This Week Dr. Nick van Terheyden and Fred Goldstein continue with Week 19 of their COVID-19 Update. In this episode they discuss the case of a person suspected of being infected who had their test lost after an ER visit, what should they do? Dr. Nick talks about his experiences early in the HIV Epidemic and lessons he learned that we can apply to the COVID-19 Pandemic.
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One of the big surprises for me was learning that certain Veteran’s groups, in particular Concerned Veterans of America is really a Koch brothers funded organization which is pushing hard for the complete privatization of the VA. This group created trouble throughout his time as VA Secretary. The problem I have with complete privatization is that there are unique issues that Veterans face, that are much different than the general population, Medicare or Medicaid. Things such as traumatic brain injury, spinal cord injury, blind rehab, hearing issues, PTSD, prosthetics and orthotics, poly trauma and environmental hazards of war; for which there is little to no expertise to treat these in the private sector. These are areas in which the VA has developed expertise through years or research and experience. Dr. Shulkin clearly articulated that the VA serves a unique role, that the Veterans deserve top notch services, and that a hybrid public/private system is appropriate. But that you can’t just push Veterans into an unprepared or inappropriate private sector service.
He also proposed an interesting idea for changing the VA structure. His approach would make it unlike other departments by removing the political appointees and making the Secretary a four year appointment, in a model similar to the Federal Reserve. This idea seems to make sense given the VA’s unique mission and what should be a Veteran centric versus political approach. At the same time, Veterans need to have a voice and how one assures their voice is heard through the very political process in Congress is important. I fear it might create pressure on Congress via heavy handed lobbying groups seeking to regulate the purse strings, although that goes on now.
During his tenure he worked on a number of important issues including wait times, the opioid crisis and Hepatitis C, among others. In each of these cases he had the VA put in a systematic and measurement based approach to improve these issues with an excellent example being Hepatitis C where they essentially worked to treat everyone, something we could learn from in the Private sector.
One thing that is I found bothersome was Dr. Shulkin’s belief that the President was unaware of what his political appointees were doing. I just kept thinking to myself “Why do you continue to separate in your mind the President and for example his Chief of Staff from the political appointees, using terms like “While largely unaware of the political appointees’ scheming…”. I cannot fathom that the President was truly unaware of what was going on, or that this was not all part of the plan. But Dr. Shulkin still believes that the President was unaware of these things. Now what that says, positive or negative about the President is clearly up for debate. But assuming as President Truman said “The Buck stops here”, as a former CEO, I fall on the side that, “being unaware” is a failing.
My recommendation to you, It Shouldn’t Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veteran is a great read, both from a healthcare and political perspective. The unique insights it provides into the VA, their issues and President Trump and his administration are deep and important to understand. There’s much more that I did not cover in this post, including the major ethical issue Dr. Shulkin faced regarding his trip to Europe and the Wimbledon Tennis match, what it really was, and how it was used in the end to remove him. But you’ll have to read the book to get those.
After our interview, Dr. Shulkin said he’d be happy to come back on and discuss more about his experiences, thoughts, and the book. I hope to take him up on that offer.
It’s a very good look at the problem we face in the United States. The high/excessive pricing structures are one of the root causes of our ever-increasing healthcare costs. Short term fixes to our cost crisis are found on the supply side. As we remove these from the system, we can free up funds , focus on the demand side and truly improve the health of populations.