A Trump Choice for Veterans Shulkin favored the status quo of limited health-care options.
https://www.wsj.com/articles/a-trump-choice-for-veterans-1522450915
It wouldn’t be a normal week in Washington without a Trump Administration personnel melodrama. But this week’s removal of Veterans Affairs Secretary David Shulkin is important on the policy merits, and let’s hope his successor is more amenable to allowing retired service members to make their own health-care choices.
On Thursday Mr. Shulkin took to the New York Times to warn of “political appointees choosing to promote their agendas instead of what’s best for veterans” by supporting “privatization leading to the dismantling of the department’s extensive health care system.” This self-justification exercise will not be remembered as the most graceful exit.
Mr. Shulkin has been on the way out for several weeks, and his euphemisms are about his months of infighting with White House and other Administration officials. The unsubtle innuendo in the press is that Mr. Shulkin was run out by the nefarious Charles and David Koch through a policy group called Concerned Veterans for America.
Yet no one except Mr. Shulkin is talking about “privatization.” Concerned Veterans for America in a white paper has sketched out a plan to restructure the VA and allow it to focus more on the expertise its doctors have developed in, say, post-traumatic stress and prosthetics. The plan includes a premium-support payment so vets could buy discounted private coverage from a menu, much like federal employees do. A current vet who preferred to be treated for diabetes elsewhere would be free to make that choice.
At bottom this is a debate over political control and cost because allowing choice outside the system is expensive. We know that denying that escape valve often traps veterans in subpar facilities with unresponsive bureaucracies. But politicians have never wanted to take on the veterans interest groups that are attached to the status quo.
Mr. Shulkin indicts private industry though VA’s single-payer system has been responsible for some of the most macabre health-care scandals in history. Manipulated wait times that resulted in death; an opioid doctor known as “the candy man”; recall the many horror stories in 2014 from Tomah, Wis., to Phoenix.
So what’s going on? “Privatization” is in part a straw man to obscure Mr. Shulkin’s own behavior, including ethical lapses on misusing VA funds on travel. More substantively, Senator Jerry Moran at a hearing earlier this year called out Mr. Shulkin for “double talk,” by which he ostensibly meant claiming to support, while really opposing, a proposal that would provide more health-care choices for veterans.
The best bill before Congress is Mr. Moran’s with Senator John McCain. After rampant VA scandals, Congress in 2014 created a choice program that allows certain vets to receive care outside the VA. But the system is based in part on where a vet lives and wait-list times, not the severity of the ailment or needs of the patient. The Moran bill would correct this dysfunction with new standards and streamline many programs that allow vets to receive private care. The bill also opens up access to telemedicine and walk-in clinics, among other useful changes.
President Trump has chosen Ronny Jackson as a VA replacement, and the rear admiral is best known as the White House doctor. The rush is to declare him unqualified, and we wonder if Mr. Trump has put his nominee in a tough spot. Rear Admiral Jackson probably felt he couldn’t say no to his Commander in Chief, but he hasn’t been immersed in the emotive and complex politics of veterans.
He will now face a long and tough confirmation process in the Senate, and Mr. Trump had better not start bashing Rear Admiral Jackson if he stumbles as the President has other cabinet officials.
But checking the right boxes on a résumé didn’t help Mr. Shulkin, who by press reports couldn’t run his own communications department. That sounds less stressful than Rear Admiral Jackson’s stint in Iraq with a surgical shock trauma platoon. One piece of advice: Don’t become a target with first-class travel, stock trades or free Wimbledon tickets.
The White House managed the Shulkin affair with its usual backbiting and disorganization. But if the goal is to transform the VA to deliver better and more efficient health care for veterans, then perhaps the real Trump mistake was choosing Mr. Shulkin in the first place.
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