One of the few major cabinet positions left to be filled by the Trump transition team is that of Secretary of Veterans Affairs.

The VA is a sprawling organization that provided a wide range of alleged services to veterans from home loans to cemeteries to disability benefits to vocational training. But the thing that catches the most attention is the VA health system. Under Obama the VA decided to create bogus wait times for appointments in order to look better than they actually were. We also found they had a hospital quality-of-care rating system that was kept secret. (Read the sorry history of the VA.) To say the VA health system is a dumpster fire of an organization is to malign inoffensive dumpster fires everywhere. But it isn’t totally the VA’s fault.

When Eisenhower left office he spoke out against the Military-Industrial-Congressional complex (he removed “Congressional” at the last moment) that had never met a weapon system it didn’t want to buy and which made the entire armaments system impossible to reform. To a great extent the VA is part of a similar Iron Triangle composed of the VA, Veterans groups, and members of Congress. The VA wants to retain its budget and workforce; the Veterans groups use their influence with the VA as a tool to recruit dues-paying members; Congressmen want VA facilities in their districts and they want to be seen as supporting veterans; veterans organization staff move back and forth to Congressional staff of the Veterans Affairs committees and the VA. Note who is left out of this equation. Yep. The veteran who can’t get an appointment or adequate care.

There have been several names kicked about to be VA secretary. Some have tossed out Sarah Palin’s name as a candidate. Three months ago I’d have believed she was in the mix because three months ago I was fully expecting Cory Lewandowski to the SecDef. The quality mark has been set pretty high and I doubt that she’s actually in the mix. Former Massachusetts Sen. Scott Brown and Toby Cosgrove, the CEO of the Cleveland Clinic, have been touted. I’m underwhelmed by both. Some are pushing to keep the current secretary, Robert McDonald, in the position. McDonald may be a Republican but the fact that he served under Obama should disqualify him from any political appointment ever.

All of these, however, with the exception of Palin, are safe choices. McDonald is highly regarded by the veterans organizations which is a double edged sword.

The real game changer… and oddly enough the most likely to be a major failure, is a guy named Peter Hegseth who was the CEO of a tiny veterans group called Concerned Veterans for America. The ideas developed by CVA are dynamic and would provide better service to veterans while reducing costs.

During the campaign, Trump indicated support for the blueprint proposed by the Concerned Veterans group, which would offer all veterans the option of acquiring health care at the doctor of their choosing through a Medicare-style system, instead of routing them automatically through VA facilities.

The larger veterans groups warn that approach could cripple the current system through which veterans receive care and leave many with complex medical problems inadequate options for treatment.

Concerned Veterans says it does not favor privatization of veterans health care. Its approach, however, would result in a significant shifting of services to the private sector. Other veterans organizations warn that could leave VA facilities underfunded and at risk for closure.

The idea, however, has gotten strong support among conservatives, including Gingrich, who allied with the Concerned Veterans to promote the idea and was an adviser to Trump during the campaign.

There is the problem and why Hegseth could be a hero or a zero. By moving the lion’s share of veterans who are eligible for medical care, and that number goes down each year as WW II, Korea, and Vietnam era vets die off, veterans would be able to use their choice of physicians and waiting times would go way down. Perhaps the VA could be relegated to treating unique and combat related injuries, such as traumatic brain injury. At the same time, he would be dismantling a huge bureaucracy that produces damned little and what it does produce does not extend to quality health care. BUT. If that happens members of Congress lose their VA hospitals and health centers. The veterans organizations lose a cash cow. The professional veteran class that congregates around veterans organizations and the 300,000+ employees of the VA health care system would have to look for other employment.

If Trump is truly interested in shaking things up he’ll go with Hegseth or someone like him. If he thinks his plate is already full, he’ll opt for safe.