The learning curve McDonald must tackle as he shifts to public-sector life reminded Gail Wilensky—administrator of the predecessor agency to the CMS under President George H.W. Bush—of one congressmen who incredulously asked her during a hearing how complicated it could be to run a federal agency. The lawmaker had previously run a major business enterprise.
“In the private sector, you don't have employees that are subject to civil service protections and a board of directors made up of 435 members of Congress that have oversight over your actions,” Wilensky said.
However, even though McDonald may not be able to deal as swiftly with underperforming employees as he might have in the private sector, that shouldn't stop him from going in on Day One and taking charge, other observers say.
“He needs to assemble all of the top-level managers and say 'This is the new boss in town and the usual is over,'” said Douglas Smith, a former assistant secretary for the private sector at the Department of Homeland Security during the Obama administration. “'You can either be with me or against me, and if it's the latter, feel free to sit in your office and we will work around you.'”
The Obama administration is lobbying hard for a quick confirmation. The next Senate session is scheduled from July 7 to Aug. 1, so hearings on his confirmation will likely begin shortly.
McDonald's limited military experience, especially compared to his predecessor Eric Shinseki, a retired general with nearly 40 years of active service, is not viewed by many as detrimental in determining if he is a good choice for the post. McDonald is a West Point graduate and served in the 82nd Airborne Division. His father served in the Army Air Corps after World War II, and his uncle-in-law was exposed to Agent Orange in Vietnam and still receives treatment from the VA.
Nevertheless, veterans' groups have had mixed reactions to some of McDonald's more arm's-length ties to the service community.
“He's been away from the military for quite a while, and will have to move quickly to show he is committed to and understands the post-9/11 generation of veterans,” Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America, said in a statement.
Others had a more positive outlook.
“Some of the strongest advocates for veterans in Congress are not vets,” said Joe Davis, public affairs director for Veterans of Foreign Wars. “What's more important is that he cares about veterans.”
Political pundits agreed. “I do not think the limited military experience is a bad thing,” said Mike DuHaime, a Republican strategist who previously oversaw campaigns for New Jersey Governor Chris Christie and former New York City Mayor Rudy Giuliani. “On the contrary, perhaps it is a good thing to have a fresh perspective. His business experience will be very valuable and is akin to running a large agency.”
“I think the issues facing the VA right now are more challenges of management and effective execution,” said Dr. Scott Gottlieb, a former deputy commissioner of the Food and Drug Administration, and a resident fellow at the American Enterprise Institute. “Bringing in someone who has strong management chops seems to be very good judgment.”
Some key lawmakers have kept their cards close to the vest regarding how they feel about the nomination. Sens. Bernie Sanders (I-Vt.) and Richard Burr (R-N.C.), chair and ranking member of the Senate Veterans' Affairs Committee, said they would first need to meet with him to hear his thoughts on the importance of transparency, accountability and hiring more medical providers, before they made up their minds.
Others, including Senate Majority Leader Harry Reid (D-Nev.) said they are hopeful for a quick confirmation so that the issues plaguing the agency can be rapidly addressed.
Assuming he does make it through the process, McDonald's first priority should be to clearly outline a comprehensive list of problems that are being addressed, as well as progress being made to remedy them, according to Joe Violante, national legislative director for the group Disabled American Veterans. He also needs to be willing to lobby Congress if additional resources are needed, Violante said.
McDonald should push for an environment in which VA employees feel they are being heard and can bring up problems without fear of retaliation, said Dr. Elspeth Cameron Ritchie, a retired Army colonel and chief medical officer in the District of Columbia's Department of Behavioral Health.
One of the most troubling aspects of the recent VA crisis has been the extreme pressure staff members felt to meet access deadlines for veterans, causing them to falsify records, instead of pushing for more reasonable timeframes to get former servicemen in front of a doctor.
“When people speak out about problems, they tend to get in trouble,” Ritchie said. “A cultural change has to happen.”
Follow Virgil Dickson on Twitter: @MHvdickson