David Shulkin Knows Sacrifice

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S1: This podcast may have explicit content and also has this implicit request if you follow me on Twitter. Why not follow the gist at Slate? Just.

S2: It’s Thursday, November 21st, 2019 from Slate. It’s the gist. I’m Mike PESCA. Last night’s debate at the Tyler Perry studios in Atlanta, Georgia, where they filmed the seminal Madea Goes to Jail. I mean, I presume. I hope they did. The candidates got into it. And then NBC cut to a commercial. Corey Booker and Kamala Harris had moments of soaring rhetoric.

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S1: Amy Klobuchar had a little more room than in past debates to demonstrate her affability. Elizabeth Warren was forceful. Andrew Yangs had a couple of things no one else was talking about made good sense. Biden was a bit confusing. Bernie Sanders railed against money in politics, also by implication, money in general. And who had I forget? Who I forget? Oh, yeah. Tom Stier probably made two hundred thousand dollars in interest just by standing there. So what I’m saying was this was a debate very much like a lot of the other debates we’ve seen, except for Pete, butI jej. Now, the debate was supposedly a test of the SBN mayor’s mettle. And on that score he was fine. But booted JEJ for the first time in the debates had something that really annoyed me. Now I thus far have thought of Bhuta Jej is very well-spoken, who seemed to favor policies I personally consider sensible. And then when describing those policies used rhetoric that I consider responsible, but that he was challenged a little bit about his relative lack of experience and getz’s, he tried to turn the obvious negative into a positive. It turns out that not having experience is the best experience of all. That is, if you modify the word experience with the word Washington. Let’s give a listen.

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S3: So first of all, Washington experience is not the only experience that matters.

S4: It’s more than one hundred years of Washington experience on this stage. And where are we right now as a country?

S1: All right. Now, you regard that as a pretty standard tack to take from someone inexperienced to rail against the usual way of doing things to claim you’ve got the fresh perspective to talk about how you’re not contaminated by the old ways of thinking. I mean, Trump did that. Wait a minute. Trump did that. But that’s not why I’m against it. First of all, Mayor Pete. This works, okay? When the governor or the mayor of a pretty big city that’s bigger than Norwalk says it. Oh, no, not Norwalk, Connecticut. Norwalk, California has a population bigger than S-band. I’m not just saying that’s a city out of your league, but League City League City, Texas is also bigger than SBN League City. Lakewood, New Jersey, bigger than South Bend. I could do this all day. I love listening cities bigger than S-band, but it’s not really about the size of the municipality. It’s about the motion of the notion. And butI JEJ doesn’t have that dreaded Washington experience. All right. If we’re gonna hold you to that, please never again align yourself with President Obama. Obviously sullied by eight years in the district. Ruin edom dimensioned JFK. I mean, that guy was a congressman and 30th senator at thirty sixth and then a president. Washington, Washington, Washington did it all in Washington. The guy leaves Washington. Look what happens. Here’s the real problem with running against the notion of Washington. It’s obviously been Republican obstructionism that makes Washington a place where progress goes to die. There are a raft of programs that can’t get done because Washington wants to do them, just not the Republican part of Washington, i.e. Mitch McConnell’s against them. So if you play this whole game, oh, Washington is this vast wasteland. You know, you’re doing your crediting uninformed cynicism and you’re denigrating the potential power of the federal government. Yeah. And also, while it’s true that Boobage Judge doesn’t have Washington experience, he doesn’t even have Indianapolis experience. So what’s the argument here that every capital, B, at a state capital or national capital being in that capital takes away from your bold, visionary way of seeing the world when booted judges criticized for losing by a large margin and who’s won statewide race? I tend to give the guys some leeway. Indiana is a very Republican state. Would be hard for a young guy like him to win in the statewide race against Richard Murdock to be the treasurer. So what I’m saying is I try to be realistic and fair, but the judge was not extending the same consideration to my intelligence. He’s at 20 something percent in a lot of polls in the early states, meaning that almost 80 percent of Democratic primary voters right now favor a person who lives in Washington or lived very close to Washington with a good Amtrack connection. Look, this isn’t a huge thing, but a JEJ didn’t lie. He just said something you’d expect a typical politician to say to cover up for a deficiency. But that’s the thing. It’s the argument you would expect of a typical politician which bruited JEJ has not been to his benefit or should we say has not been thus far on the show today. I shpiel about the testimony before Congress of a great staffer, Fiona Hill. Sturdy, steady, stiff upper lip, also stiff lower lip. What I’m saying is her lips really didn’t move very straight line. Exactly. Horizontal zero degree incline on those lips. She was great and definitely does not deserve my extraneous lip commentary. She did earn my esteem. But first, David Shooken was the head of the V.A., a Washington insider who actually advocates that his former agency be taken out of the cabinet in an acknowledgment that the services the V.A. provides couldn’t be more widespread to all walks of life in America. The former Obama cabinet official was kept on by President Trump until he wasn’t. It’s all detailed in Schellekens book.

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S5: It shouldn’t be this hard to serve your country, our broken government and the plight of veterans. An in-depth discussion up next.

S6: The Veterans Administration has a budget of 200 plus billion dollars, has three hundred seventy five thousand employees, serves millions of veterans. It’s grown from 54 hospitals in 1932. Today, 153 medical centers and more than 700 outpatient facilities running this behemoth of an agency. Second only to the Department of Defense was David Shulgin. He was the ninth secretary of Veterans Affairs, a cabinet position. He’s out with a new book called It Shouldn’t Be This Hard to Serve Your Country. Our Broken Government and the Plight of Veterans. Secretary shawkan, welcome. I’m glad to be here. Was it hard when you got the call? Not a veteran, but someone with experience running hospitals, euge institutions efficiently. Was it hard to answer the call to service to be the secretary for President Obama?

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S7: Well, I did what most people do when they’re faced with these choices. I got a blank sheet of paper, drew a line down the middle and had a pros and the cons list. Yes. Very quickly, the cons filled up very high. I’d have to move to Washington, leave my job, go in the government, risk my reputation. I didn’t even know then you could be fired by a tweet else. That would have been.

S8: Oh, yeah, you probably couldn’t then. That tie now couldn’t even even get mad at you. And on the pro side was simply, how could I say no?

S7: You know, I felt like if anybody deserved the best care anywhere. It was our veterans. And I was reading in the paper that they were having all these problems, these long wait times. So I really felt like if I could help, which I felt like I could, I had to say yes. And so I stopped thinking about it and just said, yes.

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S6: Did you? Was the offer a surprise? Did you campaign for the job? I mean, it’s great that you felt you could help. And you’re in a position is running a huge hospital system here in New York to help. But how’d they find you and how do you make it known that you’d be open to this?

S7: Well, did you ever hear the saying that there’s no free lunch? Yeah, well, I thought I was invited to a free lunch. Somebody asked me the launch and we were talking and just a normal conversation. And the person as we were leaving said, do you have any regrets in your career? And I said, I’ve had a great career. I don’t have any regrets. And I said, you know, maybe I’m reading about these horrible wait times for our veterans. And I feel terrible that they’re going through this. And I wish there was something I could do. Sort of almost a rhetorical question. And then about an hour later, my cell phone rings. I never gave my cell phone number to him, but my cell phone rings. And it was the White House. Yeah. And they said, we’d like to talk to you about helping fix the V.A..

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S9: Tell me how. So when you came in and there was this crisis of waiting times, how did you diagnose the problem? Must be a little bit like medicine. How did you diagnose the problem and then come up with a course of action?

S10: Well, I think you’re absolutely right. You don’t start jumping in the solve a problem unless you know what the problem is. So asking the right questions was, I think the key and the question that I asked when I got into the V.A. was how many veterans were waiting for urgent care? Because urgent care meant to me that a veteran, if they weren’t getting the care in the right time, could be harmed. And so once I asked that and they had to go back and look at the data very differently, the answer became clear that there were 57000 veterans waiting for urgent care more than 30 days. And that, of course, defined the problem for me because I was totally unacceptable. So we opened up every V.A. medical center at that point in what I called a national stand down, which is a military term that you stop what you’re doing and you focus on that priority. And over the course of the first weekend of the stand down, we started with 57000 veterans. We ended Monday morning with less than 1000 veterans waiting for care with urgent problems. And from there, we began to whittle that down and then put in same day services so that no veteran who had an urgent problem couldn’t be seen on the same day at every V.A. across the V.A. medical centers. And then finally, what we did was we posted or wait times publicly and they still are posted. The V.A. being the only health care system in this country that I’m aware of, that’s post-its, wait times publicly.

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S9: And it’s the wait times are better than outside the V.A., better than the hospital I might go to.

S10: Yeah. I published a study in the Journal of the American Medical Association last year that compared V.A. wait times to the private sector. And they are better than what you would find in the private sector now. Wasn’t that way when I first came to the V.A., but we showed that we reduced the wait times while the private sector during that same time period did not reduce its wait times.

S6: It seems to me that we could probably talk for hours and not really touch on politics per say. Not that it didn’t inform what you did. But tell me if this observation structure was true. It seems that among the cabinet departments and I’ve had former secretaries of defense here and I’ve had other cabinet officials here, it seems to me that the V.A. could. B, in your experience, maybe contradicts this, but it could in very many ways be apart from politics, more so than I don’t know, the Department of even Education or Labor or Housing.

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S10: Well, first of all, the V.A. always operated that way. It operated outside of the Washington bubble, worked in a bipartisan way where politics really didn’t come into it. And in fact, you know, as you know, I was confirmed 100 to zero. And all of the legislation that I got done my first year as secretary was done in a bipartisan way. Right. Unfortunately, that’s now changed. And now V.A. has entered into that mess that all of Washington’s into and everything’s turning out to be partisan. And because of that and because of the experience I’ve had, I believe that V.A. should be taken out of this political environment, that it should be run much like we run Amtrak or the post office with it.

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S8: He’s got to name something that is seen to be run efficiently and that is harmful. Well, look. National parks, people people get their mail every day in the trains. I love I love the post office stoga. There you go.

S10: And and so would I think we need to do is we need a group of people, what I would call board of directors who have knowledge of the services, particularly health care that’s provided, who do not have political affiliations. And we need a term limit for the secretaries so that we’re not having a constant turnover every two years like what we’ve been seeing, and that this is too important an issue to the country to take care of our veterans, to allow it to be subjected to the types of political arguments that we’re seeing today.

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S6: But you were a cabinet official. You went to the State of the Union, except when you didn’t when you were the designated survivor. Would you want future secretaries not to be in the cabinet?

S10: I think where I’ve come out on this is, is that it’s more important that there be a focus on the mission. And being part of the political environment is not serving veterans in the way that it had in the past. Now, I wish we could roll back time, and I wish that the V.A. had stayed out of the political mess that, you know, that we’re now seeing. But you can’t do that. And so I think we either have to have a complete reset of the environment in Washington and allow people who focus on their job to be able to do it without politics or we need to change the structure.

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S1: Yeah. And you say that in the book? I have to say, reading the book, it gets to how you left were were forced out by tweet.

S6: But you do consistently say and give President Trump credit for seeming to have a bonafide interest in the best interests of veterans and maybe not having a lot of follow through or global foresight. But when he talked to you, we really seemed the way you portrayed seem to really want to help the veterans and empowered you to do so.

S7: Yeah. You know, my job was there to help veterans and to make the system work better. And because of that, I focused on that. There was a lot of other noise in Washington, a lot of things going on that frankly, I tried to keep blinders on, stay out of on occasion. There were issues where I felt like I had to speak up, like the Charlottesville issue. I could not stay silent on that issue. And I didn’t. I thought I might get fired because I spoke up. And what was the blowback for that? For nothing. Nothing. I think that I was surprised. Look, I’m not political. I didn’t go in because I was part of somebodies campaign and I was going to speak my mind and stand up for my principles. And ultimately, I think that did lead to the tweet that ended my time as secretary.

S9: This is so I want to ask your assessment of this, because for the last year and a half. Donald Trump, oh, when criticized about anything, the Mueller investigation, the Ukraine investigation, Syria will often pivot to his great achievement with veterans and he’ll say, we passed V.A. choice.

S11: You go out now, you get a doctor, you fix yourself up. The doctor said just the bill. We pay for it. And you know what? It doesn’t matter because the life and the veteran is more important. But we also happen to save a lot of money doing that. Can you believe it?

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S9: And then after he signed that legislation, which I think was the Mission and Mission Act. Right, he would say the Obama administration didn’t get this done. And I got this done. I gave the veterans choice. What’s your assessment of the accuracy of that?

S7: Well, the facts are that the Choice program was put in place in 2014 when President Obama was president. And so this was President Obama’s program in response to the wait time crisis. It was a three year program that was going to end in 2017. And President Trump built it into a permanent way that veterans can get health care in the future. So I don’t think that this was not his program. But he does deserve credit for building this into the permanent way of delivering health. Care for veterans?

S9: What happened in this was reported in Pro Publica, and I want to ask you about when this became your understanding, but according to some very good reporting, there was a troika of individuals who are members of the Mar a Lago Club, and they included Ike Perlmutter, who’s the chairman of Marvel Entertainment. So if you like The Avengers, maybe this will color your appreciation. And a lawyer named Mark Sherman. Yeah. And then Bruce Moskowitz was also involved. These were members of the club who had their own. They weren’t veterans, but they had their own opinion on how the V.A. should be run. And they wanted to bring it towards more of a privatized model. And as members of Mara Lago, they had Donald Trump’s ear and their wishes became dictates to you. Is that how it happened?

S7: I think before I ever got involved with President Trump administration, these three individuals were advisors to the president and had clearly been asked to help try to oversee some of the changes and give advice for how V.A. could improve, because this was something that in the campaign that President elect Trump had said was very important to him and he was going to fix. And so these three individuals continued to provide advice to both the White House and to me as individuals, as did a large number of other outside individuals who offered their help and advice. And so that was part of the way that I think a good effect of executive makes change by seeking out people who can get help and advice.

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S9: FDR had a kitchen cabinet. You know, Clinton would call people he knew. So these people had Donald Trump’s here. But was their policy directives? Did it become official policy of the V.A.? Did you see that happening?

S7: I think that they offered advice and input, but they did not have policy roles. They did not make the policy or or interfere with the policy.

S6: I think they didn’t interfere. So their policy ideas didn’t become policy. It wasn’t for forced upon.

S7: Yeah. Of course, I’m not aware of what their conversations were with the president or members of the White House administration. But certainly at V.A., I think that they would offer advice, but they were not in policymaking roles.

S6: How when did you become aware of how much advice they were given? Because there were some emails that were revealed. Freedom of Information Act showed that they were having a lot of conversations with the White House and with people who were actually, you know, appointed to be up to the political appointees to the V.A..

S7: I don’t think they made any attempt to hide the fact that they were in discussions. There was a famous scene that happened to be televised in the West Wing, where one day the president and I are sitting at the same table. And he turned to me and said, are you gonna be at the meeting at Mara Lago this weekend then? I really didn’t know what he was talking about. He said, this is where we’re going to talk about V.A. and veterans policy. And I said, No, sir, I’m not, because I wasn’t invited to it. Yeah. And I was one of those viral thing right at terminal into a game. And, you know, people thought naturally, well, this is sort of strange. Why is there a meeting about veterans in V.A. and the secretary is not going to it? So I was aware that those conversations were going on without me.

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S6: Yes. When you were fired by tweet, there was the story of your wife’s itinerary on a vacation which bore at best a passing resemblance to the truth. What really did get you fired, do you think?

S7: I think that I had been in a direct battle with several of the political appointees in the White House about my unwillingness to go along with measures that would move V.A. to privatizing faster than I felt was the right thing to do. And I felt that what was being recommended didn’t serve the veterans interests well. And that was the only reason I was there. And I let them know that. And I think they were very frustrated that I wasn’t willing to drop my objections because it was politically expedient. And, you know, as I always said to my friends and my family, look, you know, I serve at the pleasure of the president. I may be fired any day. And if it’s fired over things that I believe in, you know, that’s what’s gonna happen.

S6: You you were fired by tweet a year and a half ago. Have you live with this job more than you have other jobs that you’ve left?

S10: Yeah, I think I think once you’ve had the ability to experience and meet these men and women that have served in our military and come back and need our help, that that never is going to leave you. And so I believe that I will remain committed to advocating for veterans and doing whatever I can to help as long as I live, because these are such a. Credible people that really do deserve better care than what they’re getting.

S6: And the name of the book is it shouldn’t be this hard to serve your country. And I think it comes through how earnest you are about that sentiment. But I want to push you on this. Is it hard to serve your country because of, as you say, you know, politics in Washington, D.C., or should the finger more correctly be pointed at this specific administration?

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S10: Well, first of all, I think the title it shouldn’t be this hard to serve your country has a double meaning. It really is written for veterans, because when you go off to serve and you come back, you shouldn’t have to experience the bureaucracy and the barriers that so many of our veterans have. But the other meaning is, is that if we expect and we need people who are willing to come out to the private sector, to come in to help solve these problems that are complex and government, if we continue to treat people through personal attacks and the type of toxicity of the environment we have that prevents them from doing the job. People are going to not want to come in. I worry about the brain drain that we’re seeing out of government today, but also whether future people will be willing to come to serve their government. And I do believe that that is an environment today, that there’s enough there’s enough blame on both sides that create this type of environment. But certainly, I think the leader, the president should be setting the tone for the country. And one of those jobs should be to create an environment of respect and one that honors public service.

S6: David Chokin was the ninth secretary of veterans affairs. If you’re saying wait. Doesn’t the V.A. go back to the civil war? Yes.

S12: But it was only a cabinet position under George H.W. Bush making game show, the ninth secretary of Veterans Affairs. He is the author of It Shouldn’t Be This Hard to Serve Your Country. Our Broken Government and the Plight of Veterans. Thank you very much. Thank you.

S9: And now the schpiel. Yesterday was marked by the low grade goofiness of Gordon Solin.

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S13: Remember this moment, but you remember that calls for signficantly exactly what the president said to you in response to your question about what do you want, why is that? I remember the first girl I kissed. I mean, I remember certain things I won’t say.

S1: Update today. Devin Nunez added that girl to the list of witnesses. Adam Schiff will not be allowed to be called. But seriously, after a day of Sandlin damning the Trump administration with a grin and a guffaw. Today we met the figure of Fiona Hill. At one point during her many hours of testimony, she appeared to portray an expression other than seriousness. But it just might have been a trick of light. She was stern. She was steadfast. She was steely. She was unbelievably impressive in intellect and comportment. One brief moment that I will play. She was relaying a story about a dramatic moment when then national security adviser John Bolton reacted to an inappropriate request to link aid to the Berrima investigation. Listen to how she talks about this.

S14: And then he looked up to the clock on his watch, shoved towards his rest in any case. Again, I was sitting behind him.

S1: No, wait. I said watch. I do not wish to imply that it was a watch. This presumes a time piece that may not have been in evidence. It was, in fact, his rest for years on this show. I have said that competent people doing their jobs will save America. Dr. Fiona Hill seems as competent as can be. She spoke about how she immediately recognized and reported that U.S. foreign policy toward Ukraine was being subsumed by what she called a political airand good phrase here. In an answer to Republican counsel Steve Castor, she explains that, yes, it is within the president’s ability to remove an ambassador, as Trump did with Ambassador Jovanovic. But legitimate policy considerations do not fully explain that decision.

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S14: It was very clear at this point that there was, let’s just say, a different channel and operation and relations to Ukraine, one that was domestic and political in nature, unlike with a lot of other witnesses, including David Holmes, who was right there testifying next to her.

S1: No Republican dared tangle with Hill. In fact, Trump has not thus far has not denigrated her. This, to my mind, makes Fiona Hill the only woman who has offered a high profile denunciation of Trump’s actions and policies, who the president has not attacked. I don’t think every critic can come with Fiona Hill’s impeccable credentials or steely expression or unblinking focus or scads of experience. So it’s unlikely that she will inspire a trend of presidential reticence to denigrate. But this is it is a very nice pause, is it not? Perhaps it was in this anecdote as elicited by Representative Jackie Spears, that offers an explanation as to why.

S15: Dr. Hill, I want to verify this story. I understand that when you were 11 years old, there is a schoolboy who set your pigtails on fire and you were taking a test. You turned around with your hands, snuffed out the fire and then proceeded to finish your tests. Is that a true story?

S14: It is the true stars of it. Surprised to see that pop up today. It’s one of the stories I occasionally tell because he’s had some very unfortunate consequences afterwards. My mother gave me a bowl haircut. So for the skill photograph let you in that week, I look like Richard the third off. I’m going to be in it.

S1: Richard’s the third. I mean, that’s fodder for Trump, right? And he can’t you see him tweeting about last king of the Planet, Tagine and Dynasty. Sad, but Trump has held off. And maybe it’s because the anecdote and her testimony served notice that even though government bureaucrats are always said to be running around with their hair on fire, this is one woman who will not be put off by some bully pulling at her pigtails.

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S5: And that’s it for today’s show when Daniel Shrader, just producer, was in grade school. The boy behind them in gym class attempted to give him a purple nopal, but with a clever sidestep and limited jujitsu training, Daniel did not allow his nagpal to become B Part Balt and delivered onto the would be assailant an indigo pinky toe. Added to Jozen, another just producer once endured a wet willy in an academic setting. It was while defending her senior thesis, she expected more from a department head. The gist? We’ve been known to put up with a wedgie to noogies and the ravages of the Patty WACC machine. But we never wavered in our quest to correct every fifth grader who called a Fudgsicle, a forger called Philistines, whom pre-death hurried to Peru.

S16: And thanks for listening.