The man looking to make the VA work

Veterans Affairs Secretary David Shulkin is an exception to the partisanship that affects Washington, and plans to use his unique status to bring fundamental change to the second-largest governmental agency.

Dr. Shulkin served as the VA’s Under Secretary for Health during the final 18 months of the Obama administration, after extensive experience as a medical center chief executive. Then, in February, the Senate unanimously confirmed him to run the sprawling department for President Trump. It is a massive operation with 350,000 employees, 1,700 sites, and a budget of $186.5 billion.   

At a Monitor-hosted breakfast with reporters on Tuesday, Shulkin compared the VA under the two presidents he has served. 

When he worked with former President Obama’s final Veterans secretary, Robert A. McDonald, “What I saw was improvement,” Shulkin said. “I firmly believe he was taking the organization in the right direction, and I could actually measure it and he could measure it.”

But Shulkin said his experience at the VA under the Obama administration led him to conclude “that slow and incremental steady change isn’t what this organization needs. That what we need is bolder fundamental change dealing with the issues that frankly are really hard to deal with that go back decades. That means, by definition, we are going to have to take greater risk. That is part of what [President Trump] has asked us to do,” Shulkin said.

Key bipartisan legislation in the works

One area of significant change is that both houses of Congress have passed and Mr. Trump is expected to sign bipartisan legislation making it easier for the secretary to fire bad employees faster, and to protect whistleblowers from retaliation.

“I need as secretary, if I am going to change this organization, the ability to remove employees that clearly, no longer … should have the privilege of serving our veterans,” Shulkin said.

Earlier this month, Shulkin announced that, after years of resisting the step the VA would adopt the same computerized medical records system as the Defense Department. The goal is to let the two departments share information more seamlessly and thus to improve care for veterans.

At the breakfast, Shulkin stressed his view that the VA should more sharply focus its efforts. “I am interested in building world-class services in the things that I know veterans of this country must rely upon us for,” Shulkin said. He cited post-traumatic stress, traumatic brain injury, complex rehabilitative needs, and prosthetics.

But Shulkin cautioned, “I am not interested in building world-class services that already exist in a world-class way outside in the private sector.  The most common and easiest example would be maternity care.”  Critics worry that path could lead to privatizing the VA, a charge Shulkin strongly denies.

“We don’t have enough resources to do everything” at a world-class level, he says.

Valuing the press

His opening comments at the breakfast centered on the value of the press, a refrain not often heard from Trump administration officials.  “You can be saying things that are not necessarily the most flattering about my organization, but I believe in the role of the press and I believe that it is one of the factors that really helps us get better,” Shulkin said. 

Later in the breakfast, Shulkin said he wished that reporting on the VA were “more balanced.” The secretary said he worried “that if the public views the organization as not being competent in fulfilling its mission, that people who need our help, particularly those who are committing suicide, may not seek help.” 

He offered the assessment that the VA has had problems providing timely access to care, “but when veterans get into the VA system they generally, fortunately, are getting help, and are getting good competent help.”