DAVID GREENE, HOST:
The next personnel shake-up from President Trump may be another cabinet secretary. Veterans Affairs Secretary David Shulkin is thought to be on the way out, at least according to Trump's friend and confidant Christopher Ruddy as well as a report in The Associated Press. Now, Shulkin began his work at Veterans Affairs under President Obama. He's actually the only cabinet-level holdover from that administration. His tenure has been marked by some intense debates over the future of the VA. He's also faced questions about using government money to bring his wife on a trip to Europe. Let's talk about this with Phillip Carter. He is an Army veteran. He was an official in President Obama's Pentagon, and he now directs the Military, Veterans, and Society Program at the Center for a New American Security.
Good morning.
PHILLIP CARTER: Good morning.
GREENE: So should Secretary Shulkin keep his job?
CARTER: I think so. I think he's probably putting more points on the scoreboard for President Trump than taking away from them. But he is also creating quite a bit of drama for the White House at a time when they would rather not have that.
GREENE: You're talking about the drama - the questions over his wife's trip to Europe? Is that...
CARTER: That's part of it. He's really got three fights underway. There's this policy fight over the future of VA health care, which is itself wrapped up in the Affordable Care Act debate. There's a political fight with some of the president's allies in the VA and the White House. And then there's the personal fight and the personal drama surrounding Secretary Shulkin's ethics investigations.
GREENE: What's an important point that you think he's put on the board?
CARTER: He has advanced the VA reform agenda. That really started under President Obama, but it's essentially contracting out for more VA care in 2014. They were purchasing 10 percent of their appointments in the private sector. Now that figure is about 35 percent. So they're increasingly relying on the private sector. That's a key part of the president's agenda. He's also implemented a lot of the accountability reforms that President Trump wanted. Accountability is essentially allowing the government to more easily fire civil servants, and he's done that and pleased the president's base that way. And so, you know, in some ways, the only one who really suffers here if Shulkin goes is the president and his agenda. And it's hard to see how anyone other than a caretaker comes in in the next year.
GREENE: Can you help me understand this debate over shifting some care to private providers? You say that Shulkin has been doing that to an extent. There are some critics of the president who are suggesting that if he removes him, the person who comes in is likely going to be someone who is going to push much harder to move much more care to the private sector, and there are a lot of people who - you know, especially Democrats - who are deeply concerned about that.
CARTER: So the VA is this unusual animal. It, for one, is an agency that really hasn't outsourced a lot of its activity like other agencies have done. Second, it delivers this massive amount of health care. It's got 300,000 or so health care employees who care for roughly 9 million veterans. And as much as the Republican Party is pro-veteran, this amount of government involved in health care is anathema. And so the fight is over how much of that gets done by the government versus how much gets purchased by the private sector. And Shulkin has moved deliberately and slowly towards purchasing more. But the president's close allies would really like to contract out all of the VA, if not a substantial part of it.
GREENE: Phillip Carter is the director of the Military, Veterans, and Society Program at the Center for a New American Security. Thanks a lot.
CARTER: Thank you.
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