These are some of the scenes from David Shulkin’s new book, “It Shouldn’t Be This Hard to Serve Your Country,” an account of his tumultuous 15 months as Trump’s first Veterans Affairs secretary.
The book portrays a toxic, backstabbing culture in Trump’s Washington that, as its title suggests, should give pause to anyone considering public service, Shulkin writes. From his rib-tickling interview with the president-elect to his dismissal by tweet in March 2018, Shulkin says he was blindsided at almost every turn by a multitude of institutions, from his inspector general to the media. And he says veterans are paying the cost.
“The VA was once thought to be the only part of the federal government that was above politics,” writes Shulkin, 60. But “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.”
Ultimately his own staff did him in, Shulkin writes, turning ethics questions about a trip he took to Europe that mixed business with pleasure to their advantage. The Ivy League-trained physician who had excelled at turning around ailing hospitals was unprepared for the onslaught.
The score-settling book, to be published Tuesday by a division of Hachette Book Group, is Shulkin’s comeback to the forces that derailed him. He describes a “deep state” of subordinates within his own inner circle — not of career bureaucrats but political appointees — who assumed outsize power with a single goal: to privatize veterans’ health care.
The book offers the first inside account of a federal agency from a former Trump Cabinet member.
The “politicals,” who included his communications chief and multiple senior advisers, distrusted him from the start because he was an Obama holdover, Shulkin writes. But, aided by an upstart veterans group funded by the conservative Koch network, there was more to their agenda, he writes: They wanted to turn the vast veterans health-care system over to the private sector, and he got in the way.
“Privatization leading to the dismantling of the department’s extensive health care system is a terrible idea,” he writes. He accuses his critics of pushing “unfettered” access to private care that would cost taxpayers billions of dollars, ignoring the more moderate approach he advocated.
By asserting a moral high ground over his detractors, almost all of whom have left VA, Shulkin opens himself to reliving the acrimony he set out to chronicle.
“While the former VA secretary chooses to profit off his time in office and share outlandish claims about his private conversations with the President, President Trump remains focused on ensuring veterans receive the care they have earned through their incredible sacrifice for our Nation,” White House spokesman Judd Deere said in a statement.
VA officials declined to comment. Robert Wilkie, Shulkin’s successor, and the Koch-allied group, Concerned Veterans for America (CVA), have long disputed that they want to privatize the system.
CVA senior adviser Dan Caldwell called the claims a “flagrant mischaracterization of CVA’s vision, the work of our dedicated grassroots army, and our policy agenda.”
Shulkin gives few new insights into Trump’s style or thinking. The president stayed on the sidelines of the civil war consuming the agency, supporting Shulkin until bad headlines emerged and the powerful Mar-a-Lago crowd’s disenchantment made him a liability, he says in the book.
At one point, Shulkin writes, Trump and his son-in-law, Jared Kushner, an influential White House adviser, considered closing poor-performing VA hospitals by executive order until Shulkin talked them out of it, telling them that Congress must authorize such a drastic decision.
The secretary’s fall from grace was the subject of extensive media reports last year. But his book portrays his sense of betrayal by his staff, a group he had no hand in hiring, and by a White House he says refused to come to his defense.
Shulkin said in an interview that he wrote the book both to “tell my side of the story” and to “share what I had learned and put down a road map” for anyone considering serving in Washington.
The memoir describes Marvel Entertainment Chairman Ike Perlmutter, a friend of the president who brokered Shulkin’s introduction to Trump, as forming an unorthodox shadow Cabinet with two associates that called many of the shots in the agency’s day-to-day operations. One of the associates, Marc Sherman, who acts as a representative for the three, did not respond to requests for comment.
After Trump’s election in 2016, Shulkin was preparing to resign as President Barack Obama’s undersecretary for veterans’ health when he received an urgent, mysterious call from Michael Cohen, the president’s now-jailed lawyer and fixer. Cohen patched him through to a voice with a thick Israeli accent, who summoned him to Mar-a-Lago that night, he writes.
After a grilling by Perlmutter and two associates — a trio who would become his boosters and protectors, but ultimately cut him loose, he writes — Shulkin was riding the elevator to the 26th floor of Trump Tower in New York.
“He’s a good-looking guy, isn’t he?” were the president-elect’s first words to his staff about Shulkin, he writes. He didn’t really fit the bill of the generals Trump swooned over. “But can they fix health care?” Trump asked.
Shulkin describes early successes in improving access to primary and mental health care, making wait times public, and expanding care to remote areas through technology known as telehealth. Ambitious projects to revolutionize electronic health records and improve Choice, the Obama-era law expanding private-sector care, were in the pipeline. He encountered a VA workforce largely committed to serving veterans, he writes.
But signs of trouble percolated quickly. Political appointees who worked for him held secret meetings without him, often at the White House. Shulkin began to suspect his security detail of disloyalty, circulating his schedule outside the agency and snapping photos of him doing errands, exposing him to security risks.
And the Mar-a-Lago crowd, as they came to be known in VA circles, was hovering. Perlmutter called multiple times a day seeking information and giving direction, the book says. Shulkin bristled but complied.
“In just about every conversation I had with him . . . the president asked if Ike was ‘happy’ or ‘helping,’ ” a reminder that the White House “was impatient with the pace of reform,” Shulkin writes.
The White House Personnel Office, which the book describes as inept and obstructionist, rejected many of his candidates for senior-level staff, instead foisting “like-minded partisans” on him.
A Washington Post story in September 2017 was a devastating turning point in his tenure, he writes. The article described a 10-day trip that Shulkin, his wife and senior staffers took to Europe, combining official travel with sightseeing and tennis at Wimbledon.
At the time, the administration faced widening criticism of travel expenditures among some of the billionaires, budget hawks and business executives who led federal agencies.
Shulkin devotes considerable space in his book to re-litigating his defense of the trip, which he claimed then and now involved no wrongdoing. He and his wife were “villainized for some sightseeing in London,” he writes.
He hoped that an investigation by VA Inspector General Michael J. Missal would clear his name. It didn’t, instead citing lapses in judgment. Shulkin is still angry at Missal, whose investigators he assails in the book as “twisting facts” and having “an agenda” to land a case. Missal declined to comment.
By the time he became embroiled in a nasty fight with conservatives in Congress and the White House over legislation to expand the Choice program, the stars had aligned against him, Shulkin writes. He became increasingly isolated, with little support from the White House, he writes, his enemies gaining the upper hand.