This segment was highly disturbing and maybe sadly indicative of the general disregard we have toward our veterans. I am not an expert in disability claims, but suspect I would qualify as an expert in medical claims -- in particular reducing backlogs. I spent several years of my career running turnarounds for major insurance companies who had gotten themselves into huge claim back log situations, horrible customer service (telephone) delays and poor quality results. It will take some time, but improvement could start tomorrow.

Turnaround is possible, but not through tweaks in the existing systems, or pinning hopes on and waiting for new computer systems and probably not with the same leadership.

After I listened to your show I did some reading on the Bay Citizen site and a few others about the VA and this issue, and would like to offer some ideas. These ideas work and proved themselves in volumes far greater than those in the VA. Perhaps yours is a voice that could get them to the right people.

The Map: This actually offers hope! Good work is here because monitoring is vital to success as things change. The obvious conclusion from the map (along with the horror it depicts) is that some people get it right. Forget trying to duplicate the Texas VA System (whatever that is) and don't bother transferring another executive from Arizona to Los Angeles. Any rewards would be minimal. Find out who runs things in Nebraska, Maine and Washington and see what they are doing differently. Then find out why everyone can't do it.

Quality: I have only a vague idea what it means to have a 30-60% error rate in the disability business, but this is absolutely nuts. Every mistake only comes back to you and then some. You simply cannot sacrifice quality for speed in processing (or shredding, according to one processor). Quality has to be first in line. And it does not need to take longer or cost more. There is always a good discussion with people who ask if you want them to be "fast" or "accurate" or "cost effective"! (Hint: then answer is YES).

Just Say Yes…A Lot. This one is fairly controversial. Sample and see how many times at the end of one of these ridiculous four year long waits, the answer is "YES, OK; we will cover it". My guess is, it is a pretty damn high percentage of the time since NO is usually rather obvious. Say YES at the beginning instead of starting a foolish paper stream. Short term, you might spend a little more money, long term -- I guarantee you will save. I would probably start by saying YES to everything in the backlog over a year or two old -- maybe more, maybe less -- but there would be a lot of backlog cleared in a short time and most likely, money saved. This can be tracked, too. Yes, there is fraud and yes, there will be people who will cheat the system -- but the good far outweighs the bad in something like this. Building processes to thwart the bad guys never works since there is always a way around; meanwhile, the good guys get hammered.

Leadership: A couple of websites had some interesting details on Retired General Shinseki. He seems to be a man of considerable honor and vision -- but it is not clear he kicks ass anywhere near as often as he should. If he stays to set the tone (which would seem to be something he does well), get him some help ASAP to drive that honor through this organization. I am sure that means replacing some of the senior people. There are some knowledgable ex-military folks who have gone onto executive positions in private industry (I know this -- we worked together). There is nothing they cannot do if they get support from above. I am a converted believer when it comes to what these people can do. They just laugh and say it is far easier than a combat mission. Geez, I guess so. There are lots of other experienced people around, too.

Human Capital: The number of people who care about doing the right thing in the VA is probably higher than in most organizations (should be anyway), and coming to work for this screwed up entity every day must really hurt. All that said, the human resources aspect of this huge organization looks to be a problem. This might not be the first overhaul, but an HR organization that can justify spending $5 million on "conferences" and fires an employee for refusing to deny a claim just smells bad to me. And all unions can be dealt with.

There are many many other improvement ideas that were offered by VA employees themselves in explanations of why things take so long. These ideas may be tweaks or absolute mind blowers, but they have to get surfaced and vetted, along with a good dose of "Why do we do it this way anyway?"

They can do a better job and save money doing it. But they can't do it unless they really bust some barriers and probably some heads.