President Donald Trump's decision to fire Veterans Affairs Secretary David Shulkin and to replace him with presidential physician Dr. Ronny Jackson has outsized ramifications for the Tampa Bay area, given the large number of veterans here and the expansive and unique role that two major VA health centers play on both sides of the bay. Whether Jackson is the right person for the job, or whether this amounts to yet another glaring example of gross cronyism in the Trump White House, remains to be seen. But the Senate needs to use the confirmation process to explore not only Jackson's management ability but his vision for a health system that despite all its faults delivers critical care for millions of Americans.
Shulkin was an Obama-era holdover and his firing was no surprise, coming after a critical report in February by the VA inspector general's office that faulted him for improperly accepting Wimbledon tickets during an official trip to Europe last summer. Shulkin needs to answer for his conduct, but his bigger offense may have been to slow-walk the administration's efforts to privatize VA health care services. While Shulkin agreed to explore limited privatization in some service areas and markets, he also recognized that the VA delivered a unique level of care to a specialized patient base. He was widely lauded in his tenure for improving accountability in the VA's entrenched bureaucracy and for moving to modernize the VA's delivery of care.
Jackson has won admirers for his service under two presidents prior to Trump as White House physician and for his distinguished career in emergency medicine. His service with a trauma unit in Iraq certainly makes him familiar with and sensitive to the VA's patient profile and the vital role the agency plays in caring for wounded warriors. But what appears to have propelled him to a Cabinet nominee was Jackson's televised appearance this year strongly hailing Trump's physical condition. Having the president's confidence is invaluable. But it should reflect core competence in a nominee, not merely fealty to any single president.
Jackson's lack of management experience is an obvious concern for anyone hoping to lead the nation's largest integrated health care system. With more than 1,700 hospitals and other health care facilities, and nearly 40,000 providers, the VA is the second-largest federal department, and there is nothing automatic about delivering quality, responsive services to 20 million veterans. The VA has rebounded from the recent scandals of secret waiting lists, but its bureaucratic culture still protects many incompetent leaders and outdated practices that harm its quality of care. And that in turn has colored the VA's public narrative. For all its faults, the VA has been recognized in recent years for outperforming non-VA facilities in outpatient services. And in the most recent survey of customer satisfaction, released in February, VA patients rated their experience higher than did those who were treated in private hospitals.
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The next secretary needs to recognize the unique role the VA plays in treating complex cases that involve the intersection of blunt physical trauma and post-traumatic stress. The next leader needs to recognize the challenge of meeting the evolving patient profile, as older veterans require more care and as younger ones cope with regaining physical and emotional skills necessary to get back into civilian life.
The agency also needs to plan for the special needs that veteran-heavy states like Florida — which ranks third in the nation's veteran population, with 1.6 million — are facing. With 200,000 veterans in Pinellas and Hillsborough counties alone, the VA needs to continue investing in a modern health care delivery system. The Senate should press Jackson on how he would fulfill this mission and examine his commitment to put the interests of veterans ahead of any political agenda by this administration.