Why the V.A. hospital system doesn’t work is an enigma wrapped in a mystery. Various Presidents have appointed generals to lead it that work and drift to retirement without making it resemble any sort of state of the art facility. President Trump might be the right guy to fix the system yet House Democrats might vote against any sort of upgrade of the system just to spite the President.
Why the system is broken at least is part could be something related to the inability of administrators at particular hospitals to hire and fire their own people to work there. In the private sector hospital administrators can hire and fire people without concern for civil service and union sorts of things that make personnel choice non-discretionary for the administrator. Maybe President Trump could design some kind of work around so hospital staff can be improved in quality.
Not all V.A. staff are over-promoted bureaucrats by any means. Some are quite good. Often they soon move on. Why? That is beyond my knowledge. With all the money they need apparently, the hospitals just don’t have a good patient trough-put rate at least for dentists. Maybe the President needs to find some highly qualified hospital administrator and systems analyst to discover why individual hospitals cannot be upgraded in efficiency and patient satisfaction.