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Publisher's Summary

The former VA secretary describes his fight to save health care from politics and money - and how it was ultimately derailed by a small group of unelected officials with influence in the Trump White House.

Known in health care circles for his ability to fix ailing hospitals, Dr. David Shulkin was originally brought into government by President Obama, in an attempt to save the broken Department of Veterans Affairs. When President Trump made him VA secretary, Dr. Shulkin was as shocked as anyone.

Yet this surprise was trivial compared to what Shulkin encountered as the VA secretary: a team of political appointees devoted to stopping anyone - including the secretary himself - who stood in the way of privatizing the organization and implementing their agenda. In this uninhibited memoir, Shulkin opens up about why the government has long struggled to get good medical care to military veterans and the plan he had for how to address these problems. This is a book about the commitment we make to the people who risk their lives for our country, how and why we've failed to honor it, and why the new administration may be taking us in the wrong direction.

©2019 David Shulkin (P)2019 PublicAffairs

Critic Reviews

"From the moment David Shulkin was appointed secretary of the VA, Trump's corporate henchmen put a target on his back to achieve their aim of shutting down the VA hospital system. Shulkin, the highest-ranking person to serve in both the Obama and Trump administrations, provides play-by-play detail of his tumultuous tenure and spells out the ongoing threats to the VA. A harrowing and important story." (Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services)

"A painful-to-swallow story of a political environment gone toxic. And as Dr. Shulkin points out, the casualty isn't the loss of another government servant-it's our veterans." (General (ret.) Stanley McChrystal)

"This is a very important book. I hope Americans who care about our veterans will take the time to read it. The title of the book says it all, but what's inside is a compelling story - a cautionary tale for all citizens who care about recruiting talented people to serve our government." (Bob Kerrey, former senator, former governor of Nebraska, and recipient of the Medal of Honor)

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  • Tom
  • 10-12-2019

A Powerful Account by an Impressive Public Servant

I chose this book because of my interest in the troubled history of the VA’s Information Systems and its attempts to modernize them under Trump and his predecessors over the last thirty plus years.

While the multi-billion dollar contract signed this year is not gone into in great depth, Shulkin paints an intriguing, often horrifying, picture of his attempts to meet the challenges of running the VA and make what he sees as necessary improvements to the care it delivers to Veterans.

I found the experience of reading this book in turns educational, horrifying and heartbreaking. Unlike all the other Trump Horror Stories on the market currently, many of which I have read, this one focuses on the experience of a man trying to do a job he cares about in an environment making it very difficult. It actually portrays Trump as an often well-meaning but feckless player in a world he doesn’t understand completely, surrounded by actors who know the game far better than he.

I’m not willing to cut Trump as much slack as Shulkin but I grant him his opinion however naive. It’s an interesting tale well and believably executed.

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  • Wayne Thompson
  • 05-11-2019

Chilling account of the mechanics involved in the attempts to privatize the VA

This book was and enlightening window into the positioning and tactics of the Washington elite in their attempts to move the veterans administration towards private medical care institutions and destabilizing this all too important branch of government. I was attracted to this account because it was written by a scientist a person who is well skilled in the arts of critical thinking and as such I knew I could get an unbiased account the incidents.

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  • Eamonn P. Hobbs
  • 20-02-2020

Excellent and a must read!

Dr. Shulkin provides us with a fascinating look into the inner workings of public service at the highest levels under the last two administrations. The many challenges he faced in his passionate pursuit of helping veterans provide food for thought for us all. Thank you Dr. Shulkin for your service!

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  • A
  • 26-01-2020

An accurate depiction and a horrific tale

As a VA employee, I write this as my own personal opinion. However, as a VA physician and employee, I can also say that what Dr. Shulkin relates in this book is all too true.
Policies that should be for the benefit of the Veterans are changed on a whim depending on the political climate. People are hired and fired for incomprehensible reasons, and hiring of talented employees is blocked by the bizarre VA hiring regulations. Privatization of the VA has been set in motion, which will dismantle a good system that is designed for the specific problems of Veterans and throw them to the mercy of the private sector which is vastly unprepared to care for them. Dr. Shulkin describes all of this and more, as well as his efforts to do the right thing. Of course, no good deed goes unpunished. It is sad to see how the VA and it's Veterans are treated as pawns in a bureaucratic struggle.
Dr. Shulkin writes about his experience in a very factual manner, without demonizing the people who tried in a very public fashion to make him look unethical. He is to be commended for his honesty and for bringing these issues to light.

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  • dmckain
  • 22-01-2021

Great look into the broken VHA System

This gives a great insight in the concerns of why the VHA is such a broken system. It will get you to realize it starts at the top and works its way down. Why is it so hard to serve our veterans. This is a good example of why we should not favor government run health care because this is a good example of why.

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  • Ajm121
  • 23-11-2020

If you are a veteran trying to navigate the VA, this should be required reading.

I, like I suppose many of you out there, am a United States veteran that had zero clue of the inner workings of the department of Veterans Affairs, nor the benefits that are offered to us once we transition back into civilian life. I stumbled across this book while doing research on veteran nonprofit groups that were mismanaging donor funds. The struggles that David presents have allowed me to make sense out of all of the information that I’ve come to find while conducting my research. It must have taken tremendous courage to release this book 👍🏻

Don’t give up halfway through- really listen all the way through until the end. If you read these reviews David, understand there’s a lot of us out here that saw this coming from a different side and know you did your best! Also, thanks for pointing out the legislation and policies that never took flight- We are picking up what you are laying down...

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  • Anonymous User
  • 23-05-2020

Toxic Environment in VA facilities

Finger-pointing and reporting other workers for things that have nothing to do with competence at work is an unfortunate reality. Agree with the secretary that far too many people walking around monitoring The few that actually do the work serving veterans. This is poor stewardship of our taxpayer dollars.

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  • Mindphreak
  • 05-01-2020

Great insights into the VA and Trump administration

This book is for anyone interested in current politics and the chaos of running US government during the Trump administration.

If you are a current or past VA employee, veteran, of anyone affiliated with VA or federal government service, you will appreciate this book. Dr. Shulkin does a great job of describing the challenges of this enormous bureaucracy. He also gives you a taste of how easy it is to build controversy against someone and become black balled in Washington.

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  • JLV
  • 31-12-2019

Good read...

...and very interesting, especially for VA or other government employees. Found myself fact checking some of the story.

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  • JudgeJoe
  • 15-12-2019

Great book and a very important topic!

Captivating, intriguing, insightful, and wonderfully narrated. This book highlights the political nuances of serving in one of our nation's highest cabinet level agency positions.

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