Choose Carefully, Mr. President

The troubled Department of Veterans Affairs can’t afford more drama around a secretary nominee. Here’s how Trump can make the right pick.

Admiral Ronny Jackson in uniform leaving the U.S. Capitol
Adm. Ronny Jackson departs the U.S. Capitol on Wednesday, the day before withdrawing his nomination for VA secretary. Aaron P. Bernstein/Getty Images

The scandalous withdrawal of VA secretary nominee Adm. Ronny Jackson on Thursday was just the latest episode in a long stretch of chaos at the Department of Veterans Affairs. If President Trump wants to end the turmoil at the VA and allow the department to confront its critical problems, he will need to make a careful choice in his next nominee. The VA deserves a competent and experienced leader, with the policy background and management ability to steer it through these troubled times.

The current upheaval at the VA began last month when the president removed Secretary David Shulkin following the revelation of his own controversies, and replaced him for the short term with the barely confirmed DoD Under Secretary for Personnel and Readiness, Robert Wilkie. But the head-spinning pace of change at the VA extends back over the past four years, as five different people have held the top position at the department in either an acting or permanent capacity since President Obama’s firing of retired Army Gen. Eric Shinseki in 2014. Each of these VA leaders presided over periods of intense scrutiny and infighting, and achieved varying levels of success in attempting to reform the relatively new department—which has existed as a Cabinet-level agency only since 1989.

While Trump’s eventual pick of Jackson for the role received some immediate praise from recent secretaries, significant issues quickly surfaced.
As recently as Monday, three former VA secretaries signed a letter endorsing Jackson, despite others’ concerns that he wasn’t qualified to manage such a large and complicated bureaucracy. In the past week, however, allegations emerged accusing Jackson of significant professional misconduct, which resulted in his withdrawal from consideration on Thursday. Though it may be too early to make a definitive judgment on Jackson’s conduct, these events only serve to heighten the stakes over appointing a suitable leader.

Jackson would have faced a series of daunting challenges upon his arrival to the department, as my former colleague Phillip Carter pointed out last month. The next secretary of Veterans Affairs will have to confront a number of policy dilemmas relating to disability ratings and payments, VA infrastructure and bureaucracy issues, and perhaps most importantly, an escalating debate over the “extent to which the government will purchase [medical] care from the private sector or deliver it through the VA’s huge network of hospitals and clinics.”

Recent reporting demonstrates significant problems at some VA facilities, including lingering wait time issues, quality concerns, and devastating bureaucratic hurdles. The response to these problems among many policy advocates in the veteran community, including in the Trump administration, has been to push for privatization of veteran health care, or to allow more options—“choice”—for veterans in the system. These calls led to the passage of the Veterans Choice program in 2014, which allowed veterans to access care from private doctors more easily. Even with this change, conservative veteran groups continue to press for a larger role for the private sector in veteran health care.

The reality within the veteran community, however, is much more complicated than either side of the health care debate will admit. Most obviously, while the VA health care system certainly has room to improve, hospitals in the VA network often provide high-quality care and are valued by their patients. Just Thursday, the RAND Corporation released a study showing that the VA health system “performs similar to or better than non-VA systems on most measures of inpatient and outpatient care quality.” At the same time, however, the study found a “high variation in quality across individual VA facilities,” demonstrating that some clinics and hospitals in the VA system do perform quite poorly.

It’s no surprise then that veterans’ opinions are as mixed as the overall performance of the VA health care system. While the conservative group Concerned Veterans for America released findings in 2017 showing that 92 percent of those veterans polled thought it was “very or extremely important” to improve veteran health care, a Gallup poll from 2015 found that 78 percent of military personnel and veterans were satisfied with their health care, more than any other group of health care customers. Both of these surveys followed major scandals in 2007 and 2014 that revealed neglect and poor care quality in some facilities. Though the veteran community undeniably wants to find a way to improve the quality of VA health care, it also sees the VA system as an invaluable resource for veterans.

In charting a path for the future of Veterans Affairs through this complicated landscape, the administration can take a rare lesson from Congress; on the Hill, the House and Senate veterans affairs committees represent rare venues for bipartisan compromise. Despite the contentious debate over privatization for veteran health care, these congressional committees “are quietly moving forward with an ambitious, long-sought and largely bipartisan agenda” to reform the VA for the country’s 21 million veterans. By nominating an experienced but relatively nonpartisan executive to lead the department, the president could work to empower the progress occurring in the halls of Congress, building on recent legislation.

That said, the president is undoubtedly facing political pressure from many constituencies—including advocates of privatization—to nominate “the right” person for the VA job. While several articles have speculated over possible candidates for the role, including Acting Secretary Wilkie and current VA Deputy Secretary Thomas Bowman, or even White House Chief of Staff John Kelly, the president could also nominate a political operative more committed to privatizing the VA health care system. Even though the president has confirmed his approval of the “choice” agenda in recent public appearances, it’s not clear whether his next pick for VA will mirror his policy goals. For the sake of the country’s veterans, we can only hope that the next nominee will be open to a variety of policy options and have the management experience to lead the department to accomplish them.