507: Leadership and Accountability at the VA. With Secretary Doug Collins

When a veteran dies in public, a system’s story reveals itself

The image at the start of this conversation is brutal in its clarity: a Gulf War veteran, turned away and shuffled through bureaucracy until his despair found a public, combustible end. That moment—reported in raw detail and invoked here to frame a broader effort—is the kind of failure that demands more than apology. It requires an architecture of change, and a leader willing to pry at the habits and assumptions that let harm accumulate in a service meant to protect those who served.

Leadership forged in chaplaincy, courtrooms, and campaign trails

Doug Collins arrives at these problems with a resume that reads like a study in human-scale leadership. He pastored for more than a decade, served as a military chaplain across branches, went to law school in midlife, and then moved through elective office into national politics. Each chapter left fingerprints: the chaplain’s focus on presence and readiness; the lawyer’s attention to paperwork and process; the legislator’s knowledge of how law and procedure intersect with outcomes.

Stories from Balad and hospital wards

He tells stories that persist—of soldiers who called from deployment to learn of devastating family news, of young parents who showed photographs of babies while waiting for night shifts to end, of medical corridors where faces in a paper became people he had visited at bedside. Those scenes are not war nostalgia; they are the texture behind policy. When a leader has sat in a helicopter corridor and prayed with a returned patient, policy debates about wait times or staffing become less abstract.

Why scale and standards matter as much as compassion

The Department of Veterans Affairs is both enormous and intimate. It runs more hospitals than any integrated health system in America and administers benefits that literally shape a veteran’s post-service life. Yet that scale also fostered a startling dysfunction: hospitals acting like startups, inconsistent availability of services, forms that ask veterans to re-create records that already exist in the system. Collins heard a recurring answer—"we have always done it this way"—and treated it as a provocation rather than an excuse.

Small rules, big consequences

• Forms that require a veteran to write out a service history are not harmless: they create friction that keeps benefits out of reach.
• Siloed hospitals produce wildly different treatments and inconsistent patient experiences for the same earned benefit.
• Metrics that emphasize speed instead of quality can mislead about whether care is actually effective.

Concreteness: backlogs, hours, and the ‘best medical interest’

Collins moved from critique to action with measurable changes. Within months the department reduced a massive backlog of disability claims and added extended clinic hours and weekend access in many locations—an almost tactical answer to the practical complaint of a veteran who could not get an appointment. More importantly, he pushed a new orientation: if a veteran is better served by a trusted community specialist, the VA will authorize that care without unnecessary bureaucratic detours. That “best medical interest” approach reframes access as trust rather than turf.

Standardization without erasing local care

Standardization does not mean stifling innovation. The argument Collins makes is subtler: an institution that bears the VA name cannot behave like 170 independent startups. There are huge advantages to consistent clinical protocols, accountable staffing plans, and a single playbook for veterans applying for benefits. When a health system can tell a veteran what to expect everywhere, it also becomes easier to measure quality, allocate resources, and fix problems before they metastasize.

The human habits behind policy: grief, transition, and responsibility

Throughout the conversation, Collins returns to human rituals—funerals, letters, honest talks with spouses—as essential tools for living with loss. The culture of instantaneous fixes and social media outrage masks the slow work of grieving and reintegration. He argues for practical practices: give people time after deployment, make space for grief through clear rituals and writing, and encourage peers to check in when someone goes quiet. These are as much public-health prescriptions as they are pastoral counsel.

Politics, accountability, and the peril of theater

The narrative of dysfunction in government is often simplified into tribal headlines. Collins’s account of Congress, televised hearings, and partisan theater is not a plea for cynicism. It is a call for seriousness: when the national conversation becomes a sequence of performances, substantive reform stalls. That tension—between the campaign-stage glare and the slow work of standards and systems—frames much of what the VA must do going forward.

A final thought on duty and agency

Reforming a department that stretches across hospitals, benefits offices, and cemeteries is an exercise in humility and impatience at once. The humility: acknowledging that visible change requires confronting legacy practices and listening to veteran experience. The impatience: recognizing that each day of delay is a day someone may be denied care, fall into desperation, or lose trust.

What emerges from that tension is a simple organizing idea: do not make veterans work to get the care their country promised them. The rest—standardized procedures, better metrics, flexible community care—is the machinery required to make that promise credible again. The politics will roar and the headlines will flash, but the quiet, persistent work will be measured in fewer backlogged claims, a clinic open on a Saturday, a veteran who finds a friend who answers the phone. That is the metric by which systems—and societies—are redeemed.