It Shouldn't Be This Hard to Serve Your Country: Our Broken Government and the Plight of Veterans

by David Shulkin

The former VA secretary describes his fight to save veteran health care from partisan politics and how his efforts were ultimately derailed by a small group of unelected officials appointed by the Trump White House.




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 trivial compared to what Shulkin encountered as a team of political appointees devoted to stopping anyone -- including the secretary himself -- 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 book about the commitment we make to the men and women who risk their lives fighting for our country, how the VA was finally beginning to live up to it, and why the new administration may now be taking us in the wrong direction.

Genres: Nonfiction, Military Fiction, Politics, Memoir, History

384 pages, Hardcover

First published October 22, 2019

Reviews

[HR-ML · Rating 4 out of 5]

Dr. Shulkin served as Under Secretary of Veteran's Affairs
under President Obama & Secretary of VA under Pres.
Trump. He was the 1st Secretary of the VA to be an MD.

The US has 20 million military veterans, 40% of whom
live in rural areas. Dr. S's goals were to reduce wait
time for a veteran to see a VA doctor, and simpler means
to determine clinical urgency to see a doctor, he reduced
from 31 categories to 2 : rouitine & urgent, to improve
the VA computer system to store and integrate veteran
medical data, to improve VA's PTSD & CBI care, & to
reduce instances/ frequencies of veteran suicide (more
likely for suicide ideation to occur inside of 12
mos. of someone's discharge from the US military).

Shulkin was unaware, as secretary, a Mar-a-logo
trio (2 businessmen & 1 MD) & some political appoint-
ees (from Trump's campaign) the latter associated w/
the Domestic Privacy Council, both thought Shulkin
accountable to them. About 40 political appointees
received VA jobs, without appropriate experience.
Neither faction knew: how the VA worked or how a
hospital system worked, much less a national one.
Both factions spread lies about Shulkin and gave the
wrong intell to the White House RE his decisions.

The wealthy Koch brothers and the DPC had a mutual
goal to privitize the VA and shut down VA medical
centers. Hoping to buy VA property (some prime real
estate) for financial gain.

The VA travel team arranged for Shulkin & wife (also
a doctor) to travel to Denmark (on health care mission)
& the UK (for a health care conference. ) The VA pre-
approved for these 2 to attend. Like most folks, they
explored each country, but still carried out their official
duties (including prep time & multiple meetings) They
received free tennis tickets. Later someone leaked that
Shulkin & wife enjoyed a "luxury" vacation. Ironic b/c
the Secretary mostly worked 14 hour days & 7 days a
week!! Shulkin took emergency VA calls while in Europe.

Per the author one or both factions intended to ruin the
reputation of Secretary Shulkin, as a political ploy. When
the veterans should have remained the focus. Tough WH
Chief of Staff, General Kelly, should have told both
factions to knock it off and let Shulkin run his own dept.
Shulkin ended up unjustly fired. Shulkin deserved kudos
for getting several bills benefitting vets into law, but
Trump and others frowned upon his bi-partisan methods.

The author touched on Agent Orange, Gulf War Illness
(whereby 400 US military developed brain cancer) per-
sonalized medicine etc.

[DMC · Rating 5 out of 5]

As the daughter of an Air Force Veteran I was compelled to read former VA Secretary Dr. David Shulkin’s book “It Shouldn't Be This Hard to Serve Your Country”. I was astounded by the inside story. This would make an incredible movie. Intrigue, backstabbing, an honorable VA secretary being maligned, unfortunately for Veterans, it’s a true story.

As an elementary school teacher for 20 years, in education we always teach students that there are consequences for actions. I wish there were consequences for the malicious ‘politicals’ inside the VA when Secretary Shulkin was in charge.

America and her Veterans lost a VA Secretary who put Veterans first!

[Happymike21 · Rating 5 out of 5]

A fascinating new book about Dr. Shulkin’s challenges in Washington DC as Secretary of Veterans Affairs Department and caring for 9 million Veterans.

President Trump called him ‘our David’ and ‘our 100-0 man’, the book reads like a novel. You will enjoy the book, I did. A zany pre-confirmation interview with the new president-elect, rides on Air Force One, to touching Arlington Cemetery memorials, Dr. Shulkin tells how he led the effort that made advances in an agency that had been through terrible years and public embarrassments before he came to VA. Since VA has the second largest budget in the federal government, it also has a powerful shadow government which worked to undermine him and the agency.

This book takes you on Dr. Shulkin’s wild ride through the politics of this time period. All while simultaneously combating a Shakespearen like conspiracy engineered and fueled by wealth beyond imagination, and against a set of “politicals” dedicated to destroying him and the advances he made for the healthcare of Veterans.

At the same time, with a 100% Senate support confirmation as a tailwind, he begins to transform the VA. Dr. Shulkin achieves an astonishing 11 new pieces of legislation in 1 year, brings widespread telehealth to Veterans, accountability and transparency never before seen, and brings his 30 years of private healthcare leadership to a federal agency that had been mired in years of public mistrust.

Dr. Shulkin writes with his heart about our debt to Veterans and honoring our commitment to those who make great sacrifices in service to their country. His knowledge of health systems could guide the VA in shaping our largest health system. He is an innovative leader and patriot who embraced one of the most difficult jobs in American government.

[Mindy Robinson · Rating 5 out of 5]

Passionate insightful book. A must read for every veteran and for anyone who cares About our veterans and about our country and government. You will be amazed with what goes on .

[Ownbymom Ownby · Rating 4 out of 5]

The title of the book is very descriptive of the thesis. Shulkin served in both the Obama and Trump administrations in the VA. His greatest hindrance was what he refers to as the "politicals", a shadow group whose goal was (and I assume still is) the privatization of the VA. This would include the Koch brothers, etc. Although Trump both hired and fired him in very unconventional ways, Shulkin treats the President impartially for the most part. Shulkin does, however, focus on the press as another obstacle to his success. As a reader of the Washington Post, I was surprised to discover that the Post often published stories about Shulkin which they did not fact check. Shulkin lost his position because of a smear campaign (launched and sustained by the politicals) centered on a business trip he took to Europe with his wife. False accusations were (and possibly still are) rampant in the press that this trip was an example of corruption in government. No one apparently checked out Shulkin's protestations and counter argument. Only Rachel Maddow publicly stated that she had been wrong, and this was when the harm was already done. Shulkin's summary of what he was able to accomplish in spite of all of this is inspiring.

[Tom Walsh · Rating 4 out of 5]

I chose this book because of my interest in the troubled history of the VA’s Information Systems and its attempts to modernize them under Trump and his predecessors over the last thirty plus years.

While the multi-billion dollar contract signed this year is not gone into in great depth, Shulkin paints an intriguing, often horrifying, picture of his attempts to meet the challenges of running the VA and make what he sees as necessary improvements to the care it delivers to Veterans.

I found the experience of reading this book in turns educational, horrifying and heartbreaking. Unlike all the other Trump Horror Stories on the market currently, many of which I have read, this one focuses on the experience of a man trying to do a job he cares about in an environment making it very difficult. It actually portrays Trump as an often well-meaning but feckless player in a world he doesn’t understand completely, surrounded by actors who know the game far better than he.

I’m not willing to cut Trump as much slack as Shulkin but I grant him his opinion however naive. It’s an interesting tale well and believably executed.

[Jen · Rating 5 out of 5]

As a VA employee, I found it necessary to read this. Dr. Shulkin seems like a man genuinely concerned for our veterans. His behind the scenes descriptions of the current administration are frightening. The wheels of govt have always turned slowly, but the added influences of Trump’s so called advisors (who are these people?) was chilling. Who in their right mind would want to serve?? And while I don’t completely agree with all the knocks on the VistA patient record system, the systems I’ve supported both as a vendor and govt employee, I understand the need for modernization and integration. This book is aptly titled. A solid 5/5.

[Frank Stein · Rating 4 out of 5]

David Shulkin, the former Beth Israel hospital CEO and then Veterans Affairs undersecretary for health under Obama and overall VA Secretary under Trump, had to watch his career become a political football. He was the only cabinet nominee that was unanimously confirmed under Trump, the nomination thanks mainly to the recommendation of Ike Perlmutter, the former Marvel executive and Trump ally, even though Shulkin had little contact with Ike (as Trump was always calling him, as in "Have you talked to Ike?"). He was often referred to as the "good" Trump nominee, and he became friends with CNN anchor Jake Tapper, although he tried hard to never talk business there or among other reporters. Yet he was soon targeted by what he called the "politicals" in his office, the appointees whom he was told by the White House not to touch. Most shockingly, a European trip to attend the Five Eyes intelligence conference, where he also got two free tickets to Wimbledon from a friend, was turned by an Inspector General report into an international junket. He was lambasted as part of Trump's supposedly-money hungry team. Then after the unexpected Twitter firing, he wrote a New York Times op-ed, which shared the title with this book, where he explained that his attacks were part of an attempt to "privatize" the VA, and he suddenly went from Trump ally to Trump's honorable victim in the eyes of much of the media. It was a wild ride that he clearly enjoyed, despite all of the attacks.

Unfortunately, like many people who have gotten into an intricate legal and political battle, the specifics of the IG report seem to have eaten away his focus on anything else. So much of this book recounts the costs of nonrefundable tickets or the precise hours he spent at some sight-seeing tour or another, all in attempt to prove his innocence (which, as he correctly notes, was corroborated by an official VA release after he left). Whittaker Chambers's Witness comes to mind, which also went from a fascinating overview of its time to an intricate dissection of case and countercase. The best parts of this book deal with how he tried to negotiate an IT contract with Cerner that ensured interoperability of records; how he tried to publicize and end wait times at all VA hospitals, and how he negotiated what became the 2018 Mission Act, where he worked with Senator Johnny Isakson and which passed soon after he left. Admittedly, some of his personal battle is also interesting, including how he came to distrust the security detail that was there to protect him, because they had to report everything to a political who might report it out, and how even the VA's public affairs team was turned against him and refused to defend him against charges. But a little more of his overall time at the VA, and less about his personal battles, as upsetting as they were, would have been more interesting.

Importantly for the reception of the book, this did not read as an attack on Trump or a defense of his time at Obama. To some extent he thought Obama's team was too reactive and methodical, and he appreciated some of the freedom he got under Trump (although he was tired of constantly reporting to Ike and outside advisors who didn't know the VA and the conversations with Trump could obviously be repetitive). Shulkin's main complaint were the machinations of the politicals who claimed to represent the "White House" when they didn't often have the President's own backing (at one point both Trump and chief-of-staff John Kelley said he could fire them, although the "White House" later told him he couldn't). In any case, for a thoughtful description of how modern government, and modern public relations, works, I would highly recommend this.

[Melsene G · Rating 4 out of 5]

I met the author and his wife at a medical conference at his book signing. He was a keynote speaker and after hearing some of his story I couldn't wait to read his book. The book was so disturbing and fraught with tension that I couldn't put it down. Dr. Shulkin served as under secretary of Veteran Affairs and secretary under Obama and Trump, respectively. I think he lasted for about 3 years total.

Shulkin was the only cabinet hold-over from Obama, and it didn't go well for him as he details in the book. The awful political backstabbing, the lies, not knowing who or if you could trust anyone, dealing with the 'politicals', all took away from the job of helping veterans. It seems clear that the politicals wanted him gone from day 1. I honestly felt very bad for the author and his wife even though we may not align politically. People are people. It doesn't really matter if you're left or right.

Despite all of the kabuki theater, Shulkin was able to accomplish things to improve access, value based care, and getting the EHR up and running. The media lied about him, his travel reimbursements, his wife's, and you would have thought they'd support him since they're aligned politically. As he says, and I agree, no good deed goes unpunished. The IG was corrupt until he was gone. Shulkin was okay with some privatization, but not for eliminating the VA altogether. He's probably correct here.

Every chapter is detailed with the ugly side of the DC swamp and it mostly focuses on the Trump administration. However, we all know it goes on with both parties as so much is at stake-money, power, and control. (You can leave the sex out on this one.)

My takeaway is that the media has lied about the VA. We all know about the long wait times under Obama, which Shulkin managed to reduce! DC is the ugly evil swamp and thinking you can serve and make a difference at the end of the day is rather naive. I was really disgusted after reading this book. Everyone is evil when it comes down to politics. Oh, and you see this sort of nonsense in the private sector, too, but you're not in the news everyday.

Glad you've moved on Dr. Shulkin, for both you and Merle and your family. Glad to meet and chat with both of you at the conference and I'm sorry for what you all had to suffer.

[Kim Supranovich · Rating 4 out of 5]

I thought this was an informative and very well balanced POV concerning the struggles at both the VA and at all levels of the current government regime. A lot of the narrative concerning the issues the author faced with the "politicals" strikes a familiar chord to what seems to be playing out currently in regards to the White House response to the current pandemic. I also very much appreciated the author exposing the flaws inherent in a media population more focused on sensationalism than on delivering a fair, unbiased and complete set of facts backed up by varying degrees of evidence.

[Caleb Mitchell · Rating 5 out of 5]

I honestly thought that this was an excellent book and well thought out. Although I don't agree with everything he said, it is quite clear from this book that Dr. Shulkin cared for veterans and was incredibly frustrated by the road blocks that were placed by bureaucracy and partisan showmanship. Like the name of his book, he displays the resistance he met to try to make the VA more efficient, and it's disheartening to hear the stories he told. Would recommend to anyone wanting to understand the VA more, and some things that could be done to improve our government.

[Bryan · Rating 5 out of 5]

Very enlightening about what is happening behind the scenes. The author not only provides an understanding of what occurred within VA during his tenure but also clarification of how the current administration works. It sounds like what is happening is a gang or mafia mentality. This explains why there is such high turnover and so many infilled positions. Toxic environments are difficult enough but when paired with the scrutiny of the public eye, it is overwhelming.

[Peggy Young · Rating 3 out of 5]

This was the second pick for our February book club. It’s a frightening and nauseating example of how difficult it is for anyone, no matter how well-intentioned or hardworking, to be effective in their jobs. I can’t say I enjoyed it—spending too much time listening or reading about this administration really depresses me, so I try to minimize it. But if it is emblematic of how our government is being run, it’s an important read.

[Erin Olson · Rating 5 out of 5]

I would give this book six stars if I could. Should be required reading for anyone choosing to enter public service generally and the VA specifically. Gives a very accurate picture of how the political world meets the civil service world. The “deep state”’is really the professionals working for less than they could make in the private sector to serve a cause greater than themselves. VA has the best mission in government and it lost a great leader in Dr. Shulkin.

[John · Rating 5 out of 5]

This was an amazing read- much more than I expected. Shulkin is the first Trump cabinet member to candidly describe what it’s like to serve in this administration and tells a personal and fascinating story. The passion for service to veterans is also clear and is told in a compelling fashion for what all of us who have not served, need to know. Highly recommended

[Shawnee Petrosky · Rating 4 out of 5]

As a Veteran it was interesting to hear about the complexity and relationships between the VA and the other administrations. I enjoyed Dr. Shulkin’s book and appreciated his insights. I knocked one star off because of the length at which he discussed the overseas trip, while justified to make his side known.

[Danielle · Rating 4 out of 5]

At times a little gossipy and self-congratulatory, but still a very important insight into the political, economic, and bureaucratic obstacles (and, sometimes, triumphs) of one of our biggest government agencies. I'd recommend this book to anyone who suspects the VA might be better off if it was privatized.

[Nancy Bandusky · Rating 4 out of 5]

Interesting and disturbing read of the author's time as the Secretary of Veterans Affairs. The author describes the ordeal he went through trying to achieve a stronger, well-run system. Unfortunately, his time helping those who have served our country was cut short by people with a very different agenda.

[Dan · Rating 5 out of 5]

Excellent Narrative written by the Former VA Secretary on the toxicity of public service in DC today as well as a playbook for Veterans advocates to use for improving veterans healthcare (And US Healthcare in general) in America.

[Cece Shelburne · Rating 5 out of 5]

Good book. Opening chapters perfectly capture the "huh, did that really just happen?" effect of working in DC. Also a good read for anyone who is in health care administration.

[Aaron · Rating 3 out of 5]

3.5 ⭐️’s. Easy read, learned a lot about the life of a VA Secretary and confirmed many things about the current administration.

[Daryll · Rating 3 out of 5]

A great inside view of the Secretary of VA, with a slightly slow and dull pace. I think a lot got left out, and some things got sugar coated, but for the most part a good read.

[Laura · Rating 4 out of 5]

Recommended for people in government, especially this administration. A bit dense to read, but clearly things needed to be spilled onto the page.

[Tina · Rating 5 out of 5]

Excellent read! Easy read. Most importantly a must read for anyone involved with the VA .

[Sheris225 · Rating 4 out of 5]

This is a great book!

[Alex Priest]

[kevin moore · Rating 4 out of 5]

The gutting of our government explained at the Department level. Tailor made Dr leading one of the most challenging departments; great communicator with real empathy for the veterans being served.

But, not a sycophant and thus fired.