The ongoing controversy over the leadership of the Department of Veterans Affairs has kept anyone from asking the right questions or proposing the right reforms.

The Department of Veterans Affairs (VA) has been scandal-plagued for years.

This study explored why there is so much failure and mismanagement in the federal government. Federal agencies lack incentives for efficiency and quality, and the environment in some workplaces seems to breed unethical behavior.

Last week the Senate voted to greatly increase health care spending for veterans. If the new spending were made permanent, it would cost at least $385 billion over 10 years, as Nicole Kaeding noted. The House version of the bill would cost at least $477 billion if made permanent. The chambers will now work out a compromise bill, and—going out on a limb here—I’m guessing that the compromise is also a budget buster.

Peggy Noonan’s op-ed on the weekend was titled “The VA Scandal Is a Crisis of Leadership.” Noonan discusses how President Obama “doesn’t do the plodding, unshowy, unromantic work of making government work.” Obama is not a good manager, and so scandals like the current one are to be expected.

After my blogpost yesterday about Department of Veterans Affairs spending, my research assistant Nick created the chart below on the number of VA employees. Wow, you don’t often see bureaucracies expand that rapidly! A 56 percent increase in just 13 years, from 219,000 to 341,000 employees. The VA has 100,000 new employees just since 2006.

The Department of Veterans Affairs (VA) is the fifth largest agency measured by spending. Looking at estimated outlays for 2014, VA spending of $151 billion comes in behind the Department of Health and Human Services at $958 billion, the Social Security Administration at $914 billion, the Department of Defense at $593 billion, and the Department of Treasury (mainly interest costs) at $469 billion. See Table 4.1.

The news is shocking: Patients dying on the waiting list for government-provided healthcare. But this is not a report from Canada or the British National Health Service. It’s right here in America, in the health system administered by the Department of Veterans Affairs.