For Once, Trump Makes the Right Cabinet Pick

(Photo: AP/Evan Vucci)

David Shulkin, currently undersecretary for health at the Department of Veterans Affairs, leaves a meeting with President-elect Donald Trump in New York on January 9, 2017.

In a lobbying victory for veterans’ service organizations and their allies, President-elect Donald Trump has made an unusual cabinet pick. He’s named someone to head a federal agency who’s committed to its mission, highly qualified for the job, and has relevant past experience. That someone is David Shulkin, named by Trump to head the Department of Veterans Affairs.

Before choosing Shulkin, who now serves as the VA’s undersecretary for health, Trump had flirted with some bad choices for the post, including veteran Pete Hegseth, former CEO of Concerned Veterans for America, a group funded by the billionaire Koch brothers; Sarah Palin, former governor of Alaska and mother of a veteran; and Delos “Toby” Cosgrove, vice chairperson of the Commission on Care and CEO of the Cleveland Clinic. All these candidates favored dismantling and privatizing the Veterans Health Administration (VHA), and were strongly opposed by veteran advocacy groups and unions that represent VA employees.

Shulkin, a practicing physician, is not a veteran. But he has worked with current VA Secretary Robert McDonald to remedy problems in the largest and only publicly funded and fully integrated health-care system in the country. More importantly, his published writings, public testimony, and policy proposals have demonstrated his grasp of the existing system’s considerable strengths. He has countered the right-wing narrative that the VHA is an agency broken beyond repair. Last March, in the The New England Journal of Medicine, Shulkin argued instead that the VA outperforms private industry in “lower risk-adjusted mortality rates, better patient-safety statistics, and better performance on a number of other accepted process measures.” Shulkin does not oppose veterans getting care in the private sector when needed, but wants the VHA to coordinate and integrate care within the VHA system.

Shulkin has also been outspoken in explaining how the VHA saves lives through its unfairly maligned Veterans Crisis Line. Under Shulkin and Secretary McDonald, the VA has added a second Veterans Crisis Line in Atlanta to the one first established in rural Canandaigua, New York. Shulkin understands that locating a crisis line in a major urban area will help recruit more staff to perform the arduous job of listening to veterans in crisis—many of them at risk of suicide or of posing a danger to their families, friends, and community members—hour after hour, day after day.

Most importantly, Shulkin has consistently countered conservative talking points that government can do no right, and the private sector no wrong. After more than 25 years practicing as both a physician and hospital executive in the private sector, Shulkin has cogently outlined the facts in speeches, interviews, and articles like one that appeared last May in The Federal Practitioner. The VHA is the only system, he wrote, that has developed expertise in the specific, service-related health problems of its veteran patients. Unlike private-sector providers who pay lip service to the concept of team-based, patient-centered care, the VHA practices what it preaches. Plus, unlike the private sector, the VHA pays attention to issues of poverty and homelessness, integrates mental health into primary care, and even supports family members or friends who are caring for veterans. And in an astonishing prediction for a Trump nominee, Shulkin argued that the VA “can lead the way in advancing the nation’s health care. This is the appropriate role for government: Do what the private sector cannot or will not do, given the nature of its enterprise.”

If Shulkin, whose post requires Senate confirmation, is allowed to further put his knowledge and experience into practice to work for veterans, then all veterans and their allies will be better off. That’s because he understands how the VHA’s pioneering models of clinical care, research, and teaching have benefited the veteran community and all Americans. Unfortunately, Shulkin will be under much congressional and White House pressure to adopt bad policies. Despite the VHA’s progress on reducing wait times under McDonald and Shulkin, Trump argued during his press conference announcing his VA pick that veterans are treated “very unfairly” and that they have to wait “15, 16, 17 days for an appointment.” (The average wait in the private sector is 19 days.) Trump even claimed that some have seen minor cancers become terminal in just a couple of weeks.

Trump also announced that he has assembled a brain trust of private-sector hospital leaders to “help” Shulkin, which includes Cosgrove, who for the second time in just a few years withdrew his name from consideration for the top VA job. Many of these hospital leaders would benefit financially from VHA privatization and have no understanding of what it means to lead a truly integrated health-care system.

Veterans and the organizations supporting them should not remain at “parade rest” after saluting—as many have—Shulkin’s appointment. They will still need to mobilize at short notice to protect, reform, and strengthen a system that serves their needs, as Shulkin has argued, far better than the private health care ever could.

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