Yuval Levin assesses the VA in the aftermath of the waiting list scandal, damning the fraud but also giving credit for good performance where credit is due. He debunks some recent defensive claims and apologia, especially concerning comparisons of the VA to the private health care system. Levin concludes that powerful political interests are likely to prevent any big structural changes at the VA. Bad news!
Megan McArdle thinks that fixing the VA bureaucracy is impossible short of a major upheaval, citing the kinds of experiences that have led to successful and unsuccessful corporate restructurings. “Over time, institutions develop a strong culture, a set of institutional practices, customs and norms that control what the organization is capable of doing. To see what I mean, imagine the staff of the New York Times producing Gawker — or the staff of Gawker Media producing the New York Times.” Only sweeping changes, which are often cruel to the old guard, can lead to a successful transition. This is unlikely at the VA.