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.]

Moving Pigs, from a Practical Man and Powerline

Walt Jeffries has a post on animal psychology, though that's not its title.  The url for the post differs significantly from the title of the post, which might mean Walt is succumbing to political correctness.


Meanwhile, over at Powerline, a blog I usually read and rarely agree with, Mr. Hayward discusses flying pigs. (I'm ambivalent about the subject.)

This Time Is Different

That's the theme of this post from U. of Illinois economists in response to concerns about a bubble in farmland prices leading to a bust, as we went through in the 1980's.  Their graphs are convincing, the ups and downs are of different magnitude, and the "safety net" of crop insurance is stronger (i.e., bigger) today than in the 70's.

Extension and Obamacare

Here's a Rural Blog post about new laws in Georgia, which doesn't want its citizens enrolling in Medicaid.  Extension seems to be facing some political flak there.

"Power is just really icky."

From a sarcastic post at University Diaries.

"Data never has a virgin birth"

A good sentence from Mr. Silvers (re Piketty).

Intermediaries to the Government

One of the growth industries over my life time has been in this area, organizations which mediate in some way between the citizen and the government.

The example I remember most vividly was the CED in Sherman county, KS telling me he wanted to put a consulting firm out of business; the firm was advising farmers on payment limitation issues.  Then there was our visit to Fresno county, CA (BTW the biggest ag county in the country) where one operation had a full-time employee just working as a liaison to the ASCS, FmHA, and SCS offices, plus Bureau of Reclamation.  (Irrigation was a big issue, because the federal rules limited the acreage to 960 acres, so navigating between payment limitation and irrigation was complex.)

I thought of those experiences when I saw this,a Vox piece on a firm mediating between students or their parents and the Education Department (charging $80 to fill out an application which is online).

As for lobbyists, whom we more normally think of when discussing intermediaries, today's Times has a piece on the lobbyist firm Patton, Boggs, which is merging with an international law firm.  Someone quoted in the article said that when the firm was founded in the 1960's, there were about 15 decision makers in government to influence, now there's 15,000.   And yesterday Elon Musk, who has a rocket firm, accused his competitor of hiring a former Air Force official as part of a deal to get a sole-source contract for rockets for the military. 

A conservative like George Will would say this is a reflection of the bad trend to more government; government has its hands in too much and citizens can't deal.  As a liberal I resist that idea.  I'm more comfortable with the idea that big mouths and scam artists fool the naive citizen and con them out of their money.  However, it's an issue--I really should give it more thought, but maybe in my next reincarnation.

The Data Act

Vox has a long very good post on how the Data Act got passed. Should be enlightening for people with textbook images of government.  I'm still uncertain of its impact on FSA.

Worms Are Weevils

So says the House appropriations committee: ",,,deem the pink bollworm to be a boll weevil for the purpose of boll weevil eradication program loans."  (page 22)

(A lawyer would probably respond that it's easier to do a "deem" than to amend the law on boll weevil eradication to include pink bollworms.  There's also the nagging little fact that the House appropriations committee isn't supposed to (according to all the Poli Sci 101 manuals) actually legislate--that's the role of House Ag. But if no one notices or no one complains, it's all good, innit.)

The Burden of College Loans (Circa 18th Century)

College loans change the course of one's life.  For proof, just read this post at Boston 1775 about the course of true love in the midst of college debts in the 1720's.  This is the first of a series of posts Mr. Bell is putting up on the love life of Priscilla Thomas.