Bureaucracy Implosion
by Donald Devine

Whose heart was not rent at the sight of the recovering soldier at the Walter Reed Army Medical Center annex pointing at the gaping holes in the wall of his quarters and the report that rats were omnipresent? How could one of the best bureaucracies in the U.S. government treat anyone in this way, much less heroes?

The Army works, everyone knows, in small units. Every study shows soldiers fight for their buddies, not for patriotism or for other higher values. But once the wounded leave the battlefield they are thrown into large bureaucracies. The field and operating hospitals have direct injuries to repair over periods of time too short for bureaucracies to ossify so this works. Over 97 percent of those wounded who reach a military hospital survive and initial rehabilitation is excellent. Time and complexity, however, stress bureaucracies and Walter Reed proved this too. As the recent Senate hearings suggested, the same probably takes place at most other rehabilitation centers.

The Army was wise enough to place recovering troops needing rehabilitation in temporary companies to recreate the small unit structures with which soldiers were familiar. Yet, according to soldier testimony these were at best artificial, lacking unit pride, especially among a civilian staff that had no emotional attachment to patients. With the Iraq war lasting longer than planned, the Reed company became too large and, unfortunately, was not divided until just before the scandal. It was too late. The regular Army works by relying on chains of buddies and leaders. As the commanding general said, he does not inspect barracks but relies on a chain of command. However, in the medical world, there is no tradition of buddy chains. The Army system could work if patients remained assigned to their units, which could handle recuperation and evaluation of ability to return to duty. But this flies in the face of the “professional” ethic of the medical profession, which values expertise over élan and brotherhood.

If a soldier is declared unable to return to work, the patient is transferred to the Department of Veteran Affairs. A recent study by the respected RAND Corporation found that DVA patients received “better chronic and preventive care” than a sample of similar patients in the general population. However, the study only measured amount and type of care given, not how effective was that treatment. VA patients, for example, received significantly more medical visitations than non-veteran patients and therefore more treatment but neither cost nor results were compared. While quality measures were used, it was of the input variety not results. The DVA records were better and since all comparisons were paper ones, DVA had to measure better. While thing seem improved over the past, several studies have shown inferior veteran treatment on neurobehavioral matters related to battle stress, which with the higher survival rates today are the most common residual problem, and 100 Veterans hospitals offer no such treatment at all.

The military provides health care to nine million and the DVA covers five million more. It is not surprising that the most widespread problems found at Walter Reed relate to transition between the two systems. Two massive bureaucracies baffle patients, to say nothing about the Physical Disability Board process that takes forever to make a determination regarding return to duty and degree of disability. Only 22 percent of the most widely used new drugs are available through DVA and three million have switched to the Medicare program to get its larger choice. Any bureaucracy requires lists and they become outdated quicker than the clerks can update them. Bureaucracy can only be avoided by directly assigning veterans the funds for their health care and letting them manage it with the assistance of their units, families, insurance agents and local charities.

It is not just soldiers. Its own government trustees say that the three largest government programs—Medicare, Social Security and Medicaid--will go seriously in the red in a mere dozen years, requiring unsustainable increases in taxes and/or severe inflation, leading to economic disaster. But no one will confront the status quo. In national defense, the U.S. is dominant so long as large armed forces face each other. It was not a contest when it was one bureaucracy against another in Iraq. But when it changed to a large American bureaucracy tied down with red tape and long chains-of-command against small highly-motivated sectarian units, bureaucracy found it difficult to adjust.

What could be more important than securing the homeland from terrorist attack? Department of Homeland Security airport screening methods have received the largest funds and management attention but the results have been abysmal. In tests between November 2001 and February 2002, screeners missed 70 percent of knives, 30 percent of guns and 60 percent of mock bombs. In 2003, testers were able to sneak explosives and weapons past the screeners at 15 airports nationwide. Between October 2005 and January 2006, homemade bombs were passed through security at 21 of 21 airports tested. Making things more difficult, the new Democratically-controlled House and Senate just passed bills that would allow union collective bargaining over screening matters. DHS Secretary Michael Chertoff recently told Congress the greatest need is more intelligence about local activities that can only be found if everyone gets “to know their neighbors better.”

If it were not so serious, it would be amusing how inefficiently bureaucracy operates in modern times. Rules must be adopted and the larger number of circumstances they must cover, the less they will fit particular circumstances. The problem is inherent in big government, which shuts out the independent action desired by DHS, as Katrina demonstrated when agents kept out volunteers without security clearance--and are making worse by now creating “first responder” badges only for pre-approved bureaucrats. After a half century under a single rule for safety, the Food and Drug Administration has recently recognized it must shift to more individualized definitions for different persons with different reactions to drugs. But they do not know how to do it under a bureaucratic regulatory schema. The Securities and Exchange Commission knows it is chasing investors to the London exchanges with its inflexible rules but it is powerless in the face of its institutional critics to ameliorate its rules. The FBI is so sunk in Department of Justice legalistic rules, it is unable to operate counterterrorism effectively as every independent review right up to the Robb-Silberman commission has demonstrated. Yet, with multiple rules no one can possible know or therefore obey, federal prosecutors can run amuck convicting any who fall in the way of momentary public displeasure. The inevitable result of the Scooter Libby conviction will be for public officials to routinely refuse to testify and invoking the 5th Amendment, further frustrating bureaucratic effectiveness.

The conventional wisdom is that the computer/internet age and technology advances are undermining large bureaucracies and returning power to individuals. It is true that large bureaucracies are undermined, and that helped end the Soviet Union. But this does not necessarily lead to individualism. A semi-religious belief in the efficacy of bureaucratic expertise still rules progressive and socialistic thinking so that new programs are passed daily to increase bureaucratic power in the U.S. regardless of its proven ineffectiveness. Actually, the new technology empowers small groups even more than individuals. One person cannot penetrate the complexities of modern life alone so he e-creates innumerable e-groups to help him, from buddy-lists, e-Pals and Email Penpals to buddy terrorists, recreating the spontaneity bureaucracy suppresses but cannot do without.

Bill Clinton did not know what he was saying when he reported, “The era of big government is over;” but he was right. The question is whether we can go local and private before it all implodes. Makhail Gorbachev would understand.

Donald Devine, the editor of Conservative Battleline Online, was the director of the U.S. Office of Personnel Management from 1981 to 1985 and is the director of the Federalist Leadership Center at Bellevue University.