Bob McDonald, now in his last year as secretary of Veterans Affairs as President Obama wraps up his administration, expected that there would be challenges when he took the job.
He assumed the position 18 months ago amidst a major scandal involving long patient wait times and veterans dying while waiting for appointments. At the same time, there was the widely known backlog of disability claims applications -- with some veterans waiting years for a decision -- and persistent delays and cost overruns with a major VA medical center in Colorado.
What the former head of international consumer giant Procter & Gamble, one-time airborne soldier and West Point grad did not expect was unrelenting political attacks from Congress and elsewhere -- including, he believes, a veterans group backed by billionaire brothers Charles and David Koch.
"I think the biggest surprise was the politics," he told Military.com during a recent interview at the VA Medical Center in Boston's Jamaica Plain neighborhood. "Remember, I was confirmed 97 to zero. I thought I would focus on just getting better care for veterans, so the politics has been surprising to me. I don't like politics, I'm not going to be a politician, I'm not running for anything."
But McDonald's dislike for politics and lack of political ambition, coupled with a comfortable, stable life made possible by a successful career with P&G, provides him "the freedom to do what is right" regardless of whatever pressure is exerted, he said.
"I don't need the money. I don't need the position," he said. "I'm sacrificing, in a sense, to do this, but it's not a sacrifice because it's for my brothers and sisters who served. I've got no other agenda."
McDonald was in Boston recently to tour a unique veterans' blood repository that is expected to boost medical research across the country. The Million Veterans Program will provide blood samples and DNA for research into myriad health problems, especially those plaguing veterans, but also for the wider population.
That's a point he raised during another part of his Boston visit, a recruiting talk he gave to more than 200 healthcare workers in training at the VA facility.
Making the Pitch for the VA
McDonald makes the pitch at pretty much every VA hospital he visits. He offers a bit of VA history, including the fact that the VA has earned three Nobel Prizes for its work, seven Lasker Awards -- known as the Nobel Prize of the U.S. -- and pioneered medical advances and development now common around the world: the first liver transplant, first kidney transplant, the shingles vaccine, the nicotine patch. A VA nurse came up with the idea of using barcodes to link patients with their records. The electronic health record itself was pioneered at the VA, he said.
"We need you [at the VA] because we are on the cutting edge of [this research] and not surprisingly what we're learning applies to policemen, firemen, EMT [emergency medical technician] workers, NHL players, NFL players -- and we're on the cutting edge of this," he said.
The VA spends about $1.8 billion a year on research. McDonald notes the VA's total budget runs about $190 billion, so he believes it can afford to put more money into medical research, especially since the VA has the wherewithal and the mission to look at medical problems that others, especially for-profit institutions, would shy away from.
"Talk about the necessity of the VA. Well, as a former CEO of a large company, I can only imagine if I was running a for-profit hospital if someone came to me and said, 'We'd like you to do research on spinal cord injuries.' I'd say, 'Well, how many people have spinal cord injuries?' "
The discussion that would follow would deal with the scale and the rate of return on the research investment, McDonald said, with the bottom line being there would "be no rate of return."
"But yet we do that research [at the VA] because we have veterans who have been injured in combat [or] in training who have traumatic spinal cord injuries and we have to be one of the world's leaders in spinal cord injury" treatment and prevention, he said.
Fielding Slings and Arrows
Despite that, the VA has taken multiple hits in recent years over its care -- or in some cases failure to care -- for veterans.
This includes the wait-times scandal that came to light with the VA Medical Center in Phoenix, Arizona, but was found to be systemic across the VA.
Like the claims backlog, chronic veteran homelessness and cost overruns in VA construction, the major problems all preceded McDonald's arrival. His nomination, in fact, was made possible by the scandals, which led to President Obama asking for the resignation of the prior chief, Secretary Eric Shinseki.
"We're in a political environment. We're in a presidential election," he told a VA employee in the audience who wondered at all the bad press. But, he said, there is "a group of people who want the VA to go away."
McDonald identified the group as Concerned Veterans for America, an organization widely reported to be funded by the Koch brothers. McDonald said the group's former chief executive officer, Peter Hegseth, was recorded "speaking at a Koch convention saying, 'Listen, we've got to point out everything bad going on at the VA, because if we kill the VA, we can kill Obamacare, and if we kill Obamacare, we'll kill nationalized medicine.' "
The recording, first reported and posted online by The Nation magazine in 2014, does not include those phrases, though the speaker does say that exploiting the VA's failures had "created a new line of defense against the march toward socialized medicine, educating veterans and Americans in the process. Veterans have had government-run healthcare for decades. We've had the preview of Obamacare, and the scandal has exposed the inevitable result of central planning for all Americans: massive wait times, impenetrable bureaucracy, de facto rationing, wasted tax dollars. It goes on and on."
In a statement to Military.com, Concerned Veterans for America said McDonald "is making false and baseless attacks on CVA's reform proposals."
"Concerned Veterans for America has never advocated 'destroying' the VA," spokesman John Cooper said. "In our Fixing Veterans Health Care Task Force report, which lays out our comprehensive VA reform plan, we very clearly state that we want to preserve and reform the VA health care system as opposed to completely dismantling it, as some have proposed. In fact, the recent Independent Assessment of the Veterans Health Administration, mandated by Congress and funded by the VA, cited CVA's proposed reforms as a credible way forward in making the VA work for veterans."
Taking on Congress
McDonald also criticized the tone of debate with Congress, in particular the House Veterans Affairs Committee, over VA problems and operations.
Given how well he was received in 2014, he said, McDonald believed he would be allowed to do the job he was brought in for -- to improve delivery of health care to veterans.
But the continuing, oftentimes confrontational questioning of VA officials on the Hill did not start with his tenure. Shinseki and his senior leaders -- some of whom McDonald inherited -- were grilled, as well.
McDonald believes that even if a lawmaker is genuinely concerned for veterans, the tone on the Hill is so much political posturing.
He recalled taking part in a Disabled American Veterans event in Denver last summer with Rep. Jeff Miller, the Republican chairman of the House Veterans Affairs Committee. Miller has been dogged in digging into failings at the VA and demanding accountability for incompetence or corruption.
In numerous hearings, he has castigated the VA and senior leaders over scandals, demanded reports and threatened to issue subpoenas to get testimony.
But when the two appeared together in Colorado, McDonald said, it was a far different Miller, who said at one point that "knowing that Bob McDonald is the Secretary of Veterans Affairs, I could not have a better feeling for where the department is going in the future."
Says McDonald: "Juxtapose that [appearance] with some of the drivel that you [hear in Washington]. Two different people."
Miller, in a statement to Military.com, said that if not for his committee's work investigating and exposing VA problems, "McDonald would not have the job he holds today and thousands of veterans would still be stuck on secret waiting lists."
Miller said the committee will continue to put the spotlight on VA problems because it's the only way to get the department to address them effectively. That will be the case "regardless of who's serving as VA secretary," Miller said.