Observations by former Secretary of Veterans Affairs (VA) David Shulkin may shed light on why the VA Project at Alameda Point continues to be delayed and why the health clinic may never be built. Constructing a new clinic conflicts with the Trump Administration’s goal of privatizing VA healthcare services.
In his book “It Shouldn’t Be This Hard to Serve Your Country – Our Broken Government and the Plight of Veterans” (Public Affairs Books, October 2019), Shulkin recounts his experiences after being appointed to head the VA by President Trump in January 2017, and then fired by Tweet 15 months later. Shulkin asserts he was fired because he would not go along with efforts of White House insiders to privatize VA healthcare.
Despite garnering unanimous support by the Senate at his confirmation hearing, and enjoying support among mainstream veterans advocacy groups, Shulkin soon learned that White House political appointees were working behind the scenes to undermine his effectiveness and credibility. Shulkin was forbidden by the White House from firing political appointees at the VA. His only ally at the White House was Chief of Staff General John Kelly (retired). Kelly was infuriated at Shulkin’s firing and almost resigned in protest but was convinced to stay another year before eventually resigning.
Shulkin recalls how the insiders, dubbed the Mar-a-Lago group because they frequently went to Trump’s Florida estate, would call high-level staff meetings that Shulkin would only learn about later.
But Shulkin’s biggest battle came when he became embroiled in a manufactured scandal about use of public funds during a July 2017 trip to London for a conference about veterans’ healthcare. The purpose of this meeting with representatives of United Kingdom, Canada, Australia, and New Zealand, was to discuss ways of addressing mental health after combat.
“Amazingly, this trip – otherwise not terribly significant – would become perhaps the defining event in my tenure as secretary,” said Shulkin. “Certainly, it would be used to fabricate a case that I had misused taxpayer funds and should be removed from my position.”
Not long after he returned home, an investigation was launched by the Inspector General. Among his supposed transgressions were: Attending a tennis tournament at Wimbledon while on the trip, even though he was invited by an acquaintance and the ticket not paid for by the VA; having his wife accompany him on the trip, even though she was an officially-invited guest by the conference organizer; and a diplomatic side-trip to Denmark, even though he was invited by Denmark, and it saved money by not having to come back on a separate trip.
When the Inspector General report was released, Shulkin attempted to respond to allegations by posting a statement on the VA’s website. Within minutes he was ordered by the White House to take down his statement. Shulkin was eventually exonerated of any wrongdoing in the European tour “scandal,” but only after numerous attacks by the media and countless hours of wasted time trying to defending his reputation.
Years of Delay
Years of delay in the Alameda Point project had already occurred before Shulkin arrived at the helm. Under the Obama Administration, $4 million of the $17 million budgeted in 2011 was spent on project planning. The rest was diverted to cover cost overruns at other VA projects, thereby delaying preliminary work at Alameda Point. The massive cost overruns, such as at the Denver VA Hospital, spurred Congress to force the VA to turn over management of large construction projects to the Army Corps of Engineers. Another delay came when Congress couldn’t agree on the fiscal year 2016 federal budget. But by the end of 2016, the Alameda Point VA project had $83 million–more than enough to start and complete the first phase of the project.
In the three years since taking office in 2017, the Trump Administration has still not broken ground. One of the reasons given for the delays is that the VA had to first complete the administrative change of construction management to the Army Corps of Engineers. That task was completed in October 2017. The next reason given was that Corps had to review the VA’s plans for possible design flaws. Five months into the review process, Shulkin was fired in March 2018.
The Alameda Point project received another $26 million in the 2020 budget. Despite having funding available, the VA has yet to complete and submit its wetland mitigation plan, which they began studying in 2012, or perform its required environmental review for the Regional Water Board to certify the wetland plan. When the VA appeared before the Alameda City Council in December 2018, they said they would provide the final wetland mitigation design documents to the Regional Water Board and Corps of Engineers in Spring 2019. That did not happen.
Meanwhile, the permit issued by the Bay Conservation and Development Commission in 2014 was left to expire in 2017 due to inaction.
Debating the Models of Care
In his book, Shulkin recalls how his staff was working on legislation to update the policy that allows veterans, in certain circumstances, to use private healthcare providers instead of the VA. This is to reduce excessive wait times to see a physician and excessive travel time to a VA facility. The bipartisan Senate veterans affairs committee favored Shulkin’s moderate approach by a vote of 14 to 1. But the White House sided with the lone senator advocating for the more aggressive private-access standards. The bill that got passed – the Mission Act – is the version favored by the lone senator.
In one account of a meeting with President Trump in which they talked about the Choice program for veterans to access care outside the VA system, Shulkin recalls how the President stopped and had his assistant get Fox News commentator Pete Hegseth on the phone to ask what he thought. In Shulkin’s view, Hegseth was advocating for a private-access-for-all plan. Shulkin wanted limited special circumstance private access while strengthening the existing system.
The Mission Act was an extension of the Choice program started under Obama, which includes options for veterans to utilize private healthcare providers. As Shulkin explains, “The most concerning provision […] relates to the eligibility for care in the private sector of the community. While the definition of this eligibility is rather complicated,” says Shulkin, “the provision may ultimately determine the long-term sustainability of the entire VA system.”
Shulkin continues, “It is left to the discretion of the [VA] secretary to determine who can receive private care and under what circumstances. This could result in a narrow definition of eligibility (meaning most veterans would continue receiving care at the VA) or a broad definition (allowing veterans to seek private care on the VA’s dime whenever they please) that would pave the way for privatization.”
“Privatization would not come in a single step – from a quick vote in Congress or an executive order – but rather as a result of gradually widening the conduit to the private sector while simultaneously draining the resources from the VA,” said Shulkin.
The problems with the private-access-for-all model, in Shulkin’s view, are that it would cost billions of dollars more to deliver healthcare to veterans in this manner, and that private providers aren’t geared for the intensity of care needed for war injuries.
With me out of the way,” said Shulkin, “not only could progress toward strengthening the existing VA stop, but it would be much easier to reverse direction and work toward breaking down the entire system.”
While Shulkin did not write about the VA’s construction activities, there is one ominous passage in his book that may be relevant to the property at Alameda Point. “Some people within the Trump Administration […] believed the VA system was unfixable and that the real estate was too valuable,” said Shulkin. “They suggested restricting the eligibility of new veterans into the system so that after the wave of current veterans died off, the VA would finally be able to display an ‘out of business’ sign on its front door.”
If the health clinic is never built, the only veteran services at Alameda Point will be the cemetery. It will also mean Alameda unnecessarily gave up 74 acres of open space in order for the health clinic to be moved further away from the least tern nesting site. The endangered terns nest for four-and-a-half months in the middle of 512 acres of open space, which the VA has no expertise or interest in managing as a nature preserve.
It is now a waiting game to see if the VA continues its lackadaisical pace until November, anticipating President Trump’s re-election and the possible shelving of the clinic plans during his next term.
Even if the VA begins work this year, the first phase does not include the clinic. It includes wetlands expansion at an existing wetland not far from the Seaplane Lagoon, raising the construction site elevation another five feet, utilities, roadway, and the first segment of the cemetery.
As of January 2020, the VA has a grand total of $109 million appropriated by Congress from the 2011, 2016 and 2020 budgets for planning, basic infrastructure, wetland mitigation and 20 acres of cemetery.
Funds for the clinic itself have not yet been appropriated by Congress. Total cost for the project, if everything is completed, is estimated to be $240 million. The additional funding will have to be appropriated in future federal budgets for the second phase that includes the clinic.
Shulkin will be speaking at the Commonwealth Club in San Francisco on Wednesday, January 15, 2020. Open to the public, tickets online or at the door. A recording of the event will be posted online at a later date.
“The Veterans Health Administration is the nation’s largest integrated health care system, yet almost 2 million veterans and 3.8 million of their family members are without health insurance today. David Shulkin was brought in by President Obama to clean up the Veterans Affairs’ (VA) troubled hospital network after a major scandal. His success led President Trump to name him VA secretary, making him the highest ranking official to serve both presidents and the only Trump cabinet secretary to earn unanimous Senate approval. Born on an Army base, Shulkin was the first nonveteran to hold the position.
“Shulkin introduced substantial changes to the VA system, with bold moves that dramatically reduced wait times, increased transparency, enhanced accountability and tackled veteran suicide rates. His efforts earned early praise from Republicans and Democrats alike. But Shulkin says he ran headlong into Trump associates intent on privatizing the VA and eventually was ousted.
“In his new book, Shulkin opens up about his time as VA secretary and the ruthless political appointees he says he encountered. Since leaving government in early 2018, Shulkin has continued to shed light on VA privatization and his concerns on how it will impact our ability to ensure health care for those who have fought to protect the nation.” From Commonwealth Club announcement of speaking event.
Shulkin’s book is available at the Alameda Library.
“Known in health care circles for his ability to turn around ailing hospitals, Dr. David Shulkin was originally brought into government by President Obama to save the beleaguered Department of Veterans Affairs. When President Trump appointed him as secretary of the VA, Shulkin was as shocked as anyone.
“Yet this surprise was minimal compared to what Shulkin encountered: a team of political appointees devoted to stopping anyone – including the secretary – who stood in the way of privatizing the agency and implementing their political agenda. In this uninhibited memoir, Shulkin opens up about why the government has long struggled to provide good medical care to military veterans and the plan he had to solve these problems. This is a story about serving the people who risked their lives for our country, how the VA was making real progress, and the challenges it now faces. It is also a reflection on the toxic environment forced upon public servants and how the public may pay the price.” From the book jacket – “It Shouldn’t Be This Hard to Serve Your Country.”