David Shulkin, a physician and former healthcare executive, was an under secretary at the U.S. Department of Veterans Affairs under President Obama and the Secretary of the VA under President Trump. In March 2018, he was abruptly fired amid charges of improperly accepting gifts and misusing taxpayer funds for personal travel. Shulkin has consistently denied wrongdoing and says he was pushed out by political insiders trying to privatize the VA. In his forthcoming book, It Shouldn’t Be This Hard to Serve Your Country, Shulkin traces his thirteen tumultuous months in the Trump Administration. As he notes in the book, all direct quotes are reconstructed to the best of his memory and corroborated by his wife Merle Bari’s contemporaneous daily diary, which reflected what Shulkin told her on a regular basis during his time in Washington. This excerpt has been edited for length and clarity.
Around 11 a.m. on Saturday, Jan. 7, 2017, I received a call telling me I was expected at Trump Tower in New York at 2 p.m. that afternoon. After about an hour of sustained panic driving with my wife Merle on snow-covered roads from Philadelphia, my cell phone rang. It was Reince Priebus.
“Sorry not to have called sooner, but we’re all set. You’ll be meeting with the president-elect on Monday at 2:00 p.m.” Monday, not today.
We found the nearest exit, turned around and headed back home.
Later that afternoon, Priebus called again, this time with some questions for me — mainly, it seemed, to help him figure out how I had gotten on his call list. He wanted to know how I knew Trump. I told him I didn’t. He seemed perplexed that I had no connection to the Trump campaign. He also wanted to know how I became under secretary for Obama. Without commenting on any of my answers, Priebus asked me to meet with him for lunch on Monday prior to my meeting with the president-elect.
On Sunday, still mystified but intrigued, I took a train to New York. Clarifying some final details, they asked me if I wanted to enter Trump Tower through the main lobby or use a private entrance to avoid being seen. A year and a half into my service in Washington, I still didn’t quite understand optics and the strategy behind these kinds of decisions. I saw no reason to hide a meeting with the president-elect. “I’ll go through the front door,” I said.
The next day, I headed over to Trump Tower, around which the NYPD had set up a security corridor in all directions. I wasn’t quite sure what to expect, but even if this meeting was nothing more than an exit interview, I wanted the chance to tell the president-elect where progress was being made at the VA and what direction his new administration should take.
In 2014, when Obama administration officials first approached me about coming to the VA, many of my colleagues expressed concern that the job was a no-win situation. They felt it was a sure fire way to ruin my career leading large hospital systems — a career that had been marked by distinction. They warned that the VA was simply too big and complex to change. Others pointed out that it did not make sense to accept a dramatic pay cut in return for such enormous headaches. But I took the job because I felt a sense of responsibility to our nation’s veterans.
There are more than 20 million American veterans, about a quarter of them living in rural areas, and many of them need VA benefits just to get by. More than nine million of our veterans rely on VA health care, a system that is spread across the entire country, with approximately 1,300 facilities and more than 340,000 employees. It’s the largest health care system in the U.S. and one of the most complicated organizations in the government. Dealing with the size and scope, budget realities, capital deficits and political pressure surrounding the VA is nearly impossible under the best of circumstances.
I arrived in 2015 as Under Secretary of the Veterans Health Administration amidst chilling reports of excessive wait times for VA medical care in many parts of the country. There was also an unacceptable breakdown in delivery of mental health and addiction care, which left veterans of Iraq and Afghanistan to fend for themselves during epidemics of traumatic brain injuries and posttraumatic stress — neglect that led to myriad suicides and overdoses. The VA health care system was all but publicly declared to be on life support.
But after 17 months of work and a great deal of progress on many fronts, I felt optimistic, energized and even more responsible than ever, which is why, when presented with the chaotic swirl of events that were my introduction to Donald Trump and his team, I went in head first.
Just inside Trump Tower, I was met by several Republican National Committee staffers, who escorted me to the lobby restaurant. As Priebus and I shook hands, he told me that he no longer had time for lunch. I said I understood, but knowing that he was from Green Bay, I added, “By the way, congratulations on the Packers’ win this weekend.”
He smiled and said, “You know, maybe I do have time for a quick bite.”
Making our way through the small restaurant, we were stopped by swarms of diners who all seemed to want their picture taken with Priebus, so I became the amateur photographer as table after table stood up to pose with him. We took a back table, ordered chicken Caesar salad and spent most of our time casually discussing our families and nonpolitical interests. I gleaned nothing of substance and no explanation for why I was summoned to New York. After lunch, he escorted me upstairs.
As we approached the inner sanctum, Steve Bannon came out to greet us and escort me into Trump’s office, familiar to millions as the set of The Apprentice. Against a wall of glass, the president-elect sat at a huge desk covered with copies of Time magazine with his picture on the cover as Person of the Year. A part of me wondered where the secret cameras were hidden.
As we shook hands, Trump announced to his staff in the room, “He’s a good-looking guy.” He then quickly repeated, “He’s a good-looking guy, isn’t he?”
Taken aback, I could think of nothing better to say than, “Nice to meet you, Mr. President-Elect.”
Glancing around the room, I noticed that the one non-glass interior wall was filled with awards and plaques from events honoring Trump. I sat down in the only chair facing him, across the desk.
It seemed by now that most of Trump’s inner circle were milling about in the room behind me — Jared Kushner, Kellyanne Conway, Michael Cohen, Bannon and Priebus.
Kushner and Conway were having a side conversation, which they took outside. Then Trump turned to me and asked, “So what’s the best hospital in the city?”
“Well, Mr. Trump, I think it depends on—”
“You know, I used to think well of this one place, but I know a guy who went in there feeling okay, and they just chopped his thing right off! They chopped it off! I wouldn’t go there for anything now.”
Once again, I wasn’t quite sure what to say. “Yes. Well . . . no hospital is good at treating every condition,” I managed.
“So if you were sick, where would you go?”
Before I could answer, he looked over at Cohen. “So, Michael, what do you think of this guy?” Cohen and I met each other years earlier when I had been serving as the chief executive officer of New York’s Beth Israel Medical Center.
“Donald, he’s the best in his field.”
“You really think so, huh?” Looking back at me, Trump asked, “So what do you think of McDonald?” Bob McDonald, the current VA secretary and my boss, had been appointed by President Obama to replace General Eric Shinseki, the VA secretary forced to resign in the midst of the wait-time crisis.
“I think he’s one of the best leaders in the country,” I answered truthfully. “He’s been making really good progress, and I think he should stay.”
“Yeah, I’ve heard good things, but there is no way we can keep him, just not possible. What do you think we need to do?”
Then, answering his own question, Trump said, “I’ll tell you what we need to do: we need to make sure our veterans aren’t waiting for care.”
“Mr. Trump, you’re absolutely right.”
“We have to fix this thing. It’s a mess. Do you think we can fix it?”
“We’ve been making big improvements on the wait times. We’ve developed same-day access, and we’re getting more veterans —” He cut me off again.
“I want our veterans to get the best.” Then he repeated, “They really created a mess here. Can we fix it?”
Once again, I assured him that I was committed to doing just that. Trump ruffled through a few papers on his desk and then looked up. “The VA’s an important place, but there are some good ones and some bad ones. But I’ll tell you what’s messed up. They come back with PTSD. You know what’s really bad? They come back and their wives or girlfriends didn’t wait for them.”
Trump paused for a moment and then looked up as if actually seeing me for the first time. “You know, you don’t really fit the bill. The generals . . . now they fit the bill. But can they fix health care?”
Not waiting for my response, he continued. “Who do you think would make a good secretary?”
“Well, Mr. Trump, Bob McDonald is doing a great — ”
Trump cut me off to ask about a certain African American candidate from the navy. He asked if I thought he could fix health care. I said I did not know anything about the gentleman.
“What about this CEO of Exxon Mobil?” Before I could answer, he moved on to, “What are you . . . like, the number-two or number-three guy at VA?”
“I’m number three, sir.”
Kushner and Conway came back in, still engrossed in their own private conversation, passing a piece of paper back and forth. Soon Priebus and Bannon were drawn in, and the volume of their sidebar escalated.
After a moment, Priebus interrupted. “Mr. Trump, we need your approval on this press release. It’s about Jared’s role in the administration.”
Trump glanced at the paper for a split second and then, without reading it, handed it back. “Just tell me what it says!”
“I don’t think we should release it just now,” Conway said.
“Well, I do,” Kushner countered.
Having seen all of these people parodied relentlessly over the past several weeks on Saturday Night Live, I couldn’t help thinking that I’d stepped into a skit with Alec Baldwin and Kate McKinnon. As the tension increased, Priebus leaned over to me and whispered, “Dr. Shulkin, we need to resolve this. Would you mind stepping out for 10 minutes?” I rose from my chair, but Trump swatted me back down.
“David can hear this. Stay.” I sat back down.
The debate continued, with Trump sitting quietly, until the group seemed to reach some kind of resolution. Then Trump turned back to me. “So why is it so broken? The VA.”
“Well, there are many reasons, starting with — ”
“I think we need to let the veterans go wherever they want.”
“Well, there needs to be a coordinated effort — ”
“I’ll tell you what: we’re going to fix this thing. If you were in charge, what would you do first?”
“I would make sure that we had — ”
“Do you think we can fix this thing?”
“Yes, Mr. President-Elect, I do.”
We went on like this for another 30 minutes or so while the others wandered in and out. Finally, Trump turned to Priebus, Bannon and Cohen and asked, “So what do you guys think?”
Heads nodded in approval.
Then the president-elect turned to Cohen and said, “Next time you see him, you can call him Mr. Secretary.”
Confused, I stood, shook Trump’s hand and left the office.
I took the long elevator ride down to the Trump Tower lobby, where I was met by a barrage of camera flashes and bright lights from TV crews. Reporters shouted, “Dr. Shulkin! Did you meet with Donald Trump? Dr. Shulkin, who’ll run the VA?”
I had no idea, mostly because I had no idea what had just happened.
I smiled and waved shyly but said nothing. Then I made my way quickly into the crowds on Fifth Avenue, where I was once again unrecognizable.
On January 11, 2017, when Trump announced that he had selected me as VA secretary, I was as surprised as anyone. Little about my interactions with Trump’s inner circle had made clear that I was the top pick. But I was pleased, as it meant I got to keep serving veterans, which is what I wanted to do all along. I could use the experience I had gained in the Obama administration with the freedom I was given in the Trump administration.
We broke new ground after Trump’s inauguration by publishing our wait times and quality data, expanding benefits for mental health services and adding benefits for those with other-than-honorable discharges. We dramatically increased our technological sophistication through greater reliance on telehealth and by moving toward a new electronic health record system that would connect seamlessly with the Department of Defense. We made real advances in timely access to care, and we implemented important changes that resulted in veterans having more choice in where they received their care. In large part, we found a formula for moving away from the status quo and getting the system back on track.
Part of that formula involved working more closely with the private sector and making the VA more competitive with industry practices. This was essentially a middle ground between a fully government-run organization and privatization. With Americans polarized over almost every issue, I hoped that caring for veterans wouldn’t get entangled in the usual D.C. gamesmanship. The longer I was in the capital, the more I was sorely disappointed.
Much of my tenure involved various factions pushing me to simply close the VA or at least large parts of it that weren’t working well. But I didn’t see how shutting down a system specifically designed to care for veterans could be in the veterans’ best interests. My strong belief was that my job was to find solutions, no matter how many problems plagued the VA, in order to make the existing system work better.
We made real progress during my time at the VA. The morale of the workforce was growing. We were passing new legislation. We were working more closely with our community partners, and we were making the structural changes to ensure sustainable improvements. I had found a way to get things done despite the turmoil within the Trump administration, and things seemed to be running smoothly.
Until they weren’t.
To be clear, I did not set out to tell the story of how much the VA accomplished in three years and how I was fired by a Trump tweet on the eve of passing the most important bill in the history of veterans’ medical care because I wanted anyone to feel sorry for me. I am telling my story because, in my opinion, the VA is still in grave danger. Its doctors, its administrators and most importantly our veterans are at risk as never before.
Maintaining a strong VA is also an essential piece of the puzzle that is the United States national security system: we cannot expect our sons and daughters to risk their lives and fight for our freedom unless we keep our promise to care for them if and when they return home broken, injured or traumatized. There is no excuse for not holding up our end of the bargain. The mission set forth by President Abraham Lincoln to care for those who have “borne the battle” is a sacred duty.
One year after I became the secretary of Veterans Affairs, the environment in Washington had grown so toxic, chaotic and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve. When I left, I promised to continue to speak out against those seeking to harm the VA by putting their personal agendas ahead of the care of our veterans.
I am also worried about the future of public service generally, which appears increasingly bleak as important positions remain unfilled and while cabinet secretaries are hired, fired and publicly humiliated as if our national government were a reality television show. After I was fired, I told my wife — and then repeated the thought in an op-ed I wrote for the New York Times — “It should not be this hard to serve your country.”
The time I spent in government changed me, and my family, forever — but it also gave me a renewed sense of purpose, as well as a belief that systems in government can be improved. It’s not hopeless, but it is a long road without any quick or easy solutions. It also reaffirmed my belief that as long as we have the need for a military to defend our country, the VA must continue as a strong and effective system, willing and able to serve those injured during their service. It is important that Americans understand what the VA system is, how it works and why it exists. If we are willing to commit to our veterans as they have to us, we can all work together to build a safer, healthier and prouder country.
From the book It Shouldn’t Be This Hard to Serve Your Country by David Shulkin. Copyright © 2019 by David Shulkin. Reprinted by permission of PublicAffairs, New York, NY. All rights reserved.