Did you hear the one about the fast-food-loving, exercise-averse President who got a rave health review from his doctor and then nominated him to run a vast government agency with three hundred and seventy thousand employees and an annual budget of close to two hundred billion dollars?

On Wednesday, Donald Trump picked his White House physician, Rear Admiral Ronny Jackson, a U.S. Navy medic, to run the sprawling Department of Veterans Affairs. The jokes are still coming. “Ronny Jackson says Trump weighs 239 pounds and gets to be VA Secretary,” Dean Baker, a senior economist at the liberal Center for Economic and Policy Research, tweeted on Thursday morning. “If I say he weighs 229 pounds can I be Fed chair?”

It’s worth looking more closely, however, at the circumstances that led to Jackson’s nomination: the firing from the V.A. of David Shulkin, an acknowledged expert in the management of large health-care organizations, which is what the V.A. really is. Before Shulkin joined the V.A., in 2015, initially as the Under-Secretary of Veterans Affairs for Health, he was the chief executive of Beth Israel Medical Center, in New York, and he had also worked for the Atlantic Health System, which runs a number of hospitals and clinics in New Jersey. An M.D. as well as a manager, he was known as a champion of more patient-centered care.

Early last year, after Trump nominated Shulkin to be the V.A. Secretary, the Senate confirmed him unanimously. Since then, some big veterans’ groups have praised his efforts, which have included building up the mental-health services that V.A. facilities offer; forcing hospitals and clinics to publish data about their treatments and waiting times; and reforming the appeals process for veterans seeking disability benefits. Trump himself also praised Shulkin. At a signing ceremony, last June, Trump joked that he would never fire him.

That statement turned out to be another Trump falsehood. According to the White House, the President lost confidence in Shulkin after he became embroiled in an embarrassing scandal about using public money to pay for his wife to accompany him on a trip to Europe last summer. The sums involved were relatively small—the airfare was about four thousand dollars. But a report by the V.A.’s inspector general alleged that Shulkin’s chief of staff had doctored an e-mail in an effort to cover up the expenses.

Shulkin repaid the government, insisted that he had intended to do so all along, and said that the inspector general’s report was biased against him. Some Trump Administration officials complained that he wasn’t forthcoming enough about what had happened. According to a report in the Washington Post on Thursday, “a steady drumbeat of senior officials — including White House Chief of Staff John F. Kelly — told Trump that Shulkin had been dishonest in his dealings with West Wing officials.”

For the sake of argument, let’s stipulate that Shulkin made a serious mistake and so did his chief of staff. Theoretically, Trump could still have stuck up for him, arguing that he was doing a bang-up job for veterans and that he deserved a mulligan. And, given all the grift and chaos going on elsewhere in the Administration, why should the President focus on the expensing of airfare to Europe?

Recent reports have suggested an alternative theory for Shulkin’s ouster: that he was the target of a concerted effort by other Trump appointees to use the expenses scandal to get rid of him because he wasn’t conservative enough. Indeed, the more you look at Shulkin’s departure, the more it seems like another example of virulently anti-government Republicans exploiting Trump’s Presidency to advance their own goals. In this case, the goals involve privatizing much of what the V.A. does, and maybe even dismantling the public health-care system.

During his twelve-and-a-half-month tenure as V.A. Secretary, Shulkin approved the contracting out of some services to private providers, but he resisted a broader privatization initiative that various right-wing think tanks and political groups have been pushing for years, and which has also earned the vocal support of a veteran group backed by the Koch brothers: Concerned Veterans for America. (The White House reportedly seriously considered the former head of Concerned Veterans for America, Pete Hegseth, who is now a co-host of the Fox News morning show “Fox & Friends Weekend,” as a replacement for Shulkin.)

Shulkin’s reluctance to go along with the privatization agenda earned him some influential enemies, including Jake Leinenkugel, a senior White House adviser on veteran affairs. Leinenkugel is a Wisconsin businessman who used to run the Leinenkugel brewery, a subsidiary of MillerCoors. The basis of his expertise in health-care-delivery systems isn’t immediately obvious. But, in February, the Times reported that he had written an e-mail to a former Trump campaign official who works at the V.A., Camilo Sandoval, that “listed ways to topple the leadership” at the department. The Times report went on to say that these ways included “replacing the deputy secretary, Thomas G. Bowman, with Mr. Leinenkugel; and replacing Dr. Shulkin with a ‘strong political candidate.’ ”

Leinenkugel, who kept an office at the V.A.’s headquarters, on Vermont Avenue, and Sandoval weren’t Shulkin’s only problems. Shulkin was also at odds with another White House adviser, Darin Selnick, who had initially served as a member of the Trump Administration’s “landing team” at the V.A. According to a lengthy ProPublica piece, which was also published in February, Selnick “wanted to reconceive the VA’s fundamental approach to medical care. Selnick wanted to open up the VA so any veteran could see any doctor, an approach that would transform its role into something resembling an insurance company, albeit one with no restrictions on providers.”

The dispute between the White House and Shulkin came to a head over efforts to amend the Veterans Choice Act, a piece of legislation that Congress passed in 2014 after a scandal involving long waiting lists and veterans’ inability to obtain urgently needed care. There is a consensus on Capitol Hill that vets who can’t get the treatment they need in the V.A. system should be able to see a private doctor, but there is also disagreement about how this should be done. Some V.A. officials and veterans’ groups fear that new legislation could be used as a Trojan horse for undermining the existing system.

Shulkin and Bowman, a former marine, supported a bipartisan bill put forward by the chairman of the Senate Veterans’ Affairs Committee, Johnny Isakson, a Republican of Georgia, and the committee’s ranking minority member, Jon Tester, a Democrat of Montana. Some right-wingers supported a rival bill proposed by Senator Jerry Moran, of Kansas, that would give veterans considerably more latitude in using private-sector health care. As the dispute intensified, an unnamed White House official told the Washington Post that the ouster of Bowman would be “a move to knock Shulkin down a peg or two. . . . Rather than sticking with the administration’s position on the Veterans Choice Act, Shulkin has been working with senators who don’t agree with the White House provisions.”

Despite these machinations, Bowman kept his job, for now. But, of course, Shulkin didn’t. On Wednesday afternoon, Kelly called and told him he was out. (Trump is too much of a coward to fire people in person.) On Wednesday, in an Op-Ed for the Times, which he presumably prepared in advance, Shulkin went public about the internal power struggle, saying that the “advocates within the administration for privatizing V.A. health services . . . saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.”

Shulkin’s article went on, “I have been falsely accused of things by people who wanted me out of the way. But despite these politically based attacks on me and my family’s character, I am proud of my record and know that I acted with the utmost integrity. Unfortunately, none of that mattered.”

To be sure, Shulkin has an incentive to portray his departure in this way. But deeply reported articles that appeared well before his firing also support his version of events. While Trump watches television, tweets, and plays golf, there are many others within his Administration who are working far more diligently on the long-term G.O.P. project of drastically downsizing the federal government, even the bit of it that cares for wounded and disabled veterans. If Dr. Jackson doesn’t go along with this project when he gets to the V.A., he could easily become the zealots’ next target.