Wednesday, March 28, 2018

The Dander Riseth Ever Higher: Shulkin Case Emblematic of Dysfunction

What follows is numero sesto if memory serves in a series of what gets one's dander up in this era of dysfunctional health care. Of course it seems these days our news in Health Care Renewal is so often all about focal dysfunction mirroring much broader problems of governmental and societal dysfunction. It's in this context that I learned just now of the current VA Secretary's ouster while overseas in a country that does things in many ways much more effectively.

Today we blog about this one issue only. It seems to perfectly encapsulate the Reality Show-cum-wrestling match that our Republican leadership has morphed into. Oh, wait, maybe it didn't morph. It was always that way, perhaps, and people are just now twigging to that fact.

David Shulkin, the Emblematic Case. In this series I've written before about how Shulkin was undermined by his own communications people once those political-appointee ideologues smelled blood in the water over his perceived transgression--like many others'--in accepting gifts and padding overseas travel.

But how did those guys win? Shulkin resisted their efforts but ultimately they got to their boss, Donald Trump, anyway. After trying to out-wait Shulkin in hopes he'd not have to utter those infamous words "you're fired" to someone for whom he'd promised never to do that, Trump dropped the axe.

But to what end? Is our president so enamored of privatizing an improving VA health system that he'd go back on his word and risk the ire of so many vets? Make no mistake, a very large percentage of vets love their VA medical care. I worked in it myself, back in the day, and am acutely aware of its problems past present and future. But Shulkin was not only making it better, he was handing the president a lot of his most conspicuously successful legislative victories.

Nope, none of this explains it. There's only one thing that can. The burger-meister himself is rudderless. And his increasingly whacked-out toadies, the ones who know how to survive the snake-pit and play him, are successful at turning the boss against reasonable conservatives like Shulkin. What's so scary is that it's whimsical. Are we going to create a whole new gi-normous cadre of vets from World War III, this time not only with amputations but also radiation poisoning?

Oh, and one more thing. These political hacks now clearly believe every voter will, in perpetuity, continue implacably to believe in Ronald Reagan's dictum that government in never the solution, but always the problem. Hence, effectiveness in delivering health care on Shulkin's part is something that to them is at best a cognitive inconvenience, at best a full-on tautology: "good government health care" as oxymoron. Ultimately this flaw in reasoning and resulting inhumanity can only be solved at the ballot box. Are there enough vets out there whose dander is as far up as mine?

Addendum. Dr. Shulkin has gone public in an elegant op-ed pieces in his former boss's favorite newspaper, the New York Times. Most definitely worth a read.

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