Why was David Shulkin fired as head of the Department of Veterans Affairs after just a year on the job? It's easy to make the case that the ethics mess surrounding a taxpayer-funded European trip put an expiration date on his tenure.
But that's an unsatisfying explanation for a fairly obvious reason: Donald Trump's administration is filled with high-ranking officials facing serious ethics controversies, including travel-related scandals. While many of these other officials continue to enjoy the president's full support, Shulkin was shown the door, ousted in favor of a physician with no obvious qualifications for the job.
So what's the real reason behind Shulkin's dismissal? The outgoing V.A. chief wrote an op-ed for the New York Times, pointing to "the ambitions of people who want to put V.A. health care in the hands of the private sector."
I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington's political polarization). Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what's best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.
Shulkin's piece went on to make the case that private-sector providers are poorly equipped to care for veterans -- a sentiment shared by most of the nation's largest advocacy organizations.
As Rachel explained on last night's show, however, the V.A. is essentially a single-payer system of socialized medicine, which necessarily makes it a target for the right. It remains a conservative fantasy to kill off the cabinet agency and push veterans into the private marketplace for ideological reasons.
The trouble, of course, is the number of people who buy into that fantasy, despite its unpopularity among veterans and their advocates. As Shulkin sees it, many of them are Trump-appointed political appointees working in the V.A. itself.
Indeed, the president himself has expressed support for privatizing at least some areas of veterans' care.
With this in mind, it becomes easy to believe Shulkin's ouster had less to do with a travel controversy and more to do with his resistance to an ideological campaign within the Republican administration. (Shulkin, an independent who worked in the Obama administration, was the only non-Republican in Trump's cabinet.)
His op-ed added that the environment in Washington "has turned so toxic, chaotic, disrespectful and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve..... As I prepare to leave government, I am struck by a recurring thought: It should not be this hard to serve your country."
This is the environment that Navy Admiral Ronny Jackson, the White House physician, is poised to enter. For quite a while, Jackson's sole focus has been on providing medical care for his patients -- a list that includes the president. His focus will now shift to overseeing the nation's second largest cabinet agency, with 360,000 employees and an annual budget of $186 billion, which is apparently in the midst of a brutal political fight, thanks largely to far-right efforts to privatize the care the V.A. currently provides.
It's hard not to wonder if Jackson knows what he's getting himself into. Here's hoping he spends some today with Shulkin's op-ed.