VA, Deep State, Red/Blue Divide, Civil Service, Patriotism, U.S. Government, Psychology
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| Reluctant Wife's Office View |
I was raised in a solidly Republican home. My father came from a small town in rural
Illinois and his father and grandfather before him had run a department store –
they sold women’s clothes, and their cousin’s store sold men’s clothes. They would travel to Chicago and buy what was
in style for the regions, take it back, and they would be sold through
departments that included things like sports clothes, formal wear, and
lingerie. Each department had employees
who specialized in the department and they would serve the community and the
surrounding rural folks who would come into the “city” to get the ready wear
clothing they needed. Being a retailer
was lucrative and my grandfather and great grandfather were pillars of the
community, contributing to the development of such things as a children’s home,
but also a country club. They went on
regular vacations and educated their children at good schools.
My mother was raised in Chicago. Her father was an insurance salesman but also
an early actuary, assessing risk in order to set rates. I know that he, too, was successful, though
it was a struggle to raise a family, especially during the depression. He only had an employee or two, unlike my
other grandfather who employed many, but he was an entrepreneur whose fortunes
rose and fell with the economy but also as a result of the hard work that he
put in, he was a believer in a country where people are free to raise
themselves up by their own bootstraps.
Both families fancied themselves members of the upper middle
class – less because of their income levels, which put them in this income
bracket – but more because they were educated and hard working (actually, my
paternal great- grandfather was self-educated – including learning and
employing a new word a day throughout his adult life). They were small business owners who were
interested in a government that was small, in part because they didn’t want to
pay more taxes, but also, I think, because they considered themselves to be
moral members of a basically ethical community and didn’t see much need for
governmental oversight of their conduct or that of their peers.
My father’s family believed in small town values – and
believed that the local community was best situated to take care of their own
because they knew who was worthy, who was not, who needed support and who
needed to be taught a lesson. My
great-grandfather did not start his business on his own, but was backed by others
and he, in turn, supported other ventures once his was up and running. In addition to business support, my family
contributed to local causes and individuals in need. My father contributed to the United Negro College
fund across the course of his life, and regularly donated blood. Both sides of the family were involved in
scouting and they lived by the scouting creed.
I grew up with a great deal of pride in being an American, with
a sense of the importance of self-government, but also with a distrust of
governmental institutions. I remember
that the word “bureaucrat” was said with a certain sense of disdain, and I
associated bureaucracy with the government, saw it as a drain on the economy,
and believed that bureaucrats sat in cushy government offices not doing much
except creating “red tape” and waiting to retire so they could collect their
handsome pension checks.
So, who would have thought that I would marry a member of
the deep state? Certainly not my
mother. She asked me how my sister and I
grew up to be liberals. I reminded her
that she had us listen to Pete Seeger’s records as children, and that her lived
values – her care and concern for others – values that are shared by the entire
family – are liberal values. What we
differ about is how best to translate those values into actions and who should
administer them.
The Reluctant Wife is actually my second wife. We first met when we were both married to
other people and she was working with my first wife at a local University based
psychological practice. I sometimes did
some moonlighting work at that practice, but did not know the woman who would
become my second wife at all well.
Years later, I was the chair of the department of psychology
at another local University, recently divorced, and was called to the state
capitol to evaluate whether to continue requiring a year of post-doctoral
training for graduate students before they could be licensed to practice
psychology. My position was that
students should be license eligible at graduation, based, in part, on their
having completed a full-time year of internship as a pre-requisite for
graduation in addition to three years of part-time practice before that. I had personally engaged in three years of
highly structured post-doctoral training that I found essential to my
development as a clinician, but most post-doctoral positions were, in my
experience, little more than excuse for more indentured servitude on the part
of trainees, many of whom were already deeply in debt.
My future Reluctant Wife was now the director of
psychological training at the local Veteran’s Administration (VA)
hospital. She, too, was called to the
capitol to address the issue of post-doctoral training. The future Reluctant Wife was in charge of
that last year of training before, in the model being proposed to the
government, former students would become license eligible. Nationally, about half of all psychologists
do their internship training at VA hospitals.
Her position could not have been more different from mine. Seeing students practice during that year
before they graduate, she recognized that many of them still did not know what
they were doing and she was concerned that they needed additional supervision
before being licensed to practice autonomously.
She was more focused on the well being of the citizens of the state and
protecting them, while I was more focused on protecting the well being of the
students – not wanting them to be exploited.
Well, sparks flew. We
were at the center of the argument and both passionate about our
positions. I accused her of simply
wanting to sleep better at night knowing that someone else was watching over
the trainees that she was concerned about at the end of their training with
her, and she agreed that this was the case.
Shortly after the argument, she invited me to speak at a staff training
at the VA. Mostly because she thought I
would do this without compensation, which was true. But she greeted me so warmly that I assumed
there was more than professional interest on her part. What she was actually doing (she didn’t know
that I was divorced) was just being her usual warm, inviting self. That said, she did respond to my invitation
to a meal together, and the rest is history.
Though she was the director of training, the central focus
of her job was clinical. She worked with
Veterans who had alcohol and substance abuse issues. These are veterans who are difficult to treat
– they often have histories of trauma from war and/or their earlier lives and
they are not socialized to engage in psychological treatment. She worked on an inpatient unit and then
followed some of the veterans after they left the hospital.
To be clear, despite my also being a psychologist, this is
not work that I could imagine doing, certainly not for as long as she did. At the beginning of her own internship
experience, when she and the other interns were deciding which rotations to
take, she was challenged by one of the staff members on the alcohol and
substance abuse unit who said that this is a rotation for the brave. She liked that challenge. She was able to be compassionate and clearly
cared about her patients while setting clear limits with them and challenging
them. They were very tough men (and
occasionally women) with problems that seemed intractable, but she was able to
connect with them and was able to appreciate them as needy individuals beneath
their crusty exteriors. She also had a
respectful attitude towards their ability to accomplish what they needed to –
both to address their addictions and to manage their lives. She helped them feel safe enough to
acknowledge the wounds they had received and caused and to come to grips with
leading a sober life.
The reluctant wife’s family background was both similar to
mine and very different. Her father was
an engineer who worked for GM and then IBM but left the corporate world to
start his own business – a print shop – and then – as he used to say, his life
went to hell. That is an exaggeration,
but the business did not do as well as he had hoped, and, being his own boss,
he worked himself very hard and did not reap the rewards he expected. He had married his High School sweetheart,
who was a teacher, and she came to work with him in the print shop. I should mention that my father, too, had
worked for a big corporation and then had gone into business for himself, a
transition that was difficult for him as well).
Both the Reluctant wife and I went to college when our
parent’s finances were in pretty bad shape.
She went to the local state school and commuted from home. Meanwhile, her brother went into the Army. So, after going to going to graduate school,
doing the internship at the VA, and then doing a little private practice
(where, as I mentioned before, she met my first wife), she was ready and
willing to return to the VA. She believed
in the mission of serving veterans. And
she was good at it. That said, after fifteen
years, or so, of working with one population, she felt that she was running a
bit dry – she found herself re-using the same metaphors and feeling a bit like
she was mailing it in rather than genuinely investing herself in her work.
At about that time, a former mentor, who had started a
national organization development consulting firm within the VA, invited the
Reluctant Wife to join the group of consultants. She was at first reluctant to take this
position – she was concerned that it would involve a lot of travel while our
kids (we were, by this time, married) were in school, but, when the director
assured her that she could minimize travel through the school years, she
accepted a position within this office.
She took to this work like a duck to water, and she also enjoyed
managing the consultants and, within a few years, she became the director of
the organization. This meant that she
was in charge of 40 or 50 consultants, but also that she was now a member of
the team of leaders that runs the VA Health System from Washington. I warned her that Washington would soon
recognize her gifts and hard work and invite her not to just come to Washington
once a month or so, but that they would want her there in a more permanent
position, but she just pooh-poohed me.
Her first turn at being a member of the deep state came in
the fall of 2020. As Jon Stewart pointed
out on his show, Fox news decided to support the idea that Diversity, Equity
and Inclusion (DEI) curricula should be villainized. Critical Race theory – something very few to
that point had heard about – was fingered as threatening the very fabric of the
nation. Fox called on the President to
root Critical Race Theory out of the Federal Government. Then they riled up his base to oppose the use
of DEI curricula in schools. Well,
nineteen days later, Trump answered Fox’s call, stating in a speech that
Critical Race theory should not be a part of any Federal Government activity
and then quickly cobbled together a remarkably unclear executive order
demanding that DEI efforts by offices reporting to the President should cease
and desist until they were vetted by a yet to be seated group of overseers.
Now the VA serves a very diverse patient group and they do
this with a very diverse staff. The
Reluctant Wife had been instrumental in overseeing the design and
implementation of a DEI coaching pilot program for leaders to help them improve
workplace interactions across racial, gender, religious and other potential
barriers to providing high quality service and/or collaborative work
relationships. This program had already
been well vetted within the organization, but now, with just a few months
remaining in his tenure, Trump had issued this poorly worded edict that could
have been interpreted to mean that she and the office she oversees should cease
and desist in their efforts.
The VA reports to the President. The Secretary of the VA sits on the
President’s cabinet. That said, the
funding for the VA comes from Congress, so it also reports regularly to
congressional committees. The Reluctant
Wife is a good soldier and works will within a highly structured hierarchical
system (another difference between us – I am better suited to being a faculty
member who has a private practice). When
given a set of directions, she is very good a carrying them out. So, the President’s order created a dilemma
for her. She deeply believes in the
importance of working to treat all individuals equally, but she is also aware
of just how difficult it is to do this and how much support we need to have in
order to do it effectively. My father,
for example, despite his good intentions behind supporting the United Negro
College Fund, treated African Americans as a kind of exotic species and would
often ask individuals that he met embarrassing questions clearly based on
stereotypes.
As much as my wife believes in following orders, she also
believes – or primarily believes – in doing the right thing. In this case, it was clear to her what the
right thing to do was to continue to provide a well-vetted program with preliminary
positive outcomes that supported the mission of the institution for which she
worked. She put mission over marching orders
and very publicly told her office to continue doing what they had been doing.
The Reluctant Wife also informed her supervisor that she
planned to ignore the executive order.
She continued that she fully understood that this might mean that
she could face disciplinary action for doing this, including termination of
employment, but she intended to support her team in offering the kind of
education that they had deemed was essential to the optimal functioning of the
agency. Her supervisor agreed with her
that this was the correct course of action and acknowledge that she, too, might
face disciplinary action for not correcting the Reluctant Wife, but she was
prepared to do that as well. I think
this went up the chain to the Deputy Undersecretary with all the bureaucrats
signing off on it and acknowledging that there might be consequences for having
done so.
Ultimately there were no consequences. Shortly
after this, Trump lost the election and enforcing executive orders from a lame
duck president who was in total denial that he had lost the election was the
last thing on anyone’s mind. But this
action, along with her general competence, was noticed by the leaders in the
organization and, when there was a need to fill one of the top positions in the
organization, she was tapped to be the acting Chief of Staff of the Veteran’s
Health Administration.
This is a big deal.
It is the highest position that a non-physician can fill in the
organization without a Presidential appointment. One way of explaining this is to compare her
position in the organization to mine in the University. I report to the chair of my department who
reports to the Dean who reports to the Provost who reports to the President of
the University. She reported to the
Undersecretary who reported to the Secretary who reported to the
President. Another way of thinking about
this is that she was a member of a three person leadership team that was
responsible for the functioning of 172 hospitals and almost 1300 outpatient sites
of care across the country with over 400,000 employees working to serve
millions of veterans.
Shortly after she was installed as Chief of Staff, a new Undersecretary
of the VHA was appointed. Though this
undersecretary had worked for the VA as a presidential fellow early in his
career, he had spent most of his career working in Hospital Administration in
the private sector. He was tapped by the
Secretary (a former Chief of Staff for President Obama), appointed by the
President and approved by Congress to run the VHA system. The VA actually has three branches – the Veterans
Health Administration, the National Cemetery Administration, and the Veterans
Benefits Administration, and each of these branches has an Undersecretary to
run it – all of them under the oversight of the Secretary.
The new Undersecretary is an ambitious and highly competent man
with big plans for the organization, but came in with a steep learning curve to
understand the functioning of the VHA as an entity – and of the Federal
Government in general. Part of the
Reluctant Wife’s task was to help support his acculturation – to help him learn
the ropes of this new organization. So,
for instance, she walked him through the hiring process for senior executives
with which he was unfamiliar.
One of the first big organizational agendas for the Undersecretary
was an ambitious plan to re-organize the governance structure to align it with
the priorities that he had in mind for the organization. The governance structure had been recently –
within the past few years – reorganized and was just beginning to figure
out how to function in this new system.
The Reluctant Wife had been closely involved in this project as a
consultant and she had seen the organizational chaos that ensued when new
relationships between subgroups had been articulated. She told the Undersecretary, who was very
invested in his proposed changes, that she did not believe this was a good idea
– that he should use the existing structures that were just becoming effective
to support his agenda because changing the governance structure again would
mean that there would be two more years of realignment work before the new
structures could support his agenda and, by that time, a new administration
could be in place and, as a political appointee, he could be replaced by
another Undersecretary. The
Undersecretary responded that this wouldn’t matter because his priorities were
good ones and they would be consistent with the priorities of whoever it was
that would replace him. The Reluctant Wife
(who agreed that his priorities were good and that they made sense) responded,
“That’s what they all think.” She proposed, instead, that he set up Tiger Teams
to work quickly on his priorities and to connect that work to the existing
structures. This would be a more
efficient and effective way to implement his priorities.
To his credit, the Undersecretary was able to hear this very
blunt assessment of his plan, to not take offense at it and hear it as
insubordination, and he avoided throwing the system into chaos and made use of
the feedback, recognizing that it was based on institutional knowledge and
concern for the wellbeing of the organization and its ability to carry out the
virtues of his priorities. I’m not sure
I would have had the maturity to go along with her suggestion were I in his
position (something that can cause friction in our marital relationship, by the
way).
So, the Reluctant Wife is a member of the deep state. She cares, deeply, about the mission of her
organization: to serve veterans. And she
works to protect that mission against interlopers – the Presidents and their
appointees who, whether well intentioned or not, would move her and the
organization away from carrying out that mission. Fortunately most Presidents, and most of their
appointees, also have the health of the organization, and therefore the
well-being of the country, in mind. What
they often don’t have is the institutional knowledge about how best to make use
of the office to best serve the country.
It is also the case that a large governmental office is more
like an aircraft carrier than a jet ski; it cannot turn on a dime. While my family, particularly my father’s
family, was used to seeing problems be solved on a local level, some of our
problems are bigger than that. When we
became a world power, we did this based on our military strength, and
maintaining that strength means we need to care for those who have worked to
maintain world order, such as it is. And
this is not a small group of people. In
place of the small town, the hospital unit became the place where a community
of ex-soldiers came to be known by a caring community of treaters. And this small group was part of a massive
organization – and the members of that organization, over the course of their careers,
move from direct treatment to managing the functioning of the organization, and
they need to interact with those who come with a mandate from the people to
provide better care and help them realize how best to achieve the goals they
have given the conditions that exist.
The other piece of institutional knowledge that the
Reluctant Wife, as a member of the deep state, carries is a realistic appraisal
of the pieces and parts of the institution, but also an appraisal of the
institution as a whole. In this instance
she knows that the organization is in much better health than Congress and the
press would lead us to believe. She
knows that our veterans are, in fact, being well served by the VA. Recently she let me know that over 70% of VA
medical centers received 4 or 5 Stars in a national patient survey rating
versus 42% of Private Hospitals being rated with 4 or 5 starts. Are there problems? Sure. There are problems with every health system I
have been associated with as a provider and as a patient. When you have an organization that is
employing almost half a million people at hundreds of hospitals, there are
problems every day. And you need a firm
hand at the tiller to manage these problems and to keep the ship moving
forward.
Happily for me (and for her), the Reluctant Wife’s tour of
duty has come to an end after a little more than a year as Acting Chief of
Staff. A permanent Chief of Staff has
finally been hired. She has returned to
her regular position as the director of the VA’s Internal Organization
Development Office. This is a position
that, like the acting chief of staff, would have been characterized in my
family as a bureaucratic one. It is one
that would be characterized in current political speech as being a member of
the “deep state”. Living with a
bureaucratic member of the deep state has allowed me to have a new and very
different appreciation of what I otherwise would have taken these terms to
mean.
Perhaps not for all, but for my wife, being a bureaucratic
member of the deep state meant that she worked very hard to insure that the
obligation of a country to its members that have risked life and limb for its
protection are cared for in the best manner possible. It has meant being a servant leader – and in
her case it has meant serving the mission of the VA which is, in many ways, the
mission of the government and therefore of all of us because ours is a
government of the people, by the people and for the people.
Staying in the hinterlands while she commuted to Washington,
I did not get to know the other leaders of the organization except through her
report, but her experience is that , by and large, the leaders of the
organization – the bureaucratic members of the deep state, work incredibly hard
and are incredibly talented people doing very difficult work to bring top
quality health care to a segment of the population that would otherwise likely
be underserved. They do this not
primarily because of the tangible compensation (they would actually be better
paid in the private sector) but because of their commitment to the mission.
The VA has come a long way in my life time. It is a modern health care system, a
functional national health care system in a country that is ambivalent about
such systems and reports to a body – the US Congress – that is often openly
hostile to such systems – while it also lives up to its mission. One of the subtle, but I think important
shifts in the system is that each veteran who arrives for treatment is greeted
by a staff member who thanks them for their service. I think we also owe a debt of gratitude to
the health care workers who serve those who have served.
P.S. This essay,
which is overly long, was conceived out of a brief fantasy. I imagined Joe Biden, in one of his State of
the Union addresses pointing to my wife as she sat uncomfortably in the gallery
of the House of Representatives. “There
she is,” he would say “an exemplary member of the Deep State. Educated at our best state institutions,
trained by the VA, she has risen through the ranks to become the Acting Chief
of Staff. Along the way, she has helped
countless Veterans reclaim their lives, kept the house in order, and, as acting
Chief of Staff, has helped my appointees figure out how to continue to improve
the great organization that serves our veterans.” Everyone would have applauded, and she would
have been given a medal. He would have
gone on to talk about how dedicated our civil servants are to making our
country better. To really tell the
story, I had to add a few words…
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