This paper analyzes the need for structural reform at the Department of Health and Human Services (HHS). Drawing upon interviews with the six former secretaries who began their tenures at the start of the past six presidential administrations (Gerald Ford, Jimmy Carter, Ronald Reagan, George H. W. Bush, Bill Clinton, and George W. Bush), this paper focuses on their views of reorganization as a palliative for achieving and maintaining high levels of performance in the future.1 The paper begins with a brief overview of the rationale for reorganization and then turns to the general conclusions that emerged from the interviews.
There are many perfectly legitimate reasons to reorganize, but one of them is not immediacy. History suggests that reorganizations of any size are rarely complete upon signing. Congress often goes back into reorganizations to fine-tune, reconsider, and rearrange its work long after passage. This is certainly the case with the Departments of Defense and of Health, Education, and Welfare, for example.
Congress has returned to Defense Department reorganization at least five times over the past 50 years, for example, starting with (1) the 1958 Department of Defense Reorganization Act (P.L. 85-599), which strengthened coordination among the armed services; (2) the 1980 Defense Officer Personnel Management Act (P.L. 96-513), which revised military promotion and retirement practices; (3) the 1985 Defense Procurement Improvement Act (P.L. 99-0145), which was a direct response to the procurement scandals of the early 1980s; (4) the 1985 Goldwater-Nichols Department of Defense Reorganization Act (P.L. 99-433), which once again sought to strengthen coordination; and (5) the 1989 Base Closure and Realignment Act (P.L. 100-526).
Congress has returned to health, education, and welfare reorganization even more frequently, most notably the Department of Education Organization Act in 1979 (P.L. 96-88), which set asunder what President Eisenhower had joined together, and the 1994 Social Security Independence and Improvement Act (P.L. 103-296), which separated the Social Security Administration from what had been renamed the Department of Health and Human Services in 1979.