Yet every administration going back decades has failed to appoint a leader capable of guiding the agency to fulfill its mission. Ronny L. Jackson, President Trump’s pick to lead the department after Secretary David Shulkin was fired, will continue that legacy. And veterans will continue to pay for it.
Whether the problem was covering up shoddy health care or questionable hiring practices, there is no question that Shulkin was ill-equipped for the position. His predecessor, Bob McDonald, did not adequately address staffing problems and wait times that were present before and during his tenure, and still remain. During the quality-of-care scandal at Walter Reed Army Medical Center, President George W. Bush appointed three men to the role of Veterans Affairs secretary. Since the position was created in 1989, 16 leaders have been appointed or stepped in as acting secretary, and the department continues to fail veterans.
I’m a veteran and former employee of the department. Although I enjoyed some aspects of my work as a veterans services representative, I’m the first to admit that VA is deeply dysfunctional. The reasons are well documented and myriad: chronic understaffing, limited investment in infrastructure, an ever-changing array of guidelines for who is eligible for benefits, and what those benefits consist of from year to year. It’s a complicated system prone to backlogs that can run more than two years deep — in part because of the administrative issues that arise when management and funding don’t match need.
Jackson is an experienced physician and a rear admiral with an awareness of the medical concerns of military members and their families. He’s certainly qualified to work for a VA facility, and quite possibly qualified to run a medical department, with the support of a good staff.
What he lacks experience in is responding to the concerns of veterans. Hospitals don’t run on doctors alone. Doctors don’t direct cleaning schedules, seek donors, or do dozens of other things that make their work possible.
Veterans Affairs isn’t just hospitals treating injuries. It’s compensation and pensions, it’s mental health care, rehab, and programs to house homeless veterans. It is a massive department with a staff of almost 378,000 people, a small city of workers that serves about 22 million veterans and their families. In raw numbers, that means every staff member has 58 veterans relying on them to do their jobs. In actual numbers, it means that every veterans services representative can have a caseload in the hundreds. It’s a hard job, made worse when the people making decisions about policy have no idea what the population being served needs, or how to provide it. And it’s just one aspect of the multistep process required to help veterans build a new life.
Cases are often far more complicated than they appear. A veteran who is chronically unemployed can’t simply be referred to a job program. A VSR needs to examine the reasons for unemployment. That might mean compensation for depression or for post-traumatic stress disorder, drawing on VA benefits. On the medical side, that means a referral to therapy, possibly a program for substance abuse if the veteran is self-medicating. If the unemployment has led to homelessness, housing assistance is needed through the HUD VASH, which brings in yet another side of the department. And this would be just one case handled by one representative.
Is it possible to learn? Absolutely. To be a good VSR, you need two months of classes, at eight hours a day. Then you need at least six months of supervised on-the-job training. It is a lot of paperwork and memorization and asking questions about conditions you may have never imagined were possible for one person to face. It’s complex work on the best day with all the training and experience. Jackson has no training in so much as building a file. He lacks experience in managing a large staff, directing any federal department, or even directing troops at this scale. He doesn’t understand the work or the people who do it, and that’s not how effective leadership models are built in any industry.
Jackson’s only apparent qualification, besides a medical degree, is being able to stand in front of a lectern and respond to reporters. He has that in common with Ben Carson, another doctor who was appointed to a Cabinet position and who has not generated anything but scandals and subpar policy decisions. In the parade of failed appointees under this administration, Jackson is almost the least objectionable, if you ignore the effect his inexperience will have on a system that is not adequately serve a vulnerable population.
I was a good soldier. I’m a successful writer. But I wasn’t especially good at being a VSR, and ultimately I recognized that my talents could be put to better use elsewhere. One can only hope that after Jackson gets past feeling flattered by the attention, he’ll set aside his ego long enough to recognize that he isn’t qualified to lead this department at this time. Veterans deserve better.