david shulkin
Credit: Milwaukee VA Health Center

In January of this year, President Trump surprisingly named Dr. David Shulkin, a rare Obama administration holdover, to be secretary of Veterans Affairs. He ordered Shulkin to improve medical treatment for veterans, which Trump called “horrible, horrible, and unfair” during the Obama years.

On May 31, Shulkin trooped over to the White House to deliver his first “State of VA” address since his promotion to head the agency. Shulkin likened his agency “to a patient in bad, but improving, health…We are still in critical condition and require intensive care.” He pledged to tackle some of the agency’s pressing issues, such as the backlog of 90,000 disability claims, and the persistent problem of veteran suicides, which is estimated at 20 per day. Secretary Shulkin rated the performance of 14 out of 168 veterans hospitals as less than acceptable, and noted that Veteran Health Administration (VHA) infrastructure was “increasingly falling into disrepair.”

Yet, what went unmentioned at Shulkin’s White House briefing—or anywhere else apparently—was the findings of a book, published a month later, by the VA itself. Titled Best Care Everywhere, and co-edited by Shulkin, this 440-page compilation of clinical case studies hails the VHA’s little-publicized role as an incubator for “real change” in treatment methods.

Shulkin dedicates this well-documented book to America’s “men and women in uniform,” and thanks Washington Monthly senior editor Phillip Longman, author of Best Care Anywhere: Why VA Health Care Would Work Better for Everyone—from whose 2012 book he borrowed his title—for showing “us that the VA provides some of the best health care anywhere and who inspired us to disseminate our best practices and pursue the audacious goal of delivering the best care everywhere to our Veterans.”

In his introduction, Shulkin describes the way the VA is “changing veterans’ lives” and notes that “it takes an average of 17 years for new medical evidence to reach patients in clinic or at the bedside”—a problem that all health care systems are grappling with. Yet, according to Shulkin, “VA is leading American health care in fixing it.”

“It’s difficult to exaggerate VA employees’ excitement and burst of energy when they see their great ideas translated into better access and outcomes for the veterans they proudly serve,” writes Shereef Elnahal, Shulkin’s Deputy Under Secretary for Health. “No operational system, to our knowledge, has achieved the diffusion or consistency of best practices on a scale comparable to what we’re seeing at the VA.”

For an agency often suffering from bad publicity and congressional criticism inspired by would-be privatizers of the VHA, Best Care Everywhere is a PR goldmine. If widely distributed, this book might boost institutional morale. It would also help attract more professional staff, even though VHA salaries are not competitive with private industry, and make the case for better congressional funding so more than 40,000 current vacancies could be filled. All the VHA Public Affairs staff would need to do is ship copies from the Government Printing Office (GPO) to every journalist covering the VA, members and staff of the Senate and House Committees on Veterans Affairs, and national veterans’ organizations, while making copies available to interested members of the public via the GPO website.

But that’s not what’s happening. Seven months after its publication, Best Care Everywhere—which defends rather than disses publicly-delivered veteran health care—remains one of the VA’s best-kept secrets. PR staff has not sent the book out to journalists like myself who are covering the VHA. (A VHA doctor shared his copy with me.) When I informed Phil Longman of the book’s existence, he told me, “I’ve always wanted a book to be dedicated to me…too bad no one ever told me about it, or sent me a copy.”

When I called VHA public affairs officer Michele Hammonds, she did not seem to have heard of the book. “What was that again,” she asked.  “Did you say Best Care Ever?”  I informed Hammonds that Shulkin’s book was listed as “backordered” (for almost three months) at the GPO . I ordered a copy there, provided a credit card number and have not received one yet. Hammonds asked me to hold the line while she called someone else for the information. She then asked me to request a review copy by email and promised a quick response. I have not heard from her since.

Leaders and staff of the American Legion, the Disabled American Veterans, AmVets, and Vietnam Veterans of America are always up to date on the latest books, articles, and official reports dealing with veterans’ affairs. But I drew a complete blank among many there too. (“Did Shulkin write a book?” one quizzical Legion staffer asked via email.)

Ditto for any number of relevant committee or congressional staffers on Capitol Hill. Several asked me to fax them the table of contents and Shulkin’s introduction to the book, since that was apparently the only way they could see it.

Within the VA, the book’s distribution pattern was similarly spotty—perhaps reflecting the ambivalence of a Trump Cabinet member proud of his own editorial role, fully aware of the truth of the book’s content, but now finding it a bit awkward to depart so dramatically—and in print—from his own boss’s uninformed take on the VA.

One VA leader confirmed that Secretary Shulkin had distributed Best Care Everywhere at a senior leadership meeting, but very selectively. As a leader of the agency’s mental health programs said, “Shulkin began this book under Obama and wanted to take credit for VA innovations. Now he’s working for Trump and he’s in a bind, because this is not the message the administration wants to deliver.”

A VHA mental health professional speculates that the book didn’t get pulped because too many health care professionals, highly regarded inside and outside government, had contributed chapters to it. Plus, Shulkin himself wouldn’t want to completely bury a volume that prominently displayed his name on the cover.

One wonders, however, about how the other contributing authors feel about VHA programs they describe being threatened today by Shulkin-assisted budget cuts and outsourcing of care to the private sector? Patients may no longer get the Best Care Everywhere if services for the homeless are cut—as Shulkin recently tried and failed to do—and programs for women’s veterans, or those suffering from hard-to-treat conditions mental health conditions are starved of resources. It’s not even clear how many of Shulkin’s colleagues, whose clinical or research work is showcased in Best Care Everywhere, will still have VHA jobs if Congress diverts billions of dollars to private sector providers.

But at least those who did get a copy of Best Care Everywhere will have one on their bookshelf to remind them and us what the VHA has been and still can be—if those directly affected rally to save it.

Suzanne Gordon

Suzanne Gordon is the author of The Battle for Veterans' Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care and the forthcoming Wounds of War: Veterans' Healthcare in the Era of Privatization.