Donald Trump ousts David Shulkin as VA secretary

“WE’LL never have to use those words on our David” said Donald Trump last June. He was referring to his reality-television catchphrase, “You’re fired”, and David Shulkin, his secretary of veterans affairs. But on March 28th Mr Shulkin was fired, by tweet, and Mr Trump announced that Ronny Jackson (pictured), his personal doctor and a career naval officer, would succeed him. Mr Shulkin, the lone member of Barack Obama’s cabinet still in the job, had been in a precarious position since a scandal erupted in February over a luxurious trip to Europe last year, taken on the taxpayer’s dime. The ensuing controversy revealed a VA department in a state of revolt. Staffers were disobeying Mr Shulkin’s direct orders and were, in his telling, scheming to subvert him. But veteran affairs groups, which exert an unusual degree of influence in Washington, DC, supported Mr Shulkin because they considered him a bulwark against the creeping privatisation of veterans’ health-care services (which are currently operated through a single purchaser which owns its own facilities and employs its own doctors). The appointment of Dr Jackson shows that Mr Trump is less concerned with these internecine struggles—and is instead set on running the American government as if it were his family business.

In the early days of his administration the president seemed willing to tolerate establishment appointees. Now he increasingly favours those he thinks will be personally loyal and who will argue on his behalf most vociferously—either people he knows personally, or cable-news personalities who offer strident defences of his conduct on television. Rex Tillerson, the moderate secretary of state, is shortly to be replaced by Mike Pompeo, who has been a frequent visitor to the White House as director of the Central Intelligence Agency. Talking heads are also expected to take up the critical posts of national security adviser and chief economic adviser. Many in the Trump family orbit have done well. The woman who planned the wedding of Eric Trump, one of the president’s sons, has waltzed into a senior position at the department of Housing and Urban Development with little relevant experience. Jared Kushner, the president’s son-in-law, seems to carry a limitless portfolio spanning the opioid crisis, the Arab world and diplomatic relations with Mexico. Ivanka Trump, the president’s daughter, has become a quasi-diplomat—standing in for her father in meetings with foreign heads of state.

Dr Jackson, who previously cared for Mr Obama, has no management experience but will soon be grappling with a sprawling department. The VA has 360,000 employees and has struggled to maintain its health-care infrastructure after several scandals, involving long waiting times for disabled veterans, came to light in 2014. Dr Jackson’s most high profile moment in public life came when he personally administered a cognitive assessment for Mr Trump and reported that he had easily passed (“Some people have just great genes,” he said). Some left-leaning critics detect a connection between Dr Jackson’s glowing report and his subsequent appointment to the cabinet. It seems much more likely that the president simply prefers to nominate people he already knows.

For Democrats, the news could have been worse. Little is known about Dr Jackson’s policy positions, but Mr Trump could have nominated an outrightly pro-privatisation candidate. Much of the conflict within the VA has been over the degree of privatisation of veterans’ health care. The cost of privatised care, usually available to veterans in remote areas or to those who would otherwise wait a long time for treatment, surged 500% between 2002 and 2014, according to a report by the RAND corporation. In an article in the New York Times on March 24th Mr Shulkin said Trump administration officials had seen him “as an obstacle to privatisation who had to be removed”. The debate will continue to rage under Dr Jackson, who now faces a confirmation hearing. Senators have said they look forward to learning more about him.  

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