David Shulkin
Credit: Veterans Health/Flickr

Two decades ago, Robert Reich penned an insightful account of his roller-coaster ride in Bill Clinton’s administration. His memoir, Called Locked in the Cabinet, chronicled his behind-the scenes jousting to push the Labor Department in a labor-friendly direction before he returned to academia for family reasons.

By the standards of the Trump era, Clinton’s own appointments of family and friends, like Reich, lack of organizational discipline, and sometimes chaotic White House decision-making style now look like model executive branch behavior.

Since January 2017, nearly a dozen of the president’s cabinet members have quit or been fired. David Shulkin, former Secretary for Veterans Affairsis one of three with new book out about their experience. (The others include his more high-profile colleagues James Mattis and Nikki Haley.)

Like Reich, Shulkin faced many obstacles to fulfilling the mission of his agency. But his book mistakenly identifies “broken government” as the reason for the dysfunction. In fact, the “plight of veterans” has been worsened by a Republican president who’s done everything he can to prevent the Department of Veterans Affairs from better serving them.

Shulkin’s appointment was unusual for three reasons: He was the first non-veteran to become VA Secretary (most others have been former generals or officers of some type); he was the only under-secretary in a cabinet department under Obama that Trump promoted to the agency’s top job; and there was a a rare bi-partisan consensus around his nomination. He was confirmed on a unanimous Senate vote, earning him the presidential nickname, “Mr. 100 percent.”

In June, 2017, Shulkin proudly joined Trump at a White House signing ceremony for the VA Accountability and Whistleblower Protection Act, which made it easier to discipline or fire VA employees. While the act was heralded as a way of holding higher level administrators accountable for poor job performance, it ended up having its greatest impact on housekeepers, nursing assistants, and cafeteria workers.

Trump publicly reassured Shulkin that he would never hear the words “You’re fired!” like so many failed contestants on The Apprentice. But nine months later, he fired him via Twitter.

Shulkin’s access to his work email and phone were immediately shut off: “Three years of contacts, all my documents, all my photos…gone.” He was “treated like a leper,” he writes, not even “allowed back in VA headquarters to say good bye to my staff or to clean out my own desk.”

In his book, Shulkin portrays himself as an idealistic naif. By his own account, however, Trump’s summoning him for  an unexpected job interview in late 2016 gave him an advance taste of what decision-making would be like in the new administration. At Trump Tower, he found his future boss conducting “transition” business like the Mad Hatter at the famous tea party in Alice in Wonderland.

While various aides lurked about, bickering among themselves, Trump peppered Shulkin with random questions. Then, he would cut him off and answer those queries himself before his visitor could reply. At one point, Shulkin recalls, “Trump ruffled through a few papers on his desk and then looked up … as if actually seeing me for the first time. ‘You know, you don’t really fit the bill,’ he said. ‘The generals… now they fit the bill. But can they fix health care?’”

Lucky for Shulkin, he had the backing Ike Perlmutter, a major Trump donor, fellow billionaire, and CEO of Marvel Entertainment. Perlmutter was one of three Mar-A-Lago club members who had already positioned themselves to be key White House advisors on VA issues, even though none had ever served in the U.S. military or worked at the VA, like Shulkin had.  “Donald, he’s your guy,” Perlmutter told Trump, via speakerphone during Shulkin’s job interview. “I wouldn’t steer you wrong.”

Shulkin had found Obama to be “analytical, pensive, and at times appropriately cautious.” This approach, he wrote, ensured that VA “improvement initiatives were carefully planned,” but “also led to a slower adoption of change.”

That’s why Shulkin was initially attracted to the “tumultuous and frenzied environment” of the Trump Administration. As VA Secretary, he could “take more risks, move faster, and, in many cases, make more meaningful change.”

As a private hospital administrator before he transitioned into public service, Shulkin had plenty of experience handling wealthy board members like the three “Mar-A-Lago Amigos.” He apparently assumed their pesky phone calls and uninformed political meddling would be a manageable problem.

That proved not to be the case. The anti-VA bias of Trump’s friends in Florida was shared by his political appointees at the VA. These former Trump campaign workers or staff members of the Koch-funded Concerned Veterans of America (CVA) wielded great policy influence on Shulkin—and, even more on his successor, Robert Wilkie. “CVA was at the White House on a regular basis and showing up at meetings when I hadn’t invited them,” Shulkin reveals. “At every turn, White House staff made sure CVA was given a strong voice.”

CVA operatives like Darin Selnick lobbied for “unfettered VA patient access to private care” that would pave the way for “the dismantling of the government-run system set up to serve veterans.” The “politicals,” as Shulkin calls them, undermined and helped discredit him to further an “agenda which did not include having the VA succeed.”

By systematically outsourcing veterans’ care, Shulkin writes, the Trump administration will cost taxpayers billions of dollars more than originally projected while “simultaneously draining resources from the VA.” In the end, he predicts, veterans will be left “with fewer options, a severely weakened VA, and a private healthcare system not designed to meet the complex requirements of high-need veterans.”

Shulkin describes himself as neither “pro-privatization or anti-privatization,” but “simply pro-veteran.” Unfortunately, he helped provide useful political cover for Trump, because of his own personal ambition and penchant for “working more closely with the private sector.” On Shulkin’s watch, the percentage of the VA’s nine million patients who received some care outside of it increased from 19 to 36 percent, he proudly reports.

At the same time, he promoted the VA MISSION Act of 2018, which replaced the Veterans Access, Choice and Accountability Act. It was sold as a temporary, emergency measure to reduce VA appointment wait times and give veterans with too long a drive to the nearest VA facility the option of getting private care. In fact, it was part of a broader effort to fully privatize the VA over time.

Shulkin’s memoir suggests that he understood that. He describes lobbying against a proposal by Republican Senator Jerry Moran that would have enabled veterans “to visit a VA facility or a facility in the private sector whenever he or she wanted.” Shulkin told Trump that the approach favored by Moran “would put the VA system at risk of harm by diluting its delivery capabilities and cost the U.S. Treasury billions more each year.”

In response, Trump got Pete Hegseth, former CVA director and one of his favorite Fox News commentators, on the speakerphone. “We want to have full choice where veterans can go wherever they want for care,” Hegseth told the president.

As Shulkin notes, Hegseth had “never worked at the VA, knew nothing about managing a healthcare system and had little understanding of the clinical and financial impact of the policies he was advocating.”

Meanwhile, the VA secretary’s critical relationship with Perlmutter was fraying. To educate Trump’s billionaire friend about the VA, Shulkin took him on a tour of the veterans’ hospital in West Palm Beach. It was Perlmutter’s first ever visit to a VA facility. As he roamed the halls, he would ask patients: “Do you like it here? What don’t you like? What complaints do you have?”

When they gave positive feedback, Shulkin reports, Perlmetter seemed surprised: “Come on, tell me the truth,” he would reply. “I got the distinct sense,” Shulkin writes, “that Ike was perplexed to see the VA working so well.”

But when Perlmutter and two other Mar-a-Lago Club members flew to Washington for a White House meeting with Jared Kushner on the future of the VA, Shulkin was not invited. “The president is not happy with you,” Perlmutter informed him.

News reports at the time that Shulkin, his wife, several aides, and a security detail misused tax-payer funds on a work-related trip to Europe led to an investigation by the Inspector General, which further undermined his standing with Trump. (The author devotes many pages to rebutting the IG’s report, recasting the whole episode as an attempt by his political foes to frame him.)

They seem to have succeeded. Since Shulkin was fired in March 2018, his successor, Robert Wilkie, has favored the CVA approach. For instance, the VA’s new outsourcing rules allow wide access to private care without proper clinical criteria—the sort Shulkin says he would have demanded. “The blood drained from my face when I read the details,” Shulkin writes. “Access standards like this would provide millions of veterans with the ability to get care in the private sector and lead to the rapid dismantling of the current VA system.”

Shulkin does perform several public services in his new memoir. As he did in a New York Times op-ed piece after his firing, he exposes “the toxic and dysfunctional political environment” in Washington after Obama left office. He also applauds the many innovative and successful VA programs—which were developed prior to his government service— when he was running private hospitals and, by his own admission, knew little about treating veterans. (These VA “best practices” are showcased in a 2017 book called Best Care Everywhere, co-edited by Shulkin himself and published by the Government Printing Office.)

Despite the White House’s abominable treatment of him, Shulkin remains surprisingly eager to absolve Trump and his Mar-a-Lago cronies. In very unconvincing fashion, Shulkin claims that the president was “largely unaware of his political appointees’ scheming” and “does not realize the long-term implications” of the damage they’ve done to the VA.

In a chapter entitled “Getting It Right for Veterans,” the most criticism Shulkin can muster is this observation: “when you bring a chief financial officer’s or real estate mogul’s mind set into human services, you immediately face a contradiction.” Therefore, he proposes that the VA instead be given a new non-partisan governance structure, without anyone chosen because of their ideological orientation or commitment to anyone or anything beyond the best interests of veterans.

In his view, the VA should “remain a government entity,” but with “its own board composed of healthcare experts, veterans, and business leaders.” They should all have a fixed term of office of at least four years or more, he argues, to ensure a continuity of leadership.

Such proposals, however, didn’t even gain traction when recommended by members of a 2016 commission created under Obama. The most urgent task facing friends of the VA today—be they members of  Congress, veterans’ organizations, or care-givers—is to assist with whatever damage control they can during the remainder of the Trump presidency.

That includes resisting what Shulkin calls the “narrow and aggressive anti-government ideology” of those who will continue to call the shots at our second largest federal agency. At least until January 2021.

Suzanne Gordon and Steve Early

Suzanne Gordon is the author of Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans. Steve Early is a longtime labor journalist and union activist. They are collaborating on a book about veterans’ affairs and can be reached at Lsupport@aol.com