David Shulkin ran the nation's largest health system under two presidents. As secretary of the Department of Veterans Affairs, he oversaw a hospital empire that served nine million veterans and employed 135,000 people.

Under Shulkin's leadership, the VA reduced wait times for health care, improved the appeals process for veterans seeking disability benefits, focused on reducing the number of veteran suicides by providing more mental health services, and helped to reduce unemployment among veterans.

Shulkin, 59, who still lives in Gladwyne, made his then boss, Donald Trump, look good. Shulkin delivered some bipartisan wins while other federal departments were roiled with controversy. But for some political appointees, Shulkin didn't move quickly enough. He wouldn't support their proposal to put all of veterans' health care into the hands of private interests. And according to Shulkin, that sank his career.

His tenure at the top wasn't without controversy. He was accused, and he says later absolved, of taking his wife on a European business trip at taxpayer expense. But Shulkin said his wife, Merle Bari, a dermatologist, had been invited by a conference organizer and later paid her own way. Shulkin was also accused of receiving free tickets to Wimbledon, but he insists they were gifted by a friend who had no business with the VA and was not in breach of any ethical standard.

In the wake of the imbroglio, which Shulkin said was orchestrated by his political enemies, Trump unceremoniously fired Shulkin via tweet in late March last year.

Oddly enough, he bears his old boss no ill will. And unlike other department secretaries such as former Secretary of State Rex Tillerson, who met a similar fate, he won't bad-mouth the sitting president. But he said he never offered Trump unconditional loyalty.

“My loyalty was to America's veterans, and that caused me to stand up against administration policy when it violated what I believed was in veterans' best interests,” Shulkin said. “The president as the chief executive has accountability for the way the administration is being run and I believe shares responsibility for the deteriorating environment for public service that we see today.”

Shulkin, who was a well-known hospital CEO in Pennsylvania, New Jersey, and New York before going to work for the VA, has a new book, It Shouldn't Be This Hard to Serve Your Country. He spoke to The Inquirer last week about his rise and fall as the ninth secretary of the VA. This interview has been condensed.

Reading your new book, I'm surprised you didn't title it “The Snake Pit.”

That's going to be the name of the Netflix miniseries (chuckles).

What have you done since leaving the VA?

I've been spending a lot of time writing the book. But I'm also the Distinguished Health Fellow at the University of Pennsylvania, I'm focused on veterans' health issues at Jefferson, and working with Sanford Health in the Midwest.

In the book, you wrote about “the politicals,” a shadow government — “well funded and utterly ruthless” — that repeatedly undermined your efforts. Who are the politicals?

Every president brings in 4,000 political appointees, so there's nothing new about them. The vast majority are good people who are committed to the mission and try to do the right thing. In the book, I was trying to point out the rogue political appointees who tried to interpret through their ideology what policy should be, rather than let the Senate-confirmed secretary of the department make those decisions.

Who is Ike Perlmutter? You say the Israeli American billionaire and former chairman of the Marvel Comics Entertainment empire was also part of a group you called the Mar-a-Lago Trio, that included Bruce Moskowitz and Marc Sherman, who tried to steer policy at the VA from Trump's so-called Southern White House.

Perlmutter has had a long relationship with the president and was involved with the presidential campaign. He himself had been a soldier in the Israeli army during the Six-Day War in 1967. I actually think he had good intentions in trying to fulfill the president's campaign commitments.

So what role did Perlmutter and his friends play with the VA?

They were advisers to the president. I had clearly said to them that if they wanted to be a formal group and advise the VA, they would have to become a federal advisory committee and that there were formal rules they'd have to follow. When they didn't want to do that, I let them know that advice and information they provided would have to be provided to me as private citizens. The White House may have had them as a more formal advisory committee.

President Trump appeared to really like you, and appreciated the victories you scored for him. Yet you were an Obama appointee. How did you come to be the only holdover chosen to stay on?

I don't know. No one was more surprised than me when he announced he had selected me. I was preparing to leave the administration, just like every other appointee, on Jan. 20, 2017. So when he announced it, I was pleased to have the opportunity to finish the work I had begun. We had broad-based bipartisan support and I was getting the president bills to sign while other agencies were bogged down in political infighting.

Who was pushing for privatization?

The group of political appointees certainly were. The main one had been directly employed by Concerned Veterans for America, a lobbying group funded by the Koch brothers. They're pretty up-front about the belief that the VA shouldn't be run by government, that it needs to be a private-sector operation. It wasn't clear to me whether there were communications or links between the Mar-a-Lago group and the political appointees. They were somewhat of a mysterious group. It may have been the successes we were having that accelerated their efforts. If you could show you could make a government agency work well, then taking it private wouldn't make sense.

Did either the Mar-a-Lagos or the politicals have experience in health-care management?

None had experience with health systems. Jake Leinenkugel, the senior adviser from the White House, he's the one we found had sent an email planning to replace me, the deputy secretary, and the chief of staff with people who were politically aligned with him and the Kochs. His primary qualification was he worked on the campaign and ran the Leinenkugel Brewing company. The president now has him in charge of the mental health component of the VA, the COVER Commission, which is looking into veterans' suicide. I'll let you decide whether a background in beer and alcohol is a qualification for that.

Given the constant turmoil and the personal attacks, why did you stay?

People would tell me to watch my back. But I'm a physician and a scientist, I wasn't going to react to things that I didn't have evidence for. It wasn't until I saw the email that I recognized that they were trying to oust me.

Even though it was extremely difficult for me and my family, I thought about what our veterans had gone through. Many had lost limbs; others had invisible wounds of war. When things got tough for them, they didn't quit. So I wasn't going to quit on them. That's why when the White House claimed I had resigned, I said that was absolutely not true. I was fired.

Why was there such an emphasis on privatization and why did you resist it?

Before taking the job, I hadn't been in a VA hospital since I was a student in Philadelphia. I went to the VA in 2015 with a very open mind, but I expected that I might find a system that was so broken that it wouldn't be fixable, that my job might be to close up shop.

But I began to see what the VA did, by putting on a white coat and seeing patients. There was a patient I saw, a 23-year-old man we couldn't figure out what was going on. I've been a doctor for 30 years. His complaints were so mild and minimal, it didn't make sense. I kept pressing. He finally said: “I'm homeless. I've been living in Central Park. I got discharged from the Army and after leaving, I didn't know what to do. They used to give me food and a place to sleep.” He didn't know how to proceed.

If I had been a doctor in the private sector, I'd have said those were not medical problems and directed him to a social worker. I began to see that what the VA did was different from the private sector. You couldn't just take nine million veterans, give them a voucher, and say 'good luck.' ¨

That would not be the proper way to honor them. We can do things the private sector cannot.

What is the VA doing with privatization now?

When I was fired, I sat down and wrote an editorial for the New York Times that said, “Here's the real reason I'm not there.” I was in a political battle with the White House over privatization and I was not willing to stand down over my objection. Shining some transparency on that issue has been helpful in making sure that privatization doesn't move too quickly without the right oversight from Congress.

The politicals, I believe, the people who have the strong political ideology, have gone under the radar into the shadows. They basically have not changed and they're waiting to surface and put their beliefs in place. I believe the way you make the best policy in government is to have a transparent debate. They're not willing to have an open debate, and that's worrisome. They resort to underhanded tactics to achieve their goals.

What underhanded tactics did they employ?

They impugned my reputation so that I would no longer have the ability to lead. They were ultimately successful. They leaked my confidential security itineraries. They started rumors that I was in my office behind armed guards. Everybody who is a cabinet member has an armed security force. But it made for a sexy headline.

You also claim they spread the untrue rumors that you took advantage of your position to take your wife to Europe and Wimbledon. In your book you said you were blocked by your own press people from setting the record straight.

I initially thought reporters didn't reach out for comment. It turns out the reporters tried to, but were blocked. Some of the political appointees kept me from having access to the press, they blocked my Twitter account. So I started giving out my cell number to reporters. When I responded to accusations on the VA website, they took it down in 10 minutes.

As VA secretary, your scandals seem fairly mild compared with the scandals of other cabinet secretaries.

It's difficult to keep count, but there have been 17 cabinet secretaries going through the revolving doors of the White House.

Did other departments have shadow administrators?

This was not unique. This was a common pattern of behavior. We're seeing a similar pattern of behavior with the Ukrainian ambassador and the acting director of Homeland Security who reported that inside people were working against him. He was the State Department official who went against State Department advice to not testify.

Have you recovered from this roller-coaster ride?

I don't know if anyone every fully recovers from an experience. I've tried to focus my energy to make sure the veterans aren't going to suffer from this.

What are your top concerns about veterans now?

Getting vets who were exposed to Agent Orange the care they need. That was 50 years ago, and vets still have to fight every day to get that care. Frankly, that's just wrong.

I'm also speaking out, along with Jon Stewart, for veterans exposed to the burn pits in Iraq. That's what the military used in the Gulf Wars, they set fire to large landfills of stuff with gasoline and plastic to burn in the desert. Our troops were exposed to toxic fumes. Now they have Gulf War Illness, a respiratory ailment that's not well understood. They have to fight to prove it was connected to military service.

We don't want to repeat the history of the Vietnam veterans, and make them suffer for so long. And that's what we're doing.

Did the president talk about shutting down several of the VA facilities?

Yes. The health system, being as large as it is, has some hospitals that are really good and others that were struggling. He suggested that we take the ones that weren't doing well and shut them down. I had to explain that he couldn't do it by executive order, it required a legislative process, a study had to be presented to Congress.


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