Among all the various things Donald Trump promised on the trail, few will be more central to the argument that his Administration has succeeded or failed than whether he can say, four years from now, that he made meaningful improvements in our system of veterans’ healthcare. The VA healthcare system has been a scandalous failure under President Obama, a failure that is mostly not Obama’s doing (most of its causes predate him) but against which he’s made little headway. A thorough housecleaning is long overdue at the VA, as both parties on Capitol Hill have recognized. And unlike many other issues, providing healthcare for military veterans is fundamentally the responsibility the Executive Branch of the federal government. That’s true even if you think a component of any fix should be some kind of quasi-privatization like a voucher system. The VA hospitals aren’t going to disappear overnight. The next VA Secretary doesn’t even need to be much of a conservative, as long as it’s someone who is open to introducing some free-market principles and insights into the system. It absolutely needs to be someone who knows how to manage and get results.

Trump made fixing the VA a major theme on the stump, and the nation’s veterans responded with more enthusiasm to his campaign than almost any other group. Exit polls showed that Trump won military veterans by a smashing 60-34 margin. Trump’s sincerity on any given issue is less than a certainty, but this is one of the handful of causes he really did act as if he cared about.