We don't normally expect our presidents to pay close attention to how long veterans are being asked to wait for care in the vast medical system run by the Department of Veterans Affairs.
But we do expect presidents to appoint Cabinet officers and other aides who can run the federal government well — well enough, at least, to prevent full-blown scandals from erupting.
That's what the VA's long-running scheduling problems have turned into after reports that veterans died while waiting for medical care — and bureaucrats apparently manipulated records to make their performance look good when it wasn't.
No one can read the stories of individual veterans who suffered at the hands of the bureaucracy — like Edward Laird, a 76-year-old Navy veteran who lost half of his nose because he had to wait two years for cancer tests — without feeling helpless fury.
And those stories are certain to keep coming.
It's an especially dangerous scandal for President Obama because it fits into an established narrative about his presidency: that he's a skilled politician and speechmaker but a lousy manager.
The biggest problems Obama has faced in the White House — aside from unrelenting opposition from Republicans in Congress — have come not from making policy but from trying to implement it. The calamitous launch of his healthcare plan last fall is the biggest and most painful example, but it's only one of several.
The 2009 economic stimulus plan's "shovel-ready" projects that took months to start, the confused response to the 2010 BP oil spill, the flap over IRS scrutiny of conservative organizations, even the State Department failures that led to the deaths of four Americans in Benghazi in 2012 — all were mainly lapses in management, not policy.
The president's conservative critics have accused him, often wildly, of every sin they can think of, from diabolical conspiracy (in the case of the IRS) to dereliction of duty (Benghazi). But the charge that's likely to stick is one that connects all those unrelated events to an underlying truth: Obama has never paid as much attention to the nitty-gritty of management as he has to making policy and campaigning for votes.
"Presidents get elected because of their rhetorical skills, but they succeed or fail based on their managerial skills," warned Elaine Kamarck, a former White House aide to Bill Clinton who directs a center on public management at the Brookings Institution. "In this administration ... somehow, there is no adequate communications system; the White House keeps getting hit by these unpleasant surprises."
Until recently, Kamarck noted, the White House didn't have a high-ranking aide assigned full time to monitoring how programs were being implemented. That's one of the reasons for the failure of the healthcare website; the engineers foresaw it, but nobody high up was pulling that information out of them.
Bad management alienates even a president's allies, Kamarck noted.
"His popularity can go down and stay down," she said. "That's what happened to Jimmy Carter in the last year of his presidency. That's what happened to George W. Bush after Hurricane Katrina."
And now "that's the narrative about Obama. It's the narrative even among Democrats. They're beginning to say, 'Oh, we love everything he says; we just wish he could get something done.'"
In the case of the VA health system, problems many of us are learning about now have long been evident but never quite got fixed.
"This has been building for 10 or 15 years," said Phillip E. Carter, an expert on veterans affairs at the Center for a New American Security. He said demographic surges of aging Vietnam vets, plus returning vets from Iraq and Afghanistan, were straining the system.
Even the specific problems of excessive waiting times and bureaucrats manipulating records aren't new.
The VA knew that some of its medical centers had piled up huge backlogs in patient appointments by 2011. The Government Accountability Office, Congress' investigative arm, reported in 2012 that VA bureaucrats were fiddling with waiting time records. CNN reported in 2013 that at least six veterans died in South Carolina because of long delays in providing diagnostic tests. Charges of misconduct at the VA medical center in Phoenix, the incident that turned the problem into a scandal, have been percolating through the bureaucracy for more than a year.
So if Obama only learned of the depth of the problems from watching TV, as his spokesman said last week, something is amiss with his administration's internal communications.
It's possible to hold out some optimism amid these scandals.
"Every crisis is also an opportunity," Carter said. "Fixes are available at the VA, and this is the time to put them in place."
It's even possible that the White House has learned some management lessons. After the healthcare website crashed last fall, Obama named a seasoned administrator, Jeffrey Zients, to take charge — and seven months later, the health insurance program appears to be working.
And two weeks ago, Obama created a White House post — deputy chief of staff for policy implementation — and filled it with Kristie Canegallo, an aide who worked with Zients on the healthcare crisis. "We have determined we need more senior-level focus on implementation and execution," White House chief of staff Denis McDonough said in announcing her appointment.