Ousted VA secretary blasts privatization in a New York Times op-ed

David Shulkin got fired Wednesday from his job as secretary of veterans affairs. He’s out this morning with a New York Times op-ed blasting the Trump administration as shot through with people who want to push a privatization agenda that amounts to “rewarding select people and companies with profits, even if it undermines care for veterans.”

Shulkin writes that the private sector is “ill-prepared to handle the number and complexity of patients that would come from closing or downsizing VA hospitals and clinics, particularly when it involves the mental health needs of people scarred by the horrors of war,” and vows to “continue to speak out against those who seek to harm the VA by putting their personal agendas in front of the well-being of our veterans.”

The timing of the op-ed suggests that Shulkin and the Times had this prepared in advance, a side effect of the Trump administration’s odd habit of leaving senior officials twisting in the wind, clearly on the verge of getting fired long before they’re actually pushed out the door.

His ouster sets the stage for a major political fight over the future of the agency, one that Shulkin is now firing the first shots in and which it’s a little unclear if Trump himself actually understands or cares about.

Shulkin’s ouster was really about policy

In truth, there were multiple issues with Shulkin’s tenure in the Trump administration, including a minor scandal about Wimbledon tickets and a sense from some people in the White House that he just wasn’t a team player. Shulkin is right, however, to say that at the root of his troubles was a policy dispute.

The 2014 VA scandals were eventually resolved with a bipartisan bill that didn’t do very much to push privatization. The Obama administration brought in a Republican, Bob McDonald, to serve as secretary, and Shulkin was brought in as his undersecretary for health affairs. Mainstream veterans groups thought McDonald was doing a good job and pushed for Trump to retain him.

“We all want McDonald,” Joe Chenelly, the executive director of Amvets, told the New York Times. “He has a good business mind, he is experienced and we feel we can trust him.”

Trump was not, however, willing to admit that his campaign rhetoric had been entirely inaccurate, so he insisted on firing McDonald anyway. As a compromise, he nominated Shulkin to serve as secretary. That paired veterans’ goals of continuity with Trump’s goal of avoiding an admission of error, though, of course, the fact that Shulkin had been specifically tasked with running health programs was an implicit admission that the Obama-era reform process had been successful.

But Trump did not follow this up by creating a supportive infrastructure for Shulkin’s policy approach to prevail. Instead, the overall transition was dominated by highly ideological conservatives, and Shulkin ended up at war with the other political appointees at the VA. By the end, he’d posted an armed guard outside his office door. Then the VA communications team started trashing their boss openly to the press. In response, Shulkin freelanced in his own communications with the media, going outside normal administration channels.

To Trump, this ultimately became a question of loyalty to him personally.

“In the view of senior officials,” Axios’s Jonathan Swan reported earlier this month, “there’s a difference between discreetly and professionally handling staffing issues and publicly embarrassing and firing supporters of the president.”

But Trump hasn’t replaced Shulkin with a privatizer. Instead, he’s tapped White House physician Rear Adm. Ronny Jackson.

Jackson is heading into a huge fight

Nobody knows anything about Jackson’s views on public policy, in large part because he hasn’t really ever served in a policy job. He’s been the lead White House physician since Obama’s second term and before that served on the White House medical staff. He’s clearly an accomplished doctor with significant experience in the practice of military medicine.

But the VA is a huge bureaucracy that needs to be administered; it has the second most direct employees of any federal agency.

And it’s also in the center of an ideological tug of war between the notion that veterans are best served by a dedicated agency and the idea that it ought to be a proving ground for privatization. That dispute itself is in part about how to take care of veterans. But it also obviously speaks to a larger clash of worldviews between left and right over how health care overall ought to work.

It seems at least moderately unlikely on its face that a career military officer like Jackson shares the commitment to privatization that Shulkin’s enemies in the administration were pushing. But it also seems pointless to side against Shulkin in a clash over VA privatization unless you’re actually going to push privatization.

Of course, in Trump’s Washington, things don’t necessarily have to make sense.