David Shulkin on Wednesday pledged to implement "major reform" at the Department of Veterans Affairs if he is confirmed to lead the troubled agency.
Shulkin, who President Donald Trump unveiled as his choice to lead the VA in mid-January, said before a Senate panel that he does not favor "privatization" of the VA but would work to establish an integrated and modern system for veterans health care, with better partnerships between public and private facilities.
"I will seek major reform and a transformation of VA," Shulkin told the Senate Committee on Veterans Affairs during his confirmation hearing, stressing that the agency "will not be privatized under my watch."
Shulkin is a physician who served as VA undersecretary for health during the Obama administration. If confirmed, he would be the first non-veteran VA secretary.
Shulkin faced tough questions on his plans to reform the agency, which has been under constant scrutiny since the wait list scandal nearly three years ago.
"I think that trust was eroded particularly with the wait time crisis in April 2014, and people lost trust," said Shulkin, who was appointed to the undersecretary post by President Obama in 2015. "I think that we are slowly regaining that [trust] but we have a long way to go."
When asked by Sen. Dan Sullivan (R., Alaska) about concerns that his appointment was "more of the same" given his work in the previous administration, Shulkin said he should be replaced if he does not succeed in making changes at the VA.
"I don't have a lot of patience and I am going to be serious about making those changes and rebuilding that trust," Shulkin said. "If I don't do that, I should be held accountable and you should replace me."
"I think if we continue the status quo, that's not going to get us where we need to go," Shulkin said later.
Trump has promised broad transformation at the VA, unveiling a 10-point plan that draws on a number of Republican proposals to allow the VA secretary to more easily fire employees for misconduct and give all veterans access to care outside the VA if they want it.
In response to questioning from Sen. Jon Tester (D., Mont.), the committee's ranking member, Shulkin said that Trump attached no conditions to his appointment. He said that he and Trump shared a "common vision that we have to do a lot better for our veterans."
Shulkin highlighted his experience addressing issues at the VA and consulting with veterans, service organizations, and other stakeholders since his appointment. While he acknowledged the need for further reform, Shulkin cheered the agency's progress on suicide prevention and reducing the number of patients awaiting urgent care.
Shulkin underscored the need to address infrastructure issues, reduce the disability claims backlog, explore more private-public partnerships, improve information technology systems, implement a new scheduling system, and extend and reform the Choice Program put in place in 2014. He also said the agency will need "new tools" to hold employees accountable for misconduct and recruit and retain high-performing employees.
The VA has been scrutinized for patient wait times and management issues since veterans were found to have died waiting for care at the Phoenix VA in 2014. The controversy led to extensive reform legislation, though the agency continues to face systemic problems with care delivery and management.
The Commission on Care, an independent panel of experts authorized by Congress in 2014, unveiled a series of recommendations to implement "far-reaching" transformation at the VA's network of hospitals last July.
Trump met with several candidates for the position over several weeks. He announced Shulkin as his choice last month after two rumored contenders withdrew their names from the running. The senate committee is expected to vote on Shulkin's nomination next week, paving the way for his confirmation.