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After several weeks of anxiety and ambiguity at the Department of Veterans Affairs, President Donald Trump this week fired embattled but unflagging VA Secretary David Shulkin.
And now Shulkin, a physician and former public hospital administrator, is firing back.
In a New York Times op-ed published just a day after his dismissal, Shulkin didn’t criticize the president by name, but he bluntly described the “toxic” Trump political appointees who he said pushed him out of the job.
Shulkin said these appointees, with whom he clashed regularly while running the agency in charge of veterans’ healthcare, were motivated by their own agendas rather than showing any genuine concern for veterans.
Trump’s replacement for Shulkin, pending Senate approval, is Navy Rear Adm. Ronny Jackson, Trump’s appointed White House physician, who’s respected but has little management experience.
Jackson generated headlines and late-night comedy monologues after describing the president after his annual physical exam in January as someone with “incredibly good genes.”
Trump named Robert Wilkie, the Pentagon’s current undersecretary of defense for personnel and readiness, as the interim VA secretary.
Shulkin, who throughout his tenure at VA enjoyed support from members of Congress on both sides of the aisle and from virtually all of America’s largest veterans service organizations, wrote in the Times that he was enmeshed in a “brutal power struggle” against efforts to privatize veterans’ healthcare.
“The advocates within the administration for privatizing VA health services… saw me as an obstacle to privatization who had to be removed,” Shulkin wrote. “That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”
In an interview with Healthline on Friday, Shulkin reiterated what he had written this week.
“The success of the VA during my tenure has been the alignment of interests between veteran groups, both sides of the aisle in Congress, and the administration,” Shulkin said. “However, some political appointees who are pushing for a more aggressive shift to the private sector have challenged this alignment.”
Two weeks ago, in an exclusive interview with Healthline, Shulkin said that while more public-private partnerships are a good idea for veterans, the kind of sweeping privatization of veterans’ healthcare preferred by Trump and those in his inner circle would simply not work.
“It would be a disaster,” Shulkin said.
He cited several recent studies, including a RAND Corporation report titled “Ready or Not?” in which researchers looked at whether private sector health professionals in New York state had the capacity and readiness to address the needs of the state’s 800,000 veterans.
Such patients, the study explained, are on average older, sicker, poorer, and have specific physical as well as emotional issues that are far more complex than the ordinary civilian sector patient.
The study concluded that only 2 percent of New York’s providers met RAND’s “final definition as ready to provide timely and quality care to veterans in the community.”
Travel controversy hounds Shulkin
Shulkin was scrutinized intensely after a VA inspector general found that he improperly accepted Wimbledon tickets and taxpayer-funded airfare for his wife for a Europe trip last summer.
In the Healthline interview two weeks ago, Shulkin apologized for the incidents but insisted that he did nothing wrong and didn’t commit any ethical violations.
This week, in his first media interview since that Healthline conversation, Shulkin told NPR, “There was nothing improper about this trip, and I was not allowed to put up an official statement or to even respond to this by the White House... I think this was really just being used in a political context to try to make sure that I wasn’t as effective as a leader moving forward.”
Shulkin added that the controversies that vexed him during his tenure at VA were “completely mischaracterized.”
Shulkin told NPR that the trip’s expenses were approved in advance by an internal ethics committee and that when the inspector general later didn’t like the expenditures, Shulkin wrote a check to the government.
“No one’s ever mentioned what the purpose of this trip was,” he said. “This was the five allies conference, a trip that the VA secretary has participated in for 43 years with major allies. We had over 40 hours of direct meetings. I gave three separate lectures. This is our one forum where we share how to care for our veterans among all of our allies.”
“This was being characterized as a European vacation, it was far from that,” he added. “I went out, never used government money for that. The single expenditure spent was on a coach airfare for my wife who was officially invited. Everything was preapproved by our ethics committee. When the inspector general didn’t like the way that my staff had handled the approval, I wrote a check back to the government.”
Shulkin enjoyed support… until he was fired
Despite the controversies, several prominent members of Congress on both sides of the aisle remained in Shulkin’s favor.
Rep. Phil Roe, the Tennessee Republican who chairs the House Veterans’ Affairs Committee, voiced his support this week for Shulkin.
“I have enjoyed getting to know Secretary Shulkin, and I’m glad to call David a friend,” Roe said in a statement. “I think he’s done a fantastic job and I hate to see him go. That said, I respect President Trump’s decision, support the president’s agenda, and remain willing to work with anyone committed to doing the right thing on behalf of our nation’s veterans.”
Sen. Jon Tester, the Democrat from Montana who’s the ranking member of the Senate Committee on Veterans’ Affairs, said in a statement that Shulkin had made real progress in “improving the VA’s delivery of healthcare and benefits to our veterans,” and he looks forward to “seeing if [Jackson] is up for the job.”
Most of the nation’s largest veterans service organizations — such as The American Legion, Veterans of Foreign Wars, Disabled American Veterans, AMVETS, Vietnam Veterans of America, and Paralyzed Veterans of America — stuck by Shulkin throughout his turbulent 13 months running the VA and didn’t want to see him dismissed.
Officials at the Paralyzed Veterans of America said this week that the organization is “deeply disappointed” by Shulkin’s removal.
“Given the vacuum that already exists in the senior leadership positions at the VA, this decision will only exacerbate the challenges VA faces as it works to implement meaningful reforms. We look forward to understanding more about the qualifications of Admiral Ronny L. Jackson, MD, to helm the VA during this critical time,” the organization stated in a press release.
The organization noted that under Shulkin’s leadership, “We have seen reform in VA healthcare, sorely needed improvements in the benefits and claims appeals process, and real accountability of the workforce. Veterans owe Dr. Shulkin a debt of gratitude for his service to this country while leading the VA.”
Joe Chenelly, national executive director of AMVETS, said in a statement, “We are disappointed and already quite concerned about this nominee [Jackson]. The administration needs to be ready to prove that he’s qualified to run such a massive agency, a $200 billion bureaucracy.”
Officials at the Disabled American Veterans said in a statement this week that the organization is “extremely concerned about the existing leadership vacuum in VA. At a time of critical negotiations over the future of veterans’ healthcare reform, VA today has no secretary, no undersecretary of health, and the named acting secretary has no background in healthcare and no apparent experience working in or with the department.”
Not everyone sorry to see Shulkin go
Rep. Mike Coffman (R-Colo.), a Marine Corps veteran, said in a statement that Shulkin “did nothing to clean up the culture of bureaucratic incompetence that he has defined the leadership at the VA.”
Concerned Veterans for America, a conservative group funded by the billionaire Koch Brothers, was clearly pleased with Shulkin’s removal.
“We are hopeful that this change will end the recent distractions at the VA and put the focus back on advancing policy that will ensure veterans get the healthcare and other benefits they have earned,” the organization said in a statement.
Veterans advocate says firing is a mistake
Robert Walsh, a longtime veterans advocate and attorney for veterans who have a disability claim at the VA, said the move to fire Shulkin is a bad sign.
“Dr. Shulkin was brought in to run the VA health system. He was then and remains an authority on large healthcare networks,” Walsh told Healthline. “A lot of changes need to be made to the pathetic VA benefits claims system, but total privatization will not serve the special patient populations served by the VA.”
According to Walsh, veterans with traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and amputees can’t be properly served by the private sector healthcare system in the United States.
“They cannot and will not,” Walsh said. “They will be ignored to death by the money-grubbing bean counters in the private sector.”
Senator and combat vet upset with firing
Sen. Tammy Duckworth (D-Ill.), agrees.
Duckworth, a veteran who lost both her legs while flying her helicopter on a combat mission in Iraq, is former assistant secretary at the VA.
She said she has deep concerns about the firing.
“Good leaders see problems and try to solve them. Donald Trump sees problems and makes them worse. By once again choosing chaos over consistent leadership, Donald Trump is hurting veterans around the country,” Duckworth said in a statement provided to Healthline.
Duckworth added, “Unlike so many Trump appointees, Secretary Shulkin was qualified and prepared for the job he was selected for: leading the largest integrated healthcare system in the United States and overseeing the administration of benefits to our veterans and their family members.”
Duckworth acknowledged that Shulkin “made mistakes, for which he has publicly apologized, but he also demonstrated his commitment to our veterans and to improving the quality of VA services, which is more than I can say about the president or the privatization extremists who pushed Dr. Shulkin out.”
Duckworth said that over the coming weeks, she’ll carefully review Jackson’s qualifications “to determine whether he has the best interests of our veterans at heart or whether he, like many in the Trump administration, wants to push VA down the dangerous path of privatization.”
Duckworth said the next VA secretary must be able to protect the department from becoming consumed by partisan politics.
“I hope Dr. Jackson is someone who is willing and able to do that by continuing the important tradition of VA secretaries working in a bipartisan manner,” she said.
Predicting the future of VA under Trump
Thomas Bandzul, a veteran and legislative counsel for Veterans and Military Families for Progress, has spoken many times before Congress on behalf of veterans.
He said he’s heard from several people this week who have inside knowledge of what Trump intends to do with veterans’ healthcare.
“I think the administration will be handed a huge budget from the next secretary, whoever that may be, and whatever did not get privatized in the next 8 to 10 months will be after that budget request,” Bandzul told Healthline.
“VA disability benefits, healthcare, education, and all other aspect will be done away with as a cost-savings measure. Future veterans will be given checks, depending on their time in service and rank, if they’ve been in combat, what other achievements they’ve accomplished, and be told they are on their own. The end of VA,” Bandzul added.
The general consensus, Bandzul said, “is that this firing is a political move so the friends of the people inside this administration can profit by outsourcing healthcare, and most likely all other aspects of the VA, to privately funded, for-profit organizations.”
Bandzul said this will translate into “no services for our veterans and no future helping our disabled, and people in the private sector will become very wealthy. It is my guess that disability claims processing will disappear and a new, ‘Well, you knew what might happen to you if you went into the military’ philosophy will encompass all aspects of veterans’ benefits.”
Bandzul said new disability claims from veterans will be suspended from consideration in the near future, until a new board can be empaneled to review the claims process.
“This most likely will result in fewer or even no claims being paid going forward for an indeterminate time frame,” he said. “I am sad this has taken place, and while this is a snap judgement of the situation, I believe all this will become clearer and clearer in the days, weeks, and months ahead.”
Shulkin wishes his likely successor well
Meanwhile, on CNN’s “Anderson Cooper 360” Thursday night, Shulkin reiterated that the privatization debate brought him down.
“There were some political appointees within my administration that didn’t see it that way and really wanted us to take a much harder stance toward privatization,” Shulkin said. “I wasn’t willing to do that. I don’t think that’s the right thing for veterans, and I stood up against them.”
Shulkin also had kind words and a bit of advice for his likely successor.
“I also know Dr. Jackson. He’s a friend of mine. I have considerable respect for him,” Shulkin told Cooper. “I will do everything that I can to help Dr. Jackson succeed in this position.”
Shulkin said Jackson’s job won’t be an easy one.
“This is a tough position. There are 375,000 employees and a budget of close to $200 billion next year. It is going to be a challenge for anyone to take [this job],” he said. “I have confidence that Dr. Jackson is a person who is honorable and cares about our veterans.”