Since Eric Shinseki’s resignation as secretary of veterans affairs, I’ve found myself reflecting on who resigns and who does not in Washington. James Clapper lied to a Senate committee about whether the National Security Administration collects data on the phone calls of ordinary Americans, but he is still director of national intelligence. George W. Bush’s defense secretary, Donald Rumsfeld, misjudged the occupation of Iraq, overruling senior generals (including Eric Shinseki) who told him he had too few troops, but he did not resign until November 2006, three years into the Iraqi insurgency he failed to foresee. Meanwhile, in the wake of a scandal about excessive spending for a General Services Administration conference in Las Vegas, the senior GSA official who signed off on the spending kept his job while Martha Johnson, the agency director who discovered what had happened and sought to investigate, was forced to take the fall for her subordinate. And who can forget Jocelyn Elders, the Surgeon-General who told an AIDS conference that masturbation might be a safe alternative to risky sex and was forced to resign in the name of sexual decency by a president who we now know was accepting oral sex from a young intern?
There is a rich anthropological literature on scapegoats. Scapegoats are people (or sometimes animals) who are held responsible for calamities they did not cause, and are sacrificed. In the Old Testament the Israelites piled their sins on the head of a goat, which was then driven out into the wilderness. The ancient Greeks did the same, but substituted a beggar or cripple for the goat. Anthropologists of Africa report the hunting and killing of “witches” who were held responsible for plagues and famines. In the words of the great anthropological philosopher Rene Girard, “The real source of victim substitutions is the appetite for violence that awakens in people when anger seizes them and when the true object of their anger is untouchable.”
Eric Shinseki is a modern American scapegoat. He was forced to resign as secretary of veterans affairs after it came to light that VA administrators around the country often gave the appearance of meeting the agency goal of giving veterans medical appointments within two weeks by keeping shadow waiting lists. The controversy centered on a VA hospital in Phoenix where 1,700 veterans awaiting medical care were kept off the books and real waiting times were 115 days, not the 24 days administrators reported. At least 40 veterans died while waiting to be seen by doctors.
The VA is a massive bureaucracy with 280,000 employees serving eight million veterans. Shinseki reportedly worked grueling hours, meeting regularly with the directors of every hospital in his far-flung bureaucratic empire. He was much beloved by his staff. Like Pentagon generals persuaded by body count numbers inflated by their subordinates that they were winning in Vietnam, Shinseki believed the numbers coming to him from his bureaucracy and thought his agency was improving its care for the veterans in his charge.
When the scandal broke, many in Congress called Shinseki out for weak leadership or criticized a systemic lack of integrity among VA bureaucrats. But VA administrators were just doing what those at the bottom of a bureaucracy always do when confronted with unfair metrics of accountability: Unable to change the system, they fake the numbers. Just as inner city teachers and principals fake their students’ test scores so they won’t lose their jobs under the No Child Left Behind regime, just as mortgage processors who wanted to keep their jobs faked foreclosure documentation in order to hit their quotas, just as junior officers inflated body counts in Vietnam so they wouldn’t be punished, so low-level VA officials responded to impossible demands for efficiency with fantasy book-keeping.
If Congress wanted to find the true causes of the scandal, it had only to look in the mirror. Congress put the VA in an impossible situation by not providing the resources the agency needed to handle the massive influx of veterans wounded in the wars Congress had voted to authorize. Between 2011 and 2014 demand for VA medical appointments increased 50 percent, while it was only given resources for a 9 percent increase in hiring of doctors. Each doctor was supposed to care for no more than 1,200 patients, but the average VA doctor had 2,000.
Meanwhile, at the same time that the VA struggled to deal with an onslaught of 650,000 soldiers injured in Iraq and Afghanistan, its facilities were already staggering under the escalating demands of Vietnam veterans. As the Harvard health economist Linda Bilmes points out, veterans’ health care needs typically peak 30 to 40 years after a war ends; the demands of Vietnam veterans were just reaching their peak as an influx of new veterans with amputations, traumatic brain injuries and PTSD stretched resources to the breaking point.
The problem was not one of leadership or integrity, then, but of simple arithmetic. In the words of the Washington Post’s David Farenthold, “There were too many of the veterans. There were too few of the doctors.” Even a General Eisenhower or a General MacArthur would not have prevailed against those odds.
Two contending bills are working their way through Congress to remedy the situation.
The Senate bill, co-sponsored by the improbable duo of Bernie Sanders, Democrat of Vermont, and Arizona Republican John McCain, would increase the VA budget by $500 million, make it easier to fire VA administrators, and allow veterans to get private medical care if the VA cannot treat them in a timely manner. The House bill, sponsored by Jeff Miller, a Florida Republican, does not provide the extra funding, but does make it easier to fire administrators without appeal and move patients to private care. If the House language prevails, we will have learned nothing.
The social psychologist Lee Ross has written compellingly about what he calls “the fundamental attribution error.” When explaining an outcome, people give too much weight to individuals’ personal qualities and too little to the force of situations. Even if car crashes occur repeatedly in the same spot, bad drivers are blamed; although heroin epidemics go hand in hand with economic downturns, we just blame heroin addicts for their moral failings, and so on. The fundamental cause of the VA scandal is the situation, not the person: We gave an agency too few resources for its mission. Changing the leader will not change the situation. Nor will firing lower-level bureaucrats. That is just minor-league scapegoating. When two thirds of VA facilities are doctoring their numbers, the problem is not individual administrators’ lack of integrity.
The only solution is to appropriate more money. Given that the health-care costs of the wars in Iraq and Afghanistan will not peak until between 2040 and 2050, we will have to appropriate a lot more money for a very long time if we want to stay true to our word as a society that no soldier gets left behind. Or we can look away from what we have done and pretend that it can be fixed for free.