But some of the criticism was exaggerated and highly political, not to mention the portion that was just nonsense.
None mastered the hyperbolic hits better than Donald Trump when he was stumping for votes.
“President Obama has allowed our Veterans Affairs health-care system to deny help and support to those who deserve it most,” Trump declared in July.
“The Veteran’s Administration is a disaster,” he charged in October.
If VA was that bad, why did President Trump select David Shulkin, Obama’s VA undersecretary of health, to run the entire department under the new administration?
That question wasn’t explored at Shulkin’s Senate confirmation hearing Wednesday, although it would be edifying to hear how Trump meshes his harsh criticism of the agency’s health care with his praise for the man who is in charge of it.
The truth is, VA wasn’t a disaster. Even at the low point of the scandal — and it was very low — VA continued to provide good care for vets — when they could get it. That last point is key. VA has long enjoyed a good reputation for the care it provides, a reputation that was turned upside down by disreputable practices in the way it delivered that care.
Despite his incendiary rhetoric, Trump eventually must have recognized the improvements made by the Obama administration — although he certainly hasn’t acknowledged it — and decided Shulkin was the person to keep the progress going. He became undersecretary in 2015.
“Sadly, our great veterans have not gotten the level of care they deserve, but Dr. Shulkin has the experience and the vision to ensure we will meet the health-care needs of every veteran,” Trump said when he nominated the VA secretary-designate.
Shulkin had that same vision when he worked for Obama and Robert McDonald, the former secretary.
“I came to VA during a time of crisis, when it was clear veterans were not getting the timely access to high-quality health care they deserved,” Shulkin said in his opening statement to the Senate Veterans Affairs Committee. “That is why I focused on meeting the most urgent health-care needs of our veterans first and reorganized our approach to reflect that. As a result, we’ve dramatically reduced the number of people waiting for urgent care. The VA now has same-day services in primary care and mental health at all our medical centers to make sure our veterans get the urgent care they need, when they need it most.”
In McDonald’s exit memo submitted just before leaving office, he documented a number of ways the Veterans Health Administration (VHA), which Shulkin runs, has made progress: “In FY 2016, VHA completed nearly 58 million appointments, 1.2 million more appointments than were completed in FY 2015 and almost 3.2 million more than in FY 2014. In March 2016, Veterans set a record for completed appointments — 5.3 million inside VA, 730,000 more than in March 2014; and, VA issued 268,000 authorizations for care in the community — twice as many as in March 2014.”
McDonald’s memo said 96.5 percent of appointments in September were completed within 30 days “of the clinically indicated or Veteran’s preferred date; almost 91 percent were within 14 days, over 85 percent within 7 days, and over 22 percent were completed on the same day. Average wait time for primary care is around five days, six for specialty care, and two for mental health care.”
No senator challenged Shulkin’s report about urgent-care improvements or the stats in McDonald’s memo, as members of Congress would have not long ago. There were few critical questions during Shulkin’s easy ride before the committee. It was much different from the congressional tongue lashings he and other VA officials previously suffered because of the wait-time controversy.
During a hearing in April, Rep. Jeff Miller (R-Fla.) told Shulkin that “VA continues to ignore the main forms of data manipulation … the obvious result of VA reporting only a portion of a veteran’s actual wait time is artificially low results. … It is time for VA to stop using misleading data to tout wait-time successes that simply do not show the real wait time experienced by our veterans.”
Rep. Doug Lamborn (R-Colo.) said Shulkin painted a “much too rosy picture of the system that is broken.”
It was badly bent. It still badly needs repair, but it’s not broken.
Two outside and independent reviews of VA recently reported good news about the health care it provides.
A Harvard Business School case study published in November said VA “made impressive progress over the past year.” A RAND Corp. literature review published by the Journal of General Internal Medicine in July found “VA often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care.”
Shulkin told senators “VA is a unique national resource that is worth saving, and I am committed to doing just that.”
They seem ready to give him that chance.—