Lessons from Walter Reed

by Mark Kleiman

Over the last few years, it's become increasingly clear that conservatives have an all-purpose response to any public-management disaster that happens on their watch, from New Orleans to Baghdad: "What do you expect?" they ask. "We told you government was incompetent and corrupt by nature. That's why we need to shrink it "to the size where we can drown it in the bathtub," in Grover Norquist's famous phrase. It's a clever heads-I-win-tails-you-lose game. When something goes right on conservatives' watch, that just shows the advantage of "running government like a business" (complete with a "CEO-in-chief" - are we having fun yet?) and outsourcing as much government activity as possible to private contractors (who also happen to be major GOP contributors). When something goes wrong, it's just another sign of government's inherent ineffectiveness, and a reason to re-elect the party of small government.

Since the recent exposure of horrific conditions at Walter Reed Army Medical Center and other military medical facilities around the country, many Republicans have tried to apply this trick to the growing scandal. Helped by some sloppy journalists, they've encouraged the widespread belief that Walter Reed is part of the Veterans Administration—and its mismanagement is therefore another piece of evidence in their brief against "big government", and, of course, "socialized medicine." In an example of this misdirection, President Bush recently announced a federal investigation into both military medical care and VA medical care in the wake of the scandal.

But of course Walter Reed is run by the Army, with the help of those private contractors Republicans love because they're so efficient (and so generous at campaign season). As for the VA medical system—it did used to be terrible; I recall medical-resident friends joking about "practicing veterinary medicine," because the VA treated its patients like animals. But it was fixed under President Clinton, and now, as the Monthly reported in 2005 has the best quality and customer-satisfaction numbers in the entire health-care system. The VA also leads the way in the use of information technology to improve quality and cut cost.

The Bush administration is planning to starve the VA financially, but so far hasn't badly damaged it operationally—though of course it's been busy messing up Iraq, with the help of contractors and CPA staff hired for reasons of political loyalty rather than competence. The Federal Emergency Management Agency, on the other hand, has completed the round trip, from pork-and-patronage cesspit under Reagan and Bush Sr., to superb disaster-relief agency under Clinton, back to cesspit under Bush, Jr. Part of the difference is that Clinton appointed a disaster-relief professional to run FEMA, while Bush first went with his campaign manager, and then his campaign manager's old college buddy, Heckuva Job Brownie. (At least Brown at FEMA wasn't in nearly as sensitive a position as Bernie Kerik, Giuliani's sleazeball former driver, who Bush wanted to run the Department of Homeland Security).

Of course Republicans do some things right and Democrats do some things badly. But putting the anti-government party in power is hardly likely to improve the performance of government. As Alan Wolfe wrote in the Monthly last year, "Conservatives cannot govern well for the same reason that vegetarians cannot prepare a world-class boeuf bourguignon: If you believe that what you are called upon to do is wrong, you are not likely to do it very well."

Mark Kleiman is Professor of Public Policy at UCLA. He blogs at The Reality-Based Community www.samefacts.com.