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On March 28, the day after President Trump fired him, David Shulkin, the outgoing secretary of veterans affairs, took to The New York Times to warn of the creeping privatization that has long plagued the Veterans Health Administration (VHA). The Prospect has lamented Shulkin’s efforts to outsource more care to the private sector as well as his failure to strongly and effectively defend the VHA in the media and congressional hearings. Nonetheless, Shulkin is to be commended for now warning that “privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”

After getting rid of Shulkin, Trump's new appointees to the Department of Veterans Affairs (VA) will certainly not oppose—and may actively promote—the dismantling of the agency. “The bad guys think they have won,” Rick Weidman, executive director for policy and legislative affairs for the Vietnam Veterans of America, told the Prospect. “They want to privatize the VA at any cost to veterans.”

To further that agenda, Trump has appointed his personal physician, Rear Admiral Ronny L. Jackson, to lead the second-largest agency in the federal government—one with over 370,000 employees and a budget of almost $200 billion that serves the needs of 22 million veterans and delivers health care to nine million of them. Although Jackson's title of rear admiral makes it seem as though he would be a strong candidate, he in fact has no administrative experience.

Jackson—a Navy physician—did perform combat duty in Iraq. In the field, Jackson focused on the delivery of medical treatment to military personnel. But having a background in military medicine, Weidman warns, is not relevant to delivering health care to veterans. “Military medicine,” Weidman reminds us, “is about getting people back online as quickly as possible—not managing patients, like veterans, who have multiple, complex chronic conditions.” Since 2006, when Jackson began serving as a physician in the White House, his patients have largely been well-heeled, upper-middle-class civilians.

Since 2013, as President Obama's and now Trump's personal physician, he supervised and reported on the results of the various physical examinations and tests other specialists conducted to vet the health of the president. There are literally thousands of VHA doctors who have had more relevant experience than Jackson when it comes to directing the Department of Veterans Affairs.

“The question,” Rick Weidman says about Jackson, is “who's going to be advising him?” If Jackson is confirmed and the president surrounds him with the representatives of the conservative Koch brothers who now populate the White House, “they're going to run him, rather than him running the agency.”

“I can't think of a more perfect puppet,” another veterans' advocate, who preferred to remain anonymous, told the Prospect. And indeed, Jackson’s claim to fame is his controversial report on Trump's health, in which he minimized the impact of the president’s weight, lack of exercise, and poor diet. He’s now more likely to put the VA on starvation rations, at Trump’s behest, than put the president on a much-needed diet.

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When it comes to vigorously opposing Jackson's nomination, one long-time VA observer told the Prospect, “My fear is that [veterans’ service organizations] will say, ‘At least Jackson isn’t Pete Hegseth or Jeff Miller, people totally hostile to the VA.’ But this appointment comes from the very top. They’ve got to fight it.”

Equally worrisome is the recent appointment of Robert Wilkie, who will serve as interim secretary of veterans affairs while Jackson awaits confirmation. Until this week, Wilkie, who once worked for Trent Lott and served as an aide to Jesse Helms, was undersecretary of defense for personnel and readiness at the Department of Defense. In bringing Wilkie in to steer the VA, Trump bypassed his own deputy secretary of the VA, Thomas Bowman. Bowman has a wealth of VA experience and the respect of many within the veteran community. Bowman was, however, another irritant to Trump because of his opposition to VA privatization.

Representatives of veterans service organizations who talked with the Prospect said they are astonished by this appointment. “It is absolutely unprecedented for the president to bypass the deputy secretary that he appointed and that Congress confirmed and to put in his place someone with no VA experience,” a veterans service organization representative who wished to remain anonymous told the Prospect. “The VA,” he said, “is essentially leaderless. There is no undersecretary for health, no undersecretary for the Veterans Benefit Administration. They have essentially chopped off the leadership of the VA.”

The future of the VA now rests with Congress, veterans service organizations, veterans, and the tax-paying public. While David Shulkin may not fully deserve the mantle of political martyrdom he has now donned, now that he's out of the way, it is clear that key decisions about the future of the VA will be made in the coming months. Whether they are good or bad depends on the lobbying of veterans, their organizations, and all citizens interested in the future of government. This lobbying can't just target Republicans. It must also target Democrats, like Montana's Senator Jon Tester, who has signed on to a bill that would accelerate VA privatization, as well as other congressional Democrats, like Minnesota’s Tim Walz and Wisconsin’s Tammy Baldwin, who are, to say the least, wobbly on the issue.