe in nature -- they would have died in older conflicts but advances in field medicine have allowed them to survive, albeit with complicated medical needs when they return home (Kille, 2015). Add to this the greater recognition of post-traumatic stress disorder, which also requires long-term treatment, and the financial needs of the organization have increased dramatically in recent years without a similar increase in funding.

Whether this is a leadership problem at the top, on in Congress where the funds are allocated to the VA, is up for debate, but there is culpability at both levels for the problems that the VA is facing. It is not as though Congress and VA leadership are unaware of the crisis facing the VA. Not only.