Allowing systemic problems at the Department of Veterans Affairs to persist could ultimately put the entire country at risk, according to VA Secretary David Shulkin.
“I think both the president and I believe not only have veterans earned this, but this is actually a matter of national security,” Shulkin told the Washington Examiner in an interview this week. “If we have a system that, when people are deciding if they want to serve their country, that they don’t believe that when they get home, they have a system that’s going to take care of them that they can rely upon, the approach towards having a voluntary Army and people who want to come and protect the country is at risk, and I think we have seen some recent reports that it’s getting tougher to meet recruitment standards.”
The VA secretary, whose efforts to transform the agency have earned him a spot in President Trump’s good graces, said a reflection on the VA’s failures is the first step toward fixing a department Trump has called a “disaster.”
Under Trump’s predecessor, the VA suffered through a series of controversies ranging from filthy conditions at some of its hospitals to VA workers who wrongly declared living veterans dead and stripped them of their benefits.
But the biggest scandal to strike the agency came in 2014, when whistleblowers revealed a nationwide scheme to conceal long delays in healthcare by using fake patient waiting lists. The fallout from the wait time controversy led to the resignation of then-VA Secretary Eric Shinseki and to a number of changes in the way VA officials manage and report wait times.
Trump made the VA a top target during the presidential race, holding up its failures as evidence of the Obama administration’s broader ineptitude.
Shulkin, who has worked at some level of the VA since June 2015, said he agrees with Trump’s criticism of the agency he now oversees.
“People say, ‘Well, you know, he’s been so critical of the VA.’ Well, you know, I actually think that’s a good thing,” Shulkin said of Trump’s past comments. “When you’re the boss, you get to hold up a mirror and tell people where the problems are and if you don’t do it, then the rest of the organization doesn’t really have a chance to respond.”
Although Shulkin served for more than a year as undersecretary for health in former President Barack Obama’s VA, he said his ascension to the top of the organization has given him a chance to “reboot” an agency in need of an overhaul.
“I had a very different experience under the last administration. I came in in the last 18 months of an eight-year administration that pretty much had a certain way of doing things and I wasn’t in the role of secretary,” he said. “They all have different management styles, they all have different ways of accomplishing things, so I don’t, I really don’t have criticism of the last administration.”
Shulkin has stood out in the Trump administration as one of the president’s favored Cabinet officials.
In public appearances, Trump has repeatedly touted the unanimous Senate vote that confirmed Shulkin to his position in February.
And Trump has cited reforms at the VA as a bright spot amid the stagnation of his legislative agenda and the delay of his immigration executive orders by the courts.
While Shulkin’s disciplined and apolitical approach to his post is seemingly an odd match for Trump’s brash style, the VA secretary said he works well with Trump because they have professional chemistry.
“I think that for me, it’s just a good management style fit,” Shulkin said. “When we’re together, he’s very candid, he’s very inquisitive, he understands the issues very well, and we are able to have direct conversations. It’s not a lot of formality. I mean, it’s — I appreciate that, and it helps me in performing my job better.”
Shulkin said one of his top priorities since taking the helm at VA has been to shift more of the agency’s resources into providing services unique to veterans — such as treatments for post-traumatic stress disorder and traumatic brain injuries — and away from services veterans can easily obtain from private doctors.
“They don’t need us to do things that can be done well in the community, like making eye glasses. They need eye glasses, but it doesn’t mean the VA always has to be the one to do that. Every shopping mall in America has a place you can get eyeglasses,” Shulkin said. “But for those issues that, frankly, aren’t done well in the private sector, that are important to veterans, we need to do those well. So I’m asking my medical centers to actually move more money into those services — that it’s one thing when you say they’re important, it’s another where you watch where the money goes.”
Shulkin blamed the VA’s past efforts to provide all aspects of care to all veterans for some of the agency’s failings over the past several years, such as the long wait times patients faced and the resource shortfalls that some facilities have encountered. As a result, Shulkin said, his strategy has focused on expanding veterans’ access to care in the private sector to supplement what they receive directly from the VA.
“I think, if anything, the wait time crisis in 2014 taught us that VA cannot do this alone,” he said. “You cannot take care of the health needs of every nook and cranny in this country by VA doing this alone, and so this is probably a strategy that tries to make actually a common sense approach to meeting the needs of veterans, and it doesn’t fit into the political spectrums.”
Shulkin has long resisted suggestions that his effort to expand veterans' access to private sector care means he aims to privatize the VA. Privatization fears have long underpinned resistance to the expansion of programs that allow veterans to seek treatment outside the agency.
The VA secretary said his plan will ideally let veterans choose a combination of private and public services.
"I have come out pretty clear that I am not in favor of privatization. I think that would be a huge mistake for the country to do that, and particularly for veterans, but that doesn’t mean that we need to stick to the status quo," Shulkin said. "You know, some people say, ‘Oh, you must be privatizing!’ or ‘You must be ignoring the private sector!’ This is saying, ‘No, we’re going to pick what’s right for veterans.’"