Denis McDonough’s Last Chance to Fix the Department of Veterans Affairs

The slow march to the privatization of veterans’ care began on McDonough’s watch. As Biden’s VA Secretary, can he turn back the clock?

In early 2014, CNN became feverishly and foolishly obsessed with one thing: Malaysia Airlines Flight MH370. The network’s droning coverage of this plane was mocked not only by reputable journalists and the public but even by President Barack Obama. During the 2014 White House Correspondents Dinner, Obama joked, “I am happy to be here, even though I am a little jet-lagged from my trip to Malaysia — the lengths we have to go to get CNN coverage these days.” As the ballroom exploded in laughter, Obama took another jab at CNN President Jeff Zucker and other network big wigs in attendance, suggesting that “they’re still searching for their table.”

One month after that dinner, CNN aired a story that precipitated one of the most damaging if under-appreciated scandals of Obama’s presidency. The bombshell report — dramatically titled “A Fatal Wait” — dug deep into the Veterans Affairs (VA) hospital in Phoenix, Arizona, where staff were logging inaccurate scheduling data in order to cover up wait times for care that averaged about three months.

The story — which got primetime treatment as part of Anderson Cooper’s recurring “Keeping Them Honest” segment — essentially picked up and repackaged previous reporting. Yet CNN injected a lot of heart into the piece by focusing on the tragic story of a 71-year-old Navy veteran who died while waiting for care.

The behavior uncovered inside Phoenix was unethical and dishonest, but it was far from the scandal CNN hyped it up to be. Left out of the report was a tragic but vital truth: people die all the time while waiting for health care. Some die while waiting for lifesaving procedures, others pass waiting for routine dentist appointments. The point is this: correlation doesn’t equal causation.

Another critical point: tens of thousands of civilians die annually because they have no health coverage at all. The VA which, by contrast, offers free, high-quality healthcare to millions of veterans, is in fact a paragon of a humane healthcare system.

Rather than put the scandal into the proper context, CNN gave it The Malaysian Treatment™. Pundits directly tied long wait times to veteran deaths. They also parroted thinly sourced claims from right-wing lawmakers, including that VA misdeeds were responsible for 1,000 veteran deaths. (Even if this were true, studies have estimated that as many as 250,000 Americans — and probably even more —die every year due to preventable medical errors. Deaths from preventable medical errors are the third leading cause of death in the U.S.)

The implication of CNN’s story went unsaid but was clear: Obama had veterans’ blood on his hands. It was quickly picked up by outlets across the political spectrum from Fox News to The Daily Show. Soon enough, the right-wing outrage machine — then piloted by savvy Tea Partiers — revved into high gear. The Koch-backed group Concerned Veterans of America (CVA) launched an aggressive campaign against Obama, beginning with a protest in Phoenix that drew 150 people. In short order, lawmakers called hearings and pointed fingers squarely at 1600 Pennsylvania Avenue.

Amid all this noise, CNN patted itself quite vigorously on the back. “The criticism of CNN is silly, about the planes,” one CNN producer argued to Politico. “The reality is we can walk and chew gum at the same time, we can do the plane, we can also do [VA reporting] and do both exceedingly well.”

As the scandal hit its boiling point, Obama deployed his camera-shy chief of staff, Denis McDonough, for an interview in enemy territory. McDonough went toe-to-toe with Jake Tapper, a long-time champion of vets who was clearly pissed off during the discussion. At one point, Tapper sarcastically asked McDonough “how many dead veterans” were required in order for Obama to take action.

Tapper more credibly contended that Obama had repeatedly “ignored” warning signs and brushed off calls to reenforce the VA. (U.S. Senators Bernie Sanders and Patty Murray, among others, had long warned of increasing strain on the VA system and put forth good legislative proposals to fix the problem.)

McDonough seemed nervous during the interview, and he sometimes struggled to get out his words. Yet he showed flashes of fierceness and effectively refuted Tapper’s more bogus charges. He offered a strong defense of then-VA Secretary Shinseki, who was under heavy fire and worked to properly contextualize the situation. McDonough noted, for instance, that Shinseki had secured big VA budgets, shrunk the massive claims backlog, and expanded the G.I. Bill. He also made two key points:

1.) Wait times were long due to Shinseki’s recently hailed decision to open up VA care for far more veterans.

2.) The books were being cooked in reaction to then-VA Under Secretary for Health Robert Petzel’s wildly unrealistic metric that every veteran be seen within 14 days of contacting the VA.

Unsaid by McDonough in this interview were other critical facts, including that the VA’s wait times have long been comparable (and often better) than the private sector. He also should have pointed out that the VA generally outperforms the private sector on quality metrics.

“We’re not going to get involved in any political games,” McDonough promised Tapper at one point. “We’re going to get the job done.”

Yet over the following weeks, Democrats were bullied into ditching Shinseki and supporting a totally dysfunctional privatization law: the VA Choice Act. It threw just $5 billion at the root of the problem: staff shortages. A whopping $10 billion went into outsourcing care to the private sector. In the end, dubious contractors got rich, veterans faced new problems, and the VA — long one of the most popular and progressive agencies in American government — saw its standing permanently sink.

The left also took a big political hit. In November 2014, Democrats lost the Senate, in large part due to political attacks about the VA made from the right. One of the candidates who most successfully weaponized the Phoenix scandal was then-U.S. Representative Tom Cotton, who won an Arkansas Senate Seat after accusing his opponent, incumbent Democrat Mark Pryor, of offering “silence” in response to the long wait-times.

On Wedensday, McDonough will again face the heat in confirmation hearings to be President Joe Biden’s VA Secretary. Should he secure the role, he’ll face a department deeply damaged following six years of direct attacks. The most critical questions as he gears up for the job revolve around what he learned from the past and how he’ll respond to inevitable efforts by Republicans to again squeeze scandal out of the VA.

Either he’ll buckle and again make concessions to the right in hopes of squelching their smears, or he’ll push back on these attacks, protect the department, and powerfully demonstrate that the VA is government at its best.

McDonough would be only the second civilian to run the VA. His non-military background initially irritated some veterans’ advocates, though many have since warmed to the soon-to-be secretary. A notable holdout is Paul Rieckhoff, the blustery founder of Iraq and Afghanistan Veterans of America (IAVA), who called McDonough a “wildly out-of-touch choice.”

What Rieckhoff doesn’t understand is that one’s veteran status doesn’t automatically confer loyalty to those who’ve served. VA Secretary Robert Wilkie, after all, worked to discredit a fellow Navy veteran after she was sexually assaulted at the Washington D.C. VA. Wilkie has also defended the Confederacy, improperly dosed VA patients with hydroxychloroquine, and enacted Trump’s cruel ban on transgender service members.

McDonough’s record is far from perfect, and his lack of experience running a large health system or government agency is cause for concern. But he’s proven beyond a doubt that he cares for those who’ve served.

His grandfather served in the Marines and his wife, Kari, is co-founder and president of Vets Community Connections, a San Diego-based non-profit that offers transitional support to veteran and military families. In a recent op-ed, McDonough relayed these details and also wrote fondly of his High School football coach, Joe Samuelson, an early mentor who also stormed the beaches of Normandy. “When he was in hospice at the end of his life, he and his family were grateful for the compassion of VA staff,” McDonough wrote. “When he passed, his wife gave me his coaching jacket — one of my most prized possessions.”

McDonough also knows better than most that the job of VA Secretary will entail constant migraine-inducing scrutiny. His willingness to confront these conditions is, in itself, evidence of his dedication to the cause. (Rumor has it that the perfect candidate for the job — Tammy Duckworth — knew the role of VA Secretary would hurt her political prospects and bowed out. My guess is Pete Buttigieg did the same.)

McDonough’s dedication to veterans also appears to be a form of penance for his pivotal role in launching the Forever Wars.

Hours after the Twin Towers fell, McDonough called the White House on behalf of his then-boss, Senate Majority Leader Tom Daschle, and asked what he could do to help. McDonough subsequently shepherded along the 2001 Authorization for the Use of Force Against Terrorists, which gave President George W. Bush the legal power to launch the war in Afghanistan. He also played a key role in drafting the 2002 Senate resolution authorizing the Iraq invasion. Per numerous sources, including The Gatekeepers: How the White House Chiefs of Staff Define Every Presidency, McDonough’s swift action to enable Bush’s warmongering has long haunted him.

By 2004, Daschle had also become tormented by this work, serving as one of the earliest and most outspoken Congressional skeptics of the war. That year, he became the first Senate leader in half a century to be voted out of office after facing attacks that he didn’t support the troops.

By 2007, when McDonough became then-Senator Obama’s foreign policy advisor, he seemed opposed to the War in Iraq. Though he was surely also aware that such opposition, if messaged incorrectly, could result in political failure.

After Obama won his historic 2008 election for president, largely on the bold if ill-defined promise of pulling out of the Middle East, McDonough landed a seat on the National Security Council. In this role, he made a point of visiting Iraq and Afghanistan regularly to hear from the troops.

There’s not a whole lot of great reporting on McDonough’s detailed foreign policy worldview. But it’s clear that he and Obama shared a mind meld, so it seems fair to connect the former president’s deeply mixed war record to McDonough.

In January 2013, McDonough became Obama’s chief of staff, where he earned the reputation as a “fixer.” A massive problem came in the 2014 Phoenix scandal, which, as stated above, saw lawmakers openly casting Obama as an enemy of veterans and the VA as an agency broken beyond repair. Sen. Jerry Moran, a Koch-backed Republican from Kansas who today chairs the Senate’s Veteran Affairs Committee, was one of the most bellicose in this rhetoric, claiming, for instance, that the VA was beset by a “bureaucratic culture of mediocrity.”

Shortly after McDonough took Tapper’s slings and arrows, he dispatched his deputy, Rob Nabors, to the VA to figure out what went wrong. Nabors didn’t seem to know much about the VA when he entered it. This naiveté, mixed with the boiling crisis, turned Nabors into a hammer who saw everything as a nail. “He was not a gift to the VA,” one former agency official told me.

Shortly after touching down, Nabors issued a report alleging that the VA was wracked by a “corrosive culture.” It made additional accusations, some more legitimate than others, and offered some decent recommendations, chiefly that the VA needed to hire and train additional doctors, nurses, and other clinical staff to decrease wait times. Yet this vital suggestion was all but ignored. “Nabors’ report was superficial and meant to make the problem go away,” said a former senior VA official, who more broadly described Obama’s post-Phoenix moves as “eye wash.”

In addition to commissioning the Nabors report, the White House also pushed out a number of senior VA officials to give the impression of a shakeup. Unfortunately, many of those let go would have proven critical allies in improving the VA.

The first head to roll was Shinseki, who had enjoyed a sterling reputation among lawmakers and veterans’ groups up until CNN aired their report. Bob Jesse, a brilliant doctor and the Principal Deputy Undersecretary for Health was also unceremoniously pushed out. This move greatly wounded Jesse, a 30-year employee of the department. (After Jesse died from cancer in 2017, someone at his funeral honored his request and read the Rudyard Kipling poem “If,” which begins: “If you can keep your head when all about you are losing theirs and blaming it on you…”)

Shinseki was replaced by Bob McDonald, an Army veteran and long-time CEO of Proctor & Gamble. McDonald brought on Nabors to be his Chief of Staff, replacing Joe Riojas, who was also highly respected inside the VA.

McDonald took a lot of heat and wasn’t able to fix many underlying issues, in part because Congress’ interest in veterans issues did not include allocating needed funds to hire more in-house staff. McDonald managed to make real headway in reducing veterans homelessness. He also did good work to rehabilitate the agency’s image as a welcoming place, most famously by giving out his phone number to vets in crisis.

The most consequential reform from Phoenix was the VA Choice Act, which McDonough shepherded through Congress. The scope of the bill had been hotly contested between the chairmen of the House and Senate VA committees: a right-winger named Jeff Miller and Bernie Sanders, a democratic socialist. Miller wanted to outsource care to the private sector and make it easier to fire employees. Sanders wanted to keep job protections in place and hire more doctors and other staff.

In the end, Miller won, largely because he ran a highly effective messaging effort on Capitol Hill and in the media, which amplified the Koch’s narrative of a VA broken beyond repair. (Sanders, for his part, had no dedicated press staff and got little help from the White House.)

While Obama had never rigorously defended the VA’s many successes, on August 7, 2014, the president excitedly signed Choice, telling an audience of veterans’ advocates that “as long as I hold this office, we’re going to spend each and every day working to do right by you and your families.” Choice went on to create massive headaches for the VA and veteran patients, all the while outsourcings tens of millions of appointments to the private sector. (While Sanders secured a few billion in the law to bring on more medical staff, an NPR investigation later found the VA bungled these hiring efforts.)

In ratifying Choice, Obama put the nail in the coffin of the punishing Phoenix news cycle. Yet just two weeks after he signed Choice, a report from the VA’s Office of Inspector General completely undermined the key claim of the entire scandal. “We are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans,” the watchdog concluded.

On paper, McDonough is an uncontroversial pick to lead the VA. He had zero dubious investments when he entered Obama’s White House, and he didn’t sell out after leaving it. Instead, he taught at Notre Dame and became a senior principal inside the relatively benign Markle Foundation.

I’m not sure of his current investment portfolio, but I doubt he’ll face heat unless he’s actively invested in companies profiting from VA privatization. I also doubt Senate Democrats will criticize him during his confirmation hearings for his work passing Choice or on any other matter. McDonough may, however, face barbs from some Republicans over his alleged involvement in Obama-era efforts to spy on Trump’s 2016 campaign.

As he approaches these hearings, McDonough is clearly working hard to curry favor with veterans’ service organizations in the hope that they’ll endorse his bid and smooth his path to VA headquarters. So far, he’s earned respect from a diverse array of advocates, including Joe Chenelly, the Executive Director of AMVETS, who was initially quite skeptical.

“He’s putting in a lot of effort to convey the message that he understands our concerns, and he’s going to work his butt off to answer those concerns,” Chenelly told me. “He’s not asking us to trust him right off the bat. He’s pledged to earn that.”

McDonough has so far been mum on his specific policy priorities. Among the major unanswered questions I have are: Will McDonough use his power as Secretary to reel back the outsourcing blitz made possible by the 2018 VA Mission Act? Does he plan to reinstate union rights revoked under Trump? Will he again allow the American Legion and other groups to review and assist with veterans’ disability claims?

McDonough faces a plethora of major challenges on the horizon, including a backlog of pending VA retaliation cases inside the Merit Systems Protections Board that Republicans could easily weaponize to denigrate the department. “The defendant on all the pending retaliation claims is going to change from ‘Robert Wilkie’ to ‘Denis McDonough,’” one former VA official reflected. “That’s not a fun place for Team Biden to be in. It’s going to be a blood bath.”

Maybe McDonough can swiftly use his crisis management skills to skillfully evade blame for this mess and others Trump has left him. But maybe not. “I don’t know that he fully appreciates what he’s stepping into,” this former VA official said.

McDonough is no doubt whip-smart and approaches problems with the same highly analytical approach as Obama. Yet, he’s generally described as cautious, believing not in progressive leadership but “incrementalism.” “I see McDonough as a VA secretary chosen to enforce discipline and keep a lid on things,” one source told me. “He’s risk-averse, he prefers hierarchical control. That doesn’t create a positive, transformational environment.”

Another source noted that “he seems more of an Affordable Care Act guy than a Medicare for All guy, and certainly won’t see the VA as a model for a future all-payer, all provider National Health Service-like organization.”

McDonough may not fully be on board with universal care, but, like it or not, he’ll soon be running a socialized system. The VA is a progressive agency, and it must be run like one. If McDonough declines to push this system forward meaningfully or continues to welcome in the private sector to cannibalize its budget, he will not only hurt its standing among veterans but also do a real disservice to the growing momentum for Medicare for All.

One concrete pledge McDonough has made is to bring in other agencies to supplement the VA’s work of assisting veterans. But he must also realize that other agencies can learn from the VA, a truth exemplified by another Obama scandal McDonough was tied up in the 2013 Obamacare website debacle.

“The Veterans Health Administration has effectively established massive health networks across the country and long dealt with fee-for-care providers, yet none of that expertise was brought to bear by the Obama administration behind the scenes,” one source recalled of the bungled rollout. “That stands in stark contrast with George W. Bush, who, in his expansion of Medicare Part D, looked for expertise in many other departments, including the VA, which he brought in for its many consultative benefits.”

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Jasper Craven

Jasper Craven is a freelance investigative reporter covering the military and veterans. This article originally appeared in his Substack publication, Battle Borne.