President Trump campaigned on cleaning house at the Department of Veterans Affairs, to fire inept and corrupt bureaucrats, and give veterans greater choice in their health care.
Veterans responded enthusiastically. President Trump won their votes by a margin of almost 4 million.
The president has tried to make good on his promises. He signed into law the VA Accountability and Whistleblower Protection Act, which gives the secretary the authority to fire inept or corrupt bureaucrats. He ratified the MISSION Act, which expands veterans' health care choices and support for caregivers for the seriously disabled.
But his efforts have been frustrated by the bureaucratic swamp at the VA he campaigned against. President Trump needs people who agree with his vision for the VA, not civil servants who were there before he took office and will be there after he leaves.
In other words, he needs more political appointees at the VA.
Each presidential administration gets about 4,000 political appointees spread across the various executive agencies. Responsible for implementing the administration's policies, they serve at the pleasure of the president and can be fired at will.
Career civil servants, by contrast, have no stake in the president's agenda and can hardly be held accountable for their work. Dismissing a civil servant for poor performance can take years.
If the VA is to be reformed, political appointees will be the ones to do it. Yet the VA only gets 38 -- the fewest of any cabinet-level agency. That's less than 1 percent of the appointees the administration is allotted.
Even the leaders of the VA's regional divisions are civil servants. Regional and state administrators at the Departments of Homeland Security, Agriculture, and Health and Human Services, by contrast, are all appointed by the president.
So 38 people have the impossible task of turning around the federal government's second-largest agency, with 373,000 employees.
There's a lot of misbehavior to clean up.
Some career civil servants are using the VA Accountability and Whistleblower Protection Act to fire whistleblowers and protect themselves from accusations of corruption.
If President Trump is to drain the VA swamp, he needs to first populate it with more political appointees.
In the long term, Congress must restructure the VA so every under secretary, principal deputy under secretary, and assistant secretary -- the three levels below the secretary on the organizational chart -- is nominated by the president and confirmed by the Senate.
In the shorter term, the Trump administration should shift 75 to 100 political appointees to the VA -- and make every principal deputy under secretary and principal deputy assistant secretary appointees. Likewise, all regional Veteran Integrated Service Networks directors should become appointees.
Departments with less checkered histories than the VA have five to 10 senior policy advisers reporting to the secretary who act as fixers for urgent policy priorities -- and can maneuver around bureaucratic inertia. The VA needs them, too.
Finally, the VA would benefit from a new under secretary of policy to assist the secretary with setting and enforcing standards of performance, integrated budgets, and system-wide policies and procedures.
The VA's bureaucracy is the chief impediment to delivering quality care and services to our country's veterans. Asking that same bureaucracy to fix itself is folly.
VA Secretary Robert Wilkie needs to be given the accountable personnel and political muscle required to bring about the change voters demanded in 2016.
Carey, a retired U.S. Navy captain, is chief advocacy officer of The Independence Fund. This piece originally ran in the Detroit News.