Bioengineers are creating human body parts to replace organs and manage life-threatening diseases. How techniques like 3-D printing and stem cell research are driving medical advances and raising ethical questions
The leaders of the House and Senate Veterans’ Affairs committees agreed yesterday to move forward on a bill that addresses critical problems at the V.A. The draft legislation would allow some veterans to be treated by non-V.A. health care providers, and would give the incoming V.A. secretary more authority to fire under-performing senior executives. The $17 billion package is being called a rare act of bipartisanship in a Congress known more for gridlock. Veterans groups, for the most part, say the bill is a step in the right direction, but they will continue to press for additional reforms.
- Ed O'Keefe congressional reporter, The Washington Post.
- Rep. Jeff Miller Republican, representing Florida's 1st congressional district; chairman of the House Committee on Veterans' Affairs.
- Alex Nicholson legislative director, Iraq and Afghanistan Veterans of America (IAVA); former executive director, Servicemembers United; former U.S. Army human intelligence collector.
- Lawrence Korb senior fellow at the Center for American Progress and former assistant secretary of defense in the Reagan administration.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. The Senate and House committees on veterans agreed on a bill aimed at improving the VA medical system. It addressed delays in care at VA hospitals and gross mismanagement, problems that came to light in recent months and lead to the resignation of VA Secretary Eric Shinseki. The bill's lead negotiators say they're confident the compromise package has enough support in Congress to pass before the start of summer recess.
MS. DIANE REHMJoining me to talk about the new plan and how a compromise was achieved, Alex Nicholson of the IAVA, that's the Iraq and Afghanistan Veterans of America, Ed O'Keefe of The Washington Post and Lawrence Korb of the Center for American Progress. Do feel free to call us, 800-433-8850. Send us an email to firstname.lastname@example.org. Follow us on Facebook or send us a tweet. Welcome to all of you. Thank you for being with us.
MR. ED O'KEEFEGreat to be with you.
MR. LAWRENCE KORBNice to be with you.
MR. ALEX NICHOLSONThank you.
REHMEd O'Keefe, what's in this bill that kind of addresses the worst problems facing the VA?
O'KEEFEI think many might be sitting here today, Diane, saying, what isn't in this bill. It seems to consume just about everything. And we'd be remiss, by the way, before we continue for not congratulating you on your big award yesterday at the White House.
REHMOh, thank you so much.
O'KEEFEWe all knew you were a big deal. Nice to see the president catching up. This bill, among other things, basically makes it easier now for veterans to go outside the VA system if they need to. A reminder that not all military veterans actually get their medical care from the VA, but those that opt in generally like what they're getting. Those that are trying to get in have been very frustrated.
O'KEEFESo they're changing the rules on exactly whether or not you can use VA funding to go outside the system and get care elsewhere. If you've been waiting for more than 30 days or if you live more than 40 miles from the nearest VA hospital or clinic, you can now ask the VA to give you what's called a choice card and they'll let you take that to a doctor down the street or a dentist in the shopping plaza around the corner and get your care that way.
O'KEEFEThat's a big change and that's gonna cost about $10 billion, at least initially, to allow veterans to go out and do that. How many are going to do it, we don't know yet exactly, but the presumption is that many will seek to do that if only because they live more than 40 miles away or they've been waiting more than a month for an appointment.
O'KEEFEAmong other things, they're going to get about $2 billion at the VA to build or lease about 27 new major medical facilities across the country in about 18 states and Puerto Rico. They'll get the ability to more easily fire or demote poor performing workers. Remember, this was at the crux of the whole scandal that developed over the spring, the idea that there are workers in the system who were fudging the numbers, perhaps hiding waiting lists.
O'KEEFETop VA officials now will be able to immediately remove somebody from the payroll. If that person wants to appeal, they'll have about 21 days to a month to make it happen. Otherwise that person is gone. And that is a big concession to Republicans, especially, who were looking to make sure you could rid of these people a lot faster.
REHMAlex, a good start?
NICHOLSONWe thought it was a very good deal. We're very pleased with it, but I think what you said is the key. It's a start. There's a lot more they need to get done. We had an entire laundry list of things we wanted done in this Congress. As Ed mentioned, there is a lot in this bill, a lot got done with this deal, but there's a lot more to go as well.
NICHOLSONWell, we wanted suicide prevention legislation passed by now. That's the biggest issue facing the younger generation of veterans, Iraq and Afghanistan veterans. And so we still want to see that done this year. This has taken a lot longer than it should have, than we thought it was going to. We understand, certainly, that it was a crisis that came up midyear this year and had to be dealt with.
NICHOLSONBut they started working on this back in early June and they could've -- you know, they originally intended to have it done by the July 4th recess. That didn't happen. It was looking at times like they might not have it done by the August recess. It looks like now it's certainly going to happen and we're pleased with that.
REHMLarry Korb, do you think it is going to happen? And if so, how is it going to be paid for?
KORBWell, it is going to happen, I think, given both parties are very concerned about veterans and these wars that we fought that went on so much longer than people realized. Plus, and this has kind of been lost in the debate. One of the things that the Obama administration and General Shinseki did, they allowed Vietnam veterans who may have been exposed to Agent Orange now to come to the VA.
KORBThere was a time when you couldn't do that without, you know, real specific proof. So give those things, I think it will pass. And you know, one of the things, when you look at the bill, that people forget the cost, I mean, if you look at what we're spending, the budget has gone up tremendously in the last couple of years. It's gone up about 85 percent since fiscal '09 and the drivers are not the medical care, which really needs to be taken care of.
KORBTheir pensions and disability claims are driving up the budget that people, you know, are not paying attention to. I think they're gonna use -- they're only gonna have to pay -- out of the $17 billion, they're only gonna have to pay, you know, $5 billion, by finding cuts in the VA or someplace else. $12 billion is going to be emergency funding sort of like the war funding, which doesn't...
REHMWhich was what Congressman Bernie Sanders said.
KORBWell, and I think here's an important point. We have a war funding budget. If we ever do this again, we need to put the veterans in there right from the beginning because just as Senator Sanders said, it's like a cost of a tank or a plane or something, it's for the veterans and that needs to be in. And I would hope if we ever go to war again, a big war like we did, that we -- rather than cutting taxes, we'll raise them so people will realize that we're going to be paying these costs for a long, long time.
REHMSo from your view, Ed O'Keefe, the critical long term needs, how does this bill address them?
O'KEEFEWell, if you look at long term needs of veterans care versus long term needs of the VA system, I think those are two distinct that are both dealt with in this. The long term of the department, it will expand. They will be able to spend about $5 billion hiring new nurses and doctors and specialists, people to deal with suicide prevention, among other things, that perhaps hasn't been there before.
O'KEEFEAnd there will be reforms put in place to make the department more accountable to Congress about how it's spending its money and treating patients. Long term for the veteran, I think that remains to be seen. It depends on groups like IAVA or the Veterans of Foreign Wars to really assess this in the coming years and get a sense of whether or not things have really happened.
O'KEEFEI think what's important, they didn't get suicide prevention into this. I think that's going to be a larger discussion at some point soon, hopefully. But there are a few other things that were done in this bill that do sort of address the newer needs of the newer veteran, if you will. For example, there's funding now in this for veterans who may have been the victims of sexual assault or rape in the armed forces.
O'KEEFECurrently, there's a lot of funding and attention put on those currently on active duty. This now allows someone who was a victim when they were in the service to come back to the VA and say, I need help, either with psychological issues, with physical issues, and the funding will be there for it. Another important concession, and this was sought by people for several years, it's finally getting worked into this, is there will be new tuition assistance for service members.
O'KEEFEThey'll be able to basically get in-state tuition rates, whether they're going to a university, a public university in their home state or a neighboring state. Also, for the spouses of those that served in Iraq and Afghanistan, there's been a lot of concern about their well being and their ability to advance economically in the wake of the two wars. And that's a big deal for them also.
REHMYou know, those sound really, really good, Ed, but I'm wondering, Alex, why suicide prevention was not in there. Why does it have to be a separate big deal discussion?
NICHOLSONWell, it didn't have to be. It certainly could've been included in there. I think, originally, the goal with this legislative package was to address the access and care crisis. And originally, the scope of the conference committee and the scope of the bills passed by each chamber just dealt with access and care. I think they threw in a couple of extra things that are not technically related to access and care that had already cleared committees that were noncontroversial and, you know, some of which didn't cost money.
NICHOLSONThe instate tuition provision that Ed mentioned is actually a money saver. It had a negative score. The MST, the Military Sexual Trauma reforms, are something that's noncontroversial. There's an extension of a scholarship program for spouses and widows and survivors. Those things are noncontroversial. They had already gone through the process. We had legislative hearings on them. They'd been marked up by committee.
NICHOLSONAnd so those were primed and ready to go and got tacked on. But the suicide prevention stuff...
REHMBefore I let that suicide prevention go, however, how many veterans do we know are committing suicide daily?
NICHOLSONThe best number we have, and it's just that, it's a best guess, basically, is about 22 a day. Twenty-two a day dying by suicide.
REHMEd O'Keefe, it just seems, you know, heart-wrenching that that provision wasn't included. I wonder, Larry Korb, why you think it was not?
KORBWell, I think what happened is they were focused so much on the difference between the cost that they ignored some of the things. As both Ed and Alex pointed out, they did get things like sexual trauma and the scholarship program for surviving spouses. Another thing they did do was extend a program to provide housing for veterans who are struggling with traumatic brain injury so maybe that will help somewhat there.
REHMSo how -- when do you think they might take all this up again and go further?
O'KEEFEWell, you know, it's interesting because we weren't probably paying enough attention to this. I know Alex's group certainly was earlier this year when the Senate did get a big comprehensive, sweeping package of proposals out of the veterans committee and onto the Senate floor and it had support until Republicans started playing games, as they -- I don't want to say playing games. We'll get mail for that.
O'KEEFEWhen Republicans started -- and Democrats have played these games, too. Let's be fair. But when Republicans started bringing up unrelated issues and basically killed the bill's prospects on the floor, they were trying to get votes on amendments that weren't related to veterans' care, as they have done on all sorts of legislation this year. It took a lot to get that done. We'll see whether or not, perhaps, in the new Congress they can restart this and deal with it again.
REHMEd O'Keefe of The Washington Post, Alex Nicholson of IAVA, Larry Korb of the Center for American Progress. Short break, right back.
REHMAnd welcome back. We're talking about a proposed bill that will address some of the critical problems at the VA. And everything that happened, of course, led to the resignation of former VA Secretary Shinseki. Here in the studio, Lawrence Korb. He's senior fellow at the Center for American Progress, former assistant secretary of Defense in the Reagan Administration. Ed O'Keefe is congressional reporter for the Washington Post. Alex Nicholson is legislative director of the Iraq and Afghanistan Veterans of America IAVA.
REHMAnd Larry Korb, I'm going to come right back to you. How did the VA get into this mess right from the start?
KORBWell, you've got to remember now this is not good but it's been worse before. If you go back and you take a look at Vietnam, and I was one of the people who had the privilege of serving there, it was nothing. And even when I was in the Reagan Administration, the director of VA said that Agent Orange was no worse than teenage acne. Chuck Hagel was the deputy then and he quit because of this. So it's been worse before.
KORBAnd I think what happened is people did not recognize, if you will, mental illness. They were focusing more on people who, you know, had physical wounds, didn't realize that. And then the other thing is, you know, everybody was beating up on General Shinseki. He's the one who said, with Agent Orange automatically, you know, even if you want to ship off the coast, so again, that plus the fact that you had all of these mental problems.
KORBOne of the things that's 50 percent of the people leaving active duty now asked for disability. That's higher than we've ever had in any other war and I don't think was anticipated.
REHMIt's interesting because here's a posting on Facebook from Jim who says, "I'm a veteran of almost 30 years, served in two wars. There is plenty of money for the VA if we use it effectively and efficiently. Too many veterans are in the system. Just because one served a few years sometime in the past does not justify government paying for medical care, for problems unrelated to military service." What do you think, Alex?
NICHOLSONWell, I think that's -- I would imagine that's probably a consensus opinion within the community. I mean, the VA is focused on service-connected disabilities and treating those with service-connected wounds. That's what it's primarily set up to do and that's what it does best. You know, there are some out there who want to make and are focused on making the VA a center of excellence in terms of being a medical system for war-related injuries only.
NICHOLSONMany think that the VA should not be treating colds and, you know, broken arms and things like that that may happen in the normal course of life, but should be focused on things like traumatic brain injury and PTSD and prosthetics and signature wounds of war like that.
REHMSo what's the opposing view to that email, Larry?
KORBWell, I think he raises a good point because it's like any other system. People will game it if you know you can do it. I mean, I had an experience of my own a couple of years ago and I came down with colon cancer. And the doctor asked if I had been in Vietnam. He said, oh we can send you to the VA. Well, thank goodness the center has a good health care program. I'm retired -- but, you see what I mean? This comes up and, you know, people -- has it related? I have no idea.
KORBYou know, I left there in 1966. You get into your 70's you got -- well, you don't feel too good so you go down to the VA. And I think that's what he's talking about.
REHMWell, should there be a cut-off point?
KORBWell, I think what you have to do is have proof that somehow another that this is related to what happened to you in the service. With Agent Orange we don't know, okay.
REHMBut how could you possibly know with colon cancer?
KORBYeah, I just don't know. But, I mean, my doctor was willing to send me to the VA, okay. And the same thing happened to my brother. Both of us were in Vietnam. You know when he -- and thank goodness we have good health care plans. So this is why I think you have to be careful. You get into your -- you get older, you know, and things come up. Are they related? We just don't know. And I think the caller was saying that -- and Alex just mentioned that, you know, you fall down and break your arm there's something -- what does this have to do with, you know, the war and stuff like that?
REHMEd, can you contribute to this?
O'KEEFEI mean, this is the complex, you know, debate that congress is ill-equipped to deal with these days. I think, you know, we're in such a whack-a-mole culture up on Capitol Hill that, you know, this argument about how exactly you sort out what is war-related and what isn't. I mean, first of all they'd probably say, let's leave that up to the VA. But second, I mean, that's a very nuanced argument that I don't think lawmakers are totally equipped to deal with these things.
REHMBut do you think rules might change?
O'KEEFEI mean, there's been discussion, and even through this scandal there's been talk about, you know, do you have to more specifically outline what it is that somebody can come to the system for? And that's part of why you saw so many lawmakers in both parties say, you know, if it's a simple common cold, give them a VA card, have the VA pay for their ability to go to the primary care clinic down the street. But if it's something related to their service, they should be able to walk in, get an appointment quickly and get the best care possible.
REHMSo do we now have any idea how many veterans are currently eligible for VA care?
NICHOLSONThat's a good question. Off the top of my head I want to say it's in the range of 5 to 9 million. I'd have to double check that but it's an enormous number.
KORBYeah, over the past four years you've had 1.5 million more people applying for the VA.
O'KEEFEAnd remember, you're looking at people who are getting older who have served in Vietnam or the Persian Gulf.
O'KEEFEPlus all of these new unique war wounds that are coming back from Iraq and Afghanistan. So the system's getting hit in two different ways.
REHMAnd something you mentioned -- well, you've all referred to it, how important is the provision that the secretary can get rid of underperforming executives, Larry?
KORBWell, I think given what we found out about that people were abusing the system and, you know, to get bonuses and pretending there were no ways, that's -- I think that will send a very strong signal to the people out in the field that you better, you know, play by the rules. Because unlike, you know, traditional things where if you try and get rid of a career servant, it takes you forever, and most people say, well it's too much trouble. Now you get 21 days to, you know, make your case. And if you don't, we can get rid of you.
REHMYeah, but that was a pretty blatant example. How do you define underperforming?
O'KEEFEWell, it will be established and I think it's mostly up to the VA to determine that. But most of all they're looking for people who may have been creating these phantom waiting lists that weren't actually in the official system. So anyone found to have been doing that conceivably is one that's now on the chopping block. And it could be other things. It could be a doctor who poorly provided care. It could be some other, you know, clinician or receptionist or other specialist who just poorly performed. They will be able not to do this.
O'KEEFEI think where we have to watch this in the coming years, having covered the federal workforce for a few years, I'm a little conscious of this, you know, Republicans and Democrats have been trying to make accountability among career federal workers a little sharper than it has been for decades.
O'KEEFEThis potentially now is the beginning of some real changes and how it is that you can get rid of people if they're poorly performing. Republicans would love to do that at the IRS for example. Plenty of other agencies where they have found examples of wrongdoing among career staffers who are protected by civil service protections that have been in place for so many years.
REHMAlex, what about the funding for the VA? Do you think that overall it's underfunded?
NICHOLSONI do. I think the issue is that the VA year after year has been low-balling it's budget request to congress. There's no doubt that the VA has been generously funded by congress. A lot of folks want to blame congress for a lot of this. In this particular case it's hard to do because the VA as exempted from sequestration. It's been given over 100 percent of its budget request every year. The veterans community however does an independent budget assessment of the VA's financial needs every year. And it's constantly been over what the Administration's request has been for the VA.
O'KEEFESo we believe that the VA has been -- and the administration has been low-balling it's budget request every year and is therefore now significantly underfunded. But it's certainly not because congress hasn't given it what it's asked for.
REHMDo you agree, Larry?
KORBWell again, if you take a look at it, this year they come in for $164 billion. Four years ago it was 97 billion. So I think it's going up. The real question is are we spending it correctly and basically are we dealing with the problems that we've talked about here where people are gaming the system and also people are pretending that it's more effective.
KORBI mean, it's the second largest discretionary budget in the whole federal government right after the Pentagon. So it's not - you know, when you say it's not getting the money it needs, if you add the 17 billion to what come in this year, you're over $180 billion.
REHMInteresting. All right. Let's open the phones, 800-433-8850. First to Ed in Kalamazoo, Mich. You're on the air.
EDHello. Yes, hello. Well, I was wondering about the funding. It was my impression that the war in Iraq and Afghanistan has always been underfunded because of what your previous guest said that the taxes were cut for supply side, you know, ideology. But now you say that it appears that the Veterans Administration is -- the budget has increased. So what, is the money not being spent correctly or is it still -- are the needs more than we've still estimated? In other words, I was always under the impression that maybe it was a lack of funding.
KORBWell again, I think it's people are focusing as quite correctly here on the whole medical situation. But the biggest drivers in there are pensions and disability claims. And right now, as I pointed out, 50 percent of the veterans leaving are trying to go on disability. I think the other thing that's happening, if you really want to complicate the situation, the Pentagon trying to get these people off the rolls as quickly as they can and put them over rather than medically retiring, which means that they would have to pay for it.
NICHOLSONYou know, I mean, I just have to come back to this point that it's so frustrating for us in the political community, in the advocacy community, when we talk about this debate because time and again congress has given the VA every dime it has asked for. The secretary has come up to the Hill every single year and been asked directly.
NICHOLSONAnd I think you're having Chairman Jeff Miller one of the House Veterans' Affairs Committee who will tell you this personally. He asks them every single year, do you have enough to take care of that and to fulfill your mission at the VA? Do you need any more money? And he constantly says, no. So there's certainly some efficiencies to be found within the VA. And I think that's going to be part of the reshuffling and restructuring to make this legislative deal work as well.
NICHOLSONBut there's still, I think, no doubt from the position of the veterans' advocacy and service organizations that the VA has not been asking for and honest with itself about what its real resource needs are.
REHMAnd you're listening to "The Diane Rehm Show." Let's go now to Greenbelt, Md. Hi, Robert. You're on the air.
ROBERTHi, Diane. Thank you very much. I appreciate your program every day.
ROBERTI'm a Vietnam veteran and I've been under the VA care for a long, long time. And I have the same questions that Ed just brought up in his comment that the VA is primarily underfunded. My concern is about the stopgap measure to send VA -- veterans to private providers. I think it's a good idea as a stopgap measure but my main concern is the ultimate privatization of the VA, just as they've used privatization as an excuse for privatizing the public education system. And the long range strategy of this is, I think, has to do with Grover Norquist's idea to reduce the size of government's so that it'll fit into a bathtub.
REHMWhat do you think, Ed?
O'KEEFEWell, Robert, you know, we asked this question a lot when the House and the Senate were putting together their proposals. And to a person, while I think there are many who would like to see the size of government reduced and perhaps have some services privatized, there is an agreement I think about both parties and all ideologies that the VA is uniquely equipped to be dealing with the most grievous war wounds, whether they're physical or mental. And that the VA should continue doing that and that the government will continue providing funding for it.
O'KEEFEThere was no real serious discussion about totally abolishing it among lawmakers who were being taken seriously at least. I can't recall really any that were actively advocating for its total demise. Because they feel that, you know, the government put these people in these positions and that the government should be helping to take care of them once they get back.
KORBOne of the problems they had, there was money that they couldn't spend because they couldn't hire enough doctors.
KORBWhat the VA pays compared to what you can make in the private sector, that's another problem.
REHMThat's for sure. Okay. To, let's see, Mike in Houston, Texas. You're on the air.
MIKEHi. Thanks for taking my call. I'd like to know what is the difference in this current compromised bill compared to what Bernie Sanders's bill had in February that Republicans blocked primarily for budgetary reasons?
O'KEEFEYeah, I mean, that bill was so much more enormous in that it would've provided a lot more funding for the department. It would've expanded a lot of these different scholarship programs in care to deal with various medical ailments. Among other things I think the suicide prevention was not or was part of it?
NICHOLSONIt wasn't part of that, yeah.
O'KEEFEOkay. But it was a big sweeping -- I think there were what, 120 different pieces of policy in that bill that got blocked. It was seen by Republicans as just too much because it wasn't being paid for. This is a reduced version of that primarily to address the concerns that flared up in the spring. And then, you know, expand or continue certain programs that were put in place for newer veterans.
KORBI think we should give credit with Sanders and McCain who had that bill. You know, it was a bipartisan bill.
O'KEEFEYeah, and then in recent days certainly there was squabbling, but this compromise is seen as a...
REHMHow much would the original Sanders' bill have cost?
O'KEEFEYou're racking my brain but I think it was at least a nine-figure price tag over several years...
REHMOh, I see.
O'KEEFE...which in this environment, you know, is just too much even for military care.
REHMIt's just not going to get it.
NICHOLSONWell, you got to keep in mind, it's easy to get confused here because there have been several different stages of legislative packages and so many different bills.
NICHOLSONI think the original bill that Mike was referring to was the one that came out in late winter, which was I believe about a $35 billion bill. As Ed mentioned, it covered a lot more. It was basically a compilation of the legislation that had gone through the process, we'd held hearings on and it come out a committee. And it's important to keep in mind on that one that a bipartisan package had passed out of committee and Senator Sanders added extra provisions into it that were not passed out of committee. And that's one of the reasons it failed on the floor.
REHMAll right. Short break here. We'll be back with more of your questions, your email. I look forward to hearing from you.
REHMAnd we're back. Talking about the veterans, the care they'll get, we hope. And we've got many emails, phone calls. Here is an email. "Why are vets who are eligible for Medicare, still going to the V.A.? Isn't this double dipping?" Larry?
KORBWell, it's not double dipping because, basically, you're entitled so you can -- so you can go there. And when the Congressional budget office was trying to score the, you know, the costs of, originally, the Bernie Sanders/John McCain bill, they were saying it's going to cost maybe 50 billion because you'll get a lot of people who will not go -- who are eligible for Medicare, now go to the V.A.
KORBAnd so, yeah, this happens. Do they feel -- as we were talking about at the break -- more comfortable there, is it better care, does the V.A. pay more? Medicare probably doesn't pay, you know, everything. So those are all questions. And we saw the same thing with TRICARE, when we didn't raise the premiums, people started staying on TRICARE rather than taking their health care plans at work.
REHMWhat do you think, Ed?
O'KEEFEI mean, double dipping -- I don't -- I'm no budget wonker. I never was very good at math. But I do know that the concerns about double dipping among certain military veterans, mostly career guys who were officers, who worked at the Pentagon or who maybe climbed the ranks and are now working in the private sector, the idea that they could potentially afford to pay for their own private care, but are still using TRICARE or another system, was something that Congress tried to touch.
O'KEEFEThey touched it, but they stepped back pretty quickly because the reaction was so negative, so critical of doing that. Look, the military is still revered by about 74 percent of Americans. It's under that -- one institution that still enjoys wide public acclaim, 7 out of 10 Americans. I think Congress would be lucky to find seven Americans who are pleased with the way they're behaving. So they just sort of backed off.
REHMInteresting. Here's another from Joe, who says, "The V.A. needs more doctors. Should they train their own? Should they offer incentives of loan forgiveness to medical students if they work at the V.A.?" What do you think, Alex?
NICHOLSONWell, that's a great point. And the V.A. absolutely does need more providers. That's one of the thing that the suicide prevention legislation that Chairman Miller introduced, and that's pending in both the House and Senate, would actually do, student loan repayment programs, recruitment tools, etcetera. But there's no doubt that one of the reasons we're -- the V.A. even is in this access crisis right now -- it's because there's a lack of capacity.
NICHOLSONAnd that's one of the reasons -- especially in terms of an immediate short-term solution for those waiting and needing care -- that sending them out to the private sector was considered.
O'KEEFEAnd I remember one of the first times I talked to Scott Gould, who's now the former deputy V.A. secretary. He said one of his biggest challenges was recruitment, that he could go to Johns Hopkins Medical or to schools up in Boston or out West and try to recruit medical students to come work at in the V.A., but he could only offer about half of what the beautifully, newly constructed facility down the street could pay these guys. And he said, "You know, why don't -- I -- my hands are tied.
REHMYeah, yeah, yeah.
O'KEEFE"If I don't have the money to get the best heart surgeons, I'm not going to get the best heart surgeons."
REHMOkay. To Kathleen, she's in Athens, Ohio. Hi there.
KATHLEENHi. Thanks. Hey, I spent about six years taking my World War II veteran father out to the V.A. in Dayton, Ohio. He has since passed. He was ready to go. But during that time we -- he -- I took him out there on a stretcher at one point -- well, an ambulance who -- and we were -- a counselor at the nursing home he was in had told our family that he was definitely a PTSD person.
KATHLEENWe asked that doctor to give him tests. The doctor didn't refuse, but he didn't recommend it. And then later on I asked for those records, and the doctor had actually put on there that my father had been offered five PTSD tests and that was not the truth. Anyway, I filed a complaint. But while I was out there those six years, I talked to a lot of Iraqi and Afghani vets.
KATHLEENSome of them with missing limbs. Many of them talked about -- I heard this one over and over again -- that it was difficult for them to sit across from a counselor who had never been to a war. And that pharmaceuticals, drugs were being thrown at them like candy. One vet actually went out to that parking lot and blew his brains out -- not while I was there, but later on. So can you talk about how our returning vets are treated and, of course, our older vets?
NICHOLSONThat's certainly one of the biggest issues, I think, with mental health injuries for Iraq and Afghanistan vets. Is -- and it's one of the reasons that, you know, referencing the comment from the earlier listener, is that's one of the reasons they want to go to V.A., whether they have private options or not. I mean, they want to talk to folks -- they want to be counseled and treated by folks how understand what they're going through.
NICHOLSONIf you've ever had any sort of traumatic event, trying to talk to someone about that who doesn't understand it, even if, you know, their heart's in the right place and they're trying to help you, it, for some, can be another traumatic event. Over-medication among them is another issue that our generation deals with. The V.A. has had a problem and there have even been Congressional hearings this year on the epidemic of over-medication and just treating with pills.
REHMAll right. And joining us now by phone from Capitol Hill, Republican Congressman Jeff Miller. He's chair of the House Committee on Veterans Affairs. Hello, sir. Thanks for joining us.
REP. JEFF MILLERThank you, Diane. It's a pleasure to be with you this morning.
REHMThank you. Talk about how this compromise was actually reached.
MILLERWell, unfortunately, it took us six weeks to do it. And part of that delay was the addition of the $17.5 billion into the original negotiations. We were talking about a bill of $35 billion. Senator Sanders and I knew that it was very important that we get together and get a compromise to our members so they could vote before we return for the -- or left for the August recess. And that's what we're in the process of doing.
MILLERThis bill adds accountability to the Department of Veterans Affairs. It adds choice to the veteran, to allow them to go outside the system if they meet certain metrics. And, again, it adds accountability from the standpoint of being able to discipline top managers who lie, cheat and steal within the system, as we have found in places like Phoenix, Ariz.
REHMAnd are you satisfied with the proposed legislation?
MILLERWell, Diane, I will tell you in this divided Congress in Washington getting any bipartisan legislation is an accomplishment. No. I would like to see a whole lot more emphasis put on the choice piece. I would like to see it continue in perpetuity, but Senator Sanders said he wanted a sunset in there. So we set a three-year window. And hopefully, within that period of time people will see that the vast of majority of folks I don't expect are going to flee out of the system.
MILLERHowever, you have some people that live in rural areas that travel many, many hours to get to a health care facility. And it is just not fair to make them pass local hospitals and doctors, making them go to a V.A. facility.
REHMNow, do you anticipate any opposition on the floor of the House?
MILLERWell, you know Capitol Hill very well. And to say that we would not get any opposition I think would be a wonderful thing. I don't know. I will tell you this, I have not heard of any major pockets of opposition within the House. I've had several of the most conservative, fiscally conservative members have come to me and said that they are voting for this because they think that it's important to get the veterans the care that they have earned in a timely fashion. And that's exactly what this compromise is designed to do.
REHMAnd of course you know far better than I, that the V.A. has taken a huge hit to its credibility. What do you think needs to be done to truly restore trust in the V.A.?
MILLERWell, you know, the unfortunate thing, it's a self-inflicted wound. And it's been going on so long, there are people within the system that believe that this is just the way it's done. They've done it for their entire career in certain existence. But, let me tell you this, this piece of legislation isn't going to fix things overnight because this problem didn't start overnight. It's been around for a long time.
MILLERIt was just recently that we were able to uncover the scheme that was out there, not just in one isolated space, but systemically throughout the entire agency. And so the incoming secretary, along with the number two, Sloan Gibson -- who has done an outstanding job going around trying to make sure that the hospitals and health care centers are doing what they're supposed to do. But this is not going to be solved overnight because people are going to have to…
MILLER…understand the taxpayers are not going to stand for this anymore.
REHMOne final question, and that is in regard to suicide prevention, Congressman Miller. As we've heard this morning from Alex Nicholson, the best estimate is that 22 veterans a day commit suicide. Why, from your perspective, was not some element of suicide prevention included in this bill?
MILLERActually there is an element in there. And that is the ability to hire more mental health providers. Now, granted, Congress has provided a tremendous amount of resources to hire health care providers for mental health, but this, you know, the signature wound that we are going to be dealing with not only is traumatic brain injury, but post-traumatic stress. And it's going to be around for a long time.
MILLERWe also, in this piece of legislation, raised the cap on a residency slots of V.A. to 1,500. And I would suspect, if V.A. does the right thing, the vast majority of them are going to be mental health care providers because that is where the surge is going to be.
REHMAll right. And I think Larry Korb would like to ask a question.
KORBCongressman, how come you didn't put the whole 17 billion in the emergency funding? Because another 5 of the 17 has to come out of the V.A. budget.
MILLERWell, I guess the easiest answer is nobody trusts V.A.'s numbers. V.A. gave me two pages to justify $17.5 billion. And that's just no way to show that you actually need the money. I haven't said that the money doesn't need to be appropriated through regular order. If V.A., in fact, will show where the money goes and what it's needed for -- interestingly enough, this did not come from the White House. It is not an official request. This was a wish list that the Department put forward.
REHMEd O'Keefe has a question.
O'KEEFEChairman Miller, good to talk to you again. Ed O'Keefe of the Washington Post. I know you've hesitated to discuss this yesterday and to some extent already so far, but help your colleagues, help the public who's thunderstruck that Republicans and an Independent from Vermont, born in Brooklyn, were able to put together a deal like this. How did you do it? And are there lessons here to be learned for your colleagues who are trying to cut similarly complex deals on other topics?
MILLERWell, Senator Sanders and I are trying to put lightning in a bottle. And we will be glad to give it to our colleagues because this is how it's supposed to work. One thing is we're dealing with an issue that there is absolutely no disagreement on, and that is providing quality, timely health care and benefits to the veterans who have worn the uniform of this nation.
REHMSo no lessons for your colleagues?
MILLERWell, just watch. Maybe they'll learn.
REHMCongressman Jeff Miller, he's a Republican representing Florida's 1st Congressional District. Thank you so much for joining us, sir.
MILLERThank you, Diane.
REHMAnd just for the record, we did invite his counterpart in the Senate, Bernie Sanders, to join us today. We did not hear back. Ed O'Keefe?
O'KEEFETwo quick things on Miller. First off, fun fact, you know he's a former TV weatherman? Studied journalism in college. But his district, I think more than many, actually reflects the problem that veterans face across the country. He represents the panhandle of Florida. That area that stretches just south of Alabama and Georgia, all the way towards Jacksonville. And he's reminded me, there is no major medical facility run by the V.A. in that district. Despite the fact that it's popular with aging military veterans.
O'KEEFEA lot of them have to go to facilities as far away as Mississippi and Alabama, up to Georgia, other parts of Florida. So nowhere does he understand this better than his own district, in that there are people who do have to drive by private facilities on their way to a V.A. center.
REHMAnd you're listening to "The Diane Rehm Show." Let's take one more caller. In Orlando, Fla., Ramona, you're on the air.
RAMONAYes, good morning. This is an issue I have been waiting to hear about since the '90s, when I worked between a couple of guys who made excellent money. They served each four years. Neither saw any action. They did everything through the V.A. One of them made over $100,000 a year and his wife covered him for health insurance. But he still went to the V.A. for everything from appendix to hernias to dental.
RAMONAAnd yet, I had a client, for those five years, who needed a lung transplant from Agent Orange -- who did see action. And he died waiting for that lung transplant that he never got. You know, this is the question that I have, is why weren't they on a waiting list?
RAMONAAnd why was the guy waiting for a lung transplant on a waiting list? And I'll listen for the answer.
NICHOLSONSure. Well, I think one of the reasons, systemically -- of course we don't know the particulars of those cases in those facilities at which they were treated and served. But systemically, the V.A. has certainly had a resource allocation problem and a management problem. And it has been unable in some areas to keep up, while it's been, you know, over capacity in other areas. So it's just a sad situation they found themselves in as…
REHMJust shocking from what our caller reports.
O'KEEFEThere's no doubt about it. And that's the point I made earlier about the Congressional Budget Office projecting the costs of this.
KORBBecause you'll have a lot of folks here, as what Ramona said, where they're making quite a bit of money, they're injuries are not related to their service, but yet, because they can go to the V.A., they do it. And as Ed mentioned before, you have many military people making -- retired military people making six-figure salaries, stay on TRICARE for $400 a year, rather than taking their health care programs.
REHMEd O'Keefe, tell us about Robert McDonald, the appointee for V.A. secretary.
O'KEEFESure. Wednesday -- or today's Tuesday. Tuesday afternoon Senate is expected to confirm him easily. Another fun fact, every V.A. secretary has been unanimously confirmed by the Senate since the position was created in the late 1980s. We'll see if that holds. I know a lot of people might be hearing this program later in the evening. So the vote count will have been heard, but he's expected to sail through. He's a former Proctor & Gamble executive, a military veteran himself.
O'KEEFEBecause he has that special mix of private sector managerial background, a military background himself, and someone that is sort of seen as a potential turnaround at a department that needs it. You know, will he be able to do these things quickly remains to be seen. Shinseki, when he was there, was seen as the ultimate V.A. secretary because he had a military background.
O'KEEFEHe had led troops into battle. He was a patient himself. But of course he suffered from perhaps trusting his rank and file too much. And so we'll whether McDonald takes these new accountability measures that are there, starts using them, starts holding some people accountable and making changes.
REHMHow soon might he begin?
O'KEEFEI mean, if he's confirmed today, by all means he could begin by the end of the week. Usually there's at least a few days, but there's no question that they'd like to see a full political management team there again. The problem is not only did Eric Shinseki leave, but a lot of other lower level secretaries that run various parts of the Department have left. And so there's a big void to be filled.
O'KEEFEThey've got to find, among other things, somebody to run the Veterans Health Administration, all the hospitals and clinics. In that case, they're looking for some kind of a doctor, perhaps from outside the system, to come in. But who wants to take that kind of job in this environment?
REHMEd O'Keefe, Lawrence Korb, Alex Nicholson, watch this space. We will continue to report on the V.A. Thank you all so much.
NICHOLSONGreat to be with you.
REHMThanks for listening. I'm Diane Rehm.
Most Recent Shows
Cuba releases American contractor Alan Gross after five years' imprisonment on espionage charges. The U.S. releases several Cubans in exchange. Details on the prisoner swap and the future of U.S.-Cuban relations.
The ebola epidemic in West Africa is not just a health care crisis. It has affected every corner of society in the countries most affected. Schools have been closed for months, infrastructure projects have been put on hold and GDP growth has slowed to a crawl. A discussion of the social and economic cost of Ebola in Guinea, Liberia and Sierra Leone.
Russia’s ruble strengthened today but it remains volatile after losing about 20 percent of its value yesterday. Diane and her guests discuss what falling oil prices and new U.S. sanctions mean for the Kremlin and the Russian economy.