It was November 7, 2017, when this image was captured at the close of the NASDAQ bell. At the center of the photo is Dr. David Shulkin, then head of the Veterans Administration. At the far right is Captain America (part of the Marvel Entertainment character portfolio).

This is not the first time I’ve mashed up popular culture into a post on health care here on Health Populi. However, this one is different because instead of a constructive convergence between pop culture and health, among the many health care stories I could cover since President Trump moved into the White House, this one strains even my most creative scenario planning mindset.

Let me first say I’m the daughter of one of the Greatest Generation who fought for his and my country during World War II as a brave and decorated Jungleer. Charles Sarasohn, my Dad, carried a machete, cut his way through the Philippine jungle, and came home a decorated hero with a Purple Heart.

I believe U.S. veterans are superheroes.

But I don’t believe the CEO of Marvel Entertainment should go anywhere near the VA Healthcare System, unless he, too, is a veteran of the U.S., and/or a person with significant healthcare experience.

The story, The Shadow Rulers of the VA, broke the evening of 7 August 2018 in ProPublica. The column was researched and written up by reporter Isaac Arnsdorf. It goes like this: at President Trump’s Mar-a-Lago resort, three men came together in a “troika” (ProPublica‘s chosen word description), to discuss and develop policy decisions about how the VA was being managed. The three main characters in this plotline are Ike Perlmutter, Chairman of Marvel Entertainment; Marc Sherman, a lawyer; and Bruce Moskowitz, a private physician in a concierge model serving patients in Palm Beach, FL.

These decisions have included how to deal with the multi-billion contract for the VA’s health IT system, how to embed private healthcare providers into the delivery system for veterans, and mental health challenges facing veterans of war, among other VA issues.

Quoting from the ProPublica story: “Hundreds of documents obtained through the Freedom of Information Act and interviews with former administration officials tell a [different] story — of a previously unknown triumvirate that hovered over public servants without any transparency, accountability or oversight. 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 traveled 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.”

The three men are all part of President Trump’s so-called “Mar-a-Lago Crowd.” “On any veterans issue, the first person the president calls is Ike,” the Marvel Chairman, the article asserts based on information from a former VA official. Dr. Shulkin subsequently left his office as Secretary of VA, along with a deputy secretary, chief of staff, acting under secretary for health, deputy under secretary for health, chief information officer, and the director of electronic health records modernization (that health IT project I mentioned earlier).

“At times, Perlmutter, Moskowitz and Sherman have created headaches for VA officials because of their failure to follow government rules and processes. In other cases, they used their influence in ways that could benefit their private interests. They say they never sought or received any financial gain for their advice to the VA,” the article noted.

Arnsdorf goes into a lot of detail, based on the FOIA-accessed records, including one tale of Apple and the VA discussing working together on an app to enable vet’s to find medical services — with technical assistance from Moskowitz’s son. This never came to fruition due to “discomfort” felt by both Apple and VA officials.

The Superhero issue comes into play here when on November 7, 2017, Dr. Shulkin rang the morning bell to kick off trading on the NASDAQ that day, standing three people away from Captain America, a Marvel character.

Health Populi’s Hot Points:  As I ponder this tale of mis-management and misguided leadership, my mind wanders to the “what if?” scenario….or “who” would I imagine could lead the VA at this very moment.

We’ll mine the world of Marvel, as appropriate for this post, to point to Professor X, Francis Charles Xavier. Dr. Xavier became wheelchair-bound by paraplegia, committed to a greater good to promote peaceful coexistence and equality between humans and mutants at a time of anti-mutant bigotry.

Professor X would make a great VA leader because he was well-schooled in science, expert in genetics and biophysics, and had the ability to bring skills out in those he cared about. He was also a pacifist, committed to civil rights.

Oh, and he served with distinction in the Korean War.

Stan Lee and Jack Kirby brought Professor X to comic book-life in September 1963. This was two months before the assassination of President Kennedy, to put into time-context.

In that light, he’s been compared to Martin Luther King, Jr., who said in March 1966, “Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” The account of this statement was recorded in the Oshkosh Daily Northwestern reporting on Dr. King’s meeting to raise awareness of health inequities regarding, “the segregated and inferior medical care received by Negroes,” as Dr. King was quoted to have said.

That’s healthcare leadership. 

Who would be your fantasy or real-life  leader for the VA? Let’s imagine together….

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