The consolidated Veterans Affairs system we currently have is a product of another time. We need new, creative policy proposals to help remedy its massive failures.

Since the scandal at the Department of Veterans Affairs first broke in 2014—leading to the resignation of then-VA Secretary Eric Shinseki—a public debate has been simmering over what, exactly, should be done to fix the VA.

This debate is fundamentally a good thing. In a political system such as ours, debate is crucially important to addressing problems, and few problems are so grave and morally meaningful to a national community as how its veterans are treated. Policy details matter, and most participants in the debate are sincere in their positions and seeking to do right by veterans.

But sometimes we can become so engrossed in the details that we forget the bigger picture. In light of this, it might be useful to try to see how the debates over VA reform fit into the larger context of American social and political life in the twenty-first century.

In his new book, “The Fractured Republic: Renewing America’s Social Contract in an Age of Individualism,” political scientist Yuval Levin, a fellow at the Ethics and Public Policy Center, lays out a fairly comprehensive political-cultural history of the twentieth century. While Levin does not address VA issues specifically, understanding this history and applying his analysis will help people understand how we got to where we are on a range of cultural and political issues, including the debates that swirl around VA reform proposals.

The Age of Consolidation

The twentieth century dawned with a political movement known as progressivism. The aim of the movement was, ostensibly, to lead the American republic into modernity, “progressing” past what they considered to be the outmoded constraints and institutions of the Constitution of 1787. This progress effectively consolidated power at the federal level—progressives believed the complexities of the modern world could no longer abide the inherently dispersed nature of federalism and checks and balances.

Rather, they aimed to unify the country by first undermining the authority of a range of sub-federal institutions, including state and local governments and so-called “civil society” institutions, such as churches, local schools, local communities, fraternal organizations—that is, those organizations which comprise, as Levin puts it, the “middle layers of society” between the state and the individual—and second, by elevating the executive over the other branches of the federal government to streamline its function.

World War II further served to unify and consolidate power at the federal level. This consolidation of political power also led to a cultural consolidation—what Levin refers to as “The Age of Conformity.” This is essentially the stereotypical image of the 1950s: conformist and simple, the product of a mass-produced culture. This is ironic in some ways: the “conservatism” of the 1950s was, in no small part, the product of the consolidation wrought by the Progressive Era.

This consolidation led to a certain confidence in technocratic governance, with government experts effectively and efficiently administering a range of social programs for the entire nation. During this time the VA hospital system as it currently exists was developed. To be sure, its roots go much further back, and can be traced to the very early colonial period. But Congress birthed the VA in its current form in 1921, creating the Veterans Bureau and consolidating all of the various veterans programs that had been established following World War I. In 1930, the bureau was transformed into an administration until 1989, when it became a cabinet-level department.

While it predated the post-World War II era—and was even thriving in some ways prior to it—the VA benefited from that post-war confidence in government bureaucracy, which also allowed for creating or expanding other bureaucracies, such as Medicare, Medicaid, and the Department of Transportation.

The post-World War II era also spawned a respect for veterans—a respect sometimes not accorded to veterans of World War I—leading to a high point in the influence of the Veterans Service Organizations (VSO) such as The American Legion (founded by veterans of World War I), and Veterans of Foreign Wars (or VFW, founded by veterans of the Spanish-American War), and the founding of others, such as American Veterans (or AMVETS), and Paralyzed Veterans of America (PVA). Their advocacy led to a more expansive VA hospital system, which fit the trend toward consolidation that defined that era.

The Consolidation Could Not Hold

The late 1960s saw a trend in the opposite direction, in some ways. In reaction to the restrictive social consolidation of the 1950s and early 1960s, movements aimed at social liberation began to gain traction (although these movements had their roots in earlier movements, they did not become mainstream until later). According to Levin’s analysis, the 1960s represent a time when social liberalization had not yet overcome economic consolidation, and therefore it was a time that, though inherently fleeting, many look back on as a sort of “golden age” wherein individuality was released from stifling conformity, while economic stability was somewhat secured through lingering cohesion. But that stability could not last, and soon enough it was supplanted by an economic individualism to accompany the ascendant social individualism.

Levin points to four transformations in the economic structure that helped lead to the shifts that occurred: globalization, automation, immigration, and consumerization. Each of these represent, in a certain sense, a liberalization of the economy, and they have all, without question, contributed to increased prosperity in the United States, and around the world. But they have also destabilized those who once depended on manufacturing jobs with living wages and substantial benefits packages.

In effect, the only American institutions that retain this older model—big, consolidated institutions that provide technocratic solutions and defined benefits packages—are governmental, and specifically federal. This is why government unions such as the American Federation of Government Employees (AFGE) remain powerful, while private-sector unions have lost influence.

The VA is, in effect, a similar holdover, relying on and assuming, as Levin puts it (discussing the broader welfare-state institutions that define the mid-century), “a level of stability and social order that we can no longer assume.” It “looks and functions like the institutions of a bygone age. It often still embodies the modernizing assumptions that more advanced institutions will be larger and more consolidated, rather than the postmodernizing assumption that more advanced institutions will be nimbler and more responsive, customizable, and adaptable.”

Again, while Levin does not mention the VA specifically, the description is fitting. The consolidated VA system we currently have (its coordination problems notwithstanding) is a product of another time, and, while it may have been appropriate for its time, it is, in many ways, an anachronism. Levin concludes, “Progressive public institutions took the shapes they did in response to the shape that the larger society and its economic, social, and cultural institutions were taking. As those other institutions are transformed, our public institutions will need to start taking new shapes, too.”

The Politics of Nostalgia

Levin, then, characterizes the tendencies of American politics—both Left and Right—as “nostalgic.” Each is nostalgic for different things, to be sure, but both yearn for a time in the past when our public life had a very different shape. On the Left, it is a nostalgia for a time when society was beginning to liberalize, but the economy was still consolidated enough to retain the older employment and benefits packages that they now tout as essential to the economic stability of working- and middle-class families—for the American Left, it is always 1965. On the Right, it is a nostalgia for a time when cultural and moral cohesion more or less reigned, although the economy was in the process of liberalizing, or for a time when economic liberalization was being paired with cultural cohesion in the face of the Soviet Union—for the American Right, it is always 1981.

For them, any attempt to bring sweeping change to the VA endangers what it symbolizes, and threatens to undo the hard political work they have engaged in.

Similarly, much of the debate about VA reform traffics in such nostalgia. The older, more established legacy VSOs continue to defend the VA in its current form, although many younger veterans of the post-9/11 era—most of whom are millennials—have no particular connection to the VA as a system, no particular stake in defending it as such, and tend to think of customer service more in terms of Uber and ZocDoc than do older generations of veterans. This could explain why there is some evidence that post-9/11 veterans are particularly critical of the VA.

Bureaucracies like the VA, in Levin’s words, drew “on a political outlook that arose in response to the consolidating pressure of modernization,” and therefore they are “a relic of an earlier America with a different attitude, different problems, and a different set of expectations than our own. Using it as a template for policy now is a recipe for gross inefficiency, dysfunction, and failure.”

Further exacerbating the impact of nostalgia on debates is the experience of Vietnam War veterans who, upon returning home, often experienced hostility and abuse. If the nostalgia often reverts back to 1965 or 1981 for the Left and Right in these debates, it tends to be always 1969 for these veterans. That’s when they faced a hostile home front, and the VA hospital—as bad as it may have been in terms of actually serving veterans—functioned as a symbol of the nation’s commitment, as Abraham Lincoln put it in his second inaugural address, “to care for him who shall have borne the battle and for his widow and his orphan”—the VA’s motto.

These Vietnam veterans are now largely in control of the major VSOs, and for them, any attempt to bring sweeping change to the VA endangers what it symbolizes, and threatens to undo the hard political work they have engaged in over the past 40 years, most notably successfully advocating for the Veterans Administration, an independent government agency, to become a cabinet-level department—the Department of Veterans Affairs—in 1989.

According to Levin, then, the logic of liberalization—either from the social or from the economic side—eventually works its way through the culture, and thwarts this nostalgia, however strongly held: there is likely no going back. Liberalization and individualization brought about by the social change of the 1960s and the economic liberalization of the 1980s have undermined mass cultural cohesion. Because of this, in the same way that James Madison sought in Federalist 10 a “republican remedy” for the “diseases most incident to republican government,” Levin seeks “individualist remedies for the diseases most incident to a diffuse, individualist society.”

Time for a System Update

For Levin, that means finding political and policy solutions that can stem the excesses of both collectivism and individualism while recognizing that policies that tend to run too strongly against the individualistic assumptions dominant in the culture are unlikely to be particularly effective. “Practical solutions to the problems of this dynamic society faces will need to conform to this broader ecosystem of American life,” Levin writes, “just as big, centralized, one-size-fits-all industrial models of the welfare state did in its time.”

‘Practical solutions to the problems of this dynamic society faces will need to conform to this broader ecosystem of American life.’

There is also, Levin points out, inherent in the mid-century model a “fundamentally anachronistic epistemology, or theory of knowledge.” The vision of the Progressives, he says, was to separate politics from administration, insulating the administrative state from the volatility of politics, and instead placing technocrats in positions where they might do the work of running the state, applying their technocratic expertise to the problems of modern social life. “In this view, the most effective way to regulate and manage a complex modern society was for the legitimately elected government to empower social scientists to employ their centralized expert knowledge.”

But the vision that has developed since that time emphasizes the less consolidated, more individualistic epistemic assumptions toward the power of dispersed individuals making decisions based on specific knowledge of their needs and the needs of their immediate community:

Throughout our culture and economy today, the top-down theory had given way to a kind of bottom-up theory of distributed knowledge suggesting that the expertise needed to make complex decisions is not concentrated in the hands of a small band of experts, but dispersed among all, and best aggregated through the medium of individual choice in a diverse society. This is the logic of economic competition and cultural diversity. And it will increasingly need to be applied to public administration.

That application will need to come, in no small part, by applying creative policy proposals that push the limits of the status quo, and think outside of the mid-century box.

Fortunately, such policy prescriptions can be found, and they continue to be developed. If done correctly, they should even help the pre-existing institutions improve themselves, in addition to better responding to the needs of those they serve by harnessing the power of market-based solutions.

In a recent essay in The Atlantic entitled “When Government Competes Against the Private Sector, Everybody Wins,” consultant Eric Schnurer writes, “If governments can be nimble competitors, we should welcome their entry into markets and, where they can’t compete, they should yield to superior private-sector products or services.” He lays out “managed competition” in which “public employees compete against private-sector firms for contracts to provide government services.” Surprisingly, according to Schnurer, in “most instances where such ‘managed competition’ has been tried, the in-house government workers have almost always beaten out the private sector.”

He goes on: “the idea that the government might compete successfully against private enterprise tends to provoke opposition and incredulity.” This is because government entities of the kind developed during the mid-century tend to be bureaucratic and unable to respond quickly and effectively to shifts in the needs of those they serve. They further have difficulty responding to innovations in the fields where they might compete.

Hence, government entities that are capable of competing may need to be restructured to allow them to compete effectively. This might be especially desirable in cases where users currently have little choice in the ways in which they are served, such as veterans who use the VA. This could help to harness the logic of individualism while restraining the worst tendencies of both individualistic market reductionism and stifling bureaucratic statism.

Revive the Middle Men

Good public policy in the twenty-first century should particularly address these problematic tendencies and actively work to counteract them. This will entail, in the case of Veterans Affairs, thinking carefully and deliberately about how to best enable veterans to reintegrate into their communities, and how communities can better care for veterans.

The primary remedy Levin proposes is reinvigorating those middle layers of society—those institutions of civil society that stand between the isolated individual and the raw power and impersonal labyrinthine bureaucracy of the state that Progressives had targeted for marginalization or elimination. As mentioned before, these institutions include families, churches, fraternal organizations, local businesses, and local VSO posts. It can also include local health care institutions. (There is a reason the VA calls its purchased care programs “Care in the Community.”)

Hyper-individualism is often a corollary of statism, rather than its antithesis.

Levin ties this to “subsidiarity,” that is, the traditional notion that problems ought to be handled at the lowest level of authority possible. This empowers these middle layers of society, disbursing social authority and allowing a more robust plurality of subcultures to subsist side-by-side.

While this notion is very old, Levin suggests the way forward might rest in its reinvigoration: his idea of “modernization through subsidiarity, a revival of federalism, and a commitment to a robust pluralism of moral subcultures” is more in line with the disbursing tendencies of the age while resistant to the temptation to collapse completely into solipsistic individualism. This stands in sharp contrast to the tendency of modern social ontologies that recognize only the isolated individual and the state. As sociologist Robert Nisbet noted, following Alexis de Tocqueville, hyper-individualism is often a corollary of statism, rather than its antithesis.

As important as counteracting hyper-individualism in general might be, policies that encourage veterans to connect with their local communities are even more so. As the percentage of Americans serving in the military has declined, veterans increasingly risk being marginalized and isolated from their local communities in a host of ways. This threat increases when veterans are forced to receive their health care in distant locales, segregated from the broader population.

Veterans increasingly risk being marginalized and isolated from their local communities in a host of ways.

While the artificial community that springs up in a VA hospital might be a substitute for the broader social integration of veterans, it is ultimately only a substitute. Might it not be better, then, to at least allow veterans the option to receive the health care of their choice in their community, and thereby better encourage communities to better care for the veterans living among them?

Thanking a veteran on Veterans Day is a nice gesture of course, but it cannot substitute for genuine integration into the community. Encouraging the middle layers of society—VSO posts, private medical practices, and so forth—to take more ownership of veteran well-being, while pushing health care choices to the lowest possible level, would create a symbiotic relationship benefiting both communities and veterans.

Ultimately, the goal of VA reform must be to promote policies that encourage human flourishing for communities and veterans in a variety of ways, taking into account the social, cultural, and economic shifts that have occurred over the past, and meeting the needs of veterans now and in the future.