The Shadow Rulers of the VA

How Marvel Entertainment chairman Ike Perlmutter and two other Mar-a-Lago cronies are secretly shaping the Trump administration’s veterans policies.

.. shortly after Peter O’Rourke became chief of staff for the Department of Veterans Affairs, he received an email from Bruce Moskowitz with his input on a new mental health initiative for the VA.

.. an informal council that is exerting sweeping influence on the VA from Mar-a-Lago

.. The troika is led by Ike Perlmutter, the reclusive chairman of Marvel Entertainment, who is a longtime acquaintance of President Trump’s. The third member is a lawyer named Marc Sherman. None of them has ever served in the U.S. military or government.

.. They have remained hidden except to a few VA insiders, who have come to call them “the Mar-a-Lago Crowd.”

.. they downplayed their influence, insisting that nobody is obligated to act on their counsel.

.. The Mar-a-Lago Crowd spoke with VA officials daily, the documents show, reviewing all manner of policy and personnel decisions. They prodded the VA to start new programs, and officials travelled to Mar-a-Lago at taxpayer expense to hear their views. “Everyone has to go down and kiss the ring,” a former administration official said.

.. If the bureaucracy resists the trio’s wishes, Perlmutter has a powerful ally: The President of the United States. Trump and Perlmutter regularly talk on the phone and dine together when the president visits Mar-a-Lago. “On any veterans issue, the first person the president calls is Ike,”

.. VA leaders who were at odds with the Mar-A-Lago Crowd were pushed out or passed over.

..  Offering more private healthcare to vets was a signature promise of Trump’s campaign, but at that point he hadn’t decided who should lead an effort that would reverse the VA’s longstanding practices.

.. Perlmutter then recommended Shulkin to Trump

.. Once nominated, Shulkin flew to Mar-a-Lago in early February 2017 to meet with Perlmutter, Sherman and Moskowitz.

.. Moskowitz elaborated on the terms of their relationship. “We do not need to meet in person monthly, but meet face to face only when necessary,” he wrote. “We will set up phone conference calls at a convenient time.”

.. Perlmutter, Moskowitz and Sherman acted like board members pounding a CEO to turn around a struggling company

.. “Everything needs to be run by them,” the first former official said, recalling the process. “They view themselves as making the decisions.”

..  They planned to promote the campaign by ringing the closing bell at the New York Stock Exchange around the time of Veterans Day.

The event also turned into a promotional opportunity for Perlmutter’s company. Executives from Marvel and its parent company, Disney, joined Johnson & Johnson as sponsors of the Veterans Day event at the stock exchange.

.. The Mar-a-Lago Crowd grew frustrated with Shulkin, feeling like he wasn’t listening to them, and Perlmutter came to regret recommending Shulkin to Trump in the first place

.. Trump initially nominated White House doctor Ronny Jackson to replace Shulkin, with Pentagon official Robert Wilkie filling in on a temporary basis. On Wilkie’s first day at the VA, Sherman was waiting for him in his office, according to a calendar record.

Within a few weeks, Wilkie made a pilgrimage to Mar-a-Lago.

Trump’s pick to head veterans department faces skepticism over his experience

Jackson is a career naval officer who was an emergency trauma doctor in Iraq before spending the past 12 years as a White House physician. But his résumé lacks the type of management experience usually expected from the leader of an agency that employs 360,000 people, has a $186 billion annual budget and is dedicated to serving the complex needs of the country’s veterans.

.. “It’s great that he served in Iraq and he’s our generation. But it doesn’t appear that he’s had assignments that suggest he could take on the magnitude of this job, and this makes Jackson a ­surprising pick,” said Paul Rieckhoff, chief executive of Iraq and Afghanistan Veterans of America.

 .. The active-duty rear admiral had been a behind-the-scenes figure while serving the past three administrations as a White House physician, but he moved into the spotlight in January when he delivered a glowing assessment of Trump’s physical and mental health to reporters, which aides said endeared him to the president.
.. Democratic senators said privately when Pompeo was tapped to replace Tillerson that they expect far fewer Democrats to back him than the 14 who voted for him to lead the CIA.
.. Jackson’s policy views are unknown, particularly on the most pressing issue facing VA: how much access veterans should have to private doctors outside the system at government expense. Shulkin’s moderate views on the subject, which were at odds with many administration officials, helped end his tenure.
.. VA secretary is one of Washington’s most unforgiving jobs even for someone with extensive management experience. Shulkin, also a physician, had run large hospital systems — including VA’s — before taking the job. His predecessor, Robert McDonald, was a chief executive of Procter & Gamble. The secretary before him was a decorated retired Army general, Eric K. Shinseki, who was forced out after managers in the far-flung health system were found to have fudged waitlists for veterans’ medical appointments.
.. “I’ve seen him managing a staff of a couple dozen, which he did to perfection,” said Ned Price, a National Security Council spokesman under Obama who recalled that he was treated by Jackson for a toe injury in the Philippines.“But how that would translate to managing the second-largest department in federal government I have no idea,” Price said. “He has competence and integrity. I don’t think he’s going to fly around the world first-class or be buying thousands of dollars in furniture. But can he run VA? Anyone’s guess is as good as mine.”

 

Is It Policy, or Just Reality TV?

It also announced that President Trump was nominating the White House physician to head the Department of Veterans Affairs. What do these announcements have in common?

The answer is that both are indicators of how Trump views his job. He doesn’t seem to see actual policymaking as important; instead, he treats it all as an exercise in reality TV.

.. The point, instead, is that running veterans’ health is a management, not medical, job — and Jackson has no managerial experience.

.. Once you start looking at the Trump administration as an exercise in publicity, not policy, you see signs of it everywhere.

.. Larry Kudlow to replace Gary Cohn in that role, Kudlow’s remarkable track record on the economy — he’s been wrong about everything

.. nothing in Kudlow’s role as a shouting head on cable TV has prepared him for the job he’s supposed to do.

.. So Trump is acting as if his job were to run up ratings for his TV show, not to make actual policies.

.. Wall Street had a big relief rally when investors tentatively concluded that Trump wants to only play at trade war, and can be bought off with symbolic wins that change nothing real.

.. Trump hasn’t managed to repeal Obamacare, but his officials have undermined the program’s efficiency, driving up premiums and reducing coverage.

..  if and when America needs real leadership, there will be nobody home.

.. So far, the Trump era has been almost free from crises Trump didn’t generate himself. One of the few such events demanding an effective response was Hurricane Maria — and the response was disastrously inadequate.

.. So what happens if there’s a foreign policy crisis, a financial crisis, a health crisis

.. we’ll need actual policies. And who’s going to devise those policies? Lincoln had a team of rivals; Trump has assembled a team of poseurs.

.. And even if Trump should come to realize he needs better people, he probably couldn’t get them.

.. Trump can’t even hire good lawyers!

.. one of these days, the reality TV administration is going to bump up against actual reality. And it’s not going to end well.

Trump’s Physical Revealed Serious Heart Concerns, Outside Experts Say

Cardiologists not associated with the White House said Wednesday that President Trump’s physical exam revealed serious heart concerns, including very high levels of so-called bad cholesterol, which raises the risk that Mr. Trump could have a heart attack while in office.

.. Dr. Ronny L. Jackson, a rear admiral and the White House physician, said Tuesday in his report on the president’s medical condition that Mr. Trump was in “excellent” cardiac health despite having an LDL cholesterol level of 143, well above the desired level of 100 or less.

Dr. David Maron, the director of preventive cardiology at Stanford University’s medical school, said Wednesday that it was alarming that the president’s LDL levels remain above 140 even though he is taking 10 milligrams of Crestor, a powerful drug that is used to lower cholesterol levels to well below 100.

Dr. Maron said he would “definitely” be worried about Mr. Trump’s risk for having a heart attack if the president were one of his patients. Asked if Mr. Trump is in perfect health, Dr. Maron offered a blunt reply: “God, no.”

.. Several said Mr. Trump’s goal should be to get his LDL below 100, or even under 70. He has a real risk of having a heart attack or stroke, especially considering his weight and lack of exercise, they said.

.. “That’s a really high LDL,” Dr. Topol said. “We’re talking about a 70-plus-year-old man who is obese and doesn’t exercise. Just looking at the lab value, you would raise a big red flag.”

.. several said they wondered whether Mr. Trump was regularly taking his medicine as prescribed.

.. Dr. Daniel Rader, the director of the lipid clinic at the University of Pennsylvania’s medical school, said that taking a daily dose of 10 milligrams of Crestor should reduce LDL levels by at least 30 percent, which means that Trump’s LDL started out over 200, a dangerous level.

.. “One obvious question is, how long has he been on a statin?” Dr. Rader said. “What was his LDL before he started taking it?”

.. Asked whether Mr. Trump has heart disease, Dr. Jackson said he did not. “Technically, he has nonclinical coronary atherosclerosis,” Dr. Jackson told reporters.

.. Dr. Sanjay Gupta, the chief medical correspondent for CNN, repeatedly expressed concern on Wednesday about test results that showed Mr. Trump’s coronary calcium score had increased to 133, from 34 in 2009. On CNN, Dr. Gupta repeatedly showed a chart suggesting that levels above 100 indicate someone with heart disease.

.. David Axelrod, who served as one of Mr. Obama’s top advisers in the White House, said Tuesday on Twitter: “I knew Dr. Ronny Jackson in the White House. In my experience, he was very good guy and straight shooter.”

.. Dr. Maron calculated the president’s risk of having a heart attack or stroke in the next 10 years, based on the high LDL levels and normal blood pressure. The result placed him in the top 25 percent of the population.

“I would call that high,” Dr. Maron said.