The unfolding scandal at the Department of Veterans Affairs (VA) agency is a reminder about some enduring truths about government bureaucracies. The most important is that an agency’s operators – those responsible for carrying out its core task – respond most immediately to situational imperatives rather than the agency’s stated mission or purpose. This is particularly true when the agency’s stated goals are vague or open to interpretation. So it is with the VA. Its mission is to “fulfill President Lincoln’s promise ‘To care for him who shall have borne the battle, and for his widow, and his orphan’ by serving and honoring the men and women who are America’s veterans.” This mission statement has little meaning, however, to those VA operators responsible for scheduling medical appointments for veterans. Instead, the operators quite understandably defined their task in response to the performance standards on which they were evaluated, which in the case of the VA meant minimizing the wait time between when a veteran requested a medical appointment and when she received one. When it became clear to schedulers that the performance standards on which they were evaluated were increasingly unrealistic, given the VA’s burgeoning case load and the failure to ramp up resources to match that increase, schedulers quite rationally responded by making it appear that they were meeting those standards by, in effect, falsifying records. They did so in large part because of the politically sensitive nature of their task, which was to help people who in many cases had compromised their health in service of their country. This created additional pressure to make it appear that these veterans were being treated well, and it encouraged VA supervisors to be less than vigilant in insuring that performance measures were actually being met.
My point is that we should not be surprised by the VA operators’ behavior. Nor should we expect that the solution to the problem lies in hiring more “honest” schedulers, or in replacing the recently fired VA Secretary Eric Shinseki with a more competent executive. Operators, such as the VA schedulers, define their tasks in response to situational imperatives, and not the well-meaning directives of reformers. Calls for “clearer standards” or “more transparency” are unlikely to have much impact as long as there remains a disjunction between what schedulers are asked to do – and how they are evaluated – and what it is possible to do, given limited time and resources. Like most bureaucratic scandals, the fault lies less with the failing of individuals than it does in systemic factors that govern how those individuals behave within a particular bureaucratic context.
Similarly, it is easy to blame Shinseki for his failure to “manage” the VA, but the truth is that Shinseki was not hired by President Obama because of his working knowledge of the situational imperatives that dictate how VA schedulers do their jobs. Instead, he was appointed for his symbolic value as a former military officer who served two tours of duty in Vietnam and earned a Purple Heart. And, in truth, most government executives are not chosen for being “good managers”. Moreover, they are often rewarded for being associated with a good policy outcome, or blamed for a bad policy outcome (see Clinton and Benghazi!), about which they often have little influence. That means they have little incentive to actually manage the bureaucracy, and every incentive to appear to be in charge by cultivating relationships with those who count – particularly the President, Congress and any external constituency – in this case our nation’s veterans – that wields particularly strong influence over an agency.
The response to the VA scandal has been both predictable and largely uninformative. President Obama, expressing outrage, has fired Shinseki, thus satisfying media and veterans’ calls that someone be held accountable for this mess. Congress, which arguably is more responsible for the scandal than is Shinseki, has sprung into action with promises of reform coupled with criminal investigations. On Thursday our own Bernie Sanders, chairman of the Senate Veterans’ Affairs Committee, which has oversight of the VA, will chair Senate hearings on a bipartisan reform bill that seeks to reduce veterans’ wait times, give the VA secretary power to fire “incompetent” senior VA officials, and modernize the VA’s scheduling system. This type of “fire alarm” reaction typifies how Congress conducts bureaucratic oversight. Conservatives, meanwhile, argue that the VA scandal is a reminder of the pitfalls of government-run health care.
The truth behind the VA scandal, of course, is more mundane and thus far less newsworthy. Rather than criminal malfeasance or corruption at the individual level, the scandal illustrates how the public’s contradictory impulses, as expressed through our elected representative and those they hire, often set public sector bureaucracies up for systemic failure. In this case, the VA developed a system to increase agency efficiency by monitoring how quickly our veterans received medical help. However, a measurement designed to make the VA operators more accountable for their performance, and thus to encourage efficiency, largely failed to achieve its objective because it meant operators were assessed on quantitative standards that did not truly measure how well schedulers were serving veterans’ needs. Alas, this is not the first time we have seen good intentions go awry in this way. As James Q. Wilson observed in his magisterial work on bureaucracy, “the American political system is biased toward solving bureaucratic problems through rules.” This is partly because agency managers in our system have a strong incentive to force rules on operators in order to prevent a politically controversial outcome – not servicing veterans in a timely manner – from happening on their watch. But if the rule does not alter the incentives that operators’ value – such as getting good performance reviews and associated bonuses – it is not likely to achieve its desired outcome. If the VA is to be reformed, then, it will occur only by understanding what operators do, and why they do it, and devising performance measures accordingly. In the absence of that understanding, firing departmental heads and leveling criminal charges on hapless schedulers, although perhaps beneficial at the ballot box, is unlikely to correct what really ails the VA. Nor will it help our veterans.