On the campaign trail, Donald Trump savaged the Department of Veterans Affairs, calling it a "disaster" and "the most corrupt agency in the United States." He vowed to fire many workers at the department in an effort to fix a health care system fraught with delays.
As he transitions to the White House, he has tapped the agency's harshest critics to advise him.
Trump has said he is considering Rep. Jeff Miller, R-Fla., to run the agency. As the chairman of the House Committee on Veterans Affairs, Miller has hounded the agency for failing to enact meaningful changes to cut wait times and fire workers who hid delays. If selected, he will be the first secretary of veterans affairs who has never served in the military.
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Trump's transition team did not respond Tuesday to a request for comment.
The team is being advised on policy by members of Concerned Veterans for America, a small conservative advocacy organization that is linked to free-market activists Charles G. and David H. Koch and has long supported privatizing veterans' health care.
For years, Concerned Veterans for America, based in Washington, was on the fringe of the veteran world, generally shunned by traditional veterans organizations.
During the campaign, though, Trump echoed privatization policies put out by the group, telling crowds he would give all veterans a card to use with any private doctor who accepted Medicare.
"This is a big, big deal," Pete Hegseth, a former chief executive of Concerned Veterans for America, said in an interview. "If we keep our pedal to the metal, we can get major reform done in the first six months."
Hegseth said the first priority would be making it easier to fire workers. The next would be increasing the use of private doctors, which he said was "not privatization, but choice." He said Miller's skeptical view of the management of the veterans' health care system made him the perfect selection to push through the changes.
The organization declined to say whether it was financed by the Koch brothers.
Miller, a former real estate agent and television weatherman, and one of the most conservative members of Congress, declined to comment, other than to issue a statement lauding Trump's criticism of the agency.
"Instead of trying to sugarcoat the problems at the Department of Veterans Affairs," the statement said, "he has a plan to fix them that includes common-sense solutions such as protections for VA whistleblowers, accountability for bad employees and providing veterans with more health care options."
[Key figures purged from Trump transition team]
In an interview on Friday with Fox News, Miller said the agency — the second largest in the federal government, with nearly 350,000 employees — was "mired in a bureaucracy that just doesn't want to move in the right direction." He added, "You can't have a World Series-winning team if you are not willing to get rid of those who can't or won't play their positions."
Miller has long pushed for veterans to have a card that would allow them to see a private doctor if they could not get a timely appointment with the VA.
Trump, in a 10-point plan to "make the VA great again," said he would expand eligibility for private medical care to all veterans.
Large veterans service organizations and a nonpartisan commission that examined the issue have been less than enthusiastic about the prospect of widespread use of outside doctors, warning that the high cost could siphon so much money from veterans hospitals that they would soon become dysfunctional.
A private insurance option would cost between $50 billion and $100 billion, Garry Augustine, the executive director of Disabled American Veterans, said in an interview.
"Where would that money come from?" Augustine asked. "We would hate to see the VA wither on the vine because resources are taken from it for private health care options."
Others worry that Concerned Veterans for America may be less interested in improving health care than in proving a political point.
"This is an ideological organization pushing an ideological point," said Rep. Mark Takano, D-Calif., the acting ranking member of the House veterans committee. "No one else really agrees that privatization is the right way to go. I hope Mr. Trump is a pragmatist and sees that."
Trump's criticism of the health care system for veterans is driven in large part by problems at the agency and the slow pace of change under the Obama administration.
In President Barack Obama's first term, the hospital system, which treats about 6 million veterans annually, faced rapidly rising demand as Vietnam War veterans began using more services and the wars in Iraq and Afghanistan made millions of new veterans eligible. Long waits increased as some hospitals were unable to meet the demand.
In 2014, after Eric Shinseki resigned as the secretary of veterans affairs, Obama brought in Secretary Robert A. McDonald, a Republican and former chief executive officer of Procter & Gamble, who was seen as a reformer. Although McDonald has been praised by veterans groups, progress on improving access to care has been slow, and wait times have increased.
[Dwindling funds leave veterans needing medical care stranded in Kenai, Mat-Su]
Leading the House Veterans Affairs Committee, Miller has pounded on the department, holding many more hearings than his Senate counterpart and accusing the agency of a "rampant lack of accountability."
His sometimes tense hearings have focused on failings of the agency's 1,200 health care facilities, including long wait times, overuse of opiates, unsanitary conditions, and executives who dodged discipline and collected bonuses even as scandals unfolded.
Many VA employees and veterans acknowledged the system's problems, but they said critics were cherry-picking negative stories that mischaracterized a health care system that studies had shown was as good as or better than private care.
"The rhetoric does not match up with the reality," said Dr. Kenneth Kizer, a former undersecretary for health at the VA who now works for the University of California, Davis, Health System. "There are problems, and you can't ignore that, but most people really like the VA. The care is very good."
Miller introduced bills making it easier to fire executives, but the measures languished in the Senate after being passed by the House. Disheartened by a lack of progress in Washington, Miller, 57, announced last spring that he would not seek re-election in his solidly Republican district in the Florida panhandle.
In April, he became one of the first members of Congress to support Trump, calling him "the only person who has what it takes to shake up the status quo and entrenched bureaucrats in Washington." He added, "I am more and more convinced that he has the ability to reach in and right the wrongs in the Department of Veterans Affairs once and for all."