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He Runs VA. He Soothes Trump. He Is: The Most Interesting Doctor In The World

By most accounts, Dr. David J. Shulkin, the secretary of veterans affairs, is a reasonable man thrust into an impossible situation.

His job is to reform an overburdened medical system — one with a quirky bureaucratic culture all its own — while bolstering a scandal-racked department regularly used as a punching bag by a do-nothing Congress, in the employ of a mercurial president with no prior experience in government.

“Every day I’m being asked to do things that are firsts for me,” Shulkin told Task & Purpose in an exclusive sit-down interview this month in his office at VA headquarters, overlooking the White House. “Challenging myself to step outside my comfort boundaries is clearly part of the job description.”

Add to those heavy responsibilities his obvious enthusiasm and knack for media appearances, and it’s easy to see why almost everyone in Washington loves Shulkin right now.

For President Donald Trump — a man in over his head in the hardest job of his life, assailed by critics, criminal investigators, and the occasional Gold Star family — Shulkin offers a lifeline: Fund me, listen to my ideas, and you can be seen as a commander-in-chief who really cares about American veterans.

To mainstream Republicans, Shulkin is a soft-spoken steward of good governance, pushing GOP priorities like greater firing power over union workers; privatization of services that the government executes ponderously; and rich praise for the American uniformed service member.

To Democrats, Shulkin is a rare qualified actor in the Trump government, an Obama administration holdover with deep technical knowledge, who’s willing to work with stakeholders in the community he serves — and to push back against the president and his party in ways that few in Trump’s entourage have managed with any job security.

“I do not want people to believe that we are saying that we want to listen to your feedback, and then ignoring it.”

Shulkin has demonstrated an adeptness at the political games that many of his Trump administration colleagues struggle with, and he does it with aplomb. He doesn’t make everyone happy all of the time, but his management of unhappy campers shows unusual tact. He stays in constant contact with the nation’s major veterans service organizations like the American Legion, VFW, and Disabled American Veterans, including them in policy deliberations and apologizing when they feel excluded.

It’s a delicate, occasionally manipulative relationship all around: Beltway politics as usual. But in 2017, in this administration, that’s pretty damned unusual. And it’s made veterans, pols, and news-consumers alike see Shulkin as a vessel for their biggest hopes and nagging fears. After all, Trump could have chosen another lightly experienced ideological flamethrower to run VA — like Sarah Palin, as was rumored late last year. Instead, they got an affable Obama-era technocrat who was confirmed unanimously in the Senate — Trump’s only uncontested cabinet nominee. (A framed 100-to-0 Senate roll call sheet hangs in Shulkin’s office.)

“Everyone has their issues with Shulkin,” one D.C.-based policy coordinator for a major VSO told me. Then echoing others I’d talked to, they added, “But it could have been so, so much worse.”

‘How can I say no?’

A multimillionaire doctor of internal medicine who’s run some of the largest civilian medical systems in the world, Shulkin stepped off the hospital gravy train in 2015 to take over the Veterans Health Administration, VA’s main medical arm, for President Barack Obama amid a flurry of major scandals.

As the “global war on terror” entered its second decade, backlogs of veterans seeking care had grown so huge that many VA administrators had begun falsifying their appointment records and waitlists. By the department’s own conservative estimates, at least 35 veterans died waiting for care, even as the VA announced a budget shortfall of billions of dollars. Some executives reportedly bilked the VA of hundreds of thousands in “relocation expenses.” Another — the department’s former top inspector — resigned after being caught masturbating in “an all-glass conference room visible to people across the street.”

“My dad was a captain in the Army. My grandfather worked at the Madison, Wisconsin, VA as the chief pharmacist. I trained in three VAs, and so did my wife.”

Shulkin was rarely in the mainstream media then, but the VA sure was — an easy target for conservatives who blamed Obama for the department’s failures, as well as for liberals who saw epidemics of post-traumatic stress disorder, traumatic brain injuries, and combat disabilities as proof America’s wars had grown out of control. In a sense, the VA’s failures are not entirely of its own making: The government always spends more freely to wage war than to deal with its after-effects back home.

When Trump was elected, expectations for VA couldn’t have been lower. Whatever leadership qualities he’d honed over years in real estate and reality TV, the president-elect had no experience fixing such a vexing tangle of problems, with millions of lives in the balance. But he had strong support from veterans, and he wanted to stake out a reputation as their protector.

Enlisting Shulkin to run that effort seems to have paid off. “When I was asked to help, it wasn’t a question,” he told me. “I mean, I just said: ‘How can I say no?’”

Shulkin is the first VA secretary not to be a military veteran himself, but his praise of public service, his long history with the veterans health system, and perhaps most of all, his benign get-the-job-done style of communication has immediately put many news readers — and writers — at ease.

“I think it’s really important that every American have a chance to provide service to this country,” he said. “I mean, to be able to live in this country and experience the freedoms we have is just extraordinary. My dad was a captain in the Army. My grandfather worked at the Madison, Wisconsin, VA as the chief pharmacist. I trained in three VAs, and so did my wife.”

When he’s not pushing rapid-fire schemes to make the VA workforce more accountable, reduce wait times, stop veteran suicides, and streamline electronic health records and appointment-making, Shulkin is getting used to the high profile of his position — giving near-constant press interviews, acting as the cabinet’s “designated survivor,” riding a Harley-Davidson for the first time with Secretary of State Rex Tillerson in the annual “Ride For Freedom,” and throwing out the ceremonial first pitch at a major-league ballgame. (The ball, autographed by Ken Griffey Jr., sits on a shelf in Shulkin’s office, next to an Army citation given to his grandfather.)

‘Bad ideas’

But it isn’t all fun and games. Shulkin has felt acute pressure from the White House and GOP to outsource more of the VA’s core responsibilities to the private sector. While he agrees on some privatization moves — he points out that making prescription eyeglasses is a waste of VA resources when they can be bought at any shopping mall — the health concerns of many veterans simply wouldn’t get the attention they deserve in the private care. “Those types of complex conditions in the private sector would be very, very challenging to provide the services that veterans need,” he tells me. “So I am unequivocally focused on strengthening the VA system and creating a system that is sustainable, not only now, but in the future.”

That dovetails with what most VSOs want to hear. “We’re very guarded about maintaining a very strong VA system,” Garry Augustine, executive director of Disabled American Veterans, told me when Shulkin got the job. “They take care of the whole veteran. We feel very strongly about it.”

The privatizing ideas, Shulkin tells me, “came out of some groups, but we are not moving in that direction. We heard the feedback from the VSOs that that is not an overall policy or direction that they’re supportive of.”

But the privatizers continue to loom large in Shulkin’s major decisions. Much of the pressure comes from organizers of the relatively new Koch-funded conservative lobby group Concerned Veterans For America (CVA), which has pushed hard for a pro-Trump, pro-privatization agenda at VA, and has had several of its supporters plucked up for administration roles. Pete Hegseth, the former head of CVA with a long history of working for GOP-funded vets’ political groups, was rumored to be on the Trump administration’s short list to run VA; veterans advocates tell me CVA is still prepared to push for a replacement to Shulkin if he doesn’t hew to conservatives’ privatization dogmas. 

CVA’s executive director, Mark Lucas, did not respond to a T&P; message left for him at the group’s posted phone number, which was answered by a receptionist for the Koch-funded lobby group Americans for Prosperity. In an email provided to Task & Purpose after publication of this story, Dan Caldwell, CVA’s policy director, clarified that the group has always opposed wholesale privatization of the VA’s core functions. Rather, it proposes a government-chartered nonprofit to “give the VA more ability to both compete and better integrate with the private sector while also empowering veterans with true choice over their health care.

“We want to give veterans improved access to the care they need, whether that’s inside or outside of the VA,” Caldwell said.

He added that CVA was nonpartisan, doesn’t always agree with President Trump, and pointed to the group’s longstanding advocacy of the VA Accountability and Whistleblower Protection Act that Trump was expected to sign on June 23 — legislation with broad political appeal. “We are pleased that members on both sides of the aisle supported this important reform,” Caldwell said.*

The group’s machinations have already put the VA secretary under the gun. On June 7, Shulkin and his top deputy for community care, Dr. Baligh Yehia, briefed senators on their plans to overhaul the VA’s Choice program, which provides veterans with private health care options. Their presentation included some radical proposals floated by CVA, like offering government health insurance for private medical facilities and empowering a panel to gradually shut down VA centers deemed too inefficient.

The proposals sent the VSOs and some senators reeling. “These moves show a disturbing trend toward downsizing and dismantling this VA, rather than strengthening the system,” Democratic Sen. Patty Murray of Washington told Shulkin. “I just want you to know I do not support them, and I will fight them with everything I have.”

Sources told me that while Shulkin sought input from the major VSOs on the Choice overhaul, he never mentioned these “bad ideas” to those veteran advocates; they first came to light in the Senate presentation. “Shulkin has privately apologized for this and said he and [Yehia] did not know those points were in the presentation,” one source said.

Shulkin didn’t explain how the proposals ended up in his deck, but he confirmed to T&P; that they never should have been included. “Those were recommendations that came out of some groups, but we are not moving in that direction,” he said. “We heard the feedback from the VSOs that that is not an overall policy or direction that they’re supportive of.”

Did he apologize? “Yeah,” he said. “I do not want people to believe that we are saying that we want to listen to your feedback, and then ignoring it.”

Nevertheless, some veterans advocates feel that’s Shulkin’s M.O. “He has now told us one thing and then did something very different — several times,” a representative of a major VSO told me. “He appears to understand why privatization is terrible, but he continues to march toward it.”

Those sources point to the Trump administration’s proposed budget for VA. Even though the White House plans a 6% boost in VA’s bottom line, most of the new funding goes into the Choice program. That budget also included plans to cut “individual unemployability,” or IU, benefits, which go to severely disabled vets whose conditions prevent them from finding gainful work.

The VSOs advised Shulkin closely on other budget matters, which made it all the more shocking to them when they first learned about the proposed IU cuts from news reports. Dismayed by the news, advocates for veterans scrambled to organize a campaign against the cuts, eventually securing a public promise from Shulkin that he’d nix that plan — that is, if the savings could be found elsewhere.

“Why didn’t he talk with the VSOs about the idea before putting [IU cuts] in the proposal?” ” one representative of a major vets’ organization wondered in an interview with Task & Purpose. “He ran other ideas by us and were able to provide our positions. [This time], he was surprised at our opposition at first because he didn’t really understand the ramifications. We could have helped prevent that.”

‘Our system needs to change as the people that we serve change’

Even attempting to navigate the hazardous waters between Trump-aligned privatizers and rabble-rousing veterans organizations in Washington today is enough to give most politicos serious agita. But regardless of how he’s doing at it, Shulkin seems to relish an impossible challenge. He’s also been tasked by Trump with reducing veteran suicide rates to zero — a seemingly fantastical goal, especially when you consider how many vets with suicidal tendencies don’t seek or qualify for VA care.

Confronted with those realities, Shulkin doesn’t flinch. Instead, he offers a JFK-era anecdote that’s factually dubious, but popular among business-motivation writers. “They were interviewing people at NASA and they stopped a janitor who was sweeping the floor, and they said to him, ‘What do you do here?’” he told me. “And his answer was: ‘I’m helping send a man to the moon.’ So when you have a team where everybody knows what the goal is, you get there in ways that you don’t always expect.”

Shulkin’s recent interest in medical marijuana, which has also been pushed by vet groups like the American Legion, looks like another one of those man-on-the-moon efforts. “We are acutely aware of the work that’s going on around the country, particularly in states that have legalized medical marijuana,” he told me. “And we are observing very closely work that’s being done that may be helping veterans, and we are open to any ideas and therapies that may be effective.”

But Shulkin’s cabinet colleague, Attorney General Jeff Sessions, has signaled that he wants to crack down on medical marijuana providers in states where it’s legal — effectively cutting off the VA’s only source for research into cannabis therapies.

Another of Shulkin’s more daunting responsibilities is connecting with the often-cynical younger generation of veterans that now qualifies for VA care. Many of those former service members often experience the Department of Veterans Affairs as a sad, illogical bureaucracy that exists mainly for the salty oldsters who need help getting out of a chair at the post canteen.

“Our system needs to change as the people that we serve change,” Shulkin said, showering praise on millennial vets. “We see them as very socially engaged, and we want to be that type of organization that meets their needs and is a partner with them. So keep telling us how we can do a better job.”

If Shulkin can pull off just a fraction of what he talks about, he’d leave a generations-long imprint on the VA. But he’s good at spotting easy wins, too.

At the conclusion of our interview, we discussed the collection of Abraham Lincoln memorabilia in his office — three busts and one large portrait. “You see this all over the building,” Shulkin said, noting that although VA wasn’t created until 1930, Lincoln “really established our mission” with the creation of veterans’ homes after the Civil War.

“It probably should be Reagan,” he said, adding that it wasn’t until Ronald Reagan signed legislation in 1988 that the VA secretary became a full member of the presidential cabinet.

“Yeah,” Shulkin said, appearing to realize that he’d hit the popular-president trifecta — JFK, Lincoln, Reagan — in one interview.

He smiled, looking over to his press secretary. “Maybe we need more Reagan,” he said.

*Editor’s note, June 22: This article was updated to include perspectives from Concerned Veterans for America.

For more, watch Task & Purpose’s full interview with VA Secretary David Shulkin: