The VA's Problems: a Failure of Imagination?

Much in the press about the problems with the VA.  I wonder though whether the problem wasn't at bottom a failure of imagination.  What do I mean?

Create a simplistic model of the VA--call it a bathtub.

Flowing into the VA are two flows: one is the flow of old veterans turning to the VA for support.  Now we know, I assume, pretty well the demographics of this group: how many WWII vets, how many Cold War vets, how many Iraq I vets, etc.  and the rates at which each group contacts the VA and the rate at which they are approved for care.  Once approved, I assume we also know averages of how often a vet in a specific age group needs treatment/to see a doctor.  Overall, as this group ages they're probably contacting the VA more and needing treatment more, so the potential workload is increasing.  They're also dying more, so that decreases the workload.

The second flow is of course the post 9/11 vets who need care immediately as they transition from service to civilian status.  I assume that's a bit more unpredictable, and the burden on the VA for treatment is greater, because the treatment of a 22-year old with PTSD is more difficult than a 72-year old suffering from aging.


So you have two flows of demands.  How big is the bathtub receiving the flows and how big the drain?  I assume we know how many medical professionals are employed and how many vets they can give various types of treatment to. 

Now if the flows in are bigger than the flows out, the bathtub is going to fill up and at some point it's going to overflow.  If they're exactly equal then the delay in appointments is going to represent the lag time in getting the resources to respond to the flows.  If the drain is bigger than the inflow, the appointment delay is going to represent just local conditions.  (Change the bathtub to a supermarket check out line system--sometimes lines will backup briefly just because.)

Now if you have metrics covering these items you should be able to validate your appointment time statistics by looking at the rates at which people are contacting the VA (i.e., if the rate of 72-year old vets contacting the VA drops from 2000 to 2010).  If the rates drop, that means people are giving up on the VA and going private or not getting care at all.  If the rates are pretty constant, then your stats on waiting for appointments should be goo.

  I suspect what happened with the VA is they were measuring people coming in the door, without the imagination to consider the whole universe of potential VA patients. That's my take, anyway, probably wrong.

[Updated--a Vox primer on VA care.]