We're from the Department of Health and Human Services and we're here to help. Photographer: Craig Warga/Bloomberg
Get Rid of Obamacare's Turkeys
A brief update to last week’s post on Barack Obama’s iPod presidency: Riffing off an excellent article by Ezra Klein, I pointed out that fixing the Department of Health and Human Services' technical problems isn't quite as easy as trying to replicate the lean design philosophy of the Consumer Financial Protection Bureau:
The CFPB is doing a good thing by taking a radical approach. But it can only do that because it’s a brand-new agency. In 25 years, if the CFPB is still around, I can virtually guarantee that it will have all the turf wars, bureaucratic inertia and so forth that has hobbled the Department of Health and Human Services. Not because government agencies are somehow especially awful, but because every organization calcifies over time.
Over the weekend, three good points were made to me.
The first came from the comments, pointing out that what CFPB has done (so far, at least) is vastly simpler than what HHS had to do (and also not on crazy deadlines). Yes, CFPB seems to be doing a good job, but the comparison is not quite fair; if one guy is running an Iron Man and the other is running a 40-yard dash, the second guy is bound to look to be in much better shape at the end. The health-care exchange is one of the most complicated IT projects that the government has undertaken outside of the defense and intelligence areas, involving integration with many old databases and stringent rules about data security. It’s not clear that anyone could have pulled that off in the required time frame.
The second point came from a government technical contractor who drily observed that the CFPB pays on the Federal Reserve pay scale, which is considerably higher than the regular government GS schedule for Washington.
And the third point came from my father, who became the commissioner of New York City’s Department of Environmental Protection when Mayor Ed Koch hived it off from Sanitation. New agencies, my father pointed out, have a built-in advantage not merely because they have not yet developed years of “this is how we do it” cultural barriers, but also because new agencies get to pick all of their people. When they created DEP, they chose who came over from Sanitation, which meant that they could screen out the turkeys. Turkeys aren’t a problem just because they eat up your budget and do no work; they create organizational problems by forcing good people to spend time dealing with them.
Anyone with family or friends in the civil service hears about the hours wasted on bureaucratic wrestling with the guy who spends his energy crafting strategies to get you to do his work. My favorite came from a doctor in a prestigious department at a state hospital whose secretary threw out most of his mail, including all of the invitations, because answering it was too much work. He ended up getting his wife to come into the office and act as his unpaid secretary, because firing or replacing the secretary was way too much trouble.
I am not slamming all civil servants as lazy lackwits; these stories come from good civil servants who are endlessly frustrated by the obstructive and destructive minority. Turkeys in government are like prizes on "Wheel of Fortune": Once you win one, it’s yours to keep. They can’t be fired, and they rarely quit; the best you can do is wait for a chance to transfer them somewhere else.
Because of the Universal Law of Turkey Accretion, the quality and effectiveness of a government agency’s personnel are likely to peak very shortly after that agency is established. HHS has been around for a long time, and so has its IT staff. Which means it has more than a few turkeys. Or, as David Cutler put it in a 2010 memo to Larry Summers, “The agency is demoralized, the best people have left, IT services are antiquated, and there are fewer employees than in 1981, despite a much larger burden.”
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