Basic problem with any group or system is that it’s run by imperfect people pursuing self interest. All the more reason to not have a single system – a single point of failure.
Now that the VA has erupted in scandals involving phony wait lists, and people dying because of treatment delays, an audit reveals a “systemic lack of integrity” in the system. According to the auditors, “Information indicates that in some cases, pressures were placed on schedulers to utilize inappropriate practices in order to make waiting times appear more favorable.”
In other words, they cooked the books. And what’s more, they did it to ensure bigger “performance bonuses.” The performance may have been fake, but the bonuses were real. (One whistle-blower compared the operation to a “crime syndicate.”)