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David Shulkin’s Firing at the VA Is Latest Step in Trump-Koch Push to Privatize Veterans’ Healthcare

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On Wednesday, President Trump fired Secretary of Veterans Affairs David Shulkin and said he’d replace him with White House physician Dr. Ronny Jackson, a rear admiral in the Navy. Dr. Jackson has no experience running a large agency. The Department of Veterans Affairs is the federal government’s second-largest department, with 360,000 employees. Shulkin had been facing criticism for various ethics violations, including using taxpayer money to pay for his wife’s airfare during a trip to Europe last summer. But Shulkin says he’s actually being ousted because of his opposition to privatizing the VA, which runs 1,700 hospitals and clinics. The push to privatize the VA has been led by a group called Concerned Veterans for America, which is funded by the billionaire conservative Koch brothers. We speak to Suzanne Gordon, an award-winning healthcare journalist. Her forthcoming book is titled “Wounds of War: Veterans’ Healthcare in the Era of Privatization.”

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: We begin today’s show looking at the turmoil in the Department of Veterans Affairs. On Wednesday, President Trump fired Secretary of Veterans Affairs David Shulkin and said he’d replace him with White House physician Dr. Ronny Jackson, a rear admiral in the Navy. Dr. Jackson has no experience running a large agency. The Department of Veterans Affairs is the federal government’s second-largest agency, with 360,000 employees.

Shulkin had been facing criticism for various ethics violations, including using taxpayer money to pay for his wife’s airfare during a trip to Europe last summer. But Shulkin says he’s actually been ousted because of his opposition to privatizing the VA, which runs 1,700 hospitals and clinics. In a an op-ed for The New York Times, Dr. Shulkin wrote, “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,” unquote.

The push to privatize the VA has been led by a group called Concerned Veterans for America, which is funded by the billionaire conservative Koch brothers. But other veterans’ groups, including the Veterans of Foreign Wars and the American Legion, have opposed the privatization plans. On Sunday, Senator Bernie Sanders of Vermont tweeted, “The struggle at the VA is about Trump’s desire to privatize the VA and his belief that Shulkin is not moving fast enough in that direction. The Senate Veterans Committee, on which I serve, must stand with the veterans of our country and oppose all efforts to privatize the VA,” Senator Sanders tweeted.

We’re joined now by Suzanne Gordon, an award-winning healthcare journalist. Her recent piece for The American Prospect is headlined “Studies Show Private-Sector Providers Are Not Ready to Care for Veterans.” Gordon is the author of The Battle for Veterans’ Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care. Her forthcoming book, Wounds of War: Veterans’ Healthcare in the Era of Privatization.

Well, this story is certainly up your alley, Suzanne Gordon. Can you start off by responding to the news that President Trump fired Dr. David Shulkin? Of course, he actually didn’t fire him himself. He spoke to Shulkin, had an extended conversation with Shulkin on Wednesday, according to Dr. Shulkin. He didn’t know he was being fired. And then, hours later, he tweeted that Dr. Shulkin was fired. Suzanne Gordon, your response?

SUZANNE GORDON: Well, that’s par for the course for Donald Trump. He tweets that you’re fired. He doesn’t do it in person.

I think the issue here, really—Dr. Shulkin, sadly, gave some ammunition to those who wanted to get rid of him, because they felt that he wasn’t privatizing the Veterans Health Administration, which is really what this is all about. It’s the second-largest agency—the VA is the second-largest agency in the United States, and it runs the largest healthcare system in the United States, which is the Veterans Health Administration, which serves the needs of 9 million of America’s 22 million veterans. And there’s been a move since 2014, mostly promoted by the conservative Koch brothers, to use the VA to discredit government and to try to privatize the VA and send more and more veterans to private-sector doctors and hospitals. And Secretary Shulkin wasn’t doing this quickly enough. He was doing it partially, but he wasn’t doing it quickly enough.

And his ringing defense of the VA in The New York Times is very important for people to read. I’m sad that he didn’t articulate that kind of defense earlier, in the many hearings that he was in and in other public statements. But the fact that he’s doing it now is really to be commended. And there is a huge threat to privatize the VA by people like the Koch brothers, by the infamous hedge fund insider trader Steven Cohen, who’s trying to set up an alternative mental health system to compete with the VA. This is a very serious moment for the VA.

AMY GOODMAN: I wanted to turn to David Shulkin, who appeared last night on MSNBC.

DR. DAVID SHULKIN: There was clear evidence, though, that the political appointees inside VA were working against me and my leadership team, because they felt that we were trying to strengthen the VA rather than move it towards privatization.

AMY GOODMAN: And then I wanted to turn to the man that President Trump is nominating to replace Dr. David Shulkin. Yes, Donald Trump has tapped White House physician Ronny Jackson to head the Department of Veterans Affairs. Dr. Jackson is a naval officer who served as White House physician under Presidents George W. Bush and Barack Obama, received some criticism for his enthusiastic report about Trump’s physical condition after Trump’s exam in January.

DR. RONNY JACKSON: The president’s overall health is excellent. His cardiac performance during his physical exam was very good. He continues to enjoy the significant, long-term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol. … All clinical data indicates that the president is currently very healthy and that he will remain so for the duration of his presidency.

AMY GOODMAN: The doctor was then questioned about Trump’s diet of hamburgers and diet soda, and he said it’s all in the genes, he’s got good genes. Suzanne Gordon, talk about Dr. Ronny Jackson, the president’s doctor, who he wants to make the head of this $200 billion agency, as you said, the second largest in government.

SUZANNE GORDON: Well, the doctor has no administrative experience. He has very limited clinical experience. He was a combat military doctor in Iraq. He’s familiar with military medicine, which is basically get them up, get them out quickly, get them in line and get them fighting again. The VA medicine is entirely different. It’s dealing with veterans with multiple, complex, chronic conditions. His medical experience is, as I said, within—in the White House, with largely well-to-do people, who probably eat right, with the exception of the president, and maybe get enough exercise and so on. But veterans, the Veterans Affairs—the Veterans Health Administration, which he will be administering, is dealing with older, sicker, poor veterans who bear no resemblance to the kind of patients one treats in the White House.

I mean, you know, basically, Jackson is just a doctor. That’s his qualification. He curried favor with Trump by minimizing Trump’s weight-related and diet-related problems. But I think he’ll be a puppet that will put the VHA and the VA on a starvation diet, rather than putting the president on the much-needed diet that he should have been on a long time ago.

AMY GOODMAN: I want to turn to an ad from the Koch-backed Concerned Veterans for America, criticizing Wisconsin Democratic Senator Tammy Baldwin and Veterans Affairs.

MARK: I worked at the Tomah VA for nine years. I was there as a staff nurse and as a vet getting care. They kept giving me meds. And at the one point, I was on seven different medicines. Their idea of treating the vets is to throw more pills at them. The Tomah VA were enabling these guys to become addicts. We know for a fact that Tammy Baldwin had these reports that showed bad things that were going on. Tammy Baldwin had all that information and did nothing with it. Vets were dying. Vets were committing suicide. It was heartbreaking to see that. I want an answer.

AMY GOODMAN: Again, this ad from Concerned Veterans for America, not to be confused with the American Legion or Veterans for Foreign Wars. This is the Koch-backed organization that is pushing hard for privatization. Suzanne Gordon?

SUZANNE GORDON: Well, they—the Koch brothers amplifies every tiny problem or significant problem in the VA to make it seem like it’s a systemic problem. The problem of opiate use in Tomah was a problem, yes, but it was a problem in one facility. The VA has been acting nationwide to help veterans get off opioid narcotics and manage pain with integrative—all kinds of integrative treatments. This is never reported in the media. It’s not reported in The New York Times or USA Today or The Washington Post. And the opioid crisis is simplified. I mean, all over America, when the VA started prescribing opioids, there was a criticism of doctors for not treating pain more effectively. This was also pushed by Big Pharma.

And yes, Tomah was a problem, but it was a small problem in a large system that is doing a tremendous amount to try to deal with the horrible chronic pain problems that veterans leave the military with. No one talks about where these problems begin. It’s not the VA that creates pain problems and the kind of PTSD that leads veterans to want to kill themselves. It’s the military, and it’s the wars that we electively get into, which put people in harm’s way. And the VA is trying desperately to fix these problems, but not every single one of these problems is fixable, because people are so damaged by war, and sometimes even by the exposures and occupational injuries that they have in military service, and they don’t even have to leave the country to have them.

AMY GOODMAN: Suzanne Gordon, talk about what a privatized VA looks like. In fact, the VA, Veterans Administration, is really socialized medicine. Is that right?

SUZANNE GORDON: The VA is really the nation’s only single-payer system. It treats everyone who is eligible. Not all of the 22 million veterans in this country are eligible. You have to have some sort of service-connected problem—PTSD, Agent Orange, diabetes. There’s huge variety of them, because being in the military is very dangerous, again, even without going into combat. And then you have to have income requirements. So the VA really cherry-picks the oldest, sickest and poorest veterans. There’s no other healthcare system that has so many old, sick, poor veterans—or patients.

And the VA really functions as an integrated system to take care of all their problems. It integrates primary and mental healthcare. It has probably the best mental health system in the country, because our mental health system in the private sector is a disgrace. It has the best geriatric care in the country. It has incredible end-of-life care. It has amazing rehabilitation services—blind rehabilitation centers, stroke centers, spinal cord injury centers. And these don’t just treat veterans who have been in combat.

I know a gentleman in Boston who is 78 years old. He was an MIT professor. He suffered a catastrophic injury, was quadriplegic. He was kicked out of the Mass General Hospital and Spaulding Rehab, and told to basically go home, and he’d never walk again. They discovered he was a veteran. They sent him for four months of inpatient rehabilitation, a year and a half of other rehabilitation. And he is now walking a mile with a walker.

This is the kind of thing our private-sector system never does. If I have that kind of problem, God forbid, I will never get the kind of care that Samuel Jay Keyser got at the Boston VA. And this is true all over the country. The private-sector system is just not ready to care for the kind of complex problems, multiple problems, that veterans have. It is unprepared to do that.

AMY GOODMAN: You know, often what’s raised when you talk about privatizing the VA, the issue of a vet who lives hundreds of miles away from one of the VA hospitals or clinics and wants to see a doctor, and the very reasonable need to work with maybe a local, private doctor. But that’s not what privatization of the VA is about. Talk about what it would look like. What are the Koch brothers’ plans?

SUZANNE GORDON: Well, they would like the VA to be like TRICARE, which is the military insurance program, an insurance provider that pays for care, not delivers care. And the VA has great health outcomes. And really, it’s important for people to understand that in every single study—and they keep coming out, day after day after day—every single scientific study shows that the VA, in most areas, is equal or superior to the care delivered in the private sector, for much lower costs. So, if we were to privatize, veterans would lose integrated care.

Now, it’s true that many veterans who live in rural areas have to travel to get to a facility where they can have surgery. But this is true for anybody in a rural area. And when they’ve studied the problem of would veterans get more expeditious care if they lived in rural areas under privatization, they found that they probably wouldn’t, because there just aren’t the doctors and specialists. I mean, Amy, if you look at the stats on mental healthcare in this country, 55 percent of American counties, all of them rural, have no psychiatrist, no psychologist or no social worker. There is no excess capacity out there to take care of these veterans. In San Francisco during flu season, University of California, San Francisco Hospital had people stacked up in the ER waiting for 60 hours for a bed, because there wasn’t enough capacity. Imagine adding 100,000 veterans, who now are cared for in veterans’ facilities, to those people in those ERs in flu season. It would be a disaster. The whole idea of privatization is based on this myth that we have excess capacity.

Now, what they really want is, they don’t want to take—these hospitals and the Koch brothers and the hospital chains that are fighting for more veterans, they don’t want people with chronic illnesses and mental health problems and primary care. They don’t have enough people to take care of the patients that are already on their books. What they want is they want, you know, to do the colonoscopy, the high-cost colonoscopy, or the hip replacement. But why—that would cost more money, and veterans wouldn’t get integrated care.

AMY GOODMAN: So, do you think the firing of Shulkin is the beginning—who knows if Dr. Jackson will be approved by the Senate? As one Republican lobbyist on Capitol Hill, when he heard, said the words “Harriet Miers,” a woman who didn’t quite make it through—


AMY GOODMAN: —a confirmation hearing. But because he has no experience in running a large organization, it’s kind of like the word is that Trump wants to put his private pilot as head of the FAA.


AMY GOODMAN: It means that he is a blank slate on these issues and that he could be heavily influenced, as opposed to Shulkin. However much he was criticized for even going in any privatization direction, he saw himself as a bulwark against that privatization.

SUZANNE GORDON: Ronny Jackson, under any other president, would never be considered for a position like secretary of the VA. He will be, as one veteran service representative told me, the perfect puppet, because he will owe this job to the president. He has no experience. And he will probably do what the president and his very archconservative advisers—you know, he will do their bidding, because he owes his now-elevated position, if he’s confirmed.

I think it’s up to the Senate and the veterans service organizations to oppose this. And it’s up to them to oppose privatization. And, Amy, the really frightening thing about all this is it’s not just the Republicans. I mean, there are many Democrats in the House and in the Senate who really are not standing tall enough about the issue of opposing what I call stealth privatization. You know, outsource this, outsource that, and pretty soon you have nothing left. And Democrats have to really stand firm on this issue. Jon Tester of Montana is the co-sponsor of a bill that would really increase the pace of privatization. They claim it’s not privatization, but it is creeping privatization. And we need people to say, “No, fix the VA.”

There’s 35,000 unfilled positions in the VA. There is need for more exam space and clinical space and infrastructure repair. We spent, in the past four years—or three years, 49 percent more money on private-sector care, and we spent—we gave the VA 9 percent more for its own clinical care. And we’re sending veterans out into a private sector that is not ready to serve them. The RAND Corporation just did a study of New York state physicians and nurse practitioners and mental health providers, and it found that 2 percent, according to its criteria, 2 percent of providers, in a state that serves the fifth-largest population of veterans, had the capacity and the readiness to serve and deal with veterans’ problems. Two percent.

AMY GOODMAN: Well, you talk about all the thousands of positions that haven’t been filled at the VA. Now the top one is also open, because President Trump has fired Dr. David Shulkin. Suzanne Gordon, I want to thank you for being with us, award-winning journalist and author. We’ll link to your piece at American Prospect, “Studies Show Private-Sector Providers Are Not Ready to Care for Veterans.” Gordon is the author of The Battle for Veterans’ Healthcare: Dispatches from the Frontlines of Policy Making and Patient Care.

When we come back, we’ll speak with a resident physician at the VA in Nashville, not only about Dr. Shulkin’s firing, but also about a former senator’s comments. That’s Pennsylvania Senator Rick Santorum, recommending to the kids, rather than lobbying on Capitol Hill and fighting for gun control, why don’t they do something worthwhile, he says, like learn CPR? Stay with us.

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