GELFAND’S WORLD-I once spent a brief period working at a VA Medical Center in California. I vowed that I would never return to that place or anyplace like it, ever again. The institutional culture was toxic in a way that sapped the spirit, and also explains the current scandal.
When Eric Shinseki, in his last moments as Secretary of Veterans Affairs, spoke about his experience in the Army, it was immediately obvious to me that a man like Shinseki -- that is to say, honorable -- was completely out of place in the VA system.
There are lessons to be learned about the scandal and what went into it, and one of the more telling is that appointing another general to run the VA Department is exactly the wrong approach. But there is a deeper lesson that is less amenable to a polite solution.
We can begin with the obvious point, which has become something of a joke in the past few weeks. The VA created a system in which underlings are rewarded for lying and punished for telling the truth. What could possibly go wrong?
Unfortunately, this is pretty much the extent of media discourse about what happened. Everyone understands fairly well that a large influx of walking wounded combined with not enough staff is a recipe for the proverbial logjam. Something had to give, and what gave was the ability to get a timely medical appointment. It's called rationing of care, that bugaboo that the right wing tries to pin on the more socialized systems such as the English National Health Service.
It happened here, partly because the George W. Bush administration and its congressional allies were not willing to provide the needed level of care that could be expected from an endless war. Add to that the chronic shortage of new doctors coming out of American residency programs (also, believe it or not, a function of congressional stinginess), and you can understand how the crunch came on.
It's how the VA system reacted to the crunch that is at issue here. The self-righteous howling pack wants to punish all those people who phonied up the records of how veterans were required to wait long times for medical care. The flagrant dishonesty that is now being revealed is shocking to some people, but that's because they don't recognize the huge disconnect between Shinseki's experience of institutional culture in the military and what I saw, working at a low level in the VA.
Let's consider the difference. Shinseki, in his last moments as Secretary, talked about how, as a battlefield commander, he sometimes had to order a military strike based solely on the report he got over the phone from a twenty-something soldier. He gave those orders with the faith and understanding that the soldier on the other end of the line was reporting the truth as best he saw it. Shinseki was shocked to discover that at the VA these past few years, the people who were reporting to him were themselves reporting the mistruths that had been passed up the line to them. In the Army, according to Shinseki, there was truthfulness.
We might doubt that this is always the case, but accept that it is probably the case at least in the things that count. I don't feel qualified to evaluate that claim, and I would guess that the institutional culture among West Point trained officers is different from the institutional culture among the ranks of the enlisted.
But among officers, there is at least supposed to be the requirement that they speak the truth about critical military matters. There is a word, a concept, that describes it. It is called honor. It's part of the code of conduct sworn to by military academy cadets. "A cadet will not lie, cheat, steal, or tolerate those who do."
It's not just empty words either. A scandal in 1951 implicated 83 West Point cadets over allegations that they were involved in cheating that benefitted the football team. You can read about this story and the military academy honor codes simply by clicking on Wikipedia, as I did. Then compare what you've read to recent scandals about college football teams that don't happen to be from military academies. It's all the difference in the world.
The fact that there have been additional military academy scandals in the ensuing years tells us that cadets suffer the temptations of all humans, but that the system reacts when it catches them in the act. In other words, there is an honor code, and it seems to be taken seriously.
It's important that the code has two parts. The first establishes the forbidden kinds of conduct. Note that these behaviors are not the sorts of things that would generally get you arrested on the outside. Maybe stealing, if the offense was great enough, but lying and cheating are tolerated in great part in civilian life. The soldier is held to a higher standard if he intends to become a commissioned officer. He is required to demonstrate his commitment to honor, which involves truth. And the definition of truth referred to by this particular oath is a high form of truth indeed. Half truths and vagaries are considered serious enough to cross the line.
But it is that second part of the oath that truly sets the West Point cadet apart from the VA employee. The cadet won't do any of those bad things, and he will not "tolerate those who do." Now that's a strong and, I tend to think, noble calling. There is no acceptance of the criminal's code that it is wrong to be a fink or a whistle blower. I suspect that the cadets manage to bend the rules on ratting out their bunkmates in the case of minor infractions. It would be sad if they lacked all rebellious spirit. But in weightier matters, we expect that they will live up to a tradition of honor that goes back a couple of centuries.
There is another corollary to the officers' code of honor. When an order comes down from the highest ranks, everyone is supposed to take it seriously. The idea that the middle ranks are supposed to buffer things a bit by telling the lower ranks to ignore their orders would be considered insane.
So Shinseki and his immediate subordinates demanded numerical information about metrics such as the waiting time for a veteran to be seen after he asked for an appointment. The idea that the VA system would function as a buffer against truth seems not to have occurred to Shinseki. Yet that seems to be what happened.
I think back on my days at the VAMC, and I don't remember any sense of honor or truthfulness that would be comparable to the cadets' code. I did have colleagues who were wonderful people and honorable in the true sense, but the idea of honor and truth as an institutional imperative was simply not there.
It was much the opposite actually. Mainly, I would describe the VA system as authoritarian. That's not so different from the Army, which is the ultimate in an authoritarian culture. After all, I didn't have to obey orders to kill anybody or attack a fortification. But the authoritarianism at the VA was of a different kind, for the simple reason that it was so unimportant and so petty. It was the perfect place for petty sadists who had no other victims to pick on.
They do that too in the army, or so I'm told. The hazing and brutalization of recruits and those who are attempting to enter the special forces is legendary. But there is method. It is to tear you down in order to build you up as a stronger and more disciplined person. Not everyone makes it through Hell Week, but those who do carry the pride for the rest of their lives. Those who have survived Marine Corps boot camp are told outright that they have just accomplished something significant.
I don't want to make a movie out of this, much less a fictional movie, but I think we have lots of history and evidence that our armed forces are attempting to develop great self confidence in their troops, an egotism that is only tempered by an equal level of self discipline.
And then there is the VA, full of civilians and veterans of a lower order, and administrators who are generally not of the warrior caste. It's a system that is full of red tape wrapped around red tape and shoved down your throat. The simple process of having a form incompletely filled out -- something that would require at most a polite memo in any other place -- as likely as not involves getting a strong memo containing a threat to your continued employment. It's not necessary, it's just the system.
Now here is the main point, so I would like you to listen carefully. In a system in which mid level and low level administrators abuse the staff, there is no loyalty in either direction. The staff member who is ordered to phony up an appointment record has nobody to complain to. Think about it. If your direct supervisor tells you to game the system by destroying records, who are you going to complain to? Not him, obviously, and you have no reason to believe that your lying supervisor has an honest and honorable supervisor of his own.
In short, a system which is so lacking in honor that the lowest level administrators can flat out tell the workers to phony the records is not a system which is going to enforce an honor code. There's none of that "or tolerate those who do" in this kind of system.
It's kind of catch 22 when you think about it. Any low ranking VA employee has reason to fear telling the truth, because he can't possibly know how high up the rot runs. All he really knows that there is rot, and it runs at least down to his level.
A true honor code would require that any employee told to lie would be required by law and tradition to report the illegal instruction. In a system that actually has honor, his report would be taken seriously, and equally to the point, he would be entitled to assume that breaches of honor are rare and confined to rare individuals.
But the VA system that I knew allowed for abuse of underlings by administrators, which suggests pretty strongly that the VA system is largely lacking in the virtues that Eric Shinseki was able to take for granted.
So no more generals at the head of the VA, at least not for a while. Maybe a doctor and some medical administrators. Maybe an experienced politician.
The solution to the VA mess, if there is one, is not going to come from waving a magic wand over the system and saying the magic words (by which I mean finding the absolutely best leader from one of our nation's armed services, and giving him command authority). It will come from having a savvy leader who understands institutional culture and who is willing to break it when necessary. One way to break the culture of omerta that is so obviously the case right now is to provide willing ears for whistle blowers. Create VA ombudsmen and put them off site so that honest and honorable individuals can blow the whistle in safety.
By the way, the VA system is not unwilling to enforce ethical norms when it can. I've seen a senior department head rudely replaced due to allegations of sexual misconduct. However, the routine abuse of subordinates in order to get them to quit, now that was not considered an issue. Those outrages were ignored, even when brought to the attention of investigators.
Breaking the code of silence and enforcing social norms that are closer to the military's concept of honor are what will change the institutional culture in the VA medical center. The next Secretary really has his work cut out for him.
(Bob Gelfand writes on culture and politics for City Watch. He can be reached at [email protected])
-cw
CityWatch
Vol 12 Issue 45
Pub: June 3, 2014
