In the book, obtained by The Associated Press, David Shulkin describes a March 6, 2017, conversation in the Oval Office where Trump explored ways his administration could act quickly to shutter government-run VA medical centers that he viewed as poorly performing.
Trump was fresh off his 2016 campaign in which privatizing VA had become a political hot button after he pledged to steer more veterans to private-sector doctors outside the VA. He had said the VA was the "the most corrupt" and "probably the most incompetently run" Cabinet department. Democrats and major veterans' groups oppose "privatization" and say VA facilities are best-suited to treat battlefield injuries such as post-traumatic stress disorder.
At the meeting, Trump asked whether "we should begin to close the VAs," according to the book. Legislation prohibited that, so Shulkin responded that the VA was working with Congress to set up a system-wide review to address underperforming facilities, whether by fixing or closing.
"But this takes time," Shulkin said.
Trump exclaimed, "So let's just do an executive order!"
"This is a legislative issue," Shulkin said.
Trump then offered, "Can't we just declare a national emergency?"
At that point, according to the book, Trump's son-in-law and White House adviser, Jared Kushner, chimed in, "Yes. We're still in a war, so we could."
Shulkin told the AP that ultimately he dissuaded Trump from pursuing that route, persuading him to sign executive orders for changes with wider support, such as expanded telehealth options for veterans.
The 2017 Oval Office conversation is illustrative of Trump's early intentions toward the VA and remains significant as he pushes for reelection, citing in part his accomplishments in expanding Choice and boosting mental health care for veterans. Veterans as a group have largely backed Trump throughout his presidency, despite lingering questions about his intentions about preserving the VA.
In response to a request for comment, White House spokesman Judd Deere said in an email: "While the former VA secretary chooses to profit off his time in office and share outlandish claims about his private conversations with the President, President Trump remains focused on ensuring veterans receive the care they have earned through their incredible sacrifice for our Nation."
Shulkin, a former Obama administration official, was fired by Trump in March 2018 amid an ethics scandal over a trip to Europe that Shulkin took with his wife that mixed business and pleasure, as well as mounting rebellion by political appointees in his agency. His book, "It Shouldn't Be This Hard to Serve Your Country," will be released next Tuesday.
He said the expansion of the Veterans Choice program under his successor, VA Secretary Robert Wilkie , has put the agency at risk "as never before." Shulkin cited political forces inside and outside the administration that are more interested in putting "companies with profits" over the care of veterans, and suggested that only new leadership — at the department, probably at the White House, too — could save VA.
Yet, as VA secretary, Shulkin pushed a plan to give veterans wider access to doctors outside the VA medical system. Veterans should get "more choice in the say of their care," he told the House Veterans' Affairs Committee in October 2017. "Nobody should feel trapped in the VA system."
Shulkin says Trump's plans regarding "privatization" were still an open question when Shulkin was fired.
A few weeks before, Shulkin said he was explaining to Trump in an Oval Office meeting why an aggressive expansion of private care for veterans could be very costly for the government, at more than $50 billion. Trump decided to call Pete Hegseth, a Fox News commentator who was once considered for the VA secretary job , to ask his opinion. "We can find the money from within the VA," Hegseth told Trump, according to the book, suggesting significant cuts to VA care.
"Much of my narrative deals with the factions pushing me to simply close the VA or at least large parts of it that weren't working well," Shulkin wrote. "But I didn't see how shutting down a system specifically designed to care for veterans could be in the veterans' best interests."
The legislation that Trump ultimately signed last year gives veterans more freedom to see doctors outside the VA in an effort to cut wait times, paving the way for new rules that Shulkin says will "lead to the rapid dismantling of the current VA system." Recent studies have actually found that veterans got into a VA facility for an appointment faster on average and received better care than if they went to a private facility, raising questions about the value of steering veterans to the private sector if it results in inferior care.
The legislation expanding the Choice program includes a provision for a presidentially appointed commission to be set up in 2021, after voters elected the next president, to compile a list of VA facilities nationwide to be closed or reconfigured. If the president approves, closures would then begin unless Congress voted down the entire list, giving lawmakers no input on individual facilities to be added or removed. Wilkie in recent months has been urging Congress to pass legislation to allow the commission to start before the November 2020 election, citing market assessments the VA will have completed by then to judge which facilities to keep. Wilkie insists he's opposed to privatizing VA.
"I am convinced that the path now chosen, if allowed to continue, will leave veterans with fewer options, a severely weakened VA, and a private health care system not designed to meet the complex requirements of high-need veterans," Shulkin wrote.
Associated Press writer Darlene Superville contributed to this report.