Secretary of veteran Affairs David Shulkin joined me this morning:
HH: One of the most interesting people in the United States Cabinet is Dr. David Shulkin, who is the Secretary of Veteran Affairs, and has been at the VA since taking the number two position there under President Obama. He was promoted by President Trump, confirmed unanimously because of his private sector experience with patient-centered care. He was a CEO of Beth Israel Medical Center in New York. He was the chief medical officer of the University of Pennsylvania Hospital. He was, he’s got so much pedigree for this job, but it is an enormous job, and it’s an honor to talk to Dr. Shulkin this morning. Good morning, Secretary, welcome.
DS: Hi, good morning, glad to be with you.
HH: You know, Tom Price was our guest on Meet the Press on Sunday, and I was on the panel. And he made a statement that I think many people don’t get, that there isn’t really one health care system in America. There are five. And he ticked off – Medicare, Medicaid, employer-based health insurance, the individual market, and the Veterans Administration. And I started thinking about that. You have an enormous workforce. You have 340,000 people working for you?
DS: Yes, and we’re the largest integrated health care system in the country.
HH: And so it was a disaster two years ago when you arrived. How is it doing now with the new legislation?
DS: Well, I think what we’re finding is that the VA has been a neglected organization for decades, really spanning multiple administrations. So we’re going through and we’re taking each issue, making sure that we’re modernizing this system, because the veterans deserve the very best that Americans can offer. And that’s the system that the President’s committed to putting in. So we’re on a path. We’re making progress. But this is going to be a multiyear plan.
HH: Now veterans with a 50% disability, or service-connected disability, get comprehensive care and medication at no charge. How many people does that cover, Secretary Shulkin?
DS: Well, we cover nine million veterans. There are 21 million veterans. Of course, we represent them all, but in terms of our health care system, nine million veterans are enrolled.
HH: And the legislation that was passed in June, probably the major legislative achievement of the President and the Congress thus far, gave you new authority. Have you used it, yet?
DS: Yeah, you’re talking about the President signed into law the Whistleblower Protection and Accountability Act. And that really allows the secretary to make sure that if employees who work in the VA have deviated from accepted values or principles of our mission to care for veterans, that I can remove them. And since the President’s been in office, we’ve removed over 700 employees from the VA. In fact, I now publish on a weekly basis all of our disciplinary actions of firings or suspensions or demotions so that everyone can see and track our progress.
HH: That is remarkable. I wish every agency had had this. And I’ve got to ask you, are the other cabinet secretaries jealous of this authority?
DS: Well, I think every cabinet secretary wants to make sure that their workforce is accountable. And I think that that is something that should be looked at across government. I believe that VA has a particular responsibility in this area, and so we’re leading the government in making sure that our workforce is accountable.
HH: Now in the addition to all this responsibility, you’re a member of the cabinet. How often do you see the President? How interested is he in veterans affairs after the signing of the legislation?
DS: This is one of the issues that the President feels most passionate about in terms of national defense and our veterans, something that he has a strong personal interest on. I speak to him on a regular basis. He’s always accessible when I need him, but he’ll pick up the phone and call me about issues when he’s concerned about it. And we talk about it at all of our cabinet meetings, of course, but also in our individual meetings.
HH: At these cabinet meetings when the national security set comes up, and we’ve got crises in North Korea, in Venezuela, in ISIS-land, with Iran, with Russia, do you sit there thinking this is going to increase the caseload on the Veterans Administration if we go to a shooting war? Is that point of view put forward?
DS: Of course. I do believe that having a strong VA is essential for our national security. People have to understand that if they raise their hand and go out and protect this country, put their life on the line, that they’re going to have the country behind them for the rest of their lives, and no matter what happens, they’re going to be supported. And when we do talk about these issues, the cabinet looks at these issues in a comprehensive way on the impact on, you know, the American people, the economy and how it’s going to impact systems like the VA as well as the Department of Defense.
HH: Now the cabinet doesn’t get together that often. Could you explain to the audience, Dr. Shulkin, as a member of the cabinet, how that is in that room when they start going around covering issue sets? What is that like?
DS: Well, first of all, I do believe that the cabinet will probably start getting together on a more regular basis, and get together on a more frequent basis. That is one of the things that the President talked about yesterday, and one of the pieces of order that I believe that Secretary Kelly, and now Chief of Staff Kelly, will be bringing to the table. As a former cabinet member, he understands how much the cabinet can contribute on multiple issues. And in yesterday’s cabinet meeting, there was a lot of interchange among members. And when you get that many people who have so much to contribute together, thinking about complex issues, I think the President gets the type of advice and the type of counsel that we can best help him with. And so I think it’s an extraordinary body. The energy level is high. People are very engaged. Everyone wants to help and contribute to the problems that are facing Americans.
HH: How long did that meeting go for? I’m just genuinely curious. I think the audience is fascinated by the idea of President Trump sitting around the table with this unusual group of people talking about what?
DS: Well, the meeting lasted about 90 minutes. The President, of course, leads the meeting, talks about the issues that are important to him, but also gives a chance for anyone who believes that there are important issues to put them on the table. And I think it’s run as a highly effective meeting. The new Chief of Staff had a chance to share his views on how he wants to run things moving forward. And so I think everyone left the meeting feeling extremely optimistic about the future and the way that we’re going to be working together in the White House.
HH: Now Dr. Shulkin, you have run some big operations – Beth Israel and the chief medical officer of Penn, and you’ve dealt with a lot of high-performing people. Does this President and this team compare favorably with those groups of professionals that you’ve dealt with in the past? Are you confident of them?
DS: Oh, there’s no question about it. What I think is so exciting, when you take a look at the people in the room, they come from such varied perspectives. They bring decades and decades of experience. And everybody shares the commitment to make sure that the country is making the progress that it needs. So I think it’s an extraordinary group of people that when put together and all working in the same direction, is going to accomplish great things.
HH: Now I’ve got to go back to veterans, because I have extended family in the military, and I hear about Tri-Care all the time. And I have veterans who have worked for me who had trouble with the Long Beach VA. And I know you’ve got these disability claims. So let’s go through this in that order, Mr. Secretary. Is Tri-Care functioning at the level you find acceptable?
DS: Well, Tri-Care is a system that is run by the Department of Defense. And it is a system that works more like a managed care company. They don’t operate their own facilities. They really work out in making sure that they pay for services out in the community. And Tri-Care, I think, has made tremendous progress over the past, you know, decade or so, that it’s been working to improve its operations. And while every system has an ability to improve, I think Tri-Care is doing a relatively good job as a payer of health care services.
HH: So that brings me to the question. The interface between the VA and Tri-Care is always a controversial one. And a lot of people wonder whether our veterans wouldn’t be better served via an expanded Tri-Care as opposed to a standalone system. How do you respond to that?
DS: Well, I do think that it’s one of the things that we are looking at right now. We’re looking at what systems are working for our veterans, what do we, what are we able to learn from other federal organizations? So Secretary Mattis and I have committed to working much closer together between the Department of Defense and the Department of Veteran Affairs. It’s one of the reasons why I announced that we’re going to be moving to an electronic medical record that is shared with the Department of Defense. And we are looking at other systems, including the Tri-Care system, about how we can pick what’s working already rather than trying to start over and duplicate efforts.
HH: Because that soldier, sailor, airman and Marine, they don’t change. That person is the same person whether they’re in Tri-Care or the Veterans Administration. So the interface has always struck me as, you know, the key boundary in the care of people who have served the country. And it doesn’t often operate very well.
DS: Well, they’re all veterans. There’s no question about that. And when we look at where all of our future customers are going to come from, we know it’s one source. So this is the new way that we’re looking at it, which is how do we design systems that are best for our veterans and not necessarily what’s best for the Department.
HH: Now Secretary, you’ve also got not only General Kelly, you’ve got General McMaster, you’ve got General Mattis, you have Joe Dunford who’s not shy, you have Mike Pompeo, who is a veteran, West Point grad, over at the CIA, Admiral Rogers at the NSA. You’ve got a lot of veterans now in Congress – Tom Cotton and Dan Sullivan and Todd Young. The number of people who are in a position to critique you has gone dramatically through the roof. Do you find that there’s a greater focus on your work now with this number of general officers running around the government?
DS: Well, all those people and many others that have the experience and care about this issue passionately help me do my job better. I have let people know that I welcome their input, and people who understand the system who have actually experienced it themselves help provide that perspective and input. And so I really feel very fortunate. And I reach out to members of Congress who are veterans. I hold special breakfasts and meetings with them, because these are people that this matters to, and also have particular insights and expertise that I want to take advantage of.
HH: Now bring me up to speed, if you would, on the adjudication controversy. There are so many people who are waiting for adjudication by the Veterans Administration of their benefit eligibility. It became quite the crisis a few years ago. It got improved. It slipped back. Where is it right now, Mr. Secretary?
DS: Well, there’s two parts to it. The first is people who are waiting for their appeals, and right now, it’s just unacceptable. It’ll take a veteran six years if they file an appeal today to be able to get an answer.
DS: So we have gone to Congress, and we need to change the law. The law was last changed in the 1930s. And so the House has now passed a bill to modernize the appeals law. And we’re waiting for the Senate. The committee has voted it out of committee, and so we’re waiting for a full House vote to be able to fix that, because we need to do a lot better for veterans than have them wait six years. On the disability claims, if you’re going to file a disability claim, as you know, a couple of years ago, there were over 611,000 veterans waiting more than 125 days just to get a disability claim. Today, we’re below 90,000, and we’re making progress to get that number much lower. We’re going to be introducing a new way, a faster way, to process disability claims in 30 days or less starting in September. So while we work that backlog, we’re improving our systems, and we’re committed to dramatically doing better for our veterans.
HH: You know, Dr., this is a staggering degree of complexity. I don’t even know how you go to work and organize an agenda for the largest hospital system in the country, basically. How do you do that?
DS: Well, it’s, you do it every day by waking up and thinking about what your mission is. And there’s nothing more important to me and to many Americans to making sure that this particular group of Americans is getting what they deserve. And knowing that we have a long way to go just means that you have to stick at it, and you have to work hard at it, and you have to remind people while you’re making the decisions that you’re making, and having that type of focus is really the way to get through the job.
HH: Now Dr. Shulkin, let me conclude by asking you about the President. The interest in him is so enormous. You work with him. You take phone calls from him. You actually work for him. Is the picture in the media the picture that you see?
DS: I see a man who is working tirelessly, who is extremely passionate about issues like doing better for veterans. And he is very clear on his messaging. As a boss, you can’t hope for anything more than somebody who tells you what the objective is and then allows you to go out and to do that job, and you know that you have the support of your boss. And so my ability to work with the President, and to be able to get the job done, is really a very good relationship, and one that I feel very fortunate to have given the clarity in which he has over the mission.
HH: Now when you see the controversies of the White House in the media, do you believe that the media is accurately portraying the work of this administration?
DS: Well, you know, I think that when you talk about the media, it’s a very large spectrum of the way that things are being reported. I think that there are so many media outlets with so much interest, that there are many reports, many of them clearly not true, others getting part of the story true. I think that what we’re seeing right now with Chief of Staff Kelly in place is a White House that’s really beginning to get itself in order, and being able to present a clearer picture so the media can accurately report on what’s going on. And I look forward to being able to pick up the newspaper and know that these are accurate stories coming out. And so I’m optimistic. Yeah.
HH: So when you left that cabinet meeting yesterday, last question, Mr. Secretary, thanks for your time…
HH: Do you think a reset has occurred? Do you think…
DS: I do.
HH: Go ahead.
DS: I do. I do. I think that this is a reset. I think that this is a White House that is dealing with so many issues and trying to move so quickly that it’s taking a while to learn the best way in which to organize itself internally, and to represent itself externally. And I think we now are on the right path, and I think everybody’s committed to making sure that we support both Chief of Staff Kelly and the President.
HH: Dr. David Shulkin, Secretary of Veteran Affairs, thank you. Come back early and often to talk about our vets. I appreciate the job you are doing, and the energy you bring to it very much.
DS: Thank you, Hugh.
End of interview.