If those who work in veterans policy were at a Thanksgiving dinner table, the politically charged conversation that would come up this year would certainly center around privatization of VA health care.
Back in February, during VA Secretary David Shulkin’s confirmation hearing, the statement that resonated throughout the veterans community was, “the Department of Veterans Affairs will not be privatized under my watch.”
{mosads}However, now, as Shulkin discusses a larger role for private-sector health care for veterans, many are wondering whether Shulkin is a liar, a hypocrite, or just a savvier politician than he was initially given credit for at that initial confirmation hearing.
Based on the emerging conversations regarding a merger with Tricare and the need for VA hospitals to compete with outside providers for veteran-customers, the answer appears to be the latter option, i.e., that he is in fact a savvier politician than many gave him credit for.
The first indication that Shulkin was a shrewd politician, rather than a decorated war veteran who happens to be a party donor, as past VA secretaries have usually been, was his ability to be appointed in the first place.
Many were surprised when President Trump nominated Shulkin for VA Secretary, given his previous appointment as VA Under Secretary for Health during the Obama administration. Not only did Trump campaign heavily on the promise to allow veterans to see the doctor of the choice, but appointing a holdover from the Obama administration also seemed to be at odds with that promise.
However, despite Shulkin’s ties to the Obama administration, as noted earlier this year by Task & Purpose, he, “has demonstrated an adeptness at the political games that many of his Trump administration colleagues still struggle with, and he does it with aplomb.” The article went on to state that the relationship between Shulkin and the traditional veterans service organization is “a delicate, occasionally manipulative relationship all around” but nonetheless effective.
Accordingly, Shulkin’s savviness to navigate the political landscape of today should not be under-estimated when it comes to analyzing the future of veterans health care: His perceptiveness for both President Trump and stakeholders in the veterans community is a rarity not just in today’s bewildering political climate, it is also atypical for a VA Secretary who’s been in office less than a year.
Thus, if there is anyone qualified to navigate the politically charged conversation about the changing role of private providers with VA, Shulkin is certainly the right man for the job.
No matter what direction the VA goes in, half of the political spectrum will be left feeling unhappy about it. However, another one of Shulkin’s strengths is the ability to tactfully work with those who disagree with him and make them feel included in the conversation. When one doesn’t get their way politically, at least the blow is softened by a feeling that your view was heard and understood. Shulkin has proven to be far more adept at this than most of his predecessors.
And, that adeptness is important, because thus far, most veterans service organizations, the primary stakeholder voices in conversations around VA health care, have stated that they do not agree with merging with Tricare, or with full scale privatization.
But, putting politics aside, what Shulkin is saying actually makes sense, (again, a rarity in Washington these days).
First, Shulkin has emphasized that he’s not rushing into a decision. With regard to a Tricare merger specifically, he’s noted that the implementation of an integrated medical health records system would take years, and thus, any such merger couldn’t take place before that time. So, he is not simply trying to ram through a political agenda in what could be only a four-year term. This makes sense from both a political and policy perspective.
Second, Shulkin has helped quell some critics by noting that competition and full-scale privatization are not the same thing. In other words, there is a middle ground.
“We’re trying to not only let veterans increasingly have more choice and decision making,” Shulkin said Monday. “We’re trying to let the VA understand under that system for them to remain strong, they have to be veteran-centric. They have to treat their veterans like customers, and they have to have quality of services and access to services that is equal to or better than the private sector.”
Again, encouraging competition is good politics and good policy. As stated by the FTC, “competition in health-care markets benefits consumers because it helps contain costs improve quality, and encourage innovation.” The VA would certainly benefit from additional pressure to improve costs, quality, and innovations for veterans.
Finally, as Shulkin noted in a July OpEd for USA Today, “community care or private capacity and VA’s internal capacity are not mutually exclusive.” To date, no politician or VA official has been able to successfully convey this message to politicians and veterans advocates, but it appears that Shulkin may be the first person to successfully do so.
Essentially, Shulkin is guiding the VA through an identity crisis. Does it want to preserve the status quo, or does it want to evolve? The evolution of government agencies happens slowly, but when it does happen, it can be rather historically significant. Shulkin realizes this, and he wants to guide that change.
In baseball, the general philosophy is that a tie goes to the runner. When it comes to veterans health care, given Shulkin’s experience at VA in both Republican and Democratic administrations, his political experience amounts to a tie. In other words, for purposes of this analogy, Shulkin is the runner. The fact that he’s come out in favor of greater competition and choice for veterans should give them confidence that this is ultimately the right direction for their health care.
Rory E. Riley-Topping is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veteran’s Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs. Follow her on Twitter: @RileyTopping.