The VA: "A systematic lack of integrity"

Glenn Reynolds writes:

Now that the VA has erupted in scandals involving phony wait lists, and people dying because of treatment delays, an audit reveals a "systemic lack of integrity" in the system. According to the auditors, "Information indicates that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times appear more favorable."

In other words, they cooked the books. And what's more, they did it to ensure bigger "performance bonuses." The performance may have been fake, but the bonuses were real. (One whistle-blower compared the operation to a "crime syndicate.")

VA patients were stuck with the VA. If wait times were long, they just had to wait, or do without care. In a free-market system, a provider whose wait times were too long would lose business, and even if the employees faked up the wait-time numbers, that loss of business would show up on the bottom line. That would lead top managers to act, or lose their jobs.

In the VA system, however, the losses didn't show up on the bottom line because, well, there isn't one. Instead, the losses were diffused among the many patients who went without care -- visible to them, but not to the people who ran the agency, who relied on the cooked-books numbers from their bonus-seeking underlings.

The absence of a bottom line doesn't reduce greed and self-dealing — it removes a constraint on greed and self-dealing. And when that happens, ordinary people pay the price. Keep that in mind, when people suggest that free-market systems are somehow morally inferior to socialism.

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