Toby Cosgrove, a cardiac surgeon, has run the Cleveland Clinic since 2004. | AFP/Getty Cleveland Clinic chief is Trump's favorite for VA secretary Multiple sources briefed by Trump’s transition team said that while no decision has been made, the president-elect wants the health care executive.

Cleveland Clinic CEO Toby Cosgrove has emerged as the top contender to be Donald Trump’s secretary of Veterans Affairs, a selection that would bring more private-sector experience to a Cabinet already stocked with it.

Multiple sources briefed by Trump’s transition team said that while no decision has been made, the president-elect wants the health care executive, who was also considered for the post by President Barack Obama two years ago, and that Cosgrove is mulling over the post.


Cosgrove, 75, a cardiac surgeon, has run the Cleveland Clinic, a nonprofit network of hospitals and clinics based in Ohio and with facilities in Nevada and Florida, since 2004. Before taking over, he helped start Cleveland Clinic Innovations, which helped create nearly 60 spinoff medical technology companies. He also started the first tuition-free medical school in the country.

He was also an Air Force surgeon in the Vietnam War, where he earned a Bronze Star. Most recently, he served as vice chair of the Commission on Care, a federal panel that reviewed veterans heath care.

His background will likely go over well with veterans groups — especially his reputation for handing out buttons on his first day as CEO stamped with "patients first," part of his commitment to patient-centered care that includes the Cleveland Clinic's guarantee that patients get same-day appointments with a doctor.

"I think he'd be viewed very favorably,” Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, told POLITICO. “He is definitely the most qualified of the people they have put out there.”

But reforming the VA may be one of those most challenging tasks in Washington.

The $180-billion-a-year agency — with 350,000 employees — has been the poster child for government mismanagement. Recent scandals include long wait times for many of the 9 million veterans who receive health care at VA hospitals and clinics around the country, including some instances in which patients died before they could be seen by a doctor.

Those scandals led to the 2014 departure of former VA Secretary Eric Shinseki, who oversaw the department as reports surrounding its mismanagement emerged.

He was replaced by Robert McDonald, who was brought on to reform the department but said earlier this year that it was quality of care, not wait times to receive that care, that the VA should be judged by. McDonald’s comment drew extra scrutiny because of the metaphor he used, comparing wait times at VA medical facilities to lines for popular rides at Disney World. After initially defending his comment, McDonald later apologized for it.

Reports are also rampant of a nightmare of red tape for veterans who are eligible for disability payments, subsidized home loans, education and other benefits provided by the VA. A major focus of Congress this year has been to increase accountability for VA employees, including new legislation that would make it easier for the VA to fire underperforming employees.

Trump made reforming the VA a key part of his platform, detailing a 10-point plan highlighted by the president-elect’s promise to personally address any reported issue that the department refuses or is unable to deal with. The reform plan also includes a promise from Trump to remove ineffective VA officials and of greater leeway for the VA secretary to discipline and fire employees who fail at their jobs.

Perhaps most controversially, Trump promised to offer veterans the option of seeking treatment at the hospital of their choosing, a plan panned by some as the privatization of a government health care program.

In a speech last July, Trump promised that his VA secretary will be “a person of great competence” and “not a political hack.”

But some of the candidates for the VA post whom Trump has interviewed have raised serious concerns among veterans organizations. Most controversial is Pete Hegseth, a regular Fox News contributor and the former head of Concerned Veterans for America, a conservative advocacy group established in 2012 and backed by the industrialist Koch brothers.

Trump has met twice with the 36-year-old Iraq War veteran, who has butted heads with the more traditional veterans groups for some of his aggressive tactics. Those groups have raised concerns that as secretary he would make radical changes that could hurt veterans, like pushing for privatization of health care services.

Others, including VA whistleblowers who have reported a series of dangerous failures at the agencies, recently wrote to Trump endorsing Hegseth. “These organizations each want to keep the status quo and to keep lining their pockets at the expense of our nation’s heroes,” they wrote of the more established vets groups. “That is exactly the reason Mr. Hegseth is the right choice to run the VA.”

Trump has also met with former Sen. Scott Brown (R-Mass.) to discuss the VA post, a possibility that earned the endorsement of Sen. Elizabeth Warren (D-Mass.), who defeated Brown in 2012. House Veterans’ Affairs Chairman Jeff Miller, an early supporter of Trump who is retiring from Congress, has also been mentioned as a possible choice. Miller has also advocated more privatization of veterans’ health care.

Multiple veterans groups, meanwhile, have urged Trump to keep McDonald, the former CEO of Procter & Gamble who has been running the VA since 2014 and has received bipartisan praise for his initial reform efforts.

Cosgrove, for his part, is not immune to controversy, too.

When he was being considered for the post by Obama in 2014, it was revealed that government investigators had threatened to cut off Medicare payments to the Cleveland Clinic when it failed to cooperate fully with a probe into the case of a Vietnam veteran who charged that he was operated on by someone other than his authorized surgeon in a procedure that caused serious injuries.

Bryan Bender contributed to this report.

