It's been a year and a half since a Veterans Health Administration center in Phoenix, Ariz., was revealed to have been keeping secret lists to disguise its lengthy appointment wait times.
Despite investigations pointing to widespread mismanagement, the resignation of VA Secretary Eric Shinseki, the installation of his successor, Robert McDonald, and the passage of a $16-billion law that promised to expand care and make it easier to fire errant employees, little has changed for veterans still forced to wait for months for care.
In honor of Veterans Day, the Obama administration will roll out a series of new actions, including improved access to education, expanding initiatives to end veteran homelessness, and pressing Congress to pass legislation to fix the health benefits appeals process.
The White House boasted of the reforms and improvements to the system his administration has taken since August 2014, directly aimed at targeting the problems uncovered last year: increased staff and facility space, efforts to identify and reduce inefficiencies in the system and a program to help veterans to seek care outside the system.
Speaking to reporters Tuesday, Kristie Canegallo, the White House deputy chief of staff for implementation, acknowledged the gulf between the promises made and the pace of real reform.
"A lot of really important progress has been made with respect to delivering more care for the veterans," she said. "But gosh, we've got a lot more work to do."
In Phoenix, where reports that at least 40 veterans died while waiting for care touched off the scandal, evidence of change is hard to come by.
Veterans staged a protest outside the beleaguered hospital on Monday, complaining that they still struggled with "delayed appointments, denied appointments and falsification of veterans' medical records."
"If you're putting individuals in positions who are not concerned about the veterans, then veterans are going to continue to receive the lower level care that they've always been receiving," Ricky Barnes, the protest organizer, told the local ABC affiliate.
Barnes was referring to the controversial appointment of Skye McDougall, who was appointed in October to serve as the new director of the Southwest Health Care Network, which includes Phoenix. McDougall is accused of giving false testimony before Congress on wait times in Southern California, where she served as the acting director of the Desert Pacific Healthcare Network.
The Phoenix center also resisted efforts by the VA to implement reforms, including to the "broken" personnel system.
"Our hands were tied at every decision point," a report, issued in March and obtained by the Arizona Republic, says. "Instead of our expectation to work with a leadership team that genuinely desired positive change, we were met with a leadership team that displayed obstructionist attitudes, and clearly lacked integrity."
Meanwhile, wait times remained arduously long, even for veterans in need of critical, even life-saving care.
In August, the center had 8,000 requests for care for which wait times exceeded 90 days, a estimation whistleblowers said fell short of reality. Nationwide, half a million appointments came after more than 30 days, according to documents obtained by CNN.
"The reality is veterans are waiting months -- three, six months at a time, sometimes more -- for care at the Phoenix VA," the source told CNN.
Those figures are often in sharp contrast to the publicly available documents that show wait times averaging a fraction of those listed in internal documents.
That many of the necessary reforms are behind schedule or nonexistent is doubly disappointing considering all the changes last summer -- the new secretary, the $16- billion legislation -- were seen as victories by both the president and both parties.
"It's because of the vastness of the bureaucracy," says Sen. John McCain, R-Ariz., when asked where things had gone so wrong. "The bureaucracy is totally resistant to change."
McCain and several others pointed to one of the provisions in the law, the Choice Card, that was supposed to ease the pressure on the VA system by allowing veterans to seek care at private facilities if they lived far away from a VA hospital or the wait times were excessive at their local facility.
But the program has been undermined, both by the department, which requested the shift of $3.3 billion from the Choice Card program to cover other budget shortfalls, and by Congress, which approved the request in July.
"I think the VA and the administration has done everything they can to thwart the Choice Card, which was a foundational part of the legislation," says Sen. Richard Burr, R-N.C., who was the top Republican on the committee last Congress, when the law was crafted and passed.
In addition to resisting reductions to the Choice Card program, Republicans have pushed to expand it.
"We've got to have a Choice Card with no restrictions," McCain says. "That would be one of the biggest steps forward" to solving the VA's issues.
But that has been met with the charge that Republicans want to privatize the entire Veterans Health Administration, rather than fix the one that, despite its flaws, is still highly regarded by those who are able to obtain care.
"Privatization is a betrayal, plain and simple, and I am not going to let it happen," Hillary Clinton said Tuesday at a campaign event in New Hampshire Tuesday.
She unveiled a plan to tackle the issues facing the department, saying she would implement "zero tolerance" for abuses or delays.
The current VA, meanwhile, has done far less than it could to "clean house" as McDonald promised to do. While the 2014 law makes it easier for the discipline and termination of some 500 positions connected to the wait times scandal, far fewer have faced punishment.
Last week. McDonald boasted that the agency had "proposed disciplinary action against 300 individuals for manipulating scheduling."
But numerous fact checks of his comments found that number was much smaller: Just 27 employees, including just one senior executive, were found to have been disciplined specifically for wait-time manipulation, and only three fired.
"It's been disgraceful," McCain says. "People need to be held accountable, especially when veterans die."