Avoiding the Wrong Lessons From the VA and HealthCare.gov Problems
This was published as a Wall Street Journal Think Tank column on May 27, 2014.
Problems with the launch of HealthCare.gov and with veterans hospitals allegedly concealing long waits for care feed a narrative that government doesn’t work. But many government programs, including Medicare and Social Security, work well. And there are as many examples of corporate bungling–GM and its ignition switches, BP in the Gulf–as there are of government bungling.
One impulse when government fails is to work around the responsible agencies and officials. An example is a recent proposal to establish a “CEO” for Affordable Care Act implementation who would coordinate critical functions related to the new insurance exchanges and report to the president and the secretary of health and human services. The impulse to put someone in charge is right, though the wisdom of involving the president so directly in operations is debatable (think of Lyndon Johnson trying to make battlefield decisions in Vietnam).
The history of AIDS and drugs “czars” shows that such workarounds don’t address the long-term challenge: making the government agencies with the statutory authority, budget and staff for a given job work better. Usually, white knights sent in to fix government are better at diagnosing problems and overseeing policy development than at managing operations in large agencies they don’t really control. That’s why President Obama sent his deputy chief of staff to the VA to figure out what went wrong and make recommendations for fixing problems. Cabinet officers and agency heads also know that they are the ones who will be hauled before Congress and castigated in the media for problems.
Some critics have cast the VA allegations and the HealthCare.gov issues as symptomatic of the president’s failure to effectively run the government. Presidents should be accountable, transparent about problems and make sure they are addressed. And they need to show that they care. But are they really “responsible” for operational failures deep within the government or, if this is what transpired, deliberate misdeeds such as cooking the books in local VA hospitals?
Ultimately, workarounds and corporate-sounding titles are short-term fixes. We are also likely to hear calls soon to privatize VA health care. The real challenge is to make the government work better, empower the top officials who run it–including the ability to bring in the right talent and cut through procurement red tape–and hold them accountable if and when they fail to do their jobs.