The story of trouble at the Department of Veterans Affairs is a familiar one: A political firestorm erupts, and firings are called for. Hearings are held. Outrage is produced. Pundits want to know what the president is going to do. Interested parties say he is moving too slowly. The president’s opponents take advantage. His advisers insist the president is livid. The president is “madder than hell,” Obama’s chief of staff Denis McDonough said on Face the Nation. But the president is also not going to engage in symbolic acts. Obama doesn’t just fire people because they got bad theater reviews after congressional hearings.
While the story is familiar, the context is different this time. When administration officials say that they are doing everything they can to address a problem that they insist is vitally important, we now have a standard against which to judge those claims. We know what it looks like when Obama aides rush to the sound of sirens. That was how the president and his team responded to healthcare.gov after it exploded on launch. They've been celebrating the miraculous resuscitation since the March 31 open enrollment deadline when more people signed up than anyone might have expected after such a dismal start.
So perhaps all future emergency responses should be measured on the healthcare.gov scale. In the coming weeks, will the administration response to systemic problems in the VA be on par with the response to healthcare.gov? A half? A quarter? If not, what is it about these conditions that justify lesser effort?
After healthcare.gov had its bad start, the president spoke to the country frequently and appointed an emergency team to solve the management and technological issues. Everyone in the administration was very clear on the dire stakes. So far, with the problems at the VA—long waiting lists and falsified patient appointment reports from hospitals and clinics across the country—the president has spoken once about the issue. Gen. Eric Shinseki, the secretary of veterans affairs, has taken the lead, and the president has appointed his own deputy chief of staff Rob Nabors to oversee a review.
Republicans have raised the unflattering comparison in responses, suggesting that when the president’s political legacy is at stake his team moves quickly. When it’s just veterans, though, they move at the same dull pace. We’ll see. You’d think the political incentives would be pretty great for Democrats and the administration. Not only are veterans a rightfully honored political constituency—watch Democrats in tight Senate races appeal to service members here and here—but Democrats should be worried that Republicans will successfully portray the VA mess as the ghost of Obamacare future. But you don’t have to be interested in scoring political points to find it useful to compare the all-hands effort to troubleshoot the healthcare.gov website to the slower approach being applied here.
In political situations, action is often measured against some fantastical perfect outcome. This rainbow-spiked alternative is mostly a political trap: Why isn’t the administration able to stop time to solve this problem? This creates false expectations for political gain. It also irritates whoever is in the administration and anesthetizes them. They categorize criticism as unrealistic and satisfy themselves that they are pushing as hard as they can. But in this case, the healthcare.gov comparison seems sufficiently equivalent to be a useful measuring stick. Or, if you like, a useful prod to break through the typical fog that rises up around these acute moments and strangles any meaningful response.
The VA mess does share some broad similarities with the health care law’s mess. There is the management rot: VA managers received performance bonuses even as internal audits revealed lengthy wait times for health care. There is the poorly performing technology: The VA computer system for scheduling patients is 25 years old. They also have a rough symbolic equivalence. The fact that the bureaucracy couldn’t put together the health care website reinforces fears that the health care system will be ruined by the Obamacare bureaucracy. When Gen. Shinseki testified and seemed passive in the face of congressional outrage, it mirrored the frustration of those trying to make an appointment with the VA who can’t seem to scare up any urgency from the person on the other end of the telephone line.
To recognize similarities is not to suggest the problems are the same. As much of a disaster as healthcare.gov was, the VA is a far more sprawling operation. It is the largest health system in the country. It processes 230,000 claims a day. Some 185 investigators are working on the inspector general’s investigation into the most recent allegations. Former Defense Secretary Robert Gates says reforming the VA was even harder than reforming the Pentagon.
If the VA problems and the healthcare.gov ones are thoroughly different, then knowing that will be useful, too. Resuscitating healthcare.gov is now the leading case study for taming the bureaucracy, and that experience could be used to clarify the remedy needed to solve this problem. For the last several months the administration has been teaching the American public about its success fixing healthcare.gov. No sign of activity was too small to herald. It’s harder to say that change doesn’t come quickly when you’ve been celebrating miraculous change for the past several months. Whether it’s valid or not, the Obama administration has given the public the new standard against which to judge its latest emergency response.