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tv   Politics and Public Policy Today  CSPAN  September 7, 2016 12:30pm-2:01pm EDT

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physicians. and i think that looking at how to create a more organized system that ensures that in all positions there is an ability to attract that talent. i actually think that with that, va would do a much better job attracting talent across the country, because there are many people, including some at henry ford, that have gone to work for the va because they want to help veterans. i think that if they felt that this system were more efficient and effective, they'd be there. >> i think you clearly need that. but i think ultimately at the end of the day cl, it is about people that make it work. it is not about bricks and mortar changing the culture. that's going to require sustainability at the leadership and a sustained push at changing the culture of the organization. the focus clearly has to be on the patient, the veteran, and
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how you are going to do the best thing for the veteran. everything will flow from that. that's your north star. and everybody in the organization needs to understand that from the get-go. >> i appreciate the comments on provider input in how we go about conducting business of taking care of people. thank you. i yield back. >> thank you, mr. chairman. did the commission look at all about the difficulty that the va being able to hire military doctors in the va? are there any complications or things that we can do to -- i've heard there are some issues related to that. >> i'm not sure you ha. you have to tell us what the issues are. >> okay. i was just -- apparently you don't have an answer to the question. i just wanted to pose it. the other thing is, i want just
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to make mention. i thank my colleague, mr. o'rourke, for bringing up residencies that we've increased them. my understanding is the va has not been able to assign all of them, only 300 out of the 1,500. i just want to take a moment to make an appeal to my republican doctor colleagues to address the medicare cap and the time extensions. i would hate to lose those because of the clock is running out. one issue that's come up over and over again is the way that in our bso tomorrow, from are concerns regarding private sector metrics. the va has testified many times that the private sector does not measure things that are important to veterans health care. how did the commission envision the va adopting private sector measures if the private sector does not measure them?
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in terms of there are some things that the private sector doesn't measure. >> can you give an example? >> well, there are specific things that are maybe unique to what the va does as far as what veterans do. mental health would be an example. >> those issues exist in the private sector as well. and we have a very large behavioral health population at henry ford and worked on initiatives such as perfect depression care where we've tried to reduce the level of suicide to zero for a managed population. and while the background and issues might be somewhat unique, the co-morbidity problem exists. and so we have to constantly drive toward results, even when we have those conditions, whether it's socioeconomic risk or other health factors that in
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combat experience affect people. i think there is a way to work toward that set of metrics that could be very -- >> we're looking at the same sort of things. looking at socioeconomic determinants, mental health determinants as well as physical determinant. >> are they comparable? i know you do these metrics. >> one thing i will tell you being in detroit is we live in a world of trying to always have reasons why our data looks worse. and we try not to have those excuses. that we clearly believe that are strategies to improve care even when we have a tough socioeconomic group of people with poor health conditions. we serve as many many organizations do a lot of veterans that don't seek care within the va. so i think we've got to really drive toward those kinds of metrics that push us in a direction of much higher performance. >> as you know, comparing the va to private sector care is not always a fair comparison.
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for instance, the va must secure to federal hiring and firing practices that allow for fair treatment of due process. you heard you aengage with one f the other members. i was delighted to hear that you believe a central problem is leadership training and follow-through, making sure there is progressive discipline. and that a lot of these personnel procedures exist in private sector care as well. and i might have you elaborate more on what you said before because accountability is one of the things that you're struggling with. >> it is very easy in a health care environment to find reasons why people don't perform. it just is. there are -- often there is a pattern of making excuses for people. and it is critical that we push on that level of accountability in performance in all positions. front line staff, physicians, nurses, leaders. and i think that's part of the
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culture that toby and i have talked about today, is creating that sense that you have to perform at a high level and that in fact you're going to follow through on making sure that if people aren't doing that, that there is consequences. >> i would just add to that, any time i found a problem, regardless on a nursing floor or on a hospital, goes right back to leadership. change the leadership, you put a better leader in, you get better performance. i can't stress too much the importance of leadership. >> and investing in the training. >> absolutely. >> and you believe it is possible for there to be accountability that we can improve accountability at the va. >> there has to be accountability. do you not have accountability when you get voted on every year? every other year? >> but in other words, we don't do it with due process. the due process has to be a part of that accountability system. but leadership has to work with that due process. >> let me make a comment though. i do think human resources as a
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division within va is undervalued and underinvested in from my vantage point in terms of the quality and the experience of hr leadership. because it really takes strong leadership on the hr side to really put those processes, systems, in place to make sure that people are following them. and when we talked with some of the hr leaders, we did not get the sense that that was the tradition of the va system to have that level of leadership. >> i would completely second that. it was embarrassing to hear that the level of hr activities at the va. >> so perhaps rather than focusing in on the due process procedures and all of that, there is some value in that. but focusing on the investment in hr would be a worth while thing for this community to look at. >> yes. >> great. thank you. >> thank you, dr. abraham you are recognized.
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>> just a quick comment. phenomenal work and you bring to this committee that we as the committee expect and the taxpayers expect and that's credibility. the way i understand the math, you guys command $13 billion of revenue between both clinics be with and that's done successful. so you are the experts in the room on managing health care. on the choice, certainly we are all fortunate on the committee here to have thousands of veterans in our districts and we realize how important we are to represent them and how fortunate we are. i'm a big advocate of choice. and the argumentative's heard against it as far as expanding the distance or taking away the obstacles is that two weaken the va system simply because you could possibly have a migration of patients. in my opinion i think it would actually strengthening va system. it did make some more competitive things get better with competition. so again, just saying there.
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doc, back to your comment, i've worked with the emr as well as the three physicians on my right have. you said the cleveland clinic reports up to 100 quality metrics. you and i both know those metrics should be reported just like that with an emr because they are entered into the database. so that answers the question of quality metric measurement right there. so it's a huge thing to get emrs in place. they work. and again, we need to do it commercially. the way you eat a whale is one bite at a time. of those four things you highlighted in your testimony, the emrs, and the supply chain. hopefully the va is leveraging their volume of catheters, name whatever -- trache tubes. but if they're not, i think you said you guys save $274 million over a period of time. if the va's not doing that, then, wow, shame on them for not
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getting in the game long ago. because they order millions of quantities of supplies probably on a quarterly basis. do you have a comment on that. >> yes. i think one of the other things i emphasized is that particularly for physician choice issues, like pacemakers or the artificial knees or hips or that, to get the physicians involved. then you can drive down to a couple of choices, and then you can drive the price down with the providers of those pieces of equipment. that's where we've had major savings. >> it's just good business. >> interestingly, the va does a terrific job on drug purchases. >> yes, they do. >> why not on -- >> it was surprising to us to see that they weren't providing the same type of approach on the non-drug medical supplies. >> well, again, thanks for your work. we appreciate it and i yield back, mr. chairman. >> thank you very much.
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>> thausnk you, mr. chairman. i want to welcome you both and thank you for your leadership and service. in my home district, american samoa, over 60% of the veterans have to travel off island at a minimum of five hours after by air for medical appointments. in the commission's final report as part of the commissioner's site visit observations, the report cites poor access to va care for rural veterans as one of the major weaknesses of the va. for instance, in american samoa, the hospital is in such need of upgrades to facilities and equipment, as well as being short staffed, that the va drastically limits the use of the hospital for va health care. will the u.s. insular areas included in this evaluation as part of the underserved and/or rural areas? and, would you please highlight
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which of the commission's recommendations aim to address these underserved areas, especially those you think would apply to the u.s. insular territories? >> you know, to be candid, we have not spent time on the specific issues that your place of origin really has. but on the other hand, we did pay a lot of attention to the issues of rural access and really thinking about how to provide improved access. this was one of the reasons we thought it was so critical to really look at a more integrated model of care. because in many parts of our country and beyond, we have situations where veterans simply cannot get the access they need locally through the va, but in fact are using in some cases private health care. but perhaps not organizing it as well. and the organization is actually very critical to the outcomes of care, care coordination, making sure people have the kind of providers that they need. so what we recommended was this integrated model of creating one
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system so that in every part of where veterans live and work, that they have access to what they need in a way that really enhances their outcomes. but we did not look at that specifically. >> thank you, mr. chairman. i yield back. >> thank you very much. >> mr. chicano, any other questions? >> i have no questions. >> okay. thank you very much. we have one other quick question. it kind of piggybacks on what mr. chicano was asking about training. my question is, we all agree that due process is very important. my question is, should it take a year or longer to discipline an employee or to fire them? >> well, the way i look at that is it depends on the situation that they're dealing with. in most cases, due process is much more efficient than that.
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but if someone has a serious issue that has appeals built in, sometimes time has a way of increasing. but i think the key is measuring, is the process sufficiently operating. and those are things that should be evaluated to really determine whether that timing makes sense or not. >> i agree. for example, if -- as a physician, we do annual reviews of everybody at the cleveland clinic, including physicians. we do not just fire someone unless it is something terribly egregious without having gone through the due process over a period of time. sometimes that's more than a year of collecting a physician's information. but depending upon the -- we have fired some people on the spot for egregious things that have occurred. >> all right. thank you very much.
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also, i would like to again thank the ten veteran service organizations that did in fact provide written testimony for today. it is a very important part of the record, as is the written testimony that va provided as well. again, i think you heard from every member of this committee a great appreciation of the time and the effort that tu and all commission members did provide. the document is very important for us, for transforming a department that is in need of serious transformation into the 21st century. and i would say that all members would have five legislative days with which to revise and extend or add any extraneous material regarding this hearing. without objection, so ordered. with that, this hearing is adjourned.
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you can watch this hearing again on our website, c-span.org, as well as other hearings 57bd events conceand e concerning the va. regarding today's hearing, federal commuter week is out with this article yesterday. president obama is backing 15 of the 18 recommendations made by
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the commission on care to improve service delivery, the veterans affairs department. however, he is resisting a bid to revise the way the va's health care system is run. "we must ensure that va has the ability to operate this integrated lhealth care system n a rational, efficient and dynamic way. the interest is to serve the benefits of veterans and taxpayers." finning the quote, "for that reason, i have concerns with the commission's proposed governance structure for the va health care system." va secretary robert mcdonald said in a statement that 12 of the 15 recommendations backed by the administration have been accomplished or are in progress via the "my va" initiative. more on that now and other veterans health care issues from va secretary robert mcdonald who was a guest on this morning's
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"washington journal." >> our first guest of the morning joining us is the secretary of veterans affairs department, robert mcdonald. mr. secretary, welcome. >> good morning, pedro. great to be here. >> thank you for coming. the hearing today, what does it deal coming. the hearing today what does it deal with? >> it deals with something called the commission on care. this was something that was part of the choice act, the fall of 2014. when congress asked the va to carve out over $60 million of our budget in order to pay a group of consultants money to study what should be done at the va. this committee had commissioners appointed by members of congress and the president, and they met over a period of time, we met with them, they came up with 18 recommendations. of the 18, we said we agree with 15 of the 18. and, in fact, we said that 12 of the 15 are already under way or already completed, so the commission and their findings reinforces what we're trying to
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do with our my va transformation, in transforming the work of the va to better care for veterans. >> one of the points of the commission and what it made in this initial report said this, though care delivered by the va is in many ways comparable or better in clinical quality to the generally available in the private sector, it is inconsistent from facility to facility and can be substantially compromised with problems with access, service and poorly functioning operational systems and processes. how do you respond to that? >> the biggest issue was inconsistency. you had some facilities that had outstanding service. some that were leaders and lean technology, for example, as a way to provide better care. you had others that had never heard of lean. so what we're trying to do is diffuse best practices across, just like any business would do. remember, i came from the private sector, i was 33 years with the procter & gamble company, the chairman and ceo of that company for my last years. so we're diffusing best
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practices across the enterprise to make sure we raise the level of care for all veterans. >> one of the concerns about the commission and before that, even leading for members of congress, was the wait time for veteran to get care. tell what was it like when before you started, what is it now? >> we did have wait time problems. most famous, of course, in phoenix, where we had long number of line of individuals waiting for care, we had wait lists, and what we have done is we had the capacity, we in the last year we had more than 4 million, nearly 4 million more completed appointments. we added over 1200 new doctors, over 2300 new nurses, we expanded clinical hours. we have done more telehealth, we have 700,000 veterans involved in something called telehealth, providing health care to them in their homes oftentimes. so we have done a lot of things in order to expand care. that's great. but we need to do more because
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as we improve in care, more veterans are coming to us for care. there are no co-pays, generally, with the va system. so if you have a choice, which the majority of veterans do, 78% of veterans have a choice between medicare, medicaid, private health insurance, va, and you want to get your -- let's see your knee replaced, $25,000 operation. co-pay might be 20%, that's $5,000, do it with the va, it is free. we're improving care, more veterans are coming to care. that's why it is so critical that we get the congress to pass a budget for this fiscal year, so we can continue to increase our capability. it is also why it is critical that congress authorized the 24 leases we have waiting. we have 24 new leases waiting to be authorized. they have already been funded. they already have been funded, pedro, but they have not been authorized by our authorization committees. and so we need those to be funded so we can open up these 24 new spaces and provide even
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greater care to veterans. >> this hearing today, because it deals with this commission report and ultimately deals with the department that you serve over, are you going to be testifying in it? >> no, i've not been invited to testify. kind of unusual to have a hearing determining the future of a department, but the secretary has not been asked to testify. also, the invitation that was given to the american legion and many other veteran service organizations was revoked. >> why do you believe that is? >> i have no idea, other than i did provide written testimony. but as i say, a lot of what the commission came up with is consistent with what we're doing as part of our my va transformation. look, it is very simple. when i joined the va, i'm a business guy, i went -- i've been to over 300 different trips to different facilities to learn what i need to do, to talk to members of congress, talk to veterans, talk to veteran service organizations. and the plan we put together, the my va transformation plan is
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not my plan. it is the veterans plan, the plan that the veterans and members of congress helped me put together. i'm trying to execute it. i'm putting in place new leadership, 14 of my 17 top leaders are new over the last two years. many of them with private sector experience. i put together an external advisory committee that includes people like joe robles, former ceo of usaa, former major general, connie, former doctor to presidents. rich carmona, former surgeon general, special forces general. they're advising on the transformation because i need help transforming the organization and we're in the midst of doing that. >> if you want to ask questions of our guest, we have invited those of you to call and ask questions of the va secretary robert mcdonald.
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you're also invited to post questions to him via our twitter feed, at c-span wj and facebook page at facebook.com/c-span. does transformation in your mind rely on the private sector? could the va put out more veterans who are waiting for care into the private sector system? >> we have been doing that. about 20, 22% of our appointments today, every day, are in the private sector. so the ability to do that, 4 million more appointments, did rely on using private sector capability. we don't give up responsibility for that veteran going off to the private secretary, but we have been using the private sector. that was part of the choice act in the end of 2014. even before that, we were using the private sector. but the choice act formalized that in a particular bill. >> did the commissions report cite any case for maybe more reliance on the private sector?
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>> the commission's report was very clear on something we agree whole heartedly with, as does the president. which is we need to set up a broad network, integrated network, both public sector and private sector medical capability for veterans. we don't think we should give up responsibility for taking care of the primary care nature of veterans needs. but we should continue to use the private sector. the commission did not go as far as to say they wanted to privatize the va, there was some political ideologues that suggested privatization as the answer. i think that's a bad idea. veterans think that's a bad idea. generally not veterans suggesting it. i am a veteran. i went to west point and served in the 82nd airborne division. but the va is important to all americans. the va has done research that resulted in breakthroughs in american medicine.
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the first electronic medical record, the cardiac implantable pacemaker, first liver transplant, kidney transplant, taking aspirin a day to ward off heart disease. i haven't gotten to more recent things or things that are war related. the last few months, the operation in salt lake city, rather than fitting a prosthetic device on the remaining part of the limb, we put a titanium rod in the femur and snap the prosthetic device on. bryant, one of the veterans i had a chance to meet after the operation, told me that a week or so after the operation he could feel the grout cracks in the tile of his shower with his prosthetic leg. he also said he cut his golf score by 15 strokes, so he was quite pleased. but these are the kinds of breakthrough operations that happen. this operation is not yet fda approved. but we're in the process of
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getting it fda approved. >> one more question for you, before we go to calls. one of the commission's recommendations was the establishment of 11 member board of directors that will be accountable to the president and responsible overall for the system. is that something you agree with? >> i think that's a bad idea. the reason, again, i come from a business standpoint, we don't need more bureaucracy. we have a board of directors. the board of directors is called congress. in the president's 2017 budget, we gave congress 100 pieces of legislation that we need. 40 are new this year. there are simple things, things both sides of the aisle agree on. we need to get them to pass it. we need them to get to pass a budget. we don't have a budget yet in the fiscal year running out. i told you we have leases remaining from fiscal year 2015 that we need authorized. we have simple laws, things like an appeals backlog. right now over 500,000 appeals waiting to be adjudicated. that's way too many.
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takes too long. and rather than throwing more people and more money at it, we brought veteran service organizations, congressional staffs and others together to devise a new law. we created a new law. it is ready to go. we have had hearings in both the house and the senate and our committees. we simply have to get it passed. to the senate's credit, they have put together an omnibus bill called the veterans first act. it went out of our committee unanimously. both sides of the aisle held a press conference to praise each other for bringing it out. we can't get it to the floor to get voted on. it is time to not have veterans be political pawns. it is time for veterans to, you know, for us to take -- rather than saying thank you for our service, let's actually do something that allows us to transform the va and look back on 2016 as the year that we really turn the corner for
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veterans. >> we have calls lined up for you from mike from minnesota. he's retired. you're on with va secretary robert mcdonald, go ahead. >> good morning, gentlemen. i'm actually going to the va today. i take one of the worst things we could do is privatize the va system. i had several surgeries at minneapolis va and i prefer the health care i get there. i live eight miles and i would rather use the minneapolis va rather than the mayo clinic. they do an excellent job and i would really hate to see it privatized. >> thanks so much for your comments, mike. you know, whenever somebody approaches me and says they would like -- they like us to privatize the va, i ask them three questions. number one, are you a veteran? generally they're not a veteran. and certainly not a disabled veteran. number two, have you talked to a veteran? and generally they have not talked to a veteran. their thoughts come from political ideology.
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and then number three, do you have any interest in a private health care system that would benefit if the va would privatized? and as you may recall, the veteran service organizations called out the fact that many of the commissioners on the commission for care actually had interests in private health insurance companies. but they did not say privatize. >> from laurenburg, north carolina, diane is next for our guest on our line for others. diane, good morning. >> caller: good morning, thank you for taking my call. my husband is a retired vet. and he's just recently become 100% disabled. he's been for a while, but finally got in the process and now has been declared. my concern is with the education benefit. we have three sons, two in college, and after going through all the process and going through everything, was awarded
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the e-benefits, the military chapter 35, just to discover two days later that he was not able to use it, merely because he was disabled. it felt some kind of bad way, but my son, whose father had given so much for his country, not to be able to use the benefit because he's in an intellectual developed program called beyond academics that the federal government just recently is accepting and offering pell grant, but the va process has not caught up with it. and therefore it is on the list not to receive funds. this is a four year certification at the university of north carolina greensboro. what do i need to do in order to get uncg beyond academics, done an excellent job, to give an opportunity for the dependent of a war veteran, bronze star medalist, the funds he needs to go to college?
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>> diane, that's a great question. i have a lot of empathy for your statement. many of the limitations that we have on the benefits we grant are baked into the law. so what we'll need to do is go back to the law and see what changes we might need in the law to be able to provide that benefit to you. if you would, please e-mail me at bob.mcdonald@va.gov so we can look into your case personally and see what we can do to help. >> mr. secretary, from facebook, a viewer asks how in your opinion can the va become better in taking advantage of the technological innovations as to provide better service and support for veterans? >> one thing we're doing right now is we have over 40 apps for smartphones. and many of our veterans are finding these apps very helpful. for example, we have an app that helps for post traumatic stress treatment. we have an app that we're working on and we'll be rolling out for scheduling. these are things we're trying to do. one thing i did, knowing that if
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you're going to transform an organization, you need new leadership, as i said earlier, i changed 14 of our 17 top leaders, one of the leaders i brought in was a new head of it who was head of it at johnson and johnson at dell. her name is laverne council, excellent, transforming our it organization. and systems is a big, big problem at the va. our scheduling system that was the problem in phoenix dates to 1985. our financial management system by which we manage the money that we are given by congress is written in cobalt, a language i wrote at west point in 1971. we're changing that. we're changing all of these things. technology is a big part going forward. i mentioned earlier, telehealth. we deal with over 700,000 veterans and telehealth, telehealth is the wave of the future in american medicine and we're leading it. as i said earlier, we have been on the cutting edge of innovation for american medicine
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and i think we need to continue that in technology will play a huge role. >> how does the va stay competitive with the private sector when it comes to facilities and people with new technological innovations and procedures and updating those procedures, how do you factor that into your budget? >> we have a -- we spend about $1.8 billion a year on innovation. that's a big part of what we do, i talked about the integration operation. but a big part of it too is the relationship that we have with the best medical schools in the country. when omar bradley was the head of the va in 1946, he set up a system of affiliation where many of our va hospitals are right next to the very best medical schools in the country. if you go to duke -- to durham, north carolina, our va facilities across the street from duke university medical school. we share doctors. we share hundreds of doctors, for example, at duke. we share over 300 doctors with the university of utah where we
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do this integration operation. we're getting the very best doctors in the country doing the research, who are teaching because we train 70% of the doctors in the country. so, again, if you talk about privatization, who is going to train those doctors? we train 70% of them. and then the great news for our veterans is they get doctors who have to teach it every day and are doing research. we're always on the cutting edge in innovation becomes very, very important. >> robert mcdonald joining us. leonard, dayton, ohio, good morning. go ahead. >> caller: good morning. mr. mcdonald, privatization. that's what's killing us. in 1993, we had 17 and 2014 we only had 4. so privatization is killing us. the private sector cannot take care of our veterans. the cost is high. now, as you've been -- you came from cincinnati, you know the
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dayton area real good. >> yes, sir, i do. >> caller: what do you see? >> one of the issues is that we need help recruiting doctors, dentists, nurses. one thing i did when i became secretary, first thing i did, i started going to medical schools to recruit doctors. i've been to over 24 medical schools to recruit doctors and nurses. in doing that, what i discovered was we're not competitive with the private sector. we worked with congress to put together legislation that would allow us to make sure all of our medical personnel become that is called title 38 rather than title 5, which allows us to pay competitive with the private sector. i also looked at the salary bands of our doctors and dentists and increased the salary bands so they would be competitive. we worked with congress to double our loan reimbursement.
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these are the things we're trying to do to recruit more doctors and nurses. we're being successful. one thing holding us back is the way sometimes our doctors and nurses get treated, you know. they don't necessarily like the politics of working in the va. >> creeder crest, new mexico. dave, you're next. >> caller: good morning, mr. secretary. i had a couple of questions. i wondered if you ever thought about turning all the bureaucrats turn into auditors and have the auditors audit the va every two years. and my second question was, have you ever thought about getting the watson program from ibm to help with diagnosing and treating patients? >> thanks, dave, on the first question on bureaucrats, the percentage of employees in
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washington, d.c. head office is lower today than it was in the past. one of the things we're working on is putting more and more people against care for veterans. that's something we're closely watching. we also have a new inspector general, mike missile, outstanding inspector general, doing a good job auditing us. we had a meeting last week. we get a lot of help from the gao, the comptroller general of the country who audited us. we have lots of auditors, lots of overseers. second question on watson, we do have a partnership with ibm. we're working with ibm and with watson. and watson showed tremendous capabilities in our million vet project. this is, again, one of the things we're leading research not just in the united states, but in the world. we have over 500,000, 550,000 or
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so veterans who have given us their blood samples including i give my own. we have 20, 30 years of medical history of these people. we're mapping their genome. that's where the computing power is required. through that mapping of the gener genome, we'll be able to predict future potential diseases and solve them before they become a problem. i was with a young lady the other day who unfortunately we had to do a hysterectomy, she was a veteran, had to do a hysterectomy because she had cancer of the uterus. but then, through mapping her genome, we discovered that she was susceptible to colon cancer. we increased the frequency of her colonoscopies, we discovered precancer ous polyps and was able to remove them. we were talking about the cancer moonshot, which the vice president is leading.
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and she said the va saved my life and this new technology saved my life. we need computing power for that. we have a partner with the department of energy and ibm and watson. >> anthony in north carolina, good morning. >> caller: good morning. hello, mr. secretary. >> hi, anthony. >> caller: now, i had had a unique question. i'm a veteran with an other than honorable discharge and i've been seen at the va because basically the situation is they determined that -- they're beginning to determine that what was considered just abrupt and stupid behavior on my part from when i was 17 when i was in was actually the start of schizophrenia, which i'm now dealing with now. now, the va website states that anybody with anything other than a dishonorable can get va care. but whenever i go there, the eligibility office, they give me trouble at every end, even though i'm still being seen, i'm waiting for my -- for them to
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determine if i'm considered honorable for va purposes. and i wanted to get your take on the whole issues they give to people with other than honorable discharges. >> that's a great question. other than honorable is a large category and very diverse category of discharge sdischarg. there is not one answer. e-mail me at bob.mcdonald@va.gov and we'll look at it. we're currently working within va to be clear on the regulations going as far as we can based on the law. the law is what prohibits us from dealing with dishonorable discharges and make sure we do as much as question for veterans like yourself. you should apply to the department of defense to have your discharge reviewed because
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back in the days when i was a captain in the army, many of the times people may have had something like post traumatic stress, bipolar conditions, schizophrenia, we know about today that we deposit knidn't k and you may be able to get your discharge changed and we would be happy to work with you on that. >> tracy from facebook asks what is being cdone to rectify the overprescribing of pain medications? >> we have a state of the art program i would say or some experts in the medical field said we're leading the country here. we track the dispensing of opiates, by doctor, by facility. we track it on a national basis. and the trend is down and that's good. and what we're finding is alternative methods of treatment are as effective if not more effective than opiates. we're using them. things like acupuncture, the
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largest user of acupuncture in the country. chiropractic, equine therapy, yoga. we're using databased evidence that shows that these other treatments are effective and basically we'll try whatever treatment the veteran requires in order to find something to get them off of opiates. >> here is leonard, retired vet from jefferson city, missouri. >> caller: i'm not a retired vet, but in 1975, i got an honorable discharge but 1973, agent orange at barber point naval station in hawaii and i have all of the effects of agent orange. because i did not go to south vietnam, they're refusing to label me with agent orange and i
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had four major heart attacks, i had diabetes too. and i've had cancer. and my primary doctor put in a request four years ago for testing of agent orange and they did not give it to me. >> leonard, e-mail me and let me know. one thing we have got to do and we'll help you with this, got to go back to the department of defense and get the proof that agent orange was used at your facilit facility. once we have that, we're able to help you. the department of defense has the information on where agent orange was used and not used. >> chico, california, go ahead. >> caller: i had two quick questions. sorry. good morning, secretary. >> we're listening, mark. that's fine. >> caller: okay. you know, they used to pay veterans to go to facilities and
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when you got there and saw your doctor, now they change it to where you get paid the following month in a check. but a lot of people can't or don't want to ride the bus. it is really hard on the individual to come up with the money to go down there. i don't know why they changed it. the other thing, as far as opiates, i agree that they were overprescribed at one time. but when a person is living on opiates, methadone for 20 years, you don't drop that person 40 milligrams all at one time. and it was a shock to me and took six or eight months just to get over that.
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and they still want to get me completely off opiates. i'm a 63-year-old disabled veteran. i don't think that's reasonable. >> thank you, mark. on transportation, transportation is a big issue for veterans. we work hard. we particularly work with the disabled american veterans to provide transportation. we work with county organizations to make sure bus transportation is available. or common transportation. so that is a big issue. and we are working to find ways to make sure that people have available transportation to get their facilities. secondly on the opiates, if you're unhappy with the care you're getting from your provide, raise the issue within your facility and, you know, they will look at it and get another provider's point of view. if you've been on an opiate for a long period of time, fining a
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clinically appropriate way to get you off of it is terribly important. >> let's hear from milwaukee, wisconsin. this is paul. he works in the va system. paul, go ahead. i work in housekeeping. and one problem we have, i have it just about every night. i have assignment, i do about 34 rooms, cleaning them up and sterilizing them and what not. we're understaffed. we have a lot of guys that call in and they don't come to work and we wind up not only doing my job, i do somebody else's job. they look at us like we're the underbelly. they play on their the computer, stuff on the floor, and we have to constantly clean up behind them. a lot of times i'm pulling down the bed washing, to do
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isolation. veteran who has, like, a disease, like with cdef and mrsa, we need to soot uit up an clean that up. when will they get more employees to come to work consistently and what not so i don't have to just do my job and do my job and then do somebody else's job. i'm broke down just about every night, sir. >> thank you, paul. thanks for your service to veterans through the va. i think housekeepers are heroes. i think housekeepers are heroes. they prevent infectious disease from being transmitted through our hospitals. and va has one of the best records in the country for the lack of infectious disease through a hospital.
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these house keepers make sure ebola, and hiv and all of these infectious diseases don't transfer. it sounds like we have a personnel problem and discipline problem in paul's area in milwaukee. i'll look into that when i get back. employees need to come to work. >> with the completion of the commissioner report, it prompted a letter sent out, op-ed, perhaps, from the house veterans affairs committee jeff miller. he said in part this, it is obvious that until those who cause the va scandal are removed, efforts will never succeed because instead of properly holding the problem and employees accountable, they make excuses, often bad ones for their misbehavior. >> since i've been secretary, which is about two years now, we have terminated 3,755 people. and i think if you talk to an
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individual, who is currently facing -- he's already been found guilty, he's currently facing five years in jail and hundreds of thousands of dollars of fines for manipulating records, i think you see we're holding people accountable. of course, you try to change your culture, you got to hold people accountable. one of the first things i did when i came into the organization is i have everyone retrain and then recertify on the mission and the values of the organization. we do that every year now. we train, we recertify. i was criticized by some members of congress. you can't transform an organization unless you train them. and we spent time on a program called leader developing leader where we train the top leaders of the organization and we cascade that training throughout the organization. you have to train people if you expect to have a new culture. we do hold people accountable. >> is that part of your reasoning for not having an additional board to overlook the
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affairs of the va. if the board was put into place, would that undercut your job? >> i think it would. part of the issue of the board is the justice department is suggesting and our lawyers are suggesting it would be unconstitutional because you have someone in the way of three branches of government. i don't think we need more oversight. i think what we need is everybody to do their job. i've been the ceo of a large corporation. one of the most admired companies in the country and perhaps in the world. i think we're making the transformation happen now. everybody has to do their job. i talked about the fact i need multiple pieces of legislation passed by congress. i need a budget. almost october 1st. i don't have a budget yet. everybody has got to do their job and congress has a big role in accountability as well.
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holding themselves accountable to get the bills passed to allow us to transform the organization. >> part of the hearing that takes place today deals with the possible looking at the issue of subpoenas or such things and these are the headlines of recent -- with our purchases made by the va about bulling in aurora, in colorado. could you tell us what is the interest of the committee and the possible subpoenas and how do you respond to these instances? >> many of these things happened before i became secretary. but we have done investigations on all of them. in the case of the artwork, there was no centralized policy on the purchase of artwork. as soon as we discovered that one facility, palo alto, had gone further than we wanted in terms of purchase of artwork -- >> how much? >> well, it depends what number you use. i'll get to the subpoena part in a minute. >> gotcha. >> we put in place a policy to
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stop it. the reason for the subpoena is we provided the information to the committee that they asked for, which was the cost of the artwork. they weren't happy with the answer we provided. the number was lower than the number they quoted publicly. the number they quoted publicly included furniture and many other things as well. we're clarifying that with them so they understand how much was spent. but in the meantime, we put in place a policy that limits the amount of money spent on artwork. i have to tell you, art therapy is one of the ways you deal with post traumatic stress. if you go into hospitals all over the country, you'll find art. we can get it for cheaper. you'll find art is a part of it. individuals of post traumatic stress will make masks as part of their therapy to deal with the experiences they had in the past.
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the other subpoena is on the building of the denver hospital. the organization did make mistakes in building the denver medical complex. it is a large complex, over a dozen buildings. and as a result, there was significant cost overruns. those cost overruns in my opinion, my undergraduate degree is engineering. we're built into the design. as soon as the design was baked, there was going to be a problem. we have done an investigation as to who created the mistakes, making sure we discipline those who made those mistakes. those en route to being disciplined left before being disciplined. we turned over the investigation filed to him. what we have not done is turned over the verbatims of all of the interviews, nor have we published them publicly. i need to hold people accountable. to hold people accountable, i
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need the ability to do investigations. if i start turning over to congressional committees all the verbatim transcripts of every interview we do, that will chill my ability to do investigations, because oftentimes these issues are used for political reasons. and that would just chill our ability to do these kinds of investigations. >> back to the -- you're not testifying at this hearing. did you ever have a conversation with the chair about not testifying at this hearing? >> no, i have not. chairman miller and i have each other's cell phone numbers. i call him, he calls me, i went to both the house and the senate, many months ago. maybe january or february. i said i would like -- rather than holding a hearing, on what occurred two years go, three years, four years ago, can't do anything -- i'm correcting the future. let's hold a hearing on the
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future. let's talk about the my va transformatio transformation. i'll talk about how to provide same day care. i'm going to tell you about how we're going to improve veteran trust in the va, how to improve the compensation pension exam if you pass the legislation we need. the senate held that hearing, a great hearing. out of that came the veterans first act, all this legislation we need, bipartisan. i never got that hearing in the house. i've never been -- i never had a hearing in the house where we focused on the future transformation of the va. today is a hearing about the commission on care and i've not been invited. and also veteran service organizations have not been invited. >> let's hear from greenleaf, george, retired. go ahead. >> caller: yes, sir, i'm a retired army. good morning. thank you for your work you're doing a great job.
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i applied for compensation and pension in july of last year. and i've been unable to work for the last two years, and can't seem to get any information on my claim. i have a vso and no information really from the va on my claim. my second question is on the choice program, i've been sent out by the va for the choice program, but the information doesn't get to the va i have sleep apnea, and i've been out to a sleep clinic, a civilian clin clinic, but the word doesn't get back to the va so i can get a machine. thank you for your service. >> thank you, sir. again, please e-mail me and we'll look at your individual situation on the cmp exam. and also on the choice program. we have been changing -- when the choice program was passed in the fall of 2014, we were required to set up a national program to provide care to
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veterans in 90 days. and obviously the law was put together so quickly, it was emergency and we understand that. there were some things wrong with it. we changed it over time. we have taken 40 mile distance rather than being a geodesic distance, we made it a driving distance. that should have doubled the number of veterans available to come into it. we have done a lot of things to try to improve it, working with the third party administrators we have. not perfect yet. but the good news is a couple of months ago we had about 200,000 authorizations via the choice program and it is continuing to ramp up month to month. but one of the things we have to get better at is this handoff between the va and the private sector and back to the va. it used to be required to come back from the private sector
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provider before we would pay the bill. we had a lot of veterans going into debt with that. and as a result, we have given up that -- that's not a requirement any longer, people are getting paid, so that's one of the improvements we made. but this handoff becomes very important. as everyone knows who goes into private sector medicine, handoff from doctor to doctor is a very important thing. >> let's hear from gloria, kitty hawk, north carolina. our line for others. >> caller: good morning. i'm just calling with a very simple question. my husband was in the service during the korean war. his impression of his eligibility would be only if whatever was wrong with him was combat or service related. now i can't believe all these people using the vet system, veterans hospital system, are combat or service related. i mean, a lot of them just have
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regular problems. so what is the story on that? >> gloria, it is a little bit more complicated than that. i would suggest, first of all, go to our website, va.gov. if you don't go an answer there, because the eligibility criteria are there, then please e-mail me or call me and we'll -- we will answer your question directly. your husband's service in korea is a lot more complicated than that if he didn't have a disability that came out of that service. it has to do with things like income and other things as well. but let's deal with your case off line and we'll get you -- get you what your husband has earned. >> steven is in bremerton, washington. good morning. >> caller: good morning. good morning, mr. secretary. >> good morning, steven. >> caller: i am 100% disabled
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veteran and i've been -- i don't know if you want to call it unemployable, but i haven't worked since the end of 2012. several times i made appeals to -- and the issue is being total and permanent. i think the va is doing a wonderful job for me. the issue is, am i expected, even if i do get better, and i have, i have gotten better, but will i get better to the point where i can actually go back into employment and i still struggle with issues like being around people and so on. >> sure. >> caller: that's part of it. is compensation and pension really kept up to date by the medical side of va so they can make determinations for total and permanent -- just to be honest with you, i need to improve my income and one thung i tried to do is apply for social security disability and
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i've been disabled because of the -- the doctor -- >> i think it dropped. but mr. secretary, go ahead. >> compensation and pension exam this is veterans first introduction to the va. it is an exam that a doctor goes through with the patient to determine their degree of disability. it is anxiety ridden. one of the first things i did is i went around and attended some of the exams with the patient's permission. i said, this is something we have got to fix. we brought in some experts in human center design, which is what good customer service companies use to design the delightful experiences. we have redesigned the process. the new process is in the field. we're hoping the experience will be improved upon in the future. but a very important part of the
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process of making sure we have empathy during the exam and arriving at the conclusion that the veteran and the va agree on. >> this is ed, jacksonville, florida. >> caller: good morning. i'm a service connected vietnam and also afghanistan and iraq veteran. first of all, i want to make a comment. maybe i noticed and maybe this will help the lady from north carolina that was speaking, i know this va changed into a health care system which i think was mandated by congress during afghanistan he did employments and stuff. so i know that may be part of the system clogging up the va system is now a health care system and also saying that i wonder if you are aware of the toxic water issue in camp lejeune, that national guard guys have been exposed to. i think from 1953 to 1987, if
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they attended their annual training there how you can make this aware to the guardsman that are out there among their community. >> i'm very familiar with that. in fact, i've been working hard on it. one thing i've done since i became secretary is i've taken a look at all of these problematic issues that have been around for some time. for example, c-123 crews and reserve crews flying c-123s in vietnam to drop agent orange, we have made a new rule, a new regulation about that that allows though crew allow s those crews to get care. camp lejeune, the people who served at camp lejeune are able to get medical care through the va. that's part of the law. we're also looking at should there be presumptive conditions and hoping to have some news on that within the next few weeks.
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>> one more call for you. this is anthony valdosta, georgia, retired. >> caller: yes. second mcdonald, i give kudos to you. you came into a mass and you work through it. but in light of the travel scandal, where you got employees that are transferring each other to bilk the federal system out of money, how in the world do these people maintain positions of any influence, of any influence and not be sent somewhere else? i understand it is very hard to fire a federal employee. if they're going to take money, inflate numbers, and take bonuses they don't deserve, how are they not sitting in a rubber room like the new york teachers association and i'll let you answer, sir. >> what anthony is talking about is a situation we had in philadelphia. we proposed a punishment and the merit system protection board
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overturned that punishment. we came back with a different punishment. the legislation i talked about will solve the situation anthony described. the legislation i talk about would allow us to take a number of employees, large number of employees and move them into title 38, which would allow us to not all employees, but medical employees, that would allow us to have the appeal process for their discipline within the va rather than going to the merit system protection board. we think that is an appropriate process, it worked for those in the medical facility. nevertheless, we're going to continue to hold people accountable. we're going to continue to suggest the punishments that we think are appropriate. and, you know, we will -- as i said, we terminated 3 ed 375,05
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people. >> how do you know you made the changes necessary from the problems that the va suffered previously? >> ultimately it is the vote of the veteran. one thing we know now is more veterans are coming into the system. that's good. we have 21 million veterans in the country roughly. about 9 million used the health care system. more coming in. that's good. we want that. we also measure veteran satisfaction. we measure veteran trust in the va, satisfaction, happiness with wait times. we have got right now for primary care about five days on average nationally. so we're -- we measure satisfaction and that's how we know. >> robert mcdonald, the veteran affairs secretary, va.gov for
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more information there. thank you. >> thank you. it was fun being with you this morning. >> an article about the south sudan civil war and u.s. interests in the region, it highlights a july 7th attack on seven american diplomats headed back to the u.s. embassy in the capital city. according to article, the u.s. has given more than $1.7 billion in humanitarian assistance since south sudan fell into civil war in december 2013. including $138 million just last month. according to a report by the associated press, which cited interviews with multiple witnesses on the ground. uniformed south sudanese troops singled out mesh americans for abuse and beatings. carried out mock executions and gang raped several foreign women. coming up, a house foreign affairs subcommittee will look into those incidents, the 3-year-old war, violence against
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international aid workers and the attack mentioned by foreign policy magazine. that hearing is coming up live in about 20 minutes, 2:00 p.m. eastern time on c-span3. until then, more from today's "washington journal" on veterans health care. >> representative phil row serves the state of ten step, a member of the vet reran affairs committee. good morning. we were talking about the hearing that takes place today. why wasn't he invited to testify? >> he'll have ample opportunity to testify. what we're going to do today is this is the commission on care. we're bringing two of the commissioners in. this is a 300 plus page report. the secretary was complaining about that. but he'll have ample opportunity. we want to hear from the commission first, where members of both -- so our viewers out there know, the veterans affairs committee is the most bipartisan committee in the congress. it is a privilege to work on
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that committee because we leave all the political stuff and try to do the right thing for veterans. that's why. we want to hear from the commission unfiltered. anyone gets their opinions about this, and the secretary will have lots of chances to testify. >> you're saying you'll have a hearing specifically looking at this report? >> he'll have a chance to testify. >> what about some of the issues that he brought up as far as the changes he's made concerning the va as far as wait times are concerned, everything. and he puts the heat on you as far as providing him a full budget help him do what he has to do. >> let's go back and talk about the budget, the discretionary part of the u.s. budget has been almost static since 2009 because of the budget control act passed in 2011. the veterans budget quadrupled since 2000. since i've been in congress, i was sworn in 2009, we have gone from spending mid-90 billions for veterans, cemeteries, health
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care and disability to almost 165 billion. and that doesn't include the choice program, another 15 billion. we have gone from 96 or 97 to $180 billion. money is not the problem. i had our va medical director say money is not the problem, it is management. we're having a little business meeting before the hearing this morning. this is a letter that a chairman miller wrote to secretary mcdonald, on october 9th, 2015, that's almost a year ago now, i requested the following information to date this is written july 29th of this year. va has not provide or given onupdate onu an update on what to expect. that's about the artwork and we're trying to find out what the va is doing. we have seen this scenario before with the va and denver. i want to get into that in a
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little bit. that one really bothers me how incompetent the va was in managing that project out in aurora, colorado. >> go back to the secretary's visit, just a few moments ago, we talked about the role of congress and the oversight. i wanted to get his words out there and let you respond. >> the president's 2017 budget, we gave congress 100 pieces of legislation that we need. 40 are new this year. they're simple things. things both sides of the aisle agree on. we need to get them to pass it. need to get them to pass a budget. don't have a budget yet and the fiscal year is running out. we have leases remaining from fiscal year 2015. we have simple laws, things like an appeals backlog. right now, we have over 500,000 appeals waiting to be adjudicated. that's way too many. takes too long. and rather than throwing more people and more money at it, we
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brought veteran service organizations, congressional staff and others together to devise a new law. ready to go. we had hearings in both the house and the senate. we have to get it past. to the senate's credit, johnny isakson and dick blumenthal and our committee put together an omnibus bill called the veterans first act. went out of our committee unanimously. both sides held a press conference to praise each other for bringing it out. we can't get it to the floor to get voted on. it is time to not have veterans be political pawns. time for veterans to, for us to stay -- rather than saying thank you for our service, let's do something that allows us to transform the va and look back on 2016 as the year that we really turn the corner for veterans. >> what about these issues he's brought to the table and the law that he wants passed.
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>> he has the ability to do those things now. there is not any reason why you have this -- we put resources after resources and, look, i have a good friend of mine who died last year and i've been sort of working on his claim. he's -- his daughter had information sent to department of va that didn't even exist for three months. and it was shut down. it is a matter. it is about management and,ability. don't need another law. you need a manager to go in and run the va right now. i think the secretary made great changes. don't hear me wrong here. i think he has. and the va is a huge organization. when i came to the congress in 2009, i think 250,000 people that worked at the va, there are now 330,000. they have 32,000 people who are schedulers. and they can't get scheduling
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done. 32,000 people who schedule for the va. so it is about management and accountability. that's one reason you'll see us. i agree with him completely on the budget. we need to get the budget passed. i whole heartedly agree with that. need to do our job. and va, by the way, saw that folks out there know, we appropriate money around for other departments, as defense, homeland security, all that, that's on a yearly basis. va is done on a biannual basis. with years at a time. >> are you satisfied with his leadership? i think he's done a reasonable job. there is some things we need to have changed. i like secretary mcdonald. his heart is in the right place. he's trying. >> then what changes would you like to see him make? >> i think one of the things he talked about accountability, look, this 3,000 had to do with people who weren't involved in the mistakes were made. as far as i know, no one has been fired from the aurora, colorado, debacle. this -- i don't know whether our listeners know or not, but this was a hospital planned to spend
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$600 million. that's a lot of money, $20 million change order. i think you get into things and you change. that was supposed to be completed in 2013. that hospital now is at 2017 or 2018. with a 1.71 billion, over a billion dollars. that's a thousand million dollars over budget. look, i've been in the process. i'm a physician. i've been in the process for helping to develop and build three hospitals. imminently involved in those things. and none of them -- your contractors, your people who lend you money, would stop. the va and this orlando, florida, louisville is getting ready, new orleans had problems, like it was so bad, that we took it out of the va's hands and put it under the department. >> our guest, a member of the veterans affairs committee. you'll see him and the rest of the committee at 10:15 on c-span3 talk about these issues from the commission on care report. you can ask him questions about
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that or other issues concerning the va. the numbers will be on the screen for those of you veterans in the eastern and central time zones and mountain and pacific time zones. we will let you talk to him, our first call for him is from margaret, in oklahoma on our line for others. you're talking with representative phil row of tennessee. go ahead. >> caller: congressman row, i don't know if you're familiar with dr. janet mccarol, but she said i'm a medical doctor and i'm a natural health doctor. and she said, neither side had an answer. she said, so she prayed and asked the lord what to do and he told her to take the amino acid gaba and here is how simple it is. when you are under huge stress like our troops, and i've seen it, you -- it dedepletes, wipes out the amino acids in your brain and that's what makes your
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neurotransmitters work and that's what's wrong with our troops and the -- there is something called the pain stress center, in san antonio, texas. and i have talked toveteran. i called aaa one day and i got one of the veterans. i asked him how he was doing. he has a problem with his hips. he said yes i'm already going to the pain stress center and i have had this happen a number of times over the last few years. and it does help them. it restores their brain but the man that called in, his dad said he said he was ready to kill himself. and he went to his regular doctor, not the v.a. because they had him on these drugs, 17 of them for him. there was one in colorado, the ranches which are wonderful for our vets.
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i would like him to check into it and give like a pain stress center. it is something your body needs. >> thank you for your call. i'm a physician. i served a little bit of my training at a v.a. and served in the second infantry division in korea a long time ago. there are some things that work for some patients and don't for others. certainly one of the things we don't understand very well is the neuro function of the brain. we are still learning it in. i think those things can be looked into. i'll be glad to have my staff do that and i appreciate your call. >> david from houston, texas, good morning. >> good morning, dave. >> i'm trying to find out on this appeal, when i first applied for disability they told me if it wasn't service
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connected i had nothing covered. that had been years ago. i wind up with bad knees, bad back. and old sergeant told me when you get a little older you are going to feel all these aches and pains. so they finally gave me 10% of each knee. but i have injections in my shoulders which you are going to hit that ground and you are going to have to roll. and my ankle. so i am trying to figure out why does it take so long to have an appeal when you go to the doctor and you see these doctors and they look at you ten minutes, and dismiss you then turn around and you get a letter 10% on each knee? >> thank you.
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i can never figure out why to jump out of a perfectly good airplane. thank you for what you did. what i would do skm this is what i do in my own district. i have a staff member that takes care of nothing but veterans. you have to sign a release so we can work on your behalf. that is what i recommend you do, go to your congressman. you shouldn't have to do that but many times we can help you, a veteran like you change this. and i agree with you. one of the frustrations i have and it is better when i came to washington there were a million veterans awaiting their claims to be adjudicated. that has been reduced. we put enormous resources into it. it should have been reduced and there should be a presumption that always lean in the veterans' favor. that's what i would do.
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you sign a release and then have your own person on that behalf. once again that's what i would do. >> walden, new york. frank is up next. >> hi. thank you for taking my call. >> good morning. >> i am a veteran from vietnam era. over the years from the '70s to 2012 i saw a lot of incompetence in doctors. excuse me. one thing that i want -- one example where i had problems with the v.a. and i was burned out and couldn't take it anymore was that my time was not productively used to take care of veterans. i was an x ray tech and then became certified son aug raefr. doctors say could you do this for my veteran.
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i try to institute a test that was so simple and so easy and accurate called a doppler of the arteries which we normally do. i was refused by one radiologist. and then i went to the manager of the department. she refused based on what they told her. this is just an example of conventional obstruction. and to this day i cannot understand how these people would not want to help veterans especially ones who are in severe pain. one radiologist who left the v.a. she didn't care what conventions would. she said this would be done and she recorded the man has disease where he will lose circulation in his feet. >> thanks, caller. >> for our viewers what frank is talking about is a simple test for arterial circulation.
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everyone needs accountability. i appreciate you looking out for what is best for veterans. and i think that is one of the things that we are looking at in the v.a. system is a system to hold people accountable. one thing i did when i was in practice, i had to work more efficiently. the v.a. is not an efficient system if you look at the facilities that they have. sometimes a doctor and a nurse are transporting patients. the job descriptions are not clear. that is one thing the commission on care brought out very clearly that that needs to be very clearly defined about what your job description is so you know what you are supposed to do. i had a system if i worked in the v.a. system i had to close my door in the private practice because i just couldn't earn enough money to do it to keep it open. so i hear what you are saying. there needs to be accountability both in the private sector and
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in the public sector like the v.a. >> would the v.a. system benefit from more reliance on the private sector? >> i think competition helps. i think the secretary pointed out about many people going to the outside system. one of the bills that you are going to pass is there are about seven different ways to get non-v.a. care. what the v.a. did to confuse this when it first came out was they decide -- in other words, there was a system before when we found these long waits that the v.a. had to send you out to the private sector. someone called and talked about sleep. many v.a.s don't have a sleep lab. well, they chose to use just v.a. choice program. v.a. choice program was not ready for primetime is what happened. what we are going to do is consolidate seven different systems into one so it is very clear. let me sort of pass along how complicated they made this. the simplest thing i did in my
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medical practice was make somebody an appointment. your wife came in and i sent her to the front desk. your doctor said this patient needs to be seen by a specialist outside the v.a. they then had to go to a front desk for approval. then it got sent to washington, d.c. then it got sent to tri-west. if there was a hiccup along the way that process started all over again. a lot of veterans clock started again. it looked like they were getting seen on time but they weren't. a lot of what you heard the secretary say about five and six days is not what we are hearing in the real world. >> from florida, tony, good morning. >> good morning. i'm back -- it took me 30 years on medical.
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and they end up not turning a form or else i don't know what they did. they took my disability check for five months to pay for that medicine. they don't turn them in. they leave them on the desk. and i appreciate it and i wish you could do something about it. >> what i would recommend you do is contact your local congressman and have them look into that because that's unconscionable if you are trying to live on that amount of money and then it is taken away from you because of a paper snafu. if we stayed here long enough you wouldn't be the only one we would hear that from. >> you mentioned vso. >> veteran service organization. there are many of them will see
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disabled veterans. >> will though incorporate into the commission on care? >> yes. >> who else compromises the commission? what are their back grounds? >> it's a tremendous group. i want to -- if i can find it here. here. i will let you look. these are very, very skilled and competent people. >> health care professionals, physicians, veterans service organizations, others. >> this is found online. if you want to find the report and read it our guest representative and serves on the veterans affairs committee. next call for him is gene in jackson, michigan. >> caller: i have been going to the v.a. hospital in ann arbor michigan for 15 years. it's the best medical care i have had in my life. i have had to go there two occasions unannounce f

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