An absolutely fascinating interview. Thank you for sharing it.

Expand full comment

I work for a federal agency and the sheer amount of lawyering normal employees have to go through made this article hit close to home. It really does feel most days I'm asking someone or other "is it allowed for me to do this". The worst part of it is that when you're actually in the thick of it, these "silly laws" are not apparent, and for every silly law there's a rather reasonable law that we ought to respect but still binds us in an unexpected way.

Expand full comment

>There are movements to fully privatize the VA ... I just don't know how to do that

It's pretty straightforward: you offer a VA health insurance policy that corresponds to the % disability level. The VA has a $300bn budget per year. There's something like 16.5M vets. So that's $18k/beneficiary. The highest Medicare per beneficiary spend in the US is like $13k in FL. And the veteran patient base skews way younger so this isn't even a like for like comparison.

I'm a veteran and one of the most important decisions I made in my life was not entering the VA hellscape upon getting out. As soon as I walked into that building I knew I'd be signing up for Vogon level customer service with a side of mental illness.

I appreciate that well intentioned reformers prefer to change institutions for the better (and God bless them) but it's time to acknowledge the structural failure of government run healthcare and move onto another model entirely. I mean, half of this article is about getting people to interpret the law sanely, coordinate best practices, and not copy and paste regulation. That's a dire level of incompetence and generally not giving a shit.

I also found it... odd that you didn't mention the parking lot suicides. Of course you're under no obligation to address that but I think the general public should know that the VA sucks so much that veterans premeditatedly kill themselves as an act of protest. These aren't impulsive suicides, these are suicides with an explicit a message of "The VA Sucks". Maybe others can name another customer service organization that sucks so much their customers kill themselves in protest. I can't though.

So yea, you seem smart. Maybe think a little harder on how to elegantly extinct the VA.

Expand full comment