A Pandemic With No Presidential Transition (with David Shulkin)

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Andy talks about what should be happening with the presidential transition right now in terms of managing the pandemic. Former Trump VA Secretary David Shulkin provides expertise on how a typical transition goes — and the cost of President Trump’s refusal to concede. David was there for the Obama-Trump transition and details how he sees today’s norm-shattering process playing out. The saving grace, as Andy points out, is that President-Elect Biden knows his way around the White House blindfolded.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow David Shulkin on Twitter @DavidShulkin.

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Donald Trump, Andy Slavitt, George H.W. Bush Concession Speech, David Shulkin

Andy Slavitt  00:07

Welcome IN THE BUBBLE, this is Andy Slavitt. We are going to talk today about the transition that isn’t or untransition. And how would you do a transition when the GSA, which is responsible for doing something called ascertainment, which is what allows the Biden team and the Trump’s teams to talk refuses to do so. So here we are with a pandemic. We have tenth thousands more people dying every single day. And the transition is not moving forward. That’s not good. That’s not good. That’s irresponsible. That’s disappointing. That’s not surprising. So we’re going to talk about that today with my guest, David Shulkin. David Shulkin was the VA secretary in the Trump administration, before that he was an Undersecretary of the VA, and Obama administration. So he was the one person that stayed on and did both. And the reason that I thought David would be great to talk to you today is because he’s lived through a transition. We live through both sides of a transition. He’s a doctor, he has been very focused on COVID. And someone who really understands I think, the consequences. Like me, he also knows the Vice president or I should say the President-Elect. So he may have some things to offer there. So before we bring this up, I want to let you know that we’re going to actually be the first podcast to have the actual Biden transition team on coming up next week. So that’ll be great. But also to let you know that in our archives, if you want to go back and play it, we have episodes with Ron Klain, who’s the new Chief of Staff, we have Vivek Murthy, who runs the Pandemic Task Force, as well as a couple people on it. Mike Osterholm, Zeke Emanuel, you know, you’ll be able to if you wanted to get to know some of these folks, they’re in there, because they were in our bubble. Anyway, we’re gonna get down to the conversation with David Shulkin. About our untranstion.

David Shulkin 

Hi, I have dark gray now. So hold on.

Andy Slavitt  02:31

Very sexy.

David Shulkin

It’s dark here in Philadelphia.

Andy Slavitt 

Hey Lana. I’m talking to David Shulkin for the podcast. Say hi.

David Shulkin 

Wait, you’re not in the studio. You’re at home?

Andy Slavitt 

We’re having a pandemic now.

David Shulkin 

Okay, okay. 

Andy Slavitt 

Lana says hi. 

David Shulkin 

Hi, Lana. Okay, so, So this is not the practice. This is the real thing.

Andy Slavitt 

Yeah. Now we’re better up.

David Shulkin 

Okay. Do I do the Teladoc commercial? Or is that you? Who does that?

Andy Slavitt 

We could we could do it together. We’re like, you know, we’re like Walter Matthau. And George Burns. So how do you do an untranstion? I mean, what do you think like you have been through a transition firsthand. You were Deputy Secretary, Assistant Secretary for the Veterans Affairs in the Obama administration, then you became the secretary, the man in the Trump administration. So you kind of lived through a transition, we need to start with like writ large. What are all the things that need to happen during a transition? Well, first

David Shulkin 

Well, first of all, I went through a very strange transition because I was on the Obama team, I was the undersecretary, leading the VA Health Administration. And President Obama gave us instructions to take this transition very seriously that when he entered office, President Bush did a very good job of a handoff and the transition, he wanted to do an even better job. So we spent a lot of time preparing for the incoming Trump team. The Trump team didn’t show up soon after the election, at least at VA, they didn’t. And it wasn’t until probably early December, when they finally showed up. And after they showed up, they made it pretty clear that they weren’t that interested in what we had to say. A memo came out saying that they really had no need to meet with anybody who was an Obama political appointee. 


For me, that was a somewhat of a confusing message. Because I didn’t view myself as an Obama political appointee. I was there I left for public service to serve and to improve the lives of veterans. I didn’t look at myself as being on anybody’s political team. So I couldn’t understand why they wouldn’t want to hear from the person who had designed in architected the turnaround from the wait time crisis and why they didn’t want to hear from me, personally. And so the strange thing was, was that members of the transition team would contact me secretly and ask if they could have a coffee or lunch with me as long as I didn’t tell anybody I was meeting with them. So there clearly was a design not to have a clear transition or a smooth one on the way in, that this was really being viewed more politically than the substance of the work that needed to happen.

Andy Slavitt  

But now we’re in this situation, we’re in the middle of a pandemic. And maybe we should set the stage a little bit, where we’re experiencing the highest case count growth we’ve experienced in the country, we have the largest number of hospitalizations, there are states that are quite worried about running out of hospital room, staff, etc. And we’ll come back and talk about the details of that. But I guess what I want to ask you is, you know, that that’s a crisis that we’re handing from one administration, you know, we don’t want the peaceful transformation to power. 2008 we had a crisis that was handed over, it was a financial crisis. Now we’ve got a health crisis. And the Trump administration, as we know, is in denial over this. Can you just talk about what has to happen the role of GSA, and how this hampers us just gonna give people a broad sense, who’ve never been through a transition before. What this is supposed to feel like, and then maybe a little bit about what’s actually happening?

David Shulkin  06:14

Yeah, the time of transition was one of the biggest surprises for me as a private citizen coming in the government. I had no idea that the 4000 people, the political appointees, who had been running government, and knew their jobs and knew their agencies get up and actually leave at noon, on January 20. And there isn’t necessarily 4000 people who walk in to fill their seats. Not only does it take time to fill these jobs, but 1200 and 50 of those have to have Senate confirmation. So it literally takes months to get people back into those agencies. And even when they do come in there, often people who don’t know their agencies, they don’t know their job. And anybody who started in your job knows, it often takes months to really learn what the work that’s being done is about. So this is, to me, the scariest time in our democracy where you have a transition, and it needs to be done extremely well. And it needs to be done in a very thoughtful way, even under the best of circumstances. 

Now, the transition is actually legally required. Both candidates are required to start a transition period six months prior to the election, post-election. It’s also required that they begin to start exchanging information, whether it’s security clearance information, whether it’s getting access to the material, so that on January 20th, there is continuity of government and the new administration can govern appropriately, but that clearly isn’t happening. Because what needs to happen is first there has to be what’s called ascertainment. Ascertainment is done by the GSA, where it is determined that the election results are clear. The Government Services Administration, the Government Services Administration, think about it as the government’s landlord, they run almost all the buildings and services for these government agencies. 

Andy Slavitt  08:10

So they have the power to do this ascertainment?

David Shulkin 

They do right and so without the GSA is cooperation who is led by a political appointee, you cannot begin the process of beginning to get the buildings, the materials, the basic raw infrastructure ready for transition. After ascertainment is essentially obtained, which hasn’t happened yet, then these agency reviews happen. That’s where landing teams come in from the incoming administration, to begin to start receiving the information that the agencies have prepared, so the dialogues can begin so that a new team is ready on January 20th. And clearly, we’re going to see some delays in that because the current administration has not acknowledged their full support and alignment for that process. And that is scary, particularly during a time of pandemic.

Andy Slavitt 

And to took it one step further, your landing teams, which you can think of is, you know, six or eight people in, you know, in each agency, coming in and meeting with the outgoing team and with civil servants. There’s something called an MOU a Memorandum of Understanding that’s been signed between the Biden campaign and the Trump team. And it is actually not permitted for the Biden team to have any conversations with people in the government until that ascertainment exists. So not only is there a formal process that David’s pointing out, but there are zero conversations happening right now, between the Biden people who need to take over the work and the people in the Trump administration. Truly fascinating.

David Shulkin

Yeah, I also think what we’re seeing today is parallel processing. You’re seeing a Biden Task Force on Coronavirus, and you’re seeing the current administration having a Corona virus taskforce and they clearly have different strategies, they’re working off different sets of information, the American people, no doubt will be confused by getting directions from two different groups. And frankly, this transition process is meant to bring these groups together. And to come up with a consistent plan that consistent continuity of government. And we need that now more than ever, I think we’d all agree that the conflicting messaging, particularly around the COVID handling has not been helpful to getting a handle on this pandemic.

Andy Slavitt  10:36

Yeah, I’ve talked about task forces. I’ve talked to the Trump task force in the last couple days and the Biden because they both want to talk to one another. They both believe that they need to be working together in a very perilous time. Yet, the neither one is permitted, both by law by this ascertainment. And so as you say, they’re working in their own worlds. And the Trump administration actually has access to some important things like data around where the sicknesses are, and so forth, that it will be very valuable for the Biden team to have. So what is the Biden team do? If you’re in that situation? What’s the best thing to do while you wait?

David Shulkin 

Well, I think we’re really seeing leadership out of the president elect, we’re seeing a calm, confident voice that understands that the process that is going to happen, which is a new administration will come in on January 20th, is going to happen. And there is not a reason to create even more concern in this environment, yet clear direction, that they are not stopping, they are going ahead and naming their teams that are coming in. They’re moving ahead and publishing their plans. They’re getting more visible with their messaging. And I think that we’re seeing good steady leadership right now.

Andy Slavitt

In the process of coming in and doing a transition. You know, what did you find? I mean, you know, you were in a rare situation where you saw it from both sides. But what do you find is most valuable? And if you think about, because, as I said in the introduction to David’s also a clinician, that’s one of the reasons why he was there to reform, the veterans administration’s physical delivery, medical delivery, in some really transformational ways that he did over with some success over both administrations. But as you think about now, the pandemic, and thinking, you know, as both a clinician and someone who’s familiar with the reins of government, what worries you? What could slip in this in these next few months?

David Shulkin  12:37

Well, when you’re dealing with the pandemic, unfortunately, because as you know, very well, and the, we’re talking about more than 1000 deaths a day, many, many more hundreds of thousands being developing this virus every day, every day that we delay and getting an effective national plan in place means additional suffering. And so there really can’t be any delay. And ideally, what we’d like to see is, as you mentioned, these teams coming together with consistent messaging on what we know, works. And I think a transition time is not a time of, let’s just sort of tread water until the new administration comes in. during a time of crisis. We can’t afford to do that. And we’re watching a missed opportunity before us each day that these teams aren’t talking to each other.

Andy Slavitt 

Yeah, I mean, I don’t know if you saw it, I saw that. We watched the George H.W. Bush speech when he lost. Let’s play it right now for folks.

George H.W. Bush Concession Speech 

The way we see it, and the country should say it that the people have spoken. And we respect the majesty of the democratic system. I just called that Governor Clinton over in Little Rock and offered my congratulations. He did run a strong campaign. I wish him well in the White House. And I want the country to know that our entire administration will work closely with his team to ensure the smooth transition of power. There is important work to be done. And America must always come first. So we will get behind this new president wish him well.

Andy Slavitt  14:37

That’s how it used to be. Now this was a guy who served one term and lost. I mean, it’s painful to lose. It’s painful for your supporters and painful for you to pay for your campaign expenses with a lot of money. But to come out and do that and give that speech is what every president win or lose. Whenever candidate win or lose is done. Up until now that you know this man, Donald Trump, you were in his cabinet. What’s going on in his head right now? What is he doing?

David Shulkin 

Well, I think he is having a classic discussion in his own head between what he wants to happen and what the reality is. And he is an avid observer, and avid TV watcher. And he understands what the numbers show and he understands what the reality is. But he’s trying to come to grips with how does he put it in a way that doesn’t appear that he is truly lost. And that’s a that’s a very tough challenge. But clearly, I think what the historical perspective that the president needs to understand is, is that public service is about putting the country’s needs first. And that’s something that ultimately I believe that that’s going to be the decision that he’s going to have to reach. But I don’t think this is the easy decision for him, because he feels that he has publicly already committed to being the winner of this election, he needs to take that back. And he doesn’t do that very well.

Andy Slavitt  16:16

How do you see it playing out?

David Shulkin 

Well, I think that as time goes on, he is going to have less of a bully pulpit, he’s going to have less ability to influence the way that people think about this. And once you lose public support and support of other public officials, it is going to be hard not to come to that conclusion quicker. So I think that this is a period of time. I do think that this is a time limited problem, that ultimately, the President is going to find a way to describe this as this is the way that he can help get the country on the right track. But it’s going to have to be a way that allows him to save face.

Andy Slavitt 

And now for something we like to call advertising.

So let’s say these lawsuits play out these recounts play out, you know, every other thing he throws up plays out the electors that he tries to influence in the states to vote against the way the votes in the state told him to vote. Because it all plays out. Do you think the Republicans in the senate in the house and around the country continue to stick with him? Because that’s one of the things you said, I think I agree with you that if they turn around and put pressure on him, or stop supporting him, it becomes harder for him. So far, they haven’t done that. Do you think they’re just waiting for those others?

David Shulkin  18:02

I think unfortunately, knowing Washington, the way that I’ve come to know it, many politicians are going to be looking very carefully and listening to their own constituents back home. And once you begin to start seeing some of the support, and the public opinion changing, to putting the needs to make this transition happen on their elected officials back in Washington, that’s when that supports going to erode. I think that the election results are too raw right now to be seeing that happening. And that’s going to take a little bit of time. And frankly, while we’ve just said that every day counts, the fact that the Biden team is pressing ahead, probably gives us a little, a little bit of time to play with here, a little safety net during this transition, but not a lot. So we’re gonna have to watch this very carefully. And we’re gonna have to watch to see whether elected officials do begin to start speaking up. We’ve already had four senators on the Republican side, speak up and acknowledge that the President-Elect has won this election. But we’re gonna have to see many more take that stance before I think the President begins to rethink his strategy.

Andy Slavitt 

Yeah, I mean, my own sense. Tell me if you agree with this is that you think basically a populist, he takes his energy from his crowds. And he believes his crowds want him to fight. And he never likes to disappoint his crowds because that’s a source of strength and energy and definition. You can see the way he used to tweet and speak to crowds. It’s almost like he was messaged testing, right to see what kind of he got a lot of cheers. You know, he was on the right track. He got a lot of likes; he was on the right track. And, you know, it sort of is sort of a self-fulfilling circle, where there’s this adulation he gets, it sort of makes it difficult to see how he changes his tone. I think he thinks his people don’t want him to quit.

David Shulkin  20:00

I think that’s an important perception. And I hope other people, particularly on the Democratic side, understand that, that the President has connected with a large group of Americans that didn’t feel that felt that they were really being ignored. And that connection has created this relationship. That’s a dual loyalty. So the President feels that he doesn’t want to let his base down and the base feels they don’t want to let the President down. And they do share that. And if the Democrats gloat in their win, and don’t recognize that this is part of why we’ve seen such a divided, partisan environment, I think you could just make the same mistake. The reason why I really appreciate and respect the way that President Elect Biden has been reaching out is because he’s been trying to speak to the entire country. And I think that’s what we should expect in a president. And I think the President-Elect does recognize that that needs to happen.

Andy Slavitt 

So let’s talk a little bit about the character of Biden, you and I both served under he and President Obama. And maybe it’s worth you’ve made this point a couple of times, I think it’s really a pivotal point, is in some sense, I feel like he is sort of purpose built for a moment like this, doesn’t appear to be taking a lot of the bait that McConnell and Republicans and Trump are throwing out for him, appears to try to be talking directly to the public. And he’s still stranger to the crisis, right? He took over in 2008, during the financial crisis, he was there for the Ebola crisis. So it seems to have that the gravitas and the patience and the poise that are hard to have and that we don’t always see. It’s my perception. Or the other thing I can say is he knows his way around the White House blindfolded. So if he doesn’t get any transition, it’s not like people the (UNCLEAR) or Beto O’Rourke become president, both of whom I love both were on the show, but both of whom would have some acclimation period, right?

David Shulkin  22:06

Yeah. And the I think you’re absolutely right; I think what you’re seeing in the President-Elect is somebody who’s extremely confident of the environment that he’s going to walk into, let’s remember, the democrats have only been gone for less than four years. And so there’s no surprises awaiting the Vice President, and he understands whether he gets into office. He’s going to get into office at noon on January 20th, either way, but he doesn’t need a lot of time to learn that job to learn that environment. And so he doesn’t have some of the anxiety, because the expectations of a new President are certainly very high. You know, as you said, both of us know, the President-Elect when he was Vice-President, he is thoughtful, he listens to people. He actually likes people and likes to interact. One of the only problems that I can see that he has is he doesn’t stay on time very well, because he so much enjoys, you know, the conversations he’s having and getting to know people. And that makes him genuine. 

Andy Slavitt 

That is an understatement. 

David Shulkin 

Yes. You mean his time management is the understatement. And but look, he’s gonna have a much bigger staff to help him stay on time with issues when he’s President. But, you know, I think I think those are good qualities. And they’re good qualities for bringing people together when people are heard. And they’re understood. I think that they believe that they have somebody working on their behalf.

Andy Slavitt 

Yeah. I’m sure we both have some funny Biden stories. But he said he wanted to get the room to assemble that was working the Cancer Moonshot. And you know, you’d be it noon, and he’s supposed to be there from noon to one. And at 12:30, his staff would come in, and they’d say, Okay, he’s gonna come in a few minutes. He’s running very far behind. Do not ask him any questions, please, please, please, please just we beg you. Like, do not just like don’t even make eye contact, right? Because he’s gonna, so it he’ll come in, like at 12:50. And you’ll sit down with the chair and they’ll say, I can’t say very long I settled in. And then there’ll be a big press operator. So the press will come in and throw the microbes in the face. It’ll give like, you know, 10 minutes of introductory remarks, they’ll leave, they’ll say, Well, my staff tells me they have to go to stand up. And he’ll be walking out. And then just every single time he would get to the door and he would turn around and go, you know, it’s still reminds me of the story from my uncle Finnegan. And he’ll go he’ll walk back to the table. It’ll put his arms on the chair. And it’ll tell a story that’s like a half an hour long. And we’re all staring at his staff and none of us are trying to look at him.

David Shulkin  24:45

Yeah, I want to traveled with him to New York City. And we were going for a dinner that started at six o’clock. Well, we arrived at 10PM where there were 3000 people on The Intrepid in tuxedos waiting for him to start their dinner. And I said to the staff, I said, you know, don’t you think maybe you better do a little bit, you know, better job of sort of, you know, hurrying him up so that he doesn’t have people waiting for him. And they said, you know, we prepare a detailed schedule on an index card, a three by five card for him every day, and he puts it in a shirt pocket. And we’ve yet to ever see him take a look at that, you know, he knows what’s important to him, and he’s not going to cut short, if there’s something that he’s interacting with where he’s learning or, you know, getting a chance to comfort somebody,

Andy Slavitt 

Yeah, he’s got a heart. So let’s play that for now. Okay, let’s say we so we get through this transition, it’d be good to hear from you, because you’ve done a lot of writing a lot of thinking about maybe beginning with how you think we’re doing as a country as a society in managing the pandemic, we’re going to be entering a period, that’s very difficult in the winter, we’re going to see a lot more cases, but we’re also going to see, three or four vaccines start to come to market, give us a walkthrough, as you think about it from the reins of government. And if you look at our society. 

David Shulkin  26:15

You know, people tend to be black or wider issues, I tend to try to see this from both perspectives, and in most things with President Trump, I believe that he’s actually done some things well, and some things that clearly, were big mistakes. So when you look at this pandemic, I think you do have to give the President credit for what I would call Warp Speed. And that is allowing American and international industry to do what they do best, which is to innovate, put a new product out there. And fortunately, with our fingers crossed, we may have a vaccine and some important therapeutics by the end of the year. And I think that is an important success. But I think when you go back and you look at pandemic management, we’ve had failure after failure from a failure of bio surveillance in the beginning, with the dismantling of the pandemic team that had reported into the National Security Council, we’ve seen a complete misstep on diagnostic testing, which left us behind from the very beginning of this pandemic, really where we’re just catching up to now, we’ve seen an inconsistency in messaging, a lack of acknowledgement of the public health measures that could have prevented a lot of this from happening. And we’ve watched actually misinformation being used throughout this pandemic. So while I don’t think that anybody can be held responsible for stopping a virus that, frankly, is just as contagious as this. There are many, many lessons to learn from this, and many things that I hope we will never see repeated again in our government.

Andy Slavitt  28:05

Yeah. And how about us? How about society at large? When you look at the responses you’ve had, you’ve written some interesting things about, you’ve got a particular phrase. But you know, this sort of combination, we have a fatigue and denial that’s going through society, how do you how do you think about how do you measure that?

David Shulkin  

 VI think that we are in a very concerning place. In some ways, you have an environment that nobody would have anticipated, you have a health crisis on top of an economic crisis with huge job loss and economic insecurity. At a time when people are feeling disenfranchised, and the issues of social injustice in equities have never been clear. And in a very fragmented political environment. And all those are elements for essentially, social unrest, and, you know, adverse health consequences and bringing down a lot of the progress that we’ve made over the past couple decades. At the same time, you can’t be anything but hopeful that we may be on the verge of seeing new opportunities in a new horizon, with the therapeutics that we’ve talked about in the vaccines with a new administration coming in with, you know, new people willing to set aside what they’re doing in the private sector to come in to do public service people like you who have done that people like me who have done that in the past. I always am optimistic about what we can create, if we can begin to start unifying some of the division that we’ve seen in the past.

Andy Slavitt  

You talk about COVID denial syndrome. What is that? Well,

David Shulkin 

Well, I think that what COVID denial syndrome is essentially the failure to recognize the reality before us, and that is when you’re in COVID denial, you don’t believe that it is an infectious disease, you don’t believe that it has serious health consequences. And you don’t believe that the measures that scientists and public health officials say are effective in preventing it are important to follow. And so we’ve seen consistently, just a very different acknowledgement of the realities of this virus across the country that I believe has led to what we’re seeing today, which is a growing number of infections, unfortunately, our hospitals being filled up.

Andy Slavitt  30:44

So what causes denial? And we see it all around the world. Or is that uniquely American? Is it instigated by some of the politics we were just talking about? Or is it just that it’s so novel for us? It’s a first-time event. And that’s sort of a typical reaction.

David Shulkin 

Yeah, I don’t think that this is new that people follow specific beliefs and ideologies, they’re influenced by the people in their communities. And that’s why we see geographic differences between people’s belief systems and thoughts. And that’s the way the world has largely worked. And we’ve seen it work to the good of humanity, we’ve seen it work to the detriment of humanity. When you think back to the days in Germany of Nazi Germany, this is the way that it started with a certain way of thinking and a certain demonization of groups that spread.

Andy Slavitt 

That sounds bad.

David Shulkin 

Yeah, no, it can be very dangerous. And unfortunately, I do think our current situation with the pandemic is dangerous with 240,000 Americans no longer alive because of it.

Andy Slavitt 

Don’t go anywhere, we’ve got to go earn some money to donate to charity.


Let’s lighten up a little bit. Tell us the story of how you interviewed for the VA role. And how you find out you got it because you and I were in contact, then it is pretty amazing. Let’s lighten up the people up a little bit because there’s good times ahead.

David Shulkin 

Well, you know, I was an Obama political appointee. And I had put in my letter of resignation, and I was ready to go on January 20th at noon, my boxes were being packed in my office to leave and to go back home. And that was the first week in January, and I got a call that the President-Elect wanted to meet with me in his office at Trump Tower. And I thought, what a great opportunity really to have an exit interview, because as I mentioned before, the transition team that had come in, had no real interest in hearing from me and hearing what my plans were. And what I wanted to do was to leave office with the ability to tell my predecessor, what was working and what I thought they should continue. So I had the opportunity to meet with the President Elect in his office. That was a discussion that was unlike no other for me.

Andy Slavitt  33:24

Yeah, so tell us about it.

David Shulkin 

So first of all, I wasn’t alone, that President invited into the meeting, Steve Bannon, Kellyanne Conway, Jared Kushner, Michael Cohen, and Reince Priebus. So I felt more like I was on Saturday Night Live in the middle of a skit than I did, you know, talking to the President-Elect. But what I found was, was that the President-Elect had very good questions about the VA. But as I began to answer them, he would cut me off and he’d answer them. So he’d asked me, so how do we fix the VA? And I’d say, Well, you know, Mr. President-Elect, here are the things he says, Well, I’ll tell you how we fix the VA. So he had some very, very clear thoughts on this. And it was a very entertaining and easy conversation with lots of participation. And when I left..

Andy Slavitt  34:17

You feel like you’re interviewing? 

David Shulkin 

No, I felt that it was really much more the ability for us to have a discussion about what the real issue is were in VA.

Andy Slavitt 

He didn’t say why he invited you there. You thought he cares about the VA. He campaigned about the VA. He wants to talk to me about it, because he must think I know something about it.

David Shulkin

Yeah. He asked me a number of questions, who I thought should lead the VA. I told him I thought that the current Secretary Bob McDonald was doing a great job and should be given a chance to stay and he said no, that’s not possible. But you know, it certainly wasn’t a clear outcome. When I left my wife asked me how the meeting Wasn’t I said don’t you know, I really don’t know. But I’m glad I had the opportunity to meet him. I’m glad I had the opportunity to at least share some information. And then it was several days later where he announced me as secretary.

Andy Slavitt 

Where are you at the time? Were you in your office or your home?

David Shulkin 

This is sort of an interesting story that morning that he held this press conference where he announced me, I was actually at a symposium on Veteran Affairs at George Washington University, I was at the front of the stage on a panel talking about veterans issues. And the panelists next to me, hands me his phone showing me a betting app that was betting on who the next Secretary of the VA was going to be. And there were 19 people on the list. I wasn’t on the list. And there was lots of speculation about this being you know, a FOX NEWS anchor to one of the congressmen that had been an early supporter of President Trump. And I found that sort of humorous, and then a couple minutes later, he taps me on the shoulder and says take a look at the app again. And this time, I appear on the list, which I just thought was hysterical. And then I said to myself, you know what? This is crazy. But if I’m on the list, I actually want to go watch the press conference. So I left the meeting early, I actually left walked off stage, and went and found the TV.

Andy Slavitt  36:27

So you’re by yourself, you’re watching this, and individually, as he pulls his card, he’s talking about like his finances or something. And then he pulls his card out of his pocket.

Donald Trump 

And by the way, speaking of veterans, I appointed today, the head secretary of the Veterans Administration, David Shulkin. And we’ll do a news release in a little while tell you about David. He’s fantastic. He will do a truly great job.

David Shulkin 

It was like the Oscars I thought I remember it almost like an envelope, you know. And now the new selection of the VA is and he mentioned my name, and as you said, I was by myself, I said, did he just say that?

Andy Slavitt 

I think you and I talked about you were like what just happened?

Donald Trump 

You’ll get the information on David. And I think you’ll be very impressed with the job he does. We looked long and hard, we interviewed at least 100 people, some good, some not so good. But we had a lot of talent. And we think this selection will be something that will, with time, with time, straighten it out and straightened out for good.

David Shulkin 

He would say to me, on many occasions, he’d say, I named all these great people, the head of Exxon into my cabinet, and you know, all these well-known people. But people keep on saying that you’re my best pick, it says I just don’t get it. And of course, you know, I was the only one in this cabinet that got 100 to zero confirmation by the US Senate because I wasn’t part of his campaign. I wasn’t there for political reasons I was there, really to try to help make sure that our veterans were getting the types of services and care that they needed.

Andy Slavitt  38:22

Well, the veterans and the veterans administration’s just adored you, because you got a lot done, you made changes. But you also I think realized that veterans did not want to be a system thrown out, which is kind of what some of the hardliners in the Trump side wanted. And, you know, they wanted choice, they wanted to get access to care. And even if you can explain this, obviously better and better than others, but for the nation’s veterans, you know, I remember talking to you and he said, Yeah, I’m gonna, I’m gonna stick around. And either you said it or the implication was, you know, the people that they could have put in that job. And indeed, some of the people they put around you were people that thought that the VA should be torn down, much like he did with EPA, much like he did with, in some respects Health and Human Services and other departments where it was really kind of a political charge to just against the very mission of the agency.

David Shulkin 

Well, I think that’s a lot of what I experienced and the number of people around me, that were very clear that we were going to dismantle the VA and privatized It was very clear. And I think when they learned that I was there, and I was not going to let that happen. They were not very happy with that. And so right from the beginning, I had a series of people around me who would come off the campaign, whose full-time job was to figure out a way to get me out of there so they could put somebody in place. I think the irony is, is that ultimately, the President came to believe that veterans were a political ally, and ultimately knew as he got to learn the job, that the veterans actually wanted a strong VA and wanted the VA to be successful. And so he found himself in the position where he simply wasn’t able to do what I think had been promised early on, which was to privatized the VA.

Andy Slavitt  40:15

Let’s talk about your book.

David Shulkin 

Yeah. So my book is called, “It Shouldn’t Be This Hard to Serve Your Country” which really has two meanings. It’s really written for veterans, because they come back from conflict, often with pretty serious problems, some of them physical, some of them emotional. And they find that they face a system full of bureaucracy and red tape. And frankly, that just shouldn’t happen. And they shouldn’t have to face wait times and face a system that’s not prepared to take care of it with veteran suicide being as extreme as it is with more than 20 veterans taking their life every day, we have some real serious problems to face and the veterans need our help. So I wrote this book, because I feel like I’d found a formula that was beginning to fix the VA. And one of the things I believe is, it’s a leaders responsibility to pass that information on. And there is no way in government when you leave office to assure that you can adequately pass the baton, particularly when a transition process isn’t working the way it should. 

So this book was really written to put that formula down, and to create a path so future leaders could follow what I think is a very successful formula for modernizing and sustaining the VA. But the second meaning of “It Shouldn’t Be This Hard to Serve Your Country” was really the story of my personal story coming as a private citizen, leaving a job as a CEO of a health system, to serve your government, and what I experienced and what my family experienced. And while my time in the Obama administration was relatively normal, it was what I expected to do in public service. When I entered the Trump administration, I entered a really very fierce and antagonistic political environment where I had people on my own team targeting me, as we talked about, because I wasn’t necessarily their choice to lead this agency. 

And the types of tactics that they used. And the type of disinformation that they used, and put us through was one that took a great personal toll on myself and my family. Now, I’m not complaining, because every time that I think about what I went through, I think about the people I was there to serve our veterans, many who didn’t get to return home to their families at all, many who are still suffering far greater than I ever would to this day. But public service, which is so important to our country, shouldn’t be this way. It should be not easy. We know these jobs aren’t easy. But there shouldn’t be the type of personal toll that I experienced. I wanted to share that story. Because I want our environment in Washington, I want our environment in Washington, and the government to be one where people can succeed in their public service jobs.

Andy Slavitt  

You got some great people to endorse that didn’t you?

David Shulkin 

Yeah, I think I know one of them. And now I appreciate I appreciate you doing that. You know, Andy, I think you were really a very important part of my story. Because while in the Obama administration, you know, I appreciated everything that you were bringing, when I joined the Trump administration, you reached out to me on multiple occasions to, frankly, try to find a bipartisan way to make this healthcare system work better. And you weren’t doing it in a way that would elevate your position. But you helped me actually approached the President on several occasions saying there was a way to work with the democrats to get a health care bill that would work. And unfortunately, he didn’t share that vision. He thought he could do it alone with just Republican support. And I think that was a huge missed opportunity. Because while I was not part of the Trump campaign, and I was surprised by the election results in 2016, I actually was hopeful that this would be a president that while he was going to be unorthodox, that could bring the country together in a way that a non politician possibly could have. So I think that there was a big missed opportunity that you saw and that I saw, and both of us tried to help that get done. Unfortunately, we weren’t successful in that.

Andy Slavitt  44:48

People would ask me, you know, name something that Trump has done well, because, you know, they knew that I was critique, a lot of things. And I think you need to two things. Scott Gottlieb and David Shulkin. You know, I really think, you know, in some respects, policy becomes personnel. People have heard that expression before. And, you know, the decision that you had to make I’m sure was a very difficult decision to continue to serve. you know, I couldn’t have done it, but I was rooting you on. And was grateful to have people like you, and like Scott, inside in administration, that many times just didn’t seem to care about what I believe to be the right things and glad you guys did. Unfortunately, it was increasingly difficult for people like you and Scott, to be outnumbered by people who were at different sets of values, I think,

David Shulkin 

Well, I think I think it’s actually important, particularly this time of transition, just to highlight that point. I’m often asked, when people were thinking about public service, whether they should do it, seeing what happened to me. And I say, I absolutely encourage you to do it. But you have to go in with a belief about why you’re doing it, you have to have principles. And if you ever get to the point where you’re being asked to violate your principles, that is the time to leave. And it’s a hard decision to leave. Because if you do you know that the person is replacing you may not end up doing as good a job or may not share those principles. But you can’t in Washington have moving principles. I’m convinced that that is not what helps you fulfill your responsibilities. So I think that both Scott and I spoke up for what we believe sometimes that didn’t make us very popular. But we felt that that was the right way to do this for the citizens of the country.

Andy Slavitt  46:36

Well, David, thanks for being in my bubble today. And for sharing what an untransition looks like with everybody and your own story.

David Shulkin 

Thanks so much, Andy, really appreciate it.

Andy Slavitt 

All right. So that’s everything we know. We will keep you posted. I will keep people posted on the Twitter machine. Let me tell you about our next several episodes, because I think you’re not gonna want to miss them. We’ve had some great recent episodes on the TOOLKIT FOR WINTER, which you haven’t heard you should, you should listen to fascinating on the vaccines. And then let me tell you what we have on Wednesday, Tom Inglesby from Johns Hopkins will be on and that is a real treat, because Tom is one of the country’s leading epidemiologists and one of the smartest people about this pandemic out there. following Monday, we will hear from the Biden Task Force transition team about their priorities and goals for managing the pandemic. That will be next Monday and then next Wednesday, it’s right before Thanksgiving. So we’re going to bring your show that’s going to launch into the Thanksgiving holiday. And then most importantly, though, right after that, after Thanksgiving holiday the following week, we will have an episode on vaccine distribution, including one of the major vaccine distributors CVS including one of the people who has been on the show before, David Agus who has great perspective on and a knowledge of when the vaccines are coming in how they’ll be rolled out. And between the two of them. We’re going to answer all your questions about vaccine distribution. Thank you so much. And we’ll talk to you Wednesday. 


Thanks for listening IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt, my wife. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill and additional music by Ivan Kuraev. You can find out more about our show on social media at @lemonadamedia. And you can find me at @aslavitt on Twitter or at @andyslavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen, but still tell him at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

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