In late July, Major Gen. John Bartrum sat before a Senate committee for his confirmation hearing to be the Department of Veterans Affairs’ next undersecretary of health, or USH, as it’s colloquially called. Time and again, Bartrum was pressed by lawmakers about how to best meet the health care needs of American veterans, and what roles the VA and the private sector, respectively, should play in this work. These were knotty, complex questions, and Bartrum was woefully underprepared to answer them.
Kansas Republican and Senate Veterans’ Affairs Committee Chairman Jerry Moran, a longtime champion of outsourcing veterans’ care to the private sector, asked Bartrum how, as USH, he would utilize his prior experience to address VA health care matters. Bartrum responded with a vision that amounted to little more than broad platitudes. “It’s form and function, it’s structures, it’s basic leadership 101,” Bartrum said, adding vaguely that, if confirmed, he would “look at the processes and how to better affect the veteran’s patient outcome.”
This amounted to a woeful misunderstanding of the complexities of health care management. Leading a single community clinic requires far more than “Leadership 101.” Bartrum is poised to run America’s largest and only national health care system, which requires a whole lot more. The Veterans Health Administration cares for patients at nearly 1,400 clinics, who, as a whole, are older, sicker, and poorer than civilian-sector patients. The system also deals with more complex medical and mental health conditions than private civilian hospitals, and also offers economic, legal, and housing assistance.
Among the specific tasks of a USH are: adding or subtracting drugs from the VA’s prescription formulary; assessing legitimately novel treatments versus the equivalent of snake oil salesmen; charting the future of VA patient needs based on battlefield wounds and military-related exposures; understanding veterans’ specific and complex conditions; establishing centers for excellence; hiring senior medical directors; consulting with chief medical staff and surgeons; and developing and implementing patient safety rules and regulations.
As USH, Bartrum would also manage a $900 million health care professional training program that trains 70 percent of America’s future physicians, and oversee partnerships with roughly 90 percent of the nation’s academic health care institutions. The USH also oversees the VA’s “Fourth Mission” to supplement the broader health care system in times of national, regional, and local emergencies, and to serve as backup to the Department of Defense health system in times of war or terrorist attack. Amid all this, the USH must work with myriad other stakeholders, including VA unions (which have been blocked from playing any role in agency functioning), veterans service organizations, and congressional representatives.
In his Senate confirmation hearing, Bartrum responded to questions with a vision that amounted to little more than broad platitudes.
Not only does Bartrum have little experience juggling these tasks and serving these constituencies; he has no medical bona fides to speak of. In fact, Bartrum’s appointment would break a long-standing tradition. Since the VA became a cabinet-level agency in 1989, every USH has been a physician, able to claim legitimate clinical experience. This core qualification for the job is mandated by federal statute. It demands that a ten-member commission of medical experts vet potential USH candidates before recommending the best candidate to the president on the “basis of demonstrated ability in the medical profession, in health-care administration and policy formulation, or in health-care fiscal management.” The commission did convene to vet Bartrum’s nomination.
Of the various statutory requirements, Bartrum appears to only have significant experience in the final qualification listed in the federal mandate. He has spent many years in fiscal health care work, having previously dealt with federal health care spending at various agencies, including the VA. He has an MBA and a J.D., but no M.D., no master’s in public health or public administration. Senior current and former VA officials are consequently worried that, under his watch, the VA’s vital health care mission could be compromised.
“Someone with his nonmedical background being put in this role sends a very dangerous message,” one current VA official told the Prospect. “It pushes political and economic concerns above the health interests of VA patients, which, in turn, puts them at risk.”
In an e-mail, VA press secretary Peter Kasperowicz played down concerns over Bartrum’s lack of medical experience, saying VA is “not at all” worried about Bartrum’s background “because about 95 percent of U.S. hospitals are not run by doctors, according to the Journal of Hospital Administration.” While technically correct, Kasperowicz left out an important point in the study, namely that “overall quality scores in physician-run hospitals were 25% higher than those run by non-physicians.”
BARTRUM HAS SERVED IN A SLEW of federal roles and agencies, including for the past few months as a trusted adviser to VA Secretary Doug Collins. Both men share the same conservative background and worldview. They also look remarkably alike: middle-aged white men with thin lips, closely cropped gray hair, and wire-rimmed glasses. Both are also lawyers and officers in the Air Force Reserve.
In his seven months on the job, Secretary Collins has ruthlessly attacked the agency, slashing thousands of jobs, cutting or freezing dozens of programs, and gutting labor protections. At the same time, Collins, a longtime military pastor, has heartily endorsed outsourcing and praised private-sector health care as a panacea.
Bartrum has been Collins’s right hand in this work. Under intense grilling at his confirmation hearing from Sen. Richard Blumenthal (D-CT), Bartrum admitted assisting Collins in his efforts to rid the VA of staff and cancel important contracts. Bartrum cast his efforts in the most euphemistic terms, describing his work as enacting “forced restructuring tools” and implementing a “review of contract” campaign.
While Bartrum’s exact role in Collins’s campaigns remains unclear, much of his expertise lies in the minutiae of dollars and cents. One senior VA official said that, in his experience, Bartrum has mostly “asked budgetary questions.” Another former VA official said he is seen as a “gatekeeper for Secretary Collins.” Kasperowicz, for his part, said that Bartrum “has provided counsel to the VA secretary and VA senior leaders regarding a variety of crucial matters, including accountability and whistleblower protection, budget and appropriations and Veterans health care.”
Bartrum admitted assisting VA Secretary Doug Collins in his efforts to rid the VA of staff and cancel important contracts.
Bartrum claims some broad experience in hospital administration from his time serving as a colonel in the Medical Service Corps. He also worked as the Air Force surgeon general mobilization assistant, where, according to Kasperowicz, he “helped lead” the Air Force Medical Service. Bartrum also worked as an aide in the House of Representatives, where, among other things, he helped developed the Ebola supplemental budget. He also served as budget director for the National Institutes of Health, and worked at the Office of Management and Budget, where for three years he was largely responsible for the medical budget at the VA.
During President Donald Trump’s first term, Bartrum was nominated for assistant secretary of financial resources at the Department of Health and Human Services. Somewhat inexplicably, he failed to be confirmed. One government official who worked with Bartrum reckoned it had something to do with the fact that Bartrum has a “reputation as being an ass.” According to Kasperowicz, his stalled nomination was purely political, “one of hundreds that the Senate never voted on during the first Trump Administration.”
“John can engender unhappiness among people because he has an agenda,” explained the former co-worker. “He’s willing to listen to people, but he has a set point of view and believes he’s fully right. As such, he often appears outwardly dismissive of people.” A second source familiar with Bartrum offered a similar assessment. “No one I’ve spoken to who has worked with Bartrum has said kind things,” she said. “They say he’s an ‘asshole,’ and toxic.”
A third former VA official said that the department has traditionally thrived largely by creating an open atmosphere where officials can share bad news and challenge leadership orthodoxy. This official argued that Bartrum does not value what is known in health care safety circles as a “high reliability” culture. “As people have approached him with concerns, like pulling back on a lot of the contracts, for instance, he basically said, ‘I don’t want to hear about any of these problems.’”
According to a recent ProPublica investigation, many of the hundreds of canceled contracts were critical to agency operations. “Among the canceled contracts was one to maintain a gene sequencing device used to develop better cancer treatments. Another was for blood sample analysis in support of a VA research project. Another was to provide additional tools to measure and improve the care nurses provide.”
The former co-worker cautioned that while Bartrum generally holds a “small government” ideology, his beliefs are tame compared to the current administration’s efforts. “He wants to cut, but do it more effective and efficiently,” the official asserted. “John’s not like DOGE.”
BARTRUM’S EXPERIENCE IN PRIVATE HEALTH CARE seems to be limited to his membership in the American Health Lawyers Association, where, according to his official biography, he served on the leadership team of its “Healthcare Industry Group.”
Bartrum left government in 2017, departing his job in the House to become a partner at the white-shoe law firm Squire Patton Boggs. It appears that he was set to leave Boggs for the Trump administration shortly after starting there. However, according to his LinkedIn profile, he stayed at the law firm till 2019, once his nomination fell through.
The financial disclosure Bartrum filed shortly after his HHS nomination indicates Boggs was compensating him richly, netting him at least $200,000 a year, including through bonuses and an equity partnership. At the firm, Bartrum offered legal and lobbying services to various clients, including weapons contractor BAE Systems, insurance behemoth AIG, and Management and Training Corporation, which chiefly oversees prisons and has spurred allegations of violence, abuse, and poor conditions. Bartrum also assisted MicroPact, a technology firm that fought for, and secured, various VA contracts for case management software. (Regarding any potential conflicts of interest now that he’s in the VA, Kasperowicz said that “Bartrum has followed and will continue to follow all guidance from the Office of Ethics.”)
In 2019, Bartrum left Boggs to found Brightstar Innovations Group, a strategic consulting firm and ostensibly “veteran-owned” contracting vehicle where Bartrum appears to have been hawking examination gloves. It appears to have netted a single contract from the VA for “medical equipment” just after Bartrum left Brightstar to work for Collins.
In his 2018 hearing for the HHS role, Bartrum dodged when asked to publicly commit to not cutting the Affordable Care Act and Medicare, two programs that, alongside the VA, represent the government’s most substantial health care programs. When Sen. Debbie Stabenow (D-MI) asked Bartrum point-blank if he would advise against any cuts to the Medicare program and other benefits for seniors, he responded: “Any policies seeking to strengthen the fiscal solvency and long-term sustainability of the program to ensure its existence for future generations to come, must be done so in a manner that does not impede current beneficiaries’ access to care.” It was just specific enough to seem like a pledge, but one which ultimately fell short of a genuine commitment.
Bartrum made similar hedges when recently asked if he would support further cuts to the VA health care system. “If veterans want community care, we need to allow them to have community care,” he said. On the other hand, he added, “we also need to allow that if a veteran chooses that they want to use the VA health care system—the direct care system—that they have that choice to use that direct health care system.”
Another longtime senior VA official noted that any successful USH “needs to understand the science of medicine and health care, how practice occurs, what are the actual steps and processes. It’s this experiential basis that allows you to understand what is the most complex health care system in the country.” Unfortunately, Bartrum seems not only to be unqualified for this part of the job, but from all accounts unable to recognize what he doesn’t know, what he needs to learn, and how to listen to those who have the knowledge and experience he lacks.
This does not bode well for the VA’s health care mission, for those who work to support and enhance the care of veterans, and for veterans themselves.