How much has changed at the U.S. Department of Veterans Affairs over the last three years?

That’s an important question to ask on this Memorial Day holiday. Just over three years ago, MyGovCost began covering the secret wait-list, healthcare-rationing scandal at the U.S. Department of Veterans Affairs. Here’s how we described the roots of the scandal at that time:

The rationing scheme involves the use of multiple waiting lists for veterans seeking medical care at a number of VA health care facilities across the United States. Here, a number of facilities have been discovered to be maintaining an “official” waiting list, which is meant to communicate the VA is successfully limiting waiting times to 14 days or less before providing care. But in reality, the “official” waiting list is a fraud, as these facilities would appear to also be maintaining secret waiting lists – ones where the veterans seeking care are effectively placed in a virtual waiting room where months pass before they can even get on a schedule to receive care.

That kind of deception carries a real human cost, as the story first broke in Phoenix, where as many as 40 veterans have died before receiving care after seeking it from the VA as they were placed on the facility’s secret wait list instead. Since that story first broke, it would appear that this secret rationing system has been adopted at a number of Veterans Administration facilities across the nation – something that could only happen with the knowledge and assent of the Department’s administrators.

In other words, the situation being discovered by the public today is not an isolated incident resulting from the actions of a few rogue administrators at a local facility. Instead, it is the result of deliberate actions taken on the part of the department’s top administrators, which we can see by the system of incentives they created to reward those who adopted the secret wait list scheme and punish those who did not.

Three years later, Circa‘s John Solomon describes where things stand for veterans health care in the VA’s single-payer system today after years of the Obama administration’s efforts to whitewash the scandal.

Now three years and more than 100 criminal investigations later, there is overwhelming evidence the VA wait times were in fact systematic, consequential and involved a widespread cover-up to hide the denial of timely care.

Even worse, life-threatening problems persist at VA facilities, like in the nation’s capital where the political debate on fixing the VA has malingered.

Solomon reviews the results of just-released cases investigated by the VA’s Inspector General in confirming ongoing misconduct occurring at VA facilities, which is especially notable for the comparative absence of consequences for the VA personnel who were directly responsible for the misconduct:

While the consequences were real to veterans, they were less so for responsible VA personnel. “The U.S. Attorney closed his investigation without taking any action,” the inspector general reported, meaning the only form of punishment in this case was the removal of four senior managers from the facility.

At least that limited removal is something resembling progress toward the housecleaning that badly needs to happen throughout the VA. All too often, the VA administrators who have been held accountable for the misconduct they oversaw have successfully exploited the government’s bureaucrat-friendly Merit Systems Protection Board to either overturn their removals in court or to deny any consequences altogether.

That lack of real accountability for the VA’s rationing of medical treatment is pervasive, which has become clear through the sheer scope of the problems that have slowly emerged since the first reports of the scandal broke.

Hospital by hospital, the numbers of veterans who died awaiting treatment continues to mount. At the Phoenix VA, which became the poster child of the VA wait time scandal, things haven’t improved much.

A report last October found that 215 vets died while waiting for care in 2016, specifically chronicling the story of one veteran whose death could have been forestalled if could have gotten cardiac diagnosis and treatment….

Meanwhile, tens of thousands of pages of internal reports that have emerged in the last few months make clear the VA delay scandal that emerged in 2014 was no Mickey Mouse matter but rather a true crisis of life and death.

Solomon’s “Mickey Mouse” comment refers to former VA chief administrator’s Bob McDonald’s infamous comments describing the wait times for medical treatment at VA facilities as being similar to those at Disney theme parks, which followed former President Obama’s attempt to minimize the seriousness of the VA’s problems that exploded across the nation on his watch.

Those problems arose specifically because of the perverse incentives and the government-granted monopoly power that the VA’s staff and administrators have in being the only source of health care that many U.S. veterans can access.

The first step toward fixing what ails the VA is to follow through the reforms that will break the VA’s near complete monopoly on providing medical treatment to America’s veterans and to more effectively impose accountability on its personnel for their misconduct. The VA needs to stop being the literal dead end for health care for America’s veterans.

With new leadership, the VA has the opportunity now to seriously correct its multiple deficiencies. But the longer these same ongoing problems persist, the more it will make sense to pursue actions that will permanently curtail the power of the VA’s bureaucracy and break its near monopoly, where we would argue that what matters most is providing veterans with the ability to pursue medical care wherever they choose, where the VA itself should refocus its health care provision activities to only provide specific and highly specialized care for conditions that are uniquely shared among veterans.