tv Politics and Public Policy Today CSPAN April 19, 2016 5:09pm-7:01pm EDT
to be clear, according to va provided documentation, no employee has been removed for whistle blower retaliation. this is representative of the fact that contrary to public statements by va senior officials, whistle blower retaliation appears to most certainly be tolerated within the department. so now, two years after what was and is a systemic crisis in care being brought to light. it's time for va to stop using misleading data to tout wait time successes that do not show the real wait time experienced by our veterans. i want to hear what concrete actions have been taken, what fundamental changes have been made and what tangible cultural shifts are occurring within the department. advertising artificially lowered numbers does nothing to stimulate the change that's needed to improve veterans'
access to care. with that i yield to the ranking member, ms. brown for any opening remark she may have. >> thank you, mr. chairman. for calling this hearing today. following the wait time scandal of phoenix, congress passed and president obama signed the veterans' access choice and accountability act of 2014. in it, we mandated there be an independent assessment of veterans' healthcare. the assessment highlight many of the things we hear from our veterans. we hear that va provides excellent healthcare, especially healthcare related to the special needs of our veterans. we also hear that in certain areas, the va is at the forefront of healthcare in this country. we also hear from our veterans that va care is often fragmented and that it can be difficult to
navigate and arrange non-va care. we hear of long wait times and limited access. following the assessment in the service transportation and veteran's healthcare act of 2015 we mandated a report by the va regarding a plan for how va could consolidate all purchase care programs into one new veterans' choice program. we received that report last year, and this committee is currently working with the va on the best way to implement the legislative requests. the va is on track to see -- listen to this -- 6 million 2 277,360 unique patients. in fiscal 2015. va completed 56.7 million
appointments. nearly two million more than fiscal 2014. that is roughly 226 appointments per day. let me repeat that. that's 226,000 appointments per day. the number of patients the va sees would put any other healthcare system to shame. i am pleased that the gao study newly enrolled veterans in their access to primary care in my conversations with veterans time and time again, they say once you get into the va system, the care is the best in the world. let me repeat that. once you get into the system, the care is the best in the world. it is this initial appointment that's so hard to get. i am troubled by the gao finding
that nearly half was unable to access primary care because va medical center staff did not schedule appointments for these veterans in a quick timeframe. the gao report goes on to say that veterans' access to primary care is hindered by data weaknesses and the lack of a comprehensive scheduling policy. we are at a tipping point right now. as to what the va would look like and the services it would provide for veterans in the coming decade. i look forward to hearing from witnesses today as to what this aspect of the va would look like in the future. with that, mr. chairman, i yield back the balance of my time. >> thank you very much, ms. brown. as custom with this committee i would ask all members waive their opening statement to allow me the opportunity to introduce the witnesses at the table
today. from va we'll hear from dr. shulkin and he's accompanied by dr. lynch. assistant deputy under secretary for health and clinical operations. from the office of inspector general, we have mr. larry reinkemeyer. he we'll hear from ms. debra draper director of the healthcare team at the government accountability office. i would ask if the witnesses would please stand so we can swear you in. raise your right hand. do you solemnly swear under penalty of perjury the testimony you're about to provide is the truth the whole truth and nothing but the truth? thank you. please be seated. let the record reflect that all witnesses did answer in the affirmative. dr. shulkin you are recognized for your opening statement of five minutes. >> good morning, chairman
miller. ranking member brown, members of the committee. as the chairman said i'm accompanied by dr. thomas lynch, the assistant deputy under secretary for clinical operations. seated bemihind me is the senio advisor. i arrived at va nine months ago. i understood this access crisis was a national priority and the status quo simply wasn't acceptable. it's not my objective today to tell you that we fixed all the problems or that we don't have issues. it's my objective today to tell you we are focused on this, this is my number one priority. that this is vha's number one priority. we're going to stick at this until we get this problem resolved. the first thing i did when i arrived as the undersecretary was to assess all the data on wait times. there were file cabinets full of reports and book shelves filled with data. i have to tell you, i made it through medical school okay but i had a hard time understanding all this data. very confusing.
what i didn't see was the ability to clinically prioritize which veterans needed care the first. i didn't know how to run a healthcare system unless i understood that you needed to see the patients that were sickest the first. so that's the first thing we did. we changed it. we opened up every va medical center across the country and saw those veterans who needed the care that day on the day of the stand down. and that led to real significant improvements. we had 57,000 urgent consults in what we call level one. at the first stand down. today, it's a 77% reduction. there are 12,000 urgent level one consults. we addressed 81,000 urgent appointments and got 93% of those gone through and resolved. this month, we're launching what we call our declaration of independence, which is called the declaration of access which
are nine core principles that are going to fundamentally redesign the way we provide access to veterans. they include some pretty bold moves like same day access in primary care. and same day access in mental health. now, i will tell you, these are aspirational goals to be done by the end of 2016. but i'd never been part of a change effort that started with low expectations. and i'm confident we can get these bold goals done. because today, we have 34 medical centers in the va system that are currently doing same day access in primary care. we can do this, we have to spread these best approximatitoapproximatpractice through the system. we have to make the wait times more understandable. very difficult to understand. i will tell you that i am -- my academic studies are patient safety. i teach my students there are bad systems not bad people. and so i've already said we have to change our systems. but when we do identify bad
people in the va, and people have lost their ways not following our values we will hold them accountable. we have held 29 individuals so far accountable with disciplinary actions as the chairman said four of them have been fired. we've trained 32,067 schedulers, we've done 11,500 individual visits auditing the schedulers. the joint commission has been invited and visited every single one of our medical facilities, we have a new training program for schedules to launch this spring beginning in may. but our measurement system is too complex. and where i want to move this to is the veteran experience. asking veterans are they satisfied with access. in every medical center today we have a system called vet link. you come in go to a kiosk, you are asked whether you're satisfied with the access to care, 89% of veterans today are satisfied with the access to care throughout the va's.
i have all of your individual data by the way. but we have to do better. we hired 17,000 new employees in the last fiscal year. that's a net number. a 10% increase in productivity over the last two years, 2.2 million sca 2.2 million square feet we've added of space. a new veteran's application that they can schedule themselves. we've allowed direct scheduling in optometry. group practice managers now over medical centers. we're sharing best practices across the entire system h. we're working closer with our community partners to provide care. 57 million appointments last year as the ranking member said. 1.6 million more visits last year than the year before. 96% scheduled within 30 days. we're processing claims faster than every before. we're looking forward to the
comments by the gao and ig. we're not afraid of criticism. we welcome it. we want transparency. the va is making sweeping changes, we're making progress. that's what i'm here to do. recall as the ranking member said the va provides excellent care every day. this year alone, four peer reviewed studies showing our care is equal or superior to what's happening in the private sector. we appreciate the support of all of you on this committee and look forward to answering any questions, thank you, mr. chairman. >> thank you. mr. reinkemeyer you're recognized for five minutes. >> mr. chairman, thank you for this opportunity to discuss the recent reports we have issued that have addressed various obstacles to veterans receiving timely access to healthcare. i'm accompanied by the deputy assistant general frl for audits
and evaluations. two years ago, veteran's access to care became a large focus. in twout we published two reports detailing the conditions that existed at the phoenix healthcare system and provided lur leadership with recommendations. these reports brought accountability over serious access issues. since the report, we have initiated a series of audits and reviews evaluating the extent to which veterans receive care. we have published reports detailing veterans' experiences during their application and enrollment for healthcare. vha's effectiveness in psychiatry. a number of reviews are in progress including work that congress requested to evaluate hiring approximapractices and c concerns about timely access to
care. the national attention sparked by our reporting on the phoenix healthcare system resulted in a dra dramatic increase to the number of inquiries and requests sent to us by members of congress. a number of these hot line congresss allege inappropriateness by staff. our audits reviews and inspections have reported challenges va faces in administering all aspects of programs authorizing and scheduling care and documenting care in the medical records and timely and accurate payment for care. two reports we issued in february 2016 highlights some of the problems we see. in our review of alleged untimely care at the colorado springs community based out patient clinic, we found some
veterans did not receive timely care and non-va care staff did not add veterans to the veterans choice list in a timely manner or in some cases not at all. this occurred because staff used incorrect dates that made it appear wait time was less than 30 days which resulted in the veteran's exclusion from vcl. in our review of alleged scheduling issues in tampa we substantiated the facility did not add eligible veterans to the vcl when their scheduled appointment was greater than 30 days. we found staff removed veterans from the vcl and the facility staff did not cancel existing appointments when they did receive a appointment in the community through the veteran's choice program which blocked other veterans from taking that va appointment. my office recently initiated a pilot project to audit one vision and his facilities to evaluate three components to
access. data reliability of wait time, access through the veteran's choice program and consult management. our objective for this pilot is to provide comprehensive oversight at all facilities in order to provide the directors a report detailing their current data and scheduling practices. we hope by focusing our resources on this issue we can audit facilities every three years as we currently do with our regional offices. we feel the work is important and will help provide a veteran centric view of what actions are being taken. our work has shown va faces changes. we have a number of active projects involving vha practices and procedures that ultimately affect access.
we will provide over sight to move these programs forward. this concludes my statement. i will be happy to answer any questions you or the committee may have. >> thank you. mr.s draper you're recognizes for five minutes. >> chairman miller, ranking member brown and members of the committee. thank you for the opportunity to be here today to discuss veterans access to va healthcare. my testimony today is based on gao's ongoing body of work including a report released yesterday on veteran's access to primary care. i wish i was here to discuss better news. that's not the case. since 2000 and in particular over the past five years we have consistently reported on va's failure fto insure timely acces to healthcare. in 2012 wait time data were unreliable. implementation of the scheduling policy was inconsistent across medical facilities. telephone access was problematic and scheduling resources were
not effectively allocated. in 2014 we found access to out patient care was problematic due to mismanagement of the consult process. in 2015, we looked at veterans' access to mental healthcare and found the way the va calculates wait times does not always reflect the overall time a veteran is waiting for care. and access data may not be comparable overtime or between medical facilities. our most recent work focus on newly enrolled veterans' access to care which is typically the entry point of the va system. we found many of the same problems as we have previously reported. we reviewed a sample of 180 newly enrolled veterans, medical records across six medical centers and found for the 60
veterans who requested va contact them to schedule appointments, but had not been seen by primary care providers, 17 were contacted because these veterans did not appear on the new enrollee list which is intended to help track newly enrolled veterans. officials were not aware this problem was occurring and could not tell us why these veterans did not appear on the list. for 12 of the 16 nearly enrolled veterans, medical centers did not follow policy for making contact to make an appointment. there should be three documented attempt by phone and a letter sent. for the 120 veterans who requested care and were seen by primary care providers we found the average number of days between the initial request they be contacted to schedule appointments and the dates they were seen range from 22 to 71 days. half were seen in less than 30 days. veterans' experiences varied
wildly with 12 waiting more than 90 days. delays in care were due to appointments not being available when veterans wanted to be seen and medical center's failure to follow scheduling policy. and this most recent work we continue to see data weaknesses due to errors such as schedulers incorrectly changing dates, as well as the lack of a comprehensive scheduling policy which has created confusion, and contributed to the errors seen. in 2015, veterans healthcare was added to gao's high risk list due to va's problems providing timely access to care among other reasons. this list identifies operations that are vulnerable to fraud, abuse or mismanagement or in need of major organizational transfo transformation. we identified a number of concerns all of which affect veteran's access to timely healthcare and includes, for example, ambiguous policies and inconsistent processes
inadequate oversight and poor training. it's been over a year since the addition of the va healthcare to the high risk list. we have seen little progress. we are very concerned about the lack of meaningful progress, and our concern is heightened further because the window of opportunity for making progress under the current administration is rapidly closing if not already closed. the access problems are significant persistent and a disservice to our veterans and places them at risk for harm. the status quo is not appropriate nor should it be accepted. this concludes my opening remarks i will be happy to answer any questions. >> thank you very much. dr. shulkin, i know that you have been hard at it for nine months. simple question, does it irritate you that even after your nine months -- we're talking about two years from the exposure of the wait time
problem that there still is serious problems and manipulation of wait times? >> i am very, very impatient to get this problem resolved. and i am concerned that we have data out there that is not necessarily understandable by people. i am concerned when i hear about mistakes being made and wherever we do find there is manipulation of data. that's unacceptable and we're taking action. we're doing everything we can. am i am patient, upset about it? absolutely. and we are -- this is why it's our number one priority, mr. chairman. >> expound on the action that you're taking. because it appears, you know, that folks have said for almost a decade it's been lack of training or improper training. that's ten years that this has
been going on or more. give me some concrete steps as to what you're doing and have you really analyzed what the root cause of this issue is? >> well, let me first start. it's an excellent question and a very fair question. first of all, i want everybody to be clear, we do not have access or wait times in our performance measures. nobody is getting bonuses there is no incentive whatsoever to be manipulating this financially as there was in the past. so i think thanks to your committee's work we made sure that isn't existing. i'm going to go back to the fact that in general, we mostly of our 340,000 employees have very, very good dedicated employees. we have bad systems in place. one of the things that we've talked to you about is this is our current scheduling system to
the right. it is dos black screen. to think this is how we're having our 32,000 schedulers have to schedule appointments invites confusion. it invites the inability to do this accurately. we are putting in now currently being rolled out the one to the left, which looks like a microsoft outlook calendar. that's important we give out the right tools. we're evaluating a commercial system which offers greater capabilities. number three, we are insisting that our leadership do visits to the schedulers. personally. and where they find that people aren't scheduling appropriately, they're pulling their scheduling keys and we're doing that on a regular basis. we're talking about this and trying to do better training. we are taking disciplinary actions where we find the people have deviated. and so we're going to have to
stick at this. i don't know any other faster magical way to make this happen. and i'm frustrated by it. >> i think it would surprise many of the members to know, maybe it wouldn't. you know, we just saw an example of the scheduling software that's being used $127 million later and we are just now looking at something that could be purchased off the shelf. gao found that one third of the veterans it reviewed, 17 out of 60 did not get contacted for an appointment because they did not appear on the list. one would assume that directors at these facilities neither knew this was occurring nor they didn't know why a veteran would not appear on the list. so the question is, why would a hospital director not know?
>> yeah. well, when you riead the report i think it's pretty clear that we didn't do the best that we could for veterans. so that's why we appreciate the spirit and the information because it's going to help us do this better. we are sunsetting the report. we are moving it towards an automatic system called welcome my va where we're contacting reaching out to every vaeretera. part of the problem was we had the wrong phone numbers for some of the veterans, we couldn't reach them. when we reach some veterans, they didn't want appointments, they wanted cmp exams, we get them there. other veterans said no thank you. i no longer want an appointment. we have to do a better job, but it wasn't that every veteran that ms. draper just mentioned we failed. we failed too many. but a lot of them, frankly, those facilities just weren't able to get in touch with or when we did they didn't want the
appointments is. >> okay. time has expired but i've got one more question i want to ask you. because a lot of folks have talked about accountability at the table and wanting to hold people accountable for things they have done. in the media, there have been examples including an employee who participated in an armed robbery. a chief of staff that was improperly prescribing drugs to someone's wife a nurse who is being charged with manslaughter in the death of a veteran patient. they're all still on the payroll. similarly, according to the weekly list that va provides to the committee in the wake of the nationwide wait time manipulation scandal. va has successfully fired only four people for wait time manipulation. how is any of this possible? especially those on the front end who have been -- some of them have been convicted of crimes.
>> yeah. it seems hard to believe, mr. chairman. so let me try to step through my understanding and if i make any mistake as i will commit to you i will get back to you with that. you mentioned the director, he is not on our payroll. he's retired from federal service. it is my understanding that the person who was found with some of the criminal allegations no longer at the va. the person -- one of them actually is going through a court hearing and we're following the court's procedures on that. look, somebody who does either violate the law or violate our principles, does not belong at the va. and we clearly take that seriously. we go through a very extensive process of, you know, due process to get them there. sometimes it takes a long time.
but we do not want people that shouldn't be treating veterans treating veterans. and i take that very seriously. so if there are some of those cases you've talked about we haven't acted fast enough we'll go back and take a look at them. >> you talked about the director having retired. it wasn't the director, it was his wife that was receiving prescription drugs by the chief of staff of that particular hospital. something that hit the press a couple weeks ago, and that was the doctor that was -- had his medical license suspended for emergency reasons by the state. i believe you took action, fired that individual. now a court or a -- it's been adjudicated his license should not have been suspended on an emergency basis you have had to i assume put that person back on the payroll. >> no. >> not on the payroll?
>> no. you're correct about the court action, but that does not change our administrative action. >> is that person appealing at this point your firing of them? >> my understanding is they're looking at their options in that regard, yes, sir. >> because my question would be if that person is brought back on the payroll and subsequently the medical board goes through the normal process of suspending that person's license, how do you get that money back from that individual that comes back on your payroll? >> well, you know, i think we have to let people have their due process. but right now, we've made the decision an administrative decision not to have them on the payroll. we are not planning on changing that decision unless there's new information that comes up we would have to consider. >> okay. thank you. thank you very much. ms. brown. >> thank you, mr. chairman.
mr. secretary it seems like you've been here longer than nine months. this problem that we're having with the va goes back more than ten years, you know, i've been on this committee for 23 years. we've had problems with the va over a long period of time. and it would be a misnomer to act like these things just occurred. but what i would like to ask -- i'm very concerned about -- is the report have once again, just a couple days ago put va on the high risk list. explain that to me and what we're doing to take care of this problem. i want to get to the stand down what you all have done and the positive things you all have done. please tell me about this because i'm concerned. >> yes. well, i believe the va was placed on the high risk list probably well-over a year ago. it was prior to my confirmation. but the gao has been very clear
about the reasons they put the va on the high risk list. we have inconsistent policies and procedures. we have not systematized best practices or best processes across the va the way a healthcare system should. we have out standing recommendations. i think we've gotten some of them down. there is many outstanding recommendations. we work with the gao on a regular basis. the gao was right in this regard. we have policies and procedures that were conflicting. and we're working to fix that because you can't have that. and thebubest practices across system is what health systems should be doing. we're focused on learning from the best and putting it throughout the system. this will make va a better system. and i thank gao for that. i'm anxious to get off this list
fast. i don't agree with ms. draper's assessment we're not making progress. i know we're making progress. it may not be as fast as she raup wants us to but we're heading in the right direction and addressing the right issue. >> the stand downs. >> the stand downs are a part of it. the stand downs aren't a way you sustain improvements. they are declarations of emergencies. when you have urgent patients that aren't being seen they are emergencies. we have to act like that. they've led to sustainable improvement. nine core principles of how we'll redesign access in the system. a year from now we won't be talking about this in the same way. >> when you had the stand downs, how many people showed up in the various areas? >> 100% of our medical centers were open on those saturdays. no exceptions. people asked for exceptions. i denied them. so we acted as a system in the
country, thousands of people -- doctor, do you have a number? >> i think we had 5,000 employees that were actually involved in the stand down. there were 10,000 patients or so that were actually seen on the day of the stand down. make no mistake, the stand down was only a symbol. everything was going on prior to that stand down. so we were actually evaluating open consults and pending appointments, scheduling appointments and assessing patients prior to that. the stand down was actually a way to really bring together the five points that are priorities. we focused on access, we engaged the employees. we looked to the community for help where we needed it. we engaged best practices from across the networks. and we were working to basically restore trust with our veterans. >> i just want to say the next time that you all schedule a stand down, it would be get to let the members know. because we would like to -- i
know i would like to be at my center on a saturday when you all are planning. >> i know at the last stand down, congresswoman i was in orlando, florida. there were members of the congressional staff there. so we welcome your involvement. >> last question, what policy directives have resulted from the stand downs? >> what we've done as a result of the stand down we sequestered a team of people from the field, not from the central office who have told us what needs to be done to redesign the system so we don't get long wait lists again of veterans who need care urgently. that led to this declaration of access. the nine core principles every medical center is signing their name to, committing to the principles to fix access in calendar year 2016 with sdam access and primary care mental
health. eliminating our recall system, which we've been using for veterans for a long time. and in making sure that we're using telehealth and expanded opportunities to improve access. >> thank you, and thank you mr. chairman. i yield back. >> there was something i was unaware of a second ago. you testified, i think, at a subcommittee hearing on thursday about the commercial scheduling software mass that you just talked about. and i think your testimony was that it's on a strategic hold at this point. my -- $152 million is what it would cost to do that? and the question is, how in the world could a pilot cost $152 million? >> so, again, the vse, the vista scheduling enhancement solution that's being rolled out now, total cost of the project $6.4 million. mass, which we do have a contract for, it's an idiq
contract. so we can implement this. the next step would be to do a pilot at three sites. it would be a ten month pilot where you have to build the interchanges, and the cost is $152 million. the total cost of the national rollout is 600 and something million dollars. >> with that mr. lamborn you're recognized. >> mr. secretary, you paint a much too rosy picture. the system is broken. for those of us on this side of the dais we talk and listen to the people and the people are frustrated and angry that we have all of this dysfunction here in washington. and more specifically, with the bureaucracy that continues to fail our veterans. people want real reform, real change and not just talking points about how everything is about to be fixed. and i've been told to my face the problems were already fixed
at the beginning of the study and what the gao documented -- office of inspector general documented was after the beginning of the study and everything's okay. we can't have a real conversation if you won't admit there's a problem in places like colorado springs. i'm going to share with you a brief excerpt from a letter i received from a constitchuent. he wrote a respectful letter. sir i speak for myself and thousands of veterans when i tell you enough is enough. he says stop the tough talk and for once act on the corruption and deceit going on at the clinics. he's talking about colorado springs. he ends with this letter describing a 14 month run around with the clinic and says when
will it stop? so when will it stop, mr. secretary? veterans take way too much time to get their care. and they're not being able to really have access to the veterans' choice program. which is especially frustrating because that was implemented by congress to try to stem the tide of some of this dysfunction. so the first question, mr. secretary, according to the oig and places like colorado springs, va staff did not add some veterans to the choice list or did not add others in a timely manner. what we see clearly is that besides the va altering the times for va care like phoenix and other places all over the country, it now does the same thing by acting as a gatekeeper of veterans who should have access to choice. why aren't veterans really being given the opportunity to use the choice program?
>> okay. congressman, if you think i've painted a rosy picture, i failed. because i'm telling you right now, i am acknowledging that we still have significant issues and we have a lot of work to do. and that's why it's my top priority. i'm not going to rest until we get this fixed. i am focused on it. you and i sound similar when i'm with my staff. because i'm hearing directly from the veterans just like you. so i'm with you. what i am saying, and maybe this is where you thought i was painting a rosy picture. i know we're headed in the right direction. where we had 57,000 urgent veterans waiting more than 30 days for care, today that's 12,000. our electronic wait list for level one, down 32% in the past couple months. our veterans are telli us, we can't manipulate this data. 89% are satisfied with their care. the choice program isn't working for veterans. there's no question. al we've told you that.
and we need to make this system work better and that's why we have legislation before you to try to simplify and trestream l to make this work better. we have significant problems. i'm hearing the same things you are. we're headed in the right direction. but we are long way from declaring we've got this problem solved. >> mr. secretary, your own metrics from february of this year showed that 29% of veterans received appointments in excess of 30 days, 5% waited longer than 120 days. worst of all over 2,400 veterans are waiting on a wait list to receive an appointment. 708 have been waiting longer than 120 days. these metrics made the clinic in my district the eighth worst in the united states. so and i know of at least three people who have died and it
could have been because of this waiting problem. it could have been directly a result of these delays. so i don't see the va fixing it, i don't see see them being held accountable and i just have to agree with the man who wrote the letter to my office, enough is enough. thank you, mr. chairman. i yield back. >> thank you. you're recognized for five minutes. >> thank you, mr. chairman. i'm very concerned that the vha has been placed o ton jos high risk list and that veterans are still struggling to get timely access to care. the va has undergone significant change in the past year and it will take a continued commitment from those in this room and members of the committee to work together to make sure the va is functioning the best it can to
care for our veterans. but i want to move on to some other questions i have. your testimony, you mentioned that one of the va's top priorities remains legislation to streamline the process for va to work with outside providers. i'm concerned that the provider agreement legislation this committee considers throws out crucial workplace protections in the order of expediency. when we marked up a provider agreement bill to ensure that the office of federal contract compliance programs retained the authority to enforce workplace nondiscrimination protections. it is o tnl office that protects lgbt employees from discrimination in workplace and veterans for their veteran status. your testimony seemed to imply that we can improve provider agreements without undermining workplace protections. do you agree sm?
>> we need provider agreements to make this program work better. it's not working well and we need them desperately to be able to do that. i don't if there's an unintended consequence you're talking about, so i haven't looked at your legislation, but we have no intent of wanting to impose discrimination or to take away protections from people and putting in place provider agreements. what those do is too many small providers, the doctors and small practices that are today caring for veteran, can't deal with the federal contracting processes. it's way too complex and they drop out. especially our nursing homes and our skilled nursing facilities. so, we need provider agreements to do an easy to do contract to care for our veterans and we have no intent to discriminate against our employees.
>> i'm ksh concern nd the spirit as quickly as possible on two counts, the possibility that lgpt people could be discriminated against and that our own veterans could be discriminated against. that we need to balance the provirds but make sure they're not discriminatory. >> i have to tell you, i don't the linkage between what a provider agreement does and how it could potentially discriminate, but i will get back to you and have our legislative people help me undetand that because that's not our intent. >> leveraging community providers can benefit veterans, but we must be mindful that
there are many areas across the country that face health workforce shornlg shortages in the private market. that's why i'm so supportive of increasing residencies in the choice act. can you give us a brief update on how that's going? >> i think it is one of the most important things you authorized as part of the choice act. we need to train more health care professionals. there are actually more medical students now than residency spots and so, the va expanding these spots is important. you authorized 5,000. to date, we've only implemented more than about 380 of those spots. so, we're continuing to work with your academic partners in your districts to look to expand these. there are a couple of issues. one is the funding.
so, we save our academic partners in california, would you like to expand your psychiatry program and they say, of course we would. but the fund iing is going to b eliminated when choice is set. what happens then. that's one of the problems we'd like to work with you on. >> i think there are members on both sides working with you on that, as well as the medicare cap issue. >> we believe this is part of the solution. training more health care professionals in areas of need. i know for for example, we are working with texas tech on the new agreement. >> i appreciate my colleagues on the other side of the aisle. >> there were two, 10 billion, then five.
so, the 5 billion doesn't sunset. the choice program sunsets, but the program is there until the 5 billion goes away. >> my understanding is on the gme program, it has a five-year length of time. if i have a correct understanding of that, that would be good news. >> so, it's your testimony today that part of the reason you can't get more slots is because of the sunset and that needs to change. >> the reason we're not going faster is our academic partners need to agree to do this with us. they're telling us there are two things in general keeping them from going faster. one is the medicare cap issue. the medicare cap says if you go above your number, you can't get additional medicare reimbur reimbursement and indirect
graduate funding. every hospital i've worked for has been at their cap or above. the second is the length of time it take to start a program. when you start a program from ground zero, starting it often takes two years or so. if your money is going to expire before you graduate your first group of residents, the administrators at those hospitals say i'm not so sure this is a great deal for us. those are the two issues i'm hearing. if i have it incorrect about the moneying running out, that would be good news. >> just now talk iing about setting up the program, somebody's way behind the curve. i would tend to believe that the bigger issue is the medicare cap issue and the reimbursement rate, but mr. miller, recognized. >> thank you, mr. chairman. i appreciate it. you mentioned in your testimony about direct scheduling. i want you to elaborate on direct scheduling.
it's available to certain veterans for certain specialties. elaborate. for the benefit of our veterans out there, who can direct schedule and why is it only limited to a couple of specialties. >> the way the va has done this for a long time is you go through a primary care physician, a gate keeper. so, you have to be able to get an appointment with the primary care doctor just to be authorized to get a consult. i have to tell you, i practice now, i'm a primary care physician in the va. my first appointment was just to get a pair of shoes. i had to actually approve a consult to get a pair of shoes. makes no sense. so, we've started piloting program where veterans can now directly schedule without going to a primary care doctor, in audiology and optometry. it worked terrifically.
we're expanding that now across the system. i think it was done in florida. i want to look as you're saying, other specialties. podiatry. social work. nutrition. all sorts of things that frankly veterans can make the decisions themselves. they don't need primary care doctors time to do it. >> very good. >> another question has to do with walk in clinics. how many walk in clinics are out there. you mentioneded about access, same day access. is that widespread? we have a walk in clinic in our outpatient center and i think it works very well. >> where i practice in new york city, that's where i practice in the walk in clinics. we're there if anybody needs to be seen, we see them that day.
what many, why don't they? >> because many, 34, have same day access in their primary care centers. if you can see your patients through your primary care center, you don't need walk ins. the other ones do need some type of urgent care visits. we do know that in areas that are challenged, they've begun some pilots with commercial urgent care clinics as well, too, so this is part of our declaration of access. walk in clinics are a strategy to get there. >> do veterans who need same day access, do they all qualify for care? >> we don't have walk in clinics
in defevery -- >> the ones that do. >> i can tell you if there's a walk in clinic and they are eligible for va care, they can walk in. yes. >> thank you. >> next question. one of the va's legislation asks is to have flexibility to avoid artificial -- many issues in which they attributed to lack of training and education. not too long ago, the va found a budget shortfall for the same fiscal year. the va did not submit to congress a formal request for emergency funds until months after the va had already identified a potential budget shortfall as early as march of that year. this was in part due to the employees were not utilizing the $10 billion appropriated for community care by the choice
program and utilizing the traditional nonva care account. the va's only solution was the potential shutting down of facilities throughout the country that's unacceptable. the question is should congress allow such flexibility. what assurances to veterans and taxpayers have that employers will be trained this time around properly so another budget shortfall, medical facilities being closed, does not happen again. >> i think you got it exactly right. which is what we had was we had spent all the money in one checking account, so it got down to zero, so we had lots of money in another checking account. in order to be able to give veterans care in the community, we had to ask you for authorization at the next minute. what we're seeing is we don't ever want to do that again. it's not acceptable. it's not the right way to run a
system. we want the community to use care in a community funds to support veterans who get care in the community. that means when we train our people in the system how to use it, we can train them there's one pot of money and now, focus on doing the right thing on veterans instead of following rules for seven, eight, nine different pots of money that are too complex and we've shown doesn't work for veterans. that's why we need this type of legislation and we need your support in getting that passed. >> thank you very much. i yield back. thank you. >> thank you very much. you're recognized for five minutes. >> thank you, mr. chairman, for holding this hearing. the issues we're discussing are wrong in so many different levels. i'm going the talk about three, one, are your goal, two, our data integrity and three is the veterans experience. so, goals are important because it defines your success. it helps you achieve your objectives. setting a goal of 30 days is
arbitrary. there is no clinical day to to suggest that's the best practice anywhere in the health care literature. and you had mentioned a term which earlier in the beginning of your presentation about trying to match scheduling with the clinical practice. right? so, we know that illnesses are urgent, emergent and we need to take care of them right away and some others can be scheduled. maybe more than 30 days like your routine colon os ko pis like you get once a year. i think you need to start changing your premise and getting more towards a clinical approach so you can take care of your high priorities first and not necessarily rush or take up your high priorities on things that can be done on a routine basis. the second thing is setting up
goals of urgent care appointments is nonsensical. why are they urgent if you're going to wait 30 days? usually, an urgent is what you call your walk ins or maybe within 48 days when you want to match your clinical practice with your scheduling goals. the third thing that i'm concerned about in terms of your goals is the use of the word same day access for all primary and mental health. you're setting yourself up for more controversy by not clearly defining to the veteran what access is. is it going into picking up u the phone and having speaking with a scheduler? is that what access means? is it receiving the appropriate care? is that what access means? so, the second part is your data integrity, now, we use population studies to reduce the chance that errors are done by chance or so that we can get a
statistical significant accounting of whether this is a true problem and whether this is systemic. but the only way we can really rely on those population studies is if you're data is accurate. if your data has integrity and the gao is continuing to find faults in the way that you collect data and how you're reporting it. so, you can understand why we're still skeptical when you tout the number that 96% of all appointments have been seen within this arbitrary goal of 30 days. the other thing is the way you report data. so, you're telling me that by veterans who use thvet link inse the hospitals are telling you that they are 89% of them rate their access good, but you're giving me data with a very high reporting bias. of course they're going to rate
it good because they're on the inside of the hospital. how about asking those that don't get access that are not inside the hospital, so tell us what their access is going to look like. so, for those of us who know statistics and know methodologies, we are skeptical when you report some of these reports to us. that may not be as accurate as possible. and lastly, when we can't rely on population data, when we can't rely on the integrity, then we go by case studies and case studies depending on the accuracy and write up and details is what oftentimes we're left to look at. so, let me tell you about case of a wounded warrior who actually works in my office who is a hero in my book. went for his yearly check up for the va. he has service connect disabled, manages well. prescribed medication through
the va. after waiting 30 minutes on hold, 30 minutes on hold, the veteran was notified that because he had not had an appointment in over a year, he would have to schedule a new patient appointment even though he was not a new patient. he agreed to the appointment, asked to schedule that appointment as well. they couldn't fit him in until 134 days later. again, arbitrary. as a result, this veteran elected choice, but they said you have to come in and do your new patient appointment before you get to your choice appointment. so, one, what is same day access mean and two, why do these arbitrary numbers exist in the first place. and three, why do they need to have, why do veterans need to have a new patient appointment? after a certain amount of time, even though they've been getting
prescribed medications you know, as recent as a month. >> thank you. and i appreciate your skepticism. i think most doctors and politicians generally are skeptical of data and i think that's a good thing. first of all, you said it absolutely perfectly. the va needs to clinically prioritize its appointments. exactly what i brought into the system. we used to have 31 days of ordering a consult. today, we have two. either urgent or it's not. there is no 30-day rule for urgent care. i don't know where you got that. that does not exist. urgent patients have to be seen now. that's why we did the stand downs. i've never had a patient with an urgent care need that i wasn't getting them to be seen right away. that's our goal. get them seen right away when they have an urgent care problem, so acompletely agree and you said it perfectly. secondly, same day access. what does it mean?
revolving the veteran's needs that day. if they need a prescription prefilled, they don't have to come in. we can do that on the phone or electronically. if they need to talk about how to understand how to use their treatments, we can do that over the phone or tele het. but patients who are sick and need to be seen should be seen that day. that's what we're working to get implemented. we have to set expectations and explain it in a way quicker than we do today. the last thing about the veteran's experience, the only thing that matters, are we meeting the needs of veterans. the vet link system we talked about asking them when they're in the system, you're right. so, we have a second survey called taps. it's what's used by the private sector industry. that asks whether you've been able to see your doctors when needed. so, we compare ourselves to the private sector using caps. internally, we use the vet link system because that's a point of care system. so, all your points are
absolutely right, congressman and we take them to heart. >> thank you. >> dr. roe. >> thank you, mr. chairman and you know i have great respect for you and one of the things i don't think i would have said if i were you is that one year from now, things would be different. not sure they will be. i hope they will, but i'm not convince. just a couple of three points. i'd like to have your answer on. one is if the va is doing its job, why do we need a stand down? why did that need to be done? >> believe me, stand downs are not the way you run a system. dr. roe, absolutely right. the reason is because you reach ed an unacceptable situation and the day i learned literally, the day i learned with 57,000
patients who had urgents consults greater than 30 days, i said there is no nothing but declare it an emergency and that's why two weeks from then, we had our first stand down u. it's unexplainable. but that can't be the run you run the system. you have to put in sustainable fixes. that's what we're doing now. i looked at the numbers. schedulers. 32,000. that's plenty. they schedule ten people a day, shouldn't overwork anybody. that's way past 70 million schedulers, i mean appointments in a year, so you got that fixed. if the system works and i would like to have you guys define what an appointment is. what i finally figured out there this is look, the day i called. >> we're leaving this recorded program, but you can see it fwen at 8:00 p.m. eastern. we're bringing you live road to the white house coverage in annapolis, maryland where john kasich is making a campaign stop.
>> thank you. again, there's a lot of new people. i'm the mayor of annapolis, maryland. i want to thank you all so much for coming out and supporting john kasich to be our next president. yeah. it's only a sheet if i needed it. well, governor, we're proud of the work you've done. governor, congressman and the work you're doing to do as president of the united states on day one u.
i was coming here and somebody asked me, why are you supporting john kasich for president and i told them because the country needs a strong leader to take us forward. i said the national debt, the taxes, we're on an unsustainable path and when you look at someone who has the leadership and the vision to do it, we've seen that with governor kasich. we can put this in perspective for everyone. the last time the federal government was balanced whuz when john kasich was the budget sharer. we need someone who can be a commander in chief. america used to have a lot of respect in world and some of that's gone away. last night, i was speaking to all the service academies.
people from air force, west point. i was congratulating them on two new majors. cyber operations and nuclear engineering. the challenges we face in america and cybersecurity are historic and unprecedents. the country's never seen a threat like before. people from other countries, come in, hack our bank accounts, steal our personal records and even take control of a nuclear reactor. who's the one person that's running that has more experience than everyone combined? this man right here, john kasich. a lot of people ask what is someone going to do? and all you have to do is look at their record. in ohio. he took away an $8 billion, billion dollar deficit and created a surplus. he cut taxes.
he cut regulations and he put people back to work, which is what he's going to do for america when he's president. thank you. haven't cheated yet. i know. so, a man who's ready to be commander in chief, you know, kind of stand ng this room looxs like a boxing match. we're going to need somebody in here who's ready to take it on because like i said, the challenges we've faced, we've never seen before. we got a man with leadership, with vision, with passion and a proven track record and that's why i'm proud to stand here today. i want you to make some noise. get excited for the next president of the united states, governor john kasich.
>> wow, i got to tell you. you guys have a great mayor here, don't you? young, articulate, a good leader. how old are you? and then what is your experience? >> you know, i wanted to be mayor for a long time. i did. no. i set out a five-year plan. i had worked on campaigns i managed, political campaigns. mayor's races, state senate race. worked for a software company sellinging management software as president of my community association, so had a five-year plan. set out, it's what i wanted to accomplish, it's been a blessing. 38,000 people. >> i think you got an up and comer here. everybody, have a seat. have a seat. okay. well, it's such a nice, did
somebody, who made these signs? no. okay, they made these signs, okay. i thought somebody might have paid you for them. resist the rage. research think. that's like a think tank or something, isn't it? research. no, we like the signs. they're really, really nice and you're all very, very nice to come out here and cram in here and we want to make sure that we take your questions. i had a really interesting day today. i flew in to pittsburgh last night and this morning, i went to this place called the duquesne club. now, when i was very, very fancy schmancy, when i was a kid, we used to take the bus from my little town in the keys rocks to downtown pittsburgh. and then we kind of walk to the different stores. my buddies and i. then we would go past this
duquesne club and there was always a red carpet out in front of the duquesne club and there was a general who was always stationed there. and we would walk by and we would look like this. like wonder what goes on in there. then we would all salute the general. i found out 25 years later he was the door man. okay. honestly. so now i've been in there a couple of times and then we had some events and then we went to this place called the oyster house, which has been there are if i don't know, 125 or 30 years. they wanted to take me to some like retail place, so i said let's go to the oyster house, then people showed up at the oyster house and i got to see some people who i literally haven't seen in about 30 years. and they came and they gathered and then i just looked around
and what a country we have. what an amazing country. and -- i've had such a good life. my father was a mailman. he carried mail on his back. his father was a coal miner. he died of black lung. he was losing his eyesight, there was nobody to kind of stick up for my grandfather. my mother's mother could barely speak english and actually, i remember the night she was taken from our home and she didn't survive the attack she had. barely speak engineer lir. my mother was one of a four kids. and she was the only one to have graduated from high school and really the only one to have gotten out of the eighth grade. and you know, they were like my
mother and father are gone, but i had some relatives there today. and we all look at one another and we're amazed and i have to tell you that to have a beautiful crowd like this, to have people come and listen and paint signs and whatever, i am, i'm really humbled bit and i want you to know that i'm just like a normal guy in a big office. okay. and i will be a normal guy in an even bigger office if i would become president. so, i happen to believe that what i have been given in my life is i don't want to get anybody too uptight here, but the lord has given me grace to do many things in my life, okay, and so, when that happens, when
that happens, if you recognize it, then you have to always try to honor that grace. and so for me, the thing that i've always been committed to is making sure that people, not my grandfather, but people like my grandfather, there was a guy that lived near our house, he would get up in the morning and always have clean clothes. and he would get in, i don't remember it was a van or a truck. had a couple of kids and a wife. she worked at the little bakery down in the little just down the road. try to make some money and he would come home at night and usually come home later than my father or the other fathers in the neighborhood. he was basically a fix it man and he would come home and he'd be dirty. and i'd think about how hard they worked. and i think about how they need somebody to speak up for them.
now, there's two things that bother people in our country right now. there's you know, i think two fundamental things. one is people are worried about their jobs. can they keep their jobs. and wages. can their wages go up. but the other thing they worry about is their children's future. can our kids get an education and can they have a better life than what we have because many of you have sent your kids to school, they have an education. but they're still at home. they can't seem to find their way and i know that people are worried about that. and look, this is not that hard to fix. if we can remember that we are americans before we're republicans and democrats. see, the problem -- the problem that we have is we have not had the leadership to get people to
rise to a higher level than how they would normally perform if they had a governmental position. you see, leaders get people to do better. i mean, if you think about some of the great leaders, just recent leaders in history, if you take somebody that's not even american, if you take winston churchill, he would make these addresses when the bombs were basically falling on every neighborhood in london. somehow, he would say we're never going to give up, never going to give in. people would come out of their homes, things would be basically destroyed. they'd get out their broom, sweep the streets and wait for the next bombing. he had a magic about him where he could get people to rise to a higher level. we think about reagan. saint ron. i actually knew saint ron. and look, we've created this caricature or image of him that
just isn't true. he was a guy that was practical man. a conservative, but he could figure out a way the get things done and he could get people to lift themselves higher than what we're, what we normally do. anytime you think about great leaders, you think about sports figures, you talk about soldiers. doesn't happen to matter who it is, they are people who can get people to perform at an extraordinary level and what i've noticed in government here for a while is that people we we're having the leaders to get people to do that. when you do that, it's like a flock without a sheppard. and if the shepherd doesn't guide the flock, the flock wanders around and things never work out the right way. that's what we have been missing. but there's another thing that we have to think about. i'll leave plenty of time for questions tonight. and that is us u.
so, today in pittsburgh, see, because pittsburgh is like baltimore. they're like two sides of the same coin. okay. you know, they're just, it's just neighborhoods. it's ethnicity. the ethnics. there's a connection. a closeness to them. when i was a kid, i've mentioned this before and i mentioned it today in pittsburgh, our hero wasn't some politician. we had a lot of politicians that really didn't do a good job. in fact, a number of them where i grew up couple of them went to jail. and no, they did. i went to my high school reunion. and i had become a congressman and i was like, you wear your best clothes. dye your hair, i don't dye my hair, but i would have if i needed to. it's just a great thing. especially if you've been successful. so i go to my reunion and i'm a
congressman and pretty proud of myself, you know, so i go in, a guy walks up to me. he says, johnny, i hear you're a congressman. he said, you know, i voted for you to be one of the most likely to succeed, what went wrong? no, in that little neighborhood, in that little town, our hero, one was robert clemente. he was a great, great baseball player and in fact, i think he was on a team when we might have beat the orioles in a world championship. i can't remember. but we loved that guy. and i only saw my mother in her lifetime cry a couple of times and one was the morning she she came in to tell me that clemente had been killed. in a plane crash headed to help people in nicaragua who had been victims of an earthquake.
you see, we think about what ails us. and we have some politicians that want to talk about our reason, our anxieties and they want to feed them. say that america's losing on everything. are you kidding me? our economies are bigger than the japanese and chinese put pogt. think about our life expectancies, our health care, education, nutrition. think about innovation. think about invention. i mean, we lead the world. the rest of the world tries to steal all of our stuff. okay. but here's the thing that i want us to think about. the leader has to allow to get the people in the government to rise higher. and when you talk somebody like churchill or reagan, unique moments in time where they've been able to inspire the public to do better. to live a life bigger than themselves. i think i was flying in here
from new york. i can't remember. but i met these two guys, they had an airplane. and it was a small airplane. and they got to talking to me because they were from long island. i had just left new york. i had eaten my way all across new york. so, they were there and they started talking to me, i said, what brings you guys here. they said we flew this young child down here who's got cancer for treatment. there was really no way to get this done any other way. we got him in the back of this plane. here, let me show you a picture. i said, why are you doing this? i said you get paid? no. when you fly them down here, does somebody cover your expenses? well, we could, but we don't. we just take it out of our pocket and i said why are you doing this? he said well, i probably made 25, 30 flights for different people. just because it's what i'm supposed to do.
said is this your job? oh, no, i have another job, but this is what i do. really touched me to listen to this guy talk because i always talk about us needing to live a life bigger than ourselves. the spirit of our country doesn't lie in politicians. the spirit of our country lies in us. and somehow over the last few year, i don't know if it's because we pay taxes and we let, tell people you care take of it or whether we just lost confidence in ourselves. whether we have thought that if i can't change the whole world, i shouldn't try and change any of it. and see, i to believe that we've all been made special and we have a special gift. and some people find it when they're 90. others when they're young, but it's important we find it
because when we fibd it, it's been given us to specially to do something special and so folks, if we want better education for our kids, i'll send all the federal money back here, but that's not what stops us from having great education. it's in your hands, in your schools. you have to ask yourself, are we really preparing our young people for the jobs of today and tomorrow? people, they yell a lot, common core. the federal department of education. there's nothing stopping you. from actually being able to fix your schools. if you want to. it's really hard to do though. it's very hard to do. because as a school reformer, i can tell you, the first thing you have to do to be in training to be a school reformer is to stand here and run as hard as you can into that wall, but whether we want to fix our schools, is not up to them. it may be up to the mayor a little bit. he's the mayor of this town, but it's up to us.
if you want to deal with the problem of drugs, there isn't anywhere in this country where i don't hear, it's more than it is in other places. it's in every kind of neighborhood. it's in every city. you want to get rid of the drug problem, go do it. what are we waiting on? if a community decides that they're going to wipe out the drug problem, they will. speaking of pittsburgh. when i was a kid, you'd come out in the evening and there would be a fine layer of silt and dirt on every car. did you grow up there? you know about that? you know what happened? the people of pittsburgh said, we're not going to live like this anymore. they didn't have to go call. it wasn't even a federal epa. they just made up their mind
they were going to do it. and they went and did it and they cleaned up the city, and when you go there, it's a shining city. it is unbelievable, the renaissance that's happened there. they didn't wait for the government. they just went and did it. the same is true about poverty. you know, you have a people who are hungry. we got to get them trained. got to make them offer, bring the business in is welfare office and when a person gets a welfare check, they get trained for a job that exists in a business. this is not hard. you want to fix your kids, you want to get your kids believing in something, mentor them. you don't have to wait. in my city of cincinnati, they claim there's a 63% graduation rate. the businesses of cincinnati in high school in that system, they send their employees in there for an hour a week for a year. the graduation rate in that high school is 97%. okay.
so, if nothing else gets accomplished tonight, i want you to think about what you're supposed to be doing. maybe it's an entrepreneur that creates a small business that hires our families. maybe it's an entrepreneur that's right up against the wall and has the pressure to let somebody go but doesn't. that changing the world? i think it is. if you're a schoolteacher, they're the most underpaid people we know on the earth, okay. they do this. trz she a schoolteacher? you're a schoolteacher? do you have a driver's license? okay. schoolteachers, with these, you're a school teeper here? you look more like one. he looks like he'd be your student. he gives up salary. and he's doing it because she's changing a life. you're trying.
or a nurse. how about these nurses. any nurses in here? how many times, ma'am, did you get done with your shift and you put in other 20 minutes because there was a family down the hall, how many times you do that? a lot. right. most important thing that i nurse needs. patience. don't ever forget that. now, let me give you the last, i'll be here all night playing. let me tell you one other thing. then we're going to get to the questions here. and a couple ones next. so, let's take, i made this woman up as an example. a woman who's been married for 50 years who last her husband. i made that up and she's shown up a couple of times now. she has on the rope line. nobody calls her anymore.
so you decide you're going to take that lady to dinner on saturday. you and your spouse. what do you think she does on thursday? where does she go? oh, no, there it went. >> to get her hair done. >> she goes to get her hair done. then when you see her on saturday, i don't know how they do it. there's not one hair out of place, okay. and then when you pick her up, she wears a dress she hasn't worn in six months. did you change the world? i think you changed the world. so, there's two levels. leadership up here, the leadership in the legislature, the leadership of the school board and all that. we have to do our job. as president, my job is to raise everyone. i've done it before. we balanced the federal budget and why does that matter? i don't have my debt clock here tonight, but we are 19 trillion in debt.
when the debt goes up, the job opportunities go down. just have to remember that. when the debt goes up, the job opportunities go down. any small business here here? what do you think when the debt goes up? how does that make you feel? and he sits on his wallet. he can't hire anybody else because he doesn't know what's going to happen. and you got to get the taxes cut. particularly for small business. and you can't have crazy regulations that's killing this guy. get to a point where i don't want to do this anymore. i'm trying to help people and the government's pounding me into the ground. 186 page federal you know, boy, i wish i was your accountant. i could have made a lot of money on that. you know, and i'll tell you, my view on small business. i hope the mayor's listening to this. you're a small business. open your doors.
we'll get to the rules later. fill the paper work out later. just open it up. that's what i believe. those are the people that can hire us. so, i mean, these things can be done. but it takes somebody to say we have an obligation to improve people's lives. and i've done it in washington and i've done it in ohio and finally, a lot of people have said during the debates, why does he keep talking about what he did? well, you know what? i'm a voter, too. and i remember this one person came to see me wanted to be elected in my community. and i supported this person. i wish i hadn't. because this person then turned around and raised our taxes. ipg the best way you can tell what somebody's going to do is on the base of what they've done.
so, any way. my guys are going to come in here and tell me i have to go soon. i'm the only guy, keep the applause. that's about it. these things can be fixed. a country can be great, but it doesn't just rest in a politician. it rests in us. we've got to carve out a better future and more hope for our kids and our grand kids. that's what we need to do. let me take some questions. let me have some polite applause then we can take some. right here, sir. right there. yeah. well, look. here is the thing. that i really want you to know.
let me tell you the greatest job is to be a pundit. let me tell dwrou why. i was a little bit different and i'm going to explain why. if you'll just let me finish. because you get paid when you're talking and it doesn't matter if you know what you're talking about or not. it's the greatest job going and god created pundits to make as troll gjeres look accurate, okay. there are no rules for the convention. none had been created. even if they create rules, it doesn't really matter. because you get to be nominated for the floor in a national con veng. now, here's what's happened. nobody's going to get enough delegates. the trump organization is
complaining all the time about all this and that, but you know why? because they know they're not going to get enough votes to win it on the first ballot. so we're going to be deadlocked. then dell dwat gets are going to consider two things. this one's crazy. who can win in the fall? okay? i beat hillary consistently in every national poll. every one. then they had this electoral thing. they went and surveyed 40,000 people and chartered out the electoral college.
hillary smashed the two guys i'm running against. and i beat hillary decisively, so their going to take a look at this because if we pick somebody with very high negatives, which they have. because people don't want, look, some people are angry. i tell you, ultimately, people don't like politicians who they don't like. they just don't. and i've got to tell you, when i was governor, when i was governor, after my first year because i had to change everything. when i was governor, we were 350,000 jobs down, 8 billion in the hole and i shook the state from top to bottom. people were like, what is this guy doing and i was in my first year, the most unpopular governor in america, but i didn't care about that because i don't care about the polls. i didn't even want to go back into politics, but filt i had to. by the way, when i told my wife
i was going to go back into politician, she says, now, you were a congressman for 18 years. state senator for four years. you've been out for ten years, things are great and now you want to go back into the government? she says that is really just great, john. the point is, it took me a year to fix the negatives and people began to see good results. we're now 420,000 private sector jobs. 2 billion in the black. our credit is great and the mentally ill, the drug addicted, the working poor all given a chance because i believe with economic growth comes opportunity for everyone. just like if a mom and dad do better, the kids do better. when the economy does better, we can help a lot of people we traditionally don't help. i was really re-elected, but when you have these sky high negatives, nobody's voting for you.
the field, which is great so i think the delegates are going to look, if we nominate, somebody's going get crushed. we lose the supreme court. the united states senate. we lose majorities in the state houses. it will be a wipeout and i know what it looks like when that wave comes at you. so, that's the number one thing they're going to think about. number two, this one is ooempb crazier than the first thing about who can win in the fall. who can be president. they're going to think about that. so, i believe that the delegates will look at that and make my way. that's what i believe and there's one other thing. i'm the only one here with the positive message. i think the party aubt to have a choice when it comes to that.
if you like cooking, watch the cooking channel. if you like golf, watch the golf channel. don't watch the news. it will put you in a bad mood. oh, i didn't really mean it. yes, ma'am, right here. >> what is your plan for low income health care and what are you going to do to expand or improve or do anything about it as a republican? >> that's a good question because if we run around saying we're going to get rid of obama care and it throws tens of millions of people don't have any insurance, how do you think that's going to go over? i'll give you a story. i was in maine looking for a restaurant and i'd gone up to see the governor.
i said have you lived here your whole life, he said not yet. get some tea. so, this lady, she said, who are you? i said, i'm just here on business. she says, okay, i said, what do you think of your governor? she said, i hate him. i said, why is that? she said, i spent my whole life trying to get health care and now that i have it, the republicans want to take it away. i just want you to think about this for a second. could you imagine not having health care? you'd lose everything you have if you got sick. obama care is is not the answer. three reasons why it's not.
number one, medicine is still going through the roof. health insurance has gone up by an average of 80% and number three, small business people don't want to expand because they're afraid they're going to get audited. so, what would i do? get rid of it except the one provision. nobody should be denied health insurance because they have a preexisting condition. nobody should. you can get the working poor the care they need. but that's not the end of it because we have to control these costs. it's a very complicated, but here's what we're doing in a nutshell. we want total transparency. we want to know what our hospitals charge and their
quality. we don't know any of this. i looked at it for my wife, do we have the dead sea scrolls. it would be easier for me to understand. we don't know how our doctors are doing, what they charge or their quality. am i right? we don't know anything and all we know is our deductibles are going up through the roof. almost like we have catastrophic coverage. what we're doing in our state, seventh largest state in the country, is with this information, and transparency of hospitals and doctors, we're going to force them to compete, not us, the government, but the market system themselves by making sure wii reward people who have lower prices and high quality.
below the average. if you have a primary care doctor and the primary care doctor keeps you healthy for a year, we will give him or her a financial payment for having driven down the cost of your health insurance. has to be high quality and lower prices. see, right now, all the pressure is to raise health care because we don't know anything about it. if the pressure comes to be high eququality at lower prices, thee begin to control these rising costs of health insurance. now, i didn't just create this out of the blue. we have every provider and all we told them is we'll have a meeting, but you decide. so, a hospital like the cleveland clinic is involved. i want to do this nationally. i want to make sure we begin to put downward pressure on health care so one more time, you go to the hospital, you get quality service at a lower price. because right now, sir, you don't know about your hospital.
you don't know about the infection rate, the readmission rate and when all that becomes clear, we become consumers, we control our health care better and then we know that what the heck is going on and that's a direction that i believe we need all right. are those crayons? what grade are you teaching? >> i teach fifth grade. >> perfect. >> it was a gift from a student. >> okay. >> so i'm in the teachers' lounge and we're trying to talk politics and a lot of the teachers -- >> that is not a good thing to be doing. [ laughter ] >> well, and then, but every time i bring your name up, they're like, you hate the teachers' lounge, can you explain so i can go back to the school? >> yeah. >> last question, my students want to know what's your favorite topping on pizza. [ laughter ] >> well, let me handle the hardest one first. pepperoni. okay?
now, here's what i think, and this is -- go back and tell them, this proves my point, i was in new hampshire and i was at this education summit or whatever and somebody said, if you were king or whatever, what would you do? i said, i would eliminate teachers' lounges. and somebody said, why, okay? of course this never got out. you know why? because teachers, many times, particularly by a union that is hostile, okay, they will pound the teachers down and say, we're going to take your pay, we're going to take your benefits, you're going to lose your -- am i right? all the time. that's the thing you hear over and over and over again. then we expect them to go out and teach our kids. so what i'm thinking is, not literally, but figuratively, if we didn't have those lounges where people would just make each other feel bad like they were going to lose their job, their benefits, their pay, and everything else, then it would be better because i think we
need to -- i think we need to be able to measure how our teachers are doing but i believe we need to hold our teachers up and the reason why i think we need to do it is because they're with with our specials. i mean, i have two 16-year-old daughters and i don't know if any of you saw, i was on "anderson cooper" with them and one of them, you know, one of them, anderson asked -- she wanted to go into politics. i was delighted to hear, she said, well, maybe, but i want to make a lot of money first. dear old dad, okay? counting on that. you see what i'm saying to you, sir. the other thing -- i got it tell you, this is all under your control. i'm going to send 104 federal programs back to the states. here's what the problem is right now, i believe. i do not believe that we are currently have a flexible education system where we use common sense, get kids out into the community so they can sample occupations and i'm not convinced that we are training
them for the jobs of today and the jobs of tomorrow. and i'll give you a good example. now, i know you have to take a foreign language, but you know what, i would have rather instead of taking spanish, i would have rather have taken the language of the computer because that's going to be a lot more valuable -- i'm not expecting to be, you know, like a, you know, some sort of a spanish diplomat, you know, i just -- i would love to learn how to use the compu r computer. we're not very flexible in schools and to me, we have to shape the system. i'm going to give you a story about something. we have a town in ohio called youngstown. had a very hard time. lost a lot of industry. it's coming back now. it's doing pretty well. the youngstown city schools in the last nine years has had a college ready rate of all the students in the last nine years of 1%.
1%. so i passed through the legislature this provision that says if a school fails three years in a row, that i, the governor, can appoint a body that rides over the school board because school boards can be very political and to straighten this out. now, why did i do this? well, the mayor of cleveland came to see me and the business community and asked to make me the supt of the school the ceo of the school so this guy could change the whole operation because the schools were not performing. i like that idea because i think we should put kids first. so guess what, nine straight years that they had only 1% college ready, when i passed this legislation, they sued me to block this. what were they thinking? guess what, they lost the court
case. thank you, lord, they lost the court case. we're going to move forward and we're going to pix those schools and return the power to the school board but sti kids.that shouldn't be going on in our country. what happens to the kids who don't get a good education? i'm passionate about kids, i'm passionate about teachers. i tell you something, i don't think anything should stand between us and our children when it comes to giving them the skills they need to get a job, period, end of the story. [ applause ] thank you. you know, in these meetings, somebody always lobbying for somebody. like you had a lobbyist here, she's like pick him, pick him, pick him. okay. go ahead. what's your question? >> hi, governor. i care a lot object renewable energy and i know that maryland right now is actually thinking about increasing our renewable energy standard here. and i actually -- i know that in ohio the state legislature has
actually put a freeze on the energy standard and i know that you've come out against it. i'm wondering if you're going to have, as governor, keep supporting increasing the energy standard? >> yeah, here's the situation. >> as president how would you continue to do that as well? >> i do believe that there is climate change and i do believe that we impact the climate. okay? but so do a lot of other countries a lot more than we do. i happen to believe this is true. so what can we do about it? one of the things we can do is we can promote efficiency. you know, greater efficiencies in everything, in all of our buildings. the second thing we can do is promote renewables which are wind and solar and geothermal or any of these things. of course, i love the tesla, the battery car. that's going to be the big breakthrough. when we get battery technology that's really transformative, it's going to transform our lives. let me tell you the other problem. you can mandate anything you want but that doesn't mean you
can achieve it. you play golf? [ inaudible ] okay. what do you day? >> play baseball. >> play babble. do you pitch? >> i do. >> okay. i want you to get out on the mound. i'm going to mandate for you to throw the ball 100 miles an hour. can you do it? you can't. so why would we -- i mean, i don't know. and somebody will say he was putting that kid down. you know. but i did meet the next kyle -- cal ripken. is he here? where is that kid? come up here, kiddo. all right. i'm going to just -- i'm going to demonstrate something for you. come on up here. what is your name again? okay. jake. okay, now, i want you to take your stance.
look, he's in perfect position. he's got the hands right, weight on the back foot and let's see your followthrough. that is the next cal ripken. give it to me. [ applause ] so i want to go back, sir. you can't throw at 100 miles an hour. so in ohio, they set the -- politicians set the standard at a level we can't meet. so that means we would have to buy out of state power which is going to drive up the cost for heavy industry and i'd like not to lose any industry. i'd like to get more. particularly manufacturing. by the way, we're up over 60,000 manufacturing jobs in ohio since i've come in. so we want to have energy. the problem was the legislature got carried away at one point. and our standard was like, 20%, 25% and they wanted to get rid of it. i said, no, we're not going to
get rid of it, we'll reset it to fit the economy of ohio. i believe you can have environmental protection and economic growth. if you just use common sense and you try to figure it out. that's all that's going on now and they're going to have to try to come with a common sense plan because if they try to kill it, we'll go back to the unattainable number that was set. that's called leverage. i have leverage. and i think it will -- it will work itself out. but we have -- look, i don't want to worship the environment but i do want to take care of it because we need to leave it for our children, our grandchildren. you know, we got this beautiful bay here, right, i mean, are you kidding? we're in annapolis. i was thrilled that we were in here and not down on the rocks looking out over the water, but, you know, nevertheless, this is great. i mean, but this is a beautiful, beautiful place. and we don't want to lose it. we want to preserve it. so i hope that answers your question. and by the way, i've been told here that governor ehrlich, my buddy, is here tonight. where is bob?
[ applause ] bob, i just want to point out that half the room did not stand. [ laughter ] he's a dear -- he's a dear friend of mine. christopher shays is here, congressman shays. he's another great one. come here, shays, for one second. come here. come up here. once in a while, you know, even billy graham had a testimony from somebody else every once in a while, so this is my great pal and we serve together on the budget committee, when we balanced the budget, and he actually -- this is unbelievable, he moved to new hampshire to help me campaign. he lives in -- he lives close to here, but