President Donald Trump, left, and David Shulkin, MD, during happier times on a tour of VA facilities. White House photo

WASHINGTON—In January 2017, President Donald Trump announced he was selecting David Shulkin, MD, then-VA undersecretary for health, as his new VA secretary. In March 2018, just more than a year later, Shulkin was fired by the president over Twitter, although the White House contends he’d resigned days earlier.

The stated impetus for his departure was a VA Inspector General report detailing misuse of funds for a $122,000 business trip to Europe. Shulkin was accompanied by his wife, whose travel expenses were paid for by VA.

Now Shulkin is telling the world his side of the story about his 14 months as VA Secretary. His new book is entitled, “It Shouldn’t Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veterans.”

Shulkin has not shied away from the spotlight in the months since his exit from VA, speaking publicly numerous times about problems he saw during his time at the agency. The book goes into greater detail, however, about what Shulkin describes as a Washington environment that’s “grown so toxic, chaotic, and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve.” 

Throughout the 350-page memoir, Shulkin takes aim at a number of targets, including Trump appointees at VA, the VA Inspector General, the news media and the MISSION Act, as well as detailing his relationship with the “Mar-a-Lago Trio,” members of Trump’s club in West Palm Beach who have been accused of exercising outsized and possibly unethical influence on the inner workings of VA.

Shulkin details how a rift began to form early on during his tenure among political appointees, such as David Selnick, Camilo Sandoval, Peter O’Rourke, Jake Leinenkugel, and others, and the rest of the VA leadership. He describes how these appointees would have separate meetings following Shulkin’s morning meeting to “translate my instructions into action points.”

“This sent a strong message to everyone that there was the ‘secretary’s team’ and the ‘political team,’” Shulkin writes. “In my view of the world, there should have been only the ‘VA team.’”

Later in the book he adds, “For the most part, a number of the political appointees were unwilling or unable to do the work that needed to be done. … Not only did these people know absolutely nothing about healthcare or Veterans Affairs, but they had no interest in learning or in making the place better. Apparently, all that mattered to them was their political agenda, which did not include having the VA succeed.”

One project that he championed during his time there was the MISSION Act, which revamped VA’s access standards for veterans seeking care from non-VA providers. In the book, Shulkin describes how the more lenient access standards released a year following his departure were nothing like he envisioned, and that they threatened to undermine the agency.

“Access standards like this would provide millions of veterans with the ability to get care in the private sector and lead to the rapid dismantling of the current VA system,” he writes. “If you were designing a path toward privatization, this would surely be it.” 

The expenditures for care outside VA will leech funds previously utilized for VA’s own healthcare system, he argues. “A VA system starved of capital and operating funds with an open aperture to the private sector will, by definition, lead to privatization of the system … [The new standards will] likely have the unintended consequences of leading to more fragmented care for veterans.”

Shulkin also discusses his interactions with the members of the Mar-a-Lago club, most especially Ike Perlmutter, CEO of Marvel Comics. Shulkin explains how, prior to his appointment as secretary, Perlmutter asked him to travel to West Palm Beach, FL, to meet with him. Shulkin agreed in an attempt to keep his job as undersecretary of health. Shulkin describes what was essentially a vetting interview where Perlmutter determined whether Shulkin would make a good secretary.

During his time as secretary, Shulkin would have numerous interactions with Perlmutter, along with lawyer Marc Sherman and Dr. Bruce Moskowitz—the other members of the “Mar-a-Lago Trio.” Shulkin describes how, while Trump was praising him, Perlmutter would call him, often several times a day, and berate him for not doing a good enough job, telling him that he was “on thin ice.”

“There seemed to be a large disconnect, but knowing that Ike, Bruce, and Marc had the president’s ear in ways that I did not, even as his cabinet secretary, I made efforts to be responsive to their advice and feedback,” Shulkin writes.

However, he says that he often did not follow that advice since “none of these men seemed to have much of an understanding of how the VA worked, nor did they possess any health system management experience.”

He adds, “Most concerning was that these VA ‘advisors’ had never even been to a VA facility (which was also true of the president and his senior staff).”

In the book, Shulkin says he is not accusing Trump or the trio any clear wrongdoing, explaining, “I wasn’t aware that any of the three did anything wrong other than occasionally giving some bad advice and speaking to me harshly.”

Shulkin ends the book talking about the toxic nature of politics and of how talented people are being discouraged from civil service partly due to “the very omnipresent sense of mistrust toward those serving.”

Referring back to the circumstances surrounding his own resignation, Shulkin takes aim at the VA Office of the Inspector General, which generated the report on his improper travel expenses.

“The system of inspectors general is far from ideal and, in my opinion, instills fear in our leaders and causes an unwillingness to take risks and make changes. Our current whistleblower culture flourishes in government, largely because of this system of distrust,” he writes. “Government could approach this the way the private sector does—with better management practices and more accountability rather than ‘secret police’ who come in after the fact.”