The problems suddenly emerging from the Veterans Administration, many going back more than decade, raise huge questions.
This is more than fraudulent wait lists. Is the culture of this agency too warped to repair?
Should its health care services be moved to the private sector?
All those involved in oversight - Congress, auditors and the news media - should have done more.
As an interim report from the VA's inspector general noted on the Phoenix office, a total of 18 previous reports dating back to 2005 have been issued. In fact, the 2008 report described the problems with wait lists as "systemic."
The VA had trouble meeting 30-day wait times, which then led to the impossible goal of 14-day wait times. In reaction, staff created elaborate schemes to make it appear the goals were being met.
New reports describe sustained problems with a group of seven VA hospitals that have high rates of death and infection.FUNDING OR MANAGEMENT?
Since 2000, annual spending for the VA has tripled, reported The Wall Street Journal. Since 2005, enrollment in VA services increased by 18 percent while spending increased by 76 percent.
Congress is all too willing to support more spending for the VA without providing sufficient oversight of management problems.
Only one of 435 VA executives in 2012 received a less-than- satisfactory review. In fact, the head of the Phoenix office received a bonus.
Bonuses even went to physicians who had been disciplined.
Is there a staffing issue at the VA? They don't know. An audit two years ago concluded VA had no effective method for determining if staffing is sufficient at clinics, The Washington Post reported.
The question now is if the VA is too big and too tainted to fix.
On rankings of government agencies, the VA ranked No. 13 of 19 large federal agencies. Homeland Security has long been last in line.
The top-ranked large federal operation is NASA with 74 of 100 points while the VA has 57 of 100. NASA has consistently been at the top of best places to work compiled by the Partnership for Public Service since 2003.
It is possible to turn around a federal agency, reports the Partnership for Public Service, which ranks federal agencies.
The Patent and Trademark Office has raised its satisfaction scores 20 points from 2009 to 2013.
The Department of Transportation has turned around from the worst large agency in 2009 to No. 8 in 2013.
The key to job satisfaction is leadership, the Partnership for Public Service reported. Next in importance is the match between agency mission and employee skills followed by pay.
In private business, it would be appropriate to bring in someone skilled in turnarounds. The ideal candidate would be skilled in running both private business and government and be willing to serve a few years as an interim change agent.
A new head of the VA needs to be someone of stature who knows how to turn around large bureaucracies and does not need the job.
Being familiar with the military would be ideal but not essential. Someone like Michael Bloomberg who built a large company and led New York City would be ideal. CHANGING VA'S SCOPE
The VA is an entirely government-run health system, the sort of operation that critics of Obamacare would called "socialized."
One solution is to provide qualifying veterans with vouchers that would allow them to use health care on their own. The U.S. Senate just passed a bill to do just that for veterans who cannot obtain appointments on time.
The Senate bill also would give the VA secretary the authority to remove senior officials based on poor job performance. The fact they did not have that authority indicates the total failure of management and oversight.
Hal Sherz, a member of the faculty of Emory University Medical School, wrote in The Wall Street Journal that veterans should be supplied with an insurance card allowing them to receive care in the community.
"The VA health care system is run by a centrally controlled federal bureaucracy," he wrote. "Ultimately that is the source of the poor care veterans receive."
Congress should downsize the VA to specialize in ailments common in the military - treatments for amputees, mental health services for PTSD, for example. Funds currently spent on the bureaucracy could be used to fund residency slots for primary care physicians and psychiatrists - occupations that are dearly needed throughout the nation.
VA's primary care doctors also are underpaid compared to their private counterparts. Paired with poor working conditions, it's no wonder there are physician shortages.
It is time to replace the VA's toxic bureaucracy with a smaller organization that is more responsive, more transparent, more accountable and more useful to both veterans and all the citizens.QUOTABLES"The culture of the VA has become rather toxic, intolerant of dissenting views and contradictory opinions. They have lost their commitment to transparency."- Kenneth Kizer, physician and professor at the School of Medicine at the University of California, Davis."I think people lost sight of the real goal of the VA - which is treating veterans."- Thomas Lynch, VA assistant deputy."You can cover things with money or you can fix the agency, and I think they have done the former."- Douglas Holtz-Eakin, former director of the Congressional Budget Office.