Like two troublesome students being pulled into the principal’s office, President Trump’s top two health officials were called to the White House on Wednesday for a mediation. The message they received from Vice President Mike Pence and White House Chief of Staff Mick Mulvaney was simple, per reports: They need to figure out a way to get along.

Health and Human Services Secretary Alex Azar and Medicare and Medicaid chief Seema Verma have been engaged in a public power struggle over the last year, with each seemingly seeking to undermine the other both on policy and in the press. The feud has stifled Trump’s health agenda and created another turf war between two bureaucrats in an administration largely defined by its interpersonal conflict.

The dispute is in part about personal issues: Verma’s complaints prompted the health department to hire a lawyer to investigate claims of sexual discrimination (none was found), and her side blames Azar’s for damaging leaks about her spending on public relations.

But it’s also about policy: Verma has undercut Azar’s plans to rein in drug prices, a top Trump priority, while Azar disparaged Verma’s proposal to replace the Affordable Care Act.

The conflict is one reason Trump’s health care record is an unwieldy combination of undercooked, headline-driven initiatives to bring down costs and legally dubious attempts to cut the safety net.

Trump’s agenda has been torn from the start between his populism on the campaign trail, when he attacked pharma and promised he would never cut Medicaid, and the ideological conservatism of his actual administration, which became the first to pursue Medicaid work requirements and block grants. It’s been hard to pick a path and stick to it with his two lieutenants undermining the other on their respective issues.