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The Incentives of Bureaucrats

Thursday May 15th, 2014   •   Posted by Craig Eyermann at 2:19am PDT   •  

If you count up the number of civilians who work for the U.S. federal government, you’ll find that nearly one out of eight work for the Department of Veterans Affairs, primarily in the federal government-run, single payer-style health care and hospital system that has been established to specifically deal with the medical needs of military veterans.

The VA has been wracked in recent weeks by reports of negligence on the part of the department’s managers and admininistrators, who allegedly have implemented a unique health care rationing scheme aimed at making the system appear to be meeting the needs of ailing veterans, but is instead denying critical care to them.

The rationing scheme involves the use of multiple waiting lists for veterans seeking medical care at a number of VA health care facilities across the United States. Here, a number of facilities have been discovered to be maintaining an “official” waiting list, which is meant to communicate the VA is successfully limiting waiting times to 14 days or less before providing care. But in reality, the “official” waiting list is a fraud, as these facilities would appear to also be maintaining secret waiting lists – ones where the veterans seeking care are effectively placed in a virtual waiting room where months pass before they can even get on a schedule to receive care.

That kind of deception carries a real human cost, as the story first broke in Phoenix, where as many as 40 veterans have died before receiving care after seeking it from the VA as they were placed on the facility’s secret wait list instead. Since that story first broke, it would appear that this secret rationing system has been adopted at a number of Veterans Administration facilities across the nation – something that could only happen with the knowledge and assent of the Department’s administrators.

In other words, the situation being discovered by the public today is not an isolated incident resulting from the actions of a few rogue administrators at a local facility. Instead, it is the result of deliberate actions taken on the part of the department’s top administrators, which we can see by the system of incentives they created to reward those who adopted the secret wait list scheme and punish those who did not.

Germaine Clarno is a VA social worker and employee representative in Chicago. She alleges there are multiple secret waiting lists of veterans kept at the Hines VA Medical Center.

Asked which divisions of the hospital kept the secret waiting lists, Clarno says, “Employees are coming to me from all over the hospital, from outpatient, inpatient, surgery, radiology.”

Clarno says veterans were put on secret waiting lists when they called for appointments, but they wouldn’t formally get an appointment booked in the computer until one came up within the VA’s goal of 14 days. The purpose of the lists, she says, was to hide how often veterans were not being seen on time.

Clarno says the purpose of the lists was “to make numbers look better for their own recognition and for bonuses.”

The VA grants bonuses to executives and doctors, partly based on short wait times. Whistleblowers — including Dr. Sam Foote, who revealed the scandal in Phoenix, where up to 40 veterans may have died — believe bonuses give an incentive to conceal delays in care.

The savings from denying timely medical care to veterans could very well have provided the funds needed to pay out the reported bonuses to the VA’s bureaucrats.

Meanwhile, there were consequences for those bureaucrats who didn’t go along with and adopt the VA’s secret health care rationing scheme:

Clerks at the Department of Veterans Affairs clinic in Fort Collins were instructed last year how to falsify appointment records so it appeared the small staff of doctors was seeing patients within the agency’s goal of 14 days, according to the investigation.

A copy of the findings by the VA’s Office of Medical Inspector was provided to USA TODAY.

Many of the 6,300 veterans treated at the outpatient clinic waited months to be seen. If the clerical staff allowed records to reflect that veterans waited longer than 14 days, they were punished by being placed on a “bad boy list,” the report shows.


Bureaucrats don’t like being on their bosses’ “bad boy lists”, because it denies them opportunities for advancement and reward. Combined with the bonuses that would be paid out for those who reported that they satisfied their bosses’ performance goals, we can only conclude that the government’s bureaucrats were doubly incented to impose the VA’s secret health care rationing scheme on the unsuspecting Americans veterans who trust and depend upon them.

Once again, we find that when given a choice between meeting the real needs of regular Americans or doing things that only benefit themselves, the government’s bureaucrats choose their own interests over those of the American people.

And this is how they’re treating the people who volunteered to put their lives on the line at a moment’s notice by serving in the nation’s military. Just imagine how the same kind of twisted incentives will lead the administrators of the Department of Health and Human Services to act when they decide its time to start rationing the kind of health care that people get through Medicaid, Medicare and the Affordable Care Act. Especially if their bonuses and promotions on the line.

Image Credit: American Legion – Epidemic of VA Mismanagement

Featured Image:
U.S. Department of Veterans Affairs

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May 2014