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Big Changes are Needed at the VA

Dr. Shulkin is out.  Dr. Jackson is in.  Is this good news or bad news for the beleaguered VA?  Sadly, I think it is actually no news.  When this new secretary’s tenure is done (assuming he is confirmed) I predict that the VA will be only marginally different.  Maybe it will improve a bit in some areas.  Maybe its slide will continue in others.  Overall, nothing will really get fixed.  Veterans will still be facing the same or similar problems they confront right now.

Big changes are needed at the VA, but the odds of Dr. Jackson being that change agent are poor.  Dr. Jackson has been the White House physician going back to the Bush administration.  It is reasonable to assume that one needs to be a savvy and competent physician to hold that position.  There is no reason to think that this Rear Admiral is not a good doctor.  My guess is that he is an excellent one and his military career has been impressive, including duty as a front line physician in Iraq.  However, that does not mean that he is remotely qualified to run a massive and troubled operation like the VA, let alone effect the massive changes that are needed.  He has not even run a major medical facility or hospital so his executive experience is very limited.  Think about that a minute.  The VA is a tremendous operation employing approximately 378,000 people nationwide and overseas.

In contrast, about 25 people work in the White House medical unit.  Obviously, RADM Jackson has keen political instincts having served three very different presidents – and that is not a bad thing - but other skills are far more important and, at least based on his experience, those appear to be lacking.

Putting someone like Dr. Jackson in charge probably means that the entrenched bureaucracy remains untouched and unchanged.  But it needs to be shook up and it is unlikely that someone like this new doctor can figure out how to do that effectively in the limited time he will have.  Sadly, there is nothing new about this scenario.  There is a long history of the VA getting leaders who may have had the best intentions, but who were ultimately unable to change the trajectory of this operation.

While it claimed progress, the current regime was clearly not the dynamic leadership that was needed to turn around the VA.  Perhaps Dr. Jackson will be a good surprise and he will be a powerful leader who rises to the occasion. I would not bet on it, however. Hence I am reminded of those memorable lyrics from The Who: “Meet the new boss, same as the old boss.” I hope I am wrong.


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