In the midst of the 2 longest wars in our nation’s history (ISIS and Afghanistan), the person chosen to lead the Department of Veteran’s Affairs (VA) will have a tremendous impact on the lives of veterans and their families. That much goes without saying.
Americans have watched the Trump Administration make many questionable appointments to high-level cabinet positions. Democrats in both houses have used their votes to oppose many of these unqualified or dangerous nominations. It’s gotten so bad that some Republicans have listened to their conscience (as if that’s a bad thing…) and cast votes against Trump’s nominees.
At first glance, Trump’s pick for VA Secretary had a similar controversial ring to it: The nominee, Dr. David Shulkin, if chosen, would become the first non-Veteran to lead the VA.
That fact makes for easy headlines that fit with Trump’s other unqualified selections like Betsy DeVos, his Secretary of Education who didn’t understand basic education laws. Or Scott Pruitt, Trump’s pick for the head of the Environmental Protection Agency (EPA), who has made his career a crusade against the agency.
With the shouting and political drama at a fever pitch, one might have expected a fierce battle when it came to the appointing the next VA Secretary.
Last Monday, however, the Senate voted 100-0 confirm David Shulkin's nomination.
Democrats, who have been accused of meddling in the nomination process for political purposes, sent a strong message to President Trump: If you put forward qualified people, they will be supported. The unanimous vote in favor of Dr. Shulkin’s nomination indicates a healthy congressional consensus that he is certainly fit for the task. That said, in his hearing, Senators on both sides of the aisle challenged Dr. Shulkin about his promises to veterans as he takes the helm of an embattled VA.
Rebuilding Trust with Veterans – the Promise of Shulkin’s Confirmation
Although he will become the first non-veteran to head the VA, Dr. Shulkin was born on an Army base and trained in VA hospitals as a young doctor. In his testimony to the Senate, he wrote that, “I view my VA service as a duty to give back to the men and women who secured the uniquely American freedoms and opportunities we all enjoy because of the sacrifices they made.”
For many, many years, however, the VA has struggled to honor this commitment to veterans. Dr. Shulkin, who became VA Undersecretary for health in 2015, joined an organization that, according to many, was in crisis. Veterans were unable to receive the care they earned. There were massive cost overruns, cases of fraud, and forgery. In short, there was little to no accountability.
At his confirmation hearing, many of the senators on both sides of the aisle noted that the VA has made important progress with Dr. Shulkin as Undersecretary, but also that it has a long way to go. In a significant exchange with Senator Dan Sullivan (R-AK), Dr. Shulkin argued that the VA needs to transform in order to regain the trust of veterans:
Dr. Shulkin: If you don’t have trust in the group that’s empowered to take care of you and provide you services, you can’t do your job very well.
Sen. Sullivan: Do you think the V.A. has that trust right now?
Dr. Shulkin: I think that trust was eroded, particularly with the crisis in April 2014, and many people lost trust... I approach things first as a doctor. And as a doctor, I know, no matter how smart I think I am or if I did the best in my medical school class, if my patient doesn’t trust me, they’re not going to listen to what I have to say and I’m not going to be able to help them. . . As a healthcare executive, I look at our system in V.A. and I say if we don’t have a modern system that’s responsive to our veteran’s needs, then we can’t perform our function.
One of the things that I think most people would tell you about me is that I don’t have a lot of patience. And I’m going to be serious about making changes and regaining that trust. And, if I don’t do it, I should be held accountable, and you should replace me.
So what will this new and “responsive” VA look like for veterans? The Senators seemed won over by Dr. Shulkin’s commitment to veterans, but they had serious questions regarding what could happen if this commitment comes into conflict with the unstable desires of President Trump and his administration.
The VA Will Not Be Privatized Under Shulkin’s Watch
On the campaign trail, Trump was relentless in his attacks on the VA, its mismanagement, and its scandals. After he was elected, there was considerable concern that Trump planned to privatize the VA.
By selecting Dr. Shulkin, one of the few holdovers from the Obama administration, privatization seems less likely. In his testimony, as well as responding to direct questions from Senator Jon Tester (D-MT), Dr. Shulkin promised that, “the Department of Veterans Affairs will not be privatized under my watch.”
Getting Veterans Same-Day Healthcare
What Dr. Shulkin proposes is a system that integrates public and private services in order to get veterans the help they need in a timely fashion. As he explained to Senator Tester (D-MT),
“What we really want to do is make sure that the veteran can get to the services they need in healthcare in a timely fashion. That’s why I focused on urgent care issues. That is why there is now primary care, same-day access, and mental care, mental health same-day access in every V.A. across the country. So for somebody who needs to see their doctor that day, they should be seen. If they can’t be seen at the VA, they should be seen in their community.”
To provide this level of service, the VA will need to have a broader presence than its brick and mortar services allow. How is Dr. Shulkin going to make this happen?
In a 2016 article he wrote for the New England Journal of Medicine, Dr. Shulkin wrote that “Partnerships with federal and community health care providers may result in better access and broader capabilities than simply relying on the VA’s internal capabilities and current infrastructure.” Increasing the number of partnerships between the VA and community healthcare providers will increase the options for care available to veterans.
Dr. Shulkin’s emphasis on urgent care is important – no veteran should suffer harm for want of access to a doctor. But at the same time, there are a number of serious issues that veterans have to live with, many of which do not fall under the “urgent” care category.
What about Long-Term Needs of Veterans?
Battle wounds, infectious disease, and post-traumatic stress disorder aren’t the only complex ailments facing our country’s veterans today; it’s important to remember that many of our veteran heroes – especially those who are in their 50s, 60s, and 70s – are fighting other battles that are associated with their service. Namely, cancer.
Take asbestos, for example, a naturally occurring, fibrous mineral that can prove lethal if inadvertently inhaled or ingested. During their service, many veterans could have been exposed to this deadly carcinogen while working in shipyards or serving as part of our naval fleet. Symptoms from asbestos-related diseases, such as mesothelioma, may take 20-50 years to develop, and so taking care of these veterans is a life-long commitment. According to the VA, people who served in the following occupations may have been exposed to asbestos:
- Shipyard work
- Insulation work
- Demolition of old buildings
- Carpentry and construction
- Manufacturing and installation
In addition, the VA warns that if veterans who served in the Middle East “could have been exposed to asbestos when older buildings were damaged and the contaminant was released into the air.” Because of the large number of veterans who are at risk of developing diseases like asbestosis, lung cancer, and mesothelioma, every effort must be taken to ensure that those in need get the healthcare they earned. Chemical exposure beyond asbestos is also a real problem identified by health experts.
“When we send a soldier to battle,” said Dr. Shulman during the hearing, “we’re sending the whole family off.” And when that soldier comes back with a life-long risk, they need to get the healthcare and support they need. If not, it’s the whole family that suffers.”
On February 7th, the Furthering Asbestos Claim Transparency Act (FACT Act) was reintroduced to the House of Representatives (H.R. 906). Opposed by veterans and firefighters, this bill, which failed to get through the Senate last year, would strip victims of their privacy and make it more difficult to get help to those who need it.
As the Secretary of the VA, Shulkin will be under intense pressure to support this senseless bill from special interest groups and a President who has praised asbestos. One hopes, however, that Dr. Shulkin will take the opportunity to advocate for veterans who were exposed to harmful substances, and to reassert the VA’s commitment to the lifelong care of veterans.