President Donald Trump's pick to lead the Department of Veterans Affairs pledged Wednesday to resist any plans to "privatize" veterans' services but also outlined a vision of a more robust, community-integrated system for the future.
"If confirmed as secretary, I will seek major reform and a transformation of VA," Dr. David Shulkin, the current department under secretary for health, told senators at his confirmation hearing on Wednesday.
"There will be far greater accountability, dramatically improved access, responsiveness and expanded care options, but the Department of Veterans Affairs will not be privatized under my watch."
Shulkin, the first non-veteran ever nominated for the Cabinet post, faced mainly friendly questioning from both Republicans and Democrats on the Senate Veterans’ Affairs Committee, while a slate of other contentious nomination votes simultaneously took place on the Senate floor.
The 57-year-old physician has earned high marks from lawmakers and veterans advocates in the three weeks since his surprise nomination, and his final confirmation vote is expected to easily pass in the chamber in coming days.
But senators also made it clear that the department still faces a difficult road ahead to regain public trust in the wake of the 2014 patient wait-times scandal, and that Shulkin will have to negotiate even more difficult choices on veterans’ care than in his current post.
Republicans said those challenges include reforming a problematic culture ingrained in sections of the massive 365,000-employee bureaucracy. Democrats said those challenges include the White House.
"You’ll have to deal with a new president who has taken some public positions, on everything from privatization to his personal opinion of the VA workforce, that are in stark contrast to positions you have taken," said committee Ranking Member Jon Tester, D-Mont. "Sooner than later, you’ll come to a crossroads. And you’ll have to choose whether to pursue what you think is best for veterans, or what the president tells you is best for veterans."
Shulkin is the only holdover in Trump’s planned Cabinet from President Barack Obama’s administration, and has received some criticism for not implementing enough major changes at the department in his 18-month tenure as the department’s top health official.
Trump has said publicly he would consider shifting more VA services to the private sector, a proposal that veterans advocates have greeted with fear and revulsion.
Shulkin said he spoke with the president earlier this month about the issue, but promised senators that he made no promises to shift VA programs that way and has no interest in massively cutting the department.
"I have been clear I am opposed to privatizing VA," he said, adding, "(Trump) knows I would follow my values, and he knows what needs to be done."
Shulkin also said he has been pleased with Trump’s response to VA concerns about the government-wide hiring freeze announced Jan. 23, noting that nearly 37,000 of about 45,000 open VA positions will be exempt from that presidential order.
His testimony walked a line between condemning failings at VA and praising reforms put in place by himself and his predecessor, former VA Secretary Bob McDonald. He said the department needs to both continue reform efforts but also better explain them to a skeptical veterans’ population.
"If you don’t have trust in the group that’s empowered, you can’t get the job done," Shulkin said. "We know that trust in VA was eroded with the wait-time scandal. We’ve seen since then that trust has improved ... but we still have a long way to go."
He said wait times have improved in recent years, but department officials needs to coordinate with community clinics and resources to produce even faster medical appointments for veterans. He said the VA Choice Card program, put in place to address that issue, is in need of an overhaul and simplification.
He promised to push Congress for changes in the benefits appeals process — "we can’t do it without legislation" — to bring down the average case completion time from six years, and to seek new accountability legislation to address criticism that department managers haven’t addressed poor-performing employees.
"VA has many dedicated employees across the country, and our veterans tell us that every day," he said. "It is unfortunate that a few employees who deviated from the values we hold so dear have been able to tarnish the reputation of so many who have dedicated their lives to serving those who have served."
Many of those comments echoed testimony over the last year of McDonald, who Trump refused to consider for the post in the change of administrations. The president has painted the department as a failing and broken bureaucracy, and promised that his new secretary will bring swift, significant changes.
Shulkin promised to do that, but without dismantling the department.
"VA is a unique national resource that is worth saving, and I am committed to doing just that," he said.
Leo Shane III covers Congress, Veterans Affairs and the White House for Military Times. He can be reached at firstname.lastname@example.org.