A consultant could be states away but freely able to review imaging and laboratory studies.

I'd just like to point out that that's not at all the planned Obamacare  Romneycare model of the future,quite the opposite. Limited local networks are the foreseeable future for this country, by design, to cut down costs. If you're real lucky, you might have access across your state. In most cases and definitely in the case of larger states, not even that. Why should vets have access to specialists and consults that ordinary people do not?

Neither does a national health model, which the VA resembles, and which I actually dream of and would prefer, allow everyone to go everywhere and get everything they want. That's for the rich and/or powerful, no matter what system you have. Everyone in Cuba does not get to see Fidel's gatroenterologist, nor  are they probably allowed to have the same operations he gets for the same condition.

I noted with interest in the this NYTimes article from today's print that a major part of the cost problem is the one that is bedeviling all health care systems everywhere:

...Most of the veterans now seeking treatment at department facilities are aging Vietnam-era service members, many with chronic illnesses like diabetes that require long-term care or with cancer and cardiovascular disease that require complicated and expensive treatment...

To change the subject. As regards, the title of this post, "Why Firing Shinseki is Counterproductive," from this analysis piece also from the NYTimes.  Basically from the horse's mouth via his mouthpiece; this came from the top, nobody made Obama do it:, he wanted the resignation and is not happy with how things are being run:

“To make this change, he felt that staying the course would actually be harmful to the fixes that need to happen, as opposed to changing the press narrative, which is something he would never do,” said David Plouffe, the president’s longtime adviser.

Still, Mr. Obama struggled to explain the different approaches. Keeping Mr. Shinseki, he explained, would have been “a distraction” from the important work of fixing the problems at the department. But getting rid of Ms. Sebelius right away, he said, would have been “a distraction” from the important work of fixing the problems with the health care website.

The difference was particular to the two situations, advisers said. With health care, the open enrollment period was rapidly closing, and switching leaders at that time would have complicated it. With Veterans Affairs, the issues are so systemic that it will take a long time to address and there was no sense in waiting.

At the same time, it is clear the White House views the veterans issue with more alarm than some of the other controversies of the last couple years, like how it publicly characterized the attack in Benghazi. “There’s a feeling, and I share it, that these were manufactured crises mainly by Republicans and pumped up by cable news and Twitter,” Mr. Plouffe said. “This one’s got some reality to it.”