Can the Government Govern? Lessons from the Formation of the Veterans Administration

The federal hospital system for veterans, established in the aftermath of World War I in a context of decentralization, privatization, and rejection of compulsory health insurance, seems an anomaly in health care policy-making. It is actually a good case of how the federal government achieves results in an area fraught with conflict: via normalization of crisis, containment of political decision making, and the association of the program with previously accepted goals (in this instance, workers' compensation). In the veterans' case, political judgments were transformed into scientific and bureaucratic decisions via the pragmatic use of experts. The system worked; the federal government governed.