The Office of the Surgeon General and the Dept. of Agriculture aren't run by the same people,

Depending on how far up the chain you go. Also FiftyTwo was trying to argue that the people providing health services will include future tax revenue in the set of things they seek to maximize.

Often a very effective way to further the goals of a bureaucratic organization is to bolster the political clout and prestige of the organization itself.

True, assuming you ever actually get around to furthering your goals. Unfortunately, if you optimize your organization too much for obtaining political clout and prestige it will be hard to shift to accomplishing your goals.