Value is a term many think they understand and, more often, barely grasp. Ralph Barton Perry is the seminal author on all things related to value. As value is an aspect of functioning society and contributes to the wickedness of government, it is only fitting to delve into this concept with a discussion on value, using more examples from the Department of Veterans Affairs – Office of Inspector General (VA-OIG).
Value – using only the American Heritage (5th Edition) Dictionary, a person would consider themselves learned to know that value is a price or return, monetary or material worth, possessing worth in importance, merit, or utility. Due to specialization, some would know value as the quality of a letter or diphthong, the darkness or lightness of a color, the duration of a tone or rest, or numbers or quantities expressed in algebraic terms. None of these are wrong, and each has direct application to the fields of study, but they do not encapsulate the essence of value.
Ralph Barton Perry expressed a sentiment I support wholeheartedly in his book “General Theory of Value” (1967, Harvard University Press):
“… Bridging the gap between common sense and science. Believing that philosophy must face the facts of life and nature, taking them as both the point of departure and the touchstone of truth, one can never be comprehensive enough.”
In reiterating and describing value, especially as it applies to government, I begin firm in the knowledge that a blog cannot capture all that needs to be said. As noted by Mills, quoted by Perry (p. 35), “The word value, when used without adjunct, always means, in political economy, value in exchange.” It is on this value in exchange we focus our attention, provided we keep a second thought firmly in mind, society at its most basic element is cooperation.
In “Common Sense,” Thomas Paine made this distinction, and Perry elaborated in his books on value. Cooperation in a society is the division of labor mediated by a common purpose. Hence the value in exchange is labor for mutually beneficial specialized tasks that promote society working more efficiently. Or, to better illustrate the point, you do not hire a diesel mechanic to conduct open heart surgery. The mechanic has value in their sphere, and the cardiac surgeon has a different value in their sphere, but society flourishes in the exchange of labor through cooperation.
Consider the role of the master builder in building a major building. Each specialized task, drywall, foundations, painting, plumbing, electrical, etc., must all be done on a schedule and the master builder is ultimately responsible for the entire building once complete. The building is completed promptly and efficiently through exchange and cooperation. But is the master builder responsible for the actions of those specialists; as it pertains to the functionality of the building, the answer is yes! Thus, if a plumber is stealing, an electrician is cheating, or a painter is not using the approved paints, the master builder is responsible to the owner for failing to monitor and closely supervise the subordinate contractors exchanging their skills for political and financial gain.
We must never forget that a reputation is a political title, appointed and maintained over time, and from the experiences of others. The relationship governing issuing reputations, which helps to promote or demote the master builder in society, has value, which is more than monetary remuneration for services rendered. Our reputation is not ours but was granted by others and must be maintained through careful action repeated across life.
Consider the following scenario:
“The Office of Inspector General (VA-OIG) conducted an inspection to assess a safety concern with the new electronic health record (EHR) that resulted in patient harm. The VA-OIG found that the new EHR sent thousands of orders for medical care to an undetectable location, or unknown queue, instead of to the intended location. In December 2021, VHA assessed the risk of the unknown queue as “major severity,” “frequently occurring,” and “very difficult to detect.” Immediate mitigation was needed, but Oracle Cerner (creators of the EHR) failed to inform VA end-users of the unknown queue, placing the burden on VHA to mitigate the problem.
Beginning in June 2021, VHA staff found that the new EHR’s delivery of orders to the unknown queue caused 149 patient harm events. In late 2021, VHA staff provided the Deputy Secretary and the Executive Director for VA’s EHR modernization effort with information on the unknown queue safety concern and identified patient harm. However, after finding over 200 orders in the unknown queue in May 2022, the VA-OIG has concerns with the effectiveness of Cerner’s plan to mitigate the safety risk.”
The EHR contractor designed a problem, blamed the customer, who is also, in this instance, the owner for the problem, and then placed the onus for fixing the contractor’s failure on the owner’s employees to find and mitigate. Using the context mentioned above, one can clearly deduce that this is a negative value not aligned with societal cooperation. The result will be a taxpayer nightmare creating patient harm to veterans. Since Oracle Cerner is being paid with taxpayer dollars, do you, as a taxpayer, feel valued in this transaction?
Consider another example, recalls of products happen. Mistakes occur frequently enough that since we are all humans, we accept that humans are going to make mistakes and move on. In the following example, the manufacturer made a mistake, owned it, took decisive action to rectify it, and honored their commitments. The problem arises in the VHA’s processes and procedures that govern employee actions in response to a manufacturer admitting a mistake was made.
“The VA-OIG determined that the VHA medication recall process generally met VHA requirements and identified potential vulnerabilities related to the monitoring and reporting of medication recall adverse drug events and variations in the software used to record medication lot numbers. Adverse drug events resulting from recalled medications are not identified as a category or required to be reported in the VA Adverse Drug Event Reporting System. Therefore, the OIG could not determine if VHA monitored all adverse drug events from recalled medications.”
Did you catch that; established procedures lack a category to report and track medication recalls. A quick Internet search concluded that, per the FDA, in 2022 alone (data current as of November), 55 medical devices and 59 drug recalls have occurred. Yet, the VHA has a tracking system that doesn’t categorize drug recalls as adverse drug events. Why? Imagine getting both erectile dysfunction and antidepressants in the same pill bottle. Would not this potentially cause patient harm; of course. Shouldn’t this patient harm event be tracked as an established drug recall event, so all the evidence and information are in a single place, properly labeled, and recorded? Yet, the VA-OIG cannot declare how long the adverse patient drug tracking system has been tracking and recording events related to drug recalls and report similar to the legislative bodies for accountability.
Tell me, is a lack of information socially valuable in understanding the size and scope and adequately understanding the positive and negative aspects of adverse drug event tracking? Variations between VHA facilities open the door to patient harm and increase the risk of veterans going to a VHA facility. Yet, the VA-OIG constantly finds variations in processes and procedures between VHA facilities, recommending reducing variation, and the variation never reflects improvement. Where is the value? Why? Isn’t it amazing the processes and procedures are mostly sufficient, but the processes and procedures did not catch that information was properly being collected and labeled for tracking and reporting purposes?
If all your neighbors relate XX contractor is horrible to work with, do you hire them to work on your house? Is society growing with cooperation and building value if the contractor is always making a mess and ruining property? Why is the government allowed to harm society, stop cooperation, decrease value, and never be held accountable? Since all elected officials are expected to represent their entire geographical district instead of catering to their political base, do not all of the politicians suffer for the misbehavior of a few? Why are these elected officials not taking action to clean up the government?
Repeatedly the procurement officers, highly specialized contracting officials who work for the VA, fail a VA-OIG audit and use the same excuses constantly, namely the following factors contributing to non-compliance:
- Officials not understanding their responsibilities
- Heavy workload
- Ineffective oversight
- Prioritization of awarding contracts
Where is the value to society when employees use the same excuses, shirk responsibility for errors and mistakes, and maintain their employment at taxpayer expense? Does this reflect value to the taxpayer for their investment; of course not. So why is this behavior accepted by the officers and investigators of the VA-OIG? Society has self-correcting features that preclude the incompetent from continuing to abuse the customer; why have elected officials designed this abusive and deleterious department?
David Case, Deputy Inspector General, testified before Congressional Committees (SVAC) on VA’s electronic health record modernization program and stated the following:
“Proper governance and transparency will be necessary to get it right. Failures in these areas risk cascading problems that jeopardize the entire program.”
Great words, but what actions are you taking to reign in the cost overruns, the failed EHR which put patients in harm’s way, and is so convoluted that many employees cannot do their jobs efficiently and productively? The VA-OIG has supported through in-depth investigation that the existing EHR and the new EHR are abysmal failures, are expensive to maintain, install, train, and produce no value to society. Why are we continuing to allow Congress to invest in this EHR madness with American taxpayer dollars and debt? David Case’s testimony covers none of these fundamental questions, and the SVAC elected members never asked these questions as follow-ups to the testimony provided.
Interestingly, review all the testimony on the new EHR by the VA-OIG before Congress, and elected officials ever make accountable the government employees for success or failure. Those testifying never discuss the fundamental problems, those listening elected officials never express disgust (forget outrage) over the core issues, and the taxpayer is left holding an expensive, dead albatross. How does escaping responsibility improve the value of government in society? The government is duty-bound to help enhance cooperation for the growth of society; this is a primary duty of government. Do you see the government as improving or hindering cooperation in American society?
Repeatedly throughout the last decade of covering the VA-OIG reports, the VA-OIG discusses failed audits, improvements to governance processes and procedures to protect personally identifiable information, how the VA processes are inadequate and cause patient harm, and the list continues. The same problems, the same recommendations, and the same testimony before Congress. Wash, rinse, repeat, ad nauseum ad infinitum. I repeat in words of soberness, and with the conviction of someone who knows, the actions of the VA are unacceptable, and the politicians elected to correct executive branch misbehavior are failing their US Constitutional duty to scrutinize the government. These are millstones we can sunder from the neck of American society. All without violence, using the existing laws on the books, and concrete action can, and needs to, begin immediately!
We conclude with an insight from Perry (p.515):
“The master builder of social justice oversees all the diverse social activities and takes account of their relative importance in the community. But unless those who build know what they are building and are motivated by that rather than by their wage, the unifying purpose is the exclusive prerogative of the master builder.”
Because the elected officials placed in authority by the electorate are not motivated by building society, only by how much money they can squeeze, American Society is suffering. The self-perpetuating machine of doom continues chugging steadily, and until the citizens understand the principles of value and change the elected officials, then holding them personally accountable for powering the destruction of American society and accountable for breaking the trust invested by the people for the people, the course of American society is doom bound.
© Copyright 2022 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images. Quoted materials remain the property of the original author.