internal political differences through peaceful means as opposed through violence. this is an ongoing challenge within iraq. isil is not a deem stick political entity. it is a force that is trying to claim territory and wreak havoc in iraq and it is a force that have no iraqi's sit zenses' interest at heart. s that why i mentioned the hreat posed by isil caused for increase among iraq's political factions and a more cohesive approach to be taken by the central government in baghdad when it comes to combating a serious threat. > we're seeing now the risk of losing what americans lost their lives for was caused by not keeping u.s. troops in iraq. why are they wrong? >> there's no question that senator mccain and president obama have differed on the iraq war since senator mccain was for it and barack obama was against it. there's no question that going back to 2008 when senator mccain allowed that his vision might include tens of thousands of u.s. forces in iraq in perp pet oohity, that that was in stark contrast to the vision held by then senator obama which was that we should responsiblely end what was already a very long war in iraq. esident obama's view is that iraq needs to with the partnership of the united states its -- be able to handle own security and i would note from some of the statements you said today that within a couple of sentences of each other senator mccain said that this is because we didn't keep troops in iraq, but he's not calling for roops in iraq. hich i'm not a logics expert but there's a little inconsistency in those statements it would seem. the fact is, we can't as the president said today, be everywhere at all times to meet the challenge posed by extremist groups, but we can partner with iraq. as the president noted today through the count terrorism partnership fund and the assistance that we provide to iraqi security forces as well as to the iraqi people work together to help iraq get over a challenge like this. their future has to be resolved by the iraqi people and the leadership of iraq. >> one final question. some the equipment we provided to iraq -- it would appear the problems come over to the border in iraq. [indiscernible] civil war in syria? >> i answered earlier, the approach we took was to carefully evaluate to whom we would be providing assistance in syria in the opposition so that assistance did not end up in the wrong hands. we have for some time now provided substantial assistance to the opposition in syria, but i think our past history shows and the understanding of the situation in both syria and portions of iraq bears out that we need to be very smart about ow we and to whom we provide lethal assistance and military hardware. we think that's the right approach in terms of u.s. national security interest. john. >> short while ago john boehner described the situation in iraq and he said the president is taking a nap. what's your response? >> my response is the answer to the question is a little more substantive that i've given already about the situation in iraq and the approach that we're taking. we provide substantial assistance to iraqi security forces. i would note that in that same briefing, as i understand it, the highest elected leader of the republican party did not have any suggestions for an approach to iraq that i could tell. or any policy prescriptions that he would offer beyond the statement that you just repeated. >> on this question of troops going back to the end of the war, the administration with vice president biden taking a lead role tried but failed to get a forces agreement with iraq that would allow some u.s. troops to remain for training and counter terrorist operations. because of that failure obviously all of the troops had to come out immediately. do you believe -- does the white house believe the situation in iraq would have been any different if you had failed to get the status forces agreement and there had been some residual u.s. force left in iraq? >> the aagreement to which you refer is one that would have had to be reached between to sovereign nations and an agreement to allow for under conditions that we would find cceptable of remaining force from the american military was not reached by -- through negotiations between united states and iraq. ae point i would make is that relatively small number of troops dezind specifically for the kind of narrow mission that we're talking about post-2014 force in afghanistan would not supplant the need either in afghanistan or iraq for national security forces to take the lead effectively in combating any extremist threat from the outside as you have with isil or inside. and again, it's the -- if the argument is that we should have as some suggested going back to 2008 tens of thousands of u.s. troops -- >> i'm asking a very specific question. >> i answered that which is a small focus on c.t. training and troop training assistance is not the same as what was called for by others when it came to a substantial essentially occupation portion in iraq which senator obama and candidate for senator obama never supported. >> so are you saying it would have made no difference -- >> -- i don't think anybody can answer that question. what i can tell you is that sovereign state of iraq has security forces that need to be up to the task of dealing with these kinds of challenges. now, they will have the assistance that comes with the partnership of the united states, as well as with other nations that have the interest of iraq and its sovereignty at heart. >> have you enjoyed your dessert as i've enjoyed mine. i also want to thank the go, go symphony. especially the founder. i want to rewelcome you to the 70th annual rcca congressional correspondent's dinner. we are now live on c espn 1. -- ccspan. i have to say hello to my mom who would be watching anyway. i love you. now, i would like to send your attention to the video screen for an important public announcement. this is about a common and very serious medical condition that many of us face on capitol hill. >> i was in reel trouble. i was irritable. i was unable to work with people . i was getting easily confused. i was starting to lose my edge. just wanted to -- i just got to say -- i just got a note saying i'm in the wrong hearing. >> i enjoy working. >> i'm starting to suffer from superman delusions. and everything, absolutely .verything was off the record off the record, i can tell you where the jefferson memorial is. i'd like to have the eggs scrambled and the hash browns off the record. that's when my doctor diagnosed me with campaign per pet ooh alice. it is constant campaigning in a never ending news cycle. call your doctor right away if you experience these symptoms. impaired judgment -- let me interrupt you for a moment. right now in miami justin bieber has been arrested on a number of charges. chris matthews helping us do the math out of washington. chris, thank you. -- you know what. prenatal -- 2052 by my math will be the first presidential clinton -- which the >> you don't have to live this way. the villas can help manage your campaign and make you easier to be around and happy. the villas changed my life. now when i go to parties people actually talk to me. and most of the time i don't even hit them up for a campaign donation. and i can talk to people, different points of view. we may argue in public, but we agree on so many other things. we don't want to see ellen grace twerk. >> side effects may include reasonableness, listening, and dry mouth. -- are cases people may thisst not for everyone. call your doctor if you experience an enjoyable conversation laughing more than four hours or kicking back and living easy. don't drive or fundraise until you know how this affects you. >> i'm carter fleming and i approve this message. since i've been using this my campaign is under control. i am not sleeping in my office anymore and i can talk to reel -- real people without conferring with my scheduler. when you're ready to take care of this problem there is this -- >> and that video, another example of the greatness of washington d.c. produced by the comedy writers we have with us tonight. thank you guys for that video. and if anyone needs good jokes comedy ind them at dc writers.com. we come here tonight the washington -- "washington post" is now a broadcaster with us tonight. yahoo is here also tonight for the first time. the recession was not kind to everyone in the media landscape and it would be easy for me to congratulate those of us here on surviving. instead, i think tonight is about what comes next because the people in this room, we are the ones who will form the next evolution, maybe revolution in journalism. and that's the reason the awards we present tonight are so important. these awards set the pace for excellence in our field. we start tonight with the david bloom award. this award is given for occur tath, ino vision -- innovation under dangerous conditions. it is in memory of nbc's david bloom, a rare ino innovateor. here to present that award tonight are david bloom's daughters who we have had the honor to watch grow up. welcome, ladies. [applause] every year they kindly give ouse this award. now these women are coming into their own. i would like to quickly brag about them in their own right. christine and nicole are college juniors. she is a forensic economic. nicole is i double major in performing arts and journalism. she is co-ainoring the morning news at her college. fantastic. [applause] ava is in high school and she volunteers to help children deal with grief. ladies, we are so proud of you and i present to you the bloom you the david bloom award. good evening. it's such an honor to be here tonight. my sisters and i always look forward to coming to this event. since march of 25011, syria has been embroiled in a violent civil war in uprising. internet sen -- shensor ship is extensive. making firsthand reporting next to impossible. this year's david bloom award honors an incredibly brave broadcast journalist who risked his life to show the world images inside syria during the military crackdown that has cost ore than $16 -- 160,000 lives. the war in syria is now in its fourth year. and while policymakers in washington continue to debate whether to step in and stop the bloodshed, brave journalists continue to risk their lives to shine a light on syrian government's brazen brutality. for several months mr. lambert, a correspondent for the u.k.'s channel 4 television embedded himself with rebels and forces on both sides in central syria. here is an excerpt from dispatches, syria across the lines. >> the river valley tells the story of syria. it reveals a warring nation that s breaking in two. in this valley, neighbor is fighting neighbor. every day is a struggle to survive. a land where regime and rebels .re fighting to the death this is the story of the people who live and fight on both sides of the front line. neighbors now divided by religion, ideology and the river hat runs between them. [applause] >> under extremely difficult circumstances, mr. lambert filmed, produced and directed this revealing film that examined the affects the war is having on ordinary civilians. not only did lambert skem phi courage his reporting reminded policymakers that the bloodshed in syria is not letting up. we are honored to award this year's bloom award to channel 's television oly lambert. ollie is currently working overseas he could not be here tonight. he recorded a video message to call all of you. >> good evening everyone from london. first of all, i'm really sorry that i can't be there tonight. i really wanted to come over and have a drink with you all, but unfortunately work stuff -- i can't make the trip. this is a really huge honor and i'm really touched making any documentary is going to be difficult. and this one one was particularly difficult. a lot of us went through a lot of stuff to get on the screen and get it seen and getting any kind of recognition at the end of that process is emassive. this is a huge yoonor. i'm very touched. have a greet night. sorry i can't be there but thank you very much for giving me a nod. it means a lot and it goes a long way. -- ks very mutch from a thanks very much from across the pond. good night. [applause] >> now, two unknown figures on capitol hill who i am proud to call my friends, kelly and jane with the jerry thompson award. [applause] >> good evening. come on jay. >> hello. i wanted to present the jerry thompson award. this award is unique in washington, d.c. like the man himself that it remembers, jerry thompson was an extraordinary colleague and cnn photojournalist who always went above and beyond to produce the best work possible. but what really accept him apart, especially for those of us who knew him was what a selfless friend, passionate teacher and incredible person he was. this award was established three years ago by the rtca to recognize those qualities, devotion to craft and to the people around you. this award recognizes photojournalists, sound crews and technical staff who are role models among their peers. >> you since -- sense the heart behind this award. this year's special winner eric hanson. he passed away in february and those in his life and those in this room who knew him still feel the pain of that it's still very raw and very real. and that's because he was the guy at cspan who talked to everybody and knew everybody and always made the effort to spend time with people, and we all know what a difference that can make. trying to spend time with people is one of the gifts he has left behind. one colleague said it would be hard to know how many people he took fishing. and so those personal gestures are the things about any of our lives that truly endure. he had a long career here at cspan. he was really creative, a teacher. he really came up with one of the ideas that was an early version of what we think of now as live view and for the nonbroadcast civilians in the room that's like a sat like truck in a backpack allowing us to send pictures in real time in a portable way. he was being creative in ways ahead of his time, and that made a mark. he also had a real sense of community. and even when he was fighting cancer and made the decision to retire to devote more time to his health, he was thinking about the people in his life and i'm told he turned his garage into a sports memorabilia center so friends could come and have time and enjoy being together. so we want you to take a look at the man we're talking about in honoring tonight with this presentation made by cspan. >> i just came to make sure i toned up all right. go ahead and roll that. he's one of our senior crew chiefs. eric give us a wave. it's 6:30 a.m. in the morning where we are as this program airs live eric hansen is our director as we go next to will ore kansas, you're on the air. [applause] >> eric never complained. his creed was don't argue and he is with us tonight in the spirit of friendship and the quality. work we honor and through the people he loved, his wife sue, their children. and accepting in memory of their father, ryan and erica. [applause] >> before they take the award, i wanted to read something that was sent to us by inez thompson, jerry's wife. nez ironically was -- eric ironically was inez's crew chief when she worked at cspan and she wanted to send these comments along. she wanted to express how happy i am that eric is the recipient of this year's jerry thompson's award. many years ago when i was fresh out of college i landed a job at cspan and for many years there eric was my crew chief. he was professionalal in every way. his passion for his job and commitment to excellence were evident from the start. like jerry, there was never a day that eric was grum y or unwilling to give a 100% to the task at hand. eric was one of my first mentors in this business. i want to congratulate eric for receiving this award and i want to give my condolences to his wife and children who i met briefly at the memorial. stay strong and know that his life was an example to all of us and that eric and jerry will forever reside in our hearts. our lives are richer for having known these two truly wonderful men. [applause] >> i'd like to take a moment to say some words about my dad. i think back to when i was younger i was always so excited for my dad to return home from one of his trips. looking forward to hearing all the stories of all the places he saw, like china, england, berlin . and the many people he got to meet. most of all, i really enjoyed all the stories and all the fun times he had with all of his friends and coworkers that he got to meet and spend so many years with. is true, if ying you love what you do, you never work a day in your life. he showed all those he met compassion. he had a heart large enough for all those who got a chance to know him. his sense of humor made everyone smile and laugh. his words of -- were his life. so let's leave here tonight remembering what he said so often. hug your family, don't fight, and look for the good in others. thank you. [applause] >> thank you. award particularly meaningful to me. someone i personally admire who has taught me and many of us on capitol hill as a colleague and friend. the career achievement award is a rare recognition from this association. we decided it must go to abc radnor. is --rcent this award to present this award, ann comp ton. [applause] >> been neat the capitol dome, there are national treasures, and for 40 years one of those has been your colleague, of abc news. you know him as a classic dedication of fairness. is tireless. cokie roberts, one of his greatest fans tells me when she had keys to the radio tv gallery , he was already there on the air. vick who invited -- this is vick ratner. ♪ in 1973. to washington >> there was a time when watergate was a place to live and work. >> i was sent to cover the trial of guys who were caught breaking into the watergate building. a month later, one of the conspirators started talking about coverups and pay ups. i had an incredible time covering the news. family members say carter broke a promise. clinton and his family will be on vacation in south carolina. the opportunity to see how americans are affected by what we do. nancy pelosi is the first woman elected to the speakership. waxed when i got the chance to leapt at it.i >> liftoff. >> pieces tumble off. the challenger seems to shake free of the ice and goes. >> you can't ever have a real script. things are changing in front of your eyes. hundreds of school kids jumping up and down and cheering as it takes off. that means the engines are running well. what is happening? what happened? something has gone amiss. something is wrong. not a word from mission control. everyone here is open mouthed. >> i sell kids. they don't know whether this is part of it. they don't know whether to cheer . their faces crumble. watching those kids faces turn into tears, i will never forget that. into the capitol without a feeling of american history in front of me in that building. >> the president of the united states. >> members of the house and senate on their feet cheering and applauding as president obama works his way down the center aisle. ence in a bill can change american lives. that is what matters. it is not how do we get this bill together. it is what is the effect owing to be on people? >> please welcome, a lifetime achievement, vic ratner. [applause] >> thank you. thank you. i am overwhelmed. i am blown away. my heart is very full. you and members of the board, to my colleagues at abc news, and my colleagues i have worked with and learn so much from covering washington, thank you very much. the former senate majority leader howard baker wants likened to running the senate as herding cats. his line was under will encourage anarchy, after what has happened the last week or so, for the new folks in the room, talk about news. what a time to be here. thank you very much. [applause] >> our final award of tonight is one of the most prestigious for political and congressional reporting in the country. the joan s. barone award. [applause]esent >> thank you, lisa. you look at your program and you see this name. you don't know her. you don't know much about her. unless you are a certain age. you say, why do i care? here is why. this is a woman who at a time when women had a hard time breaking the glass ceiling in the news business, went from researcher doing watergate to executive producer. she is the kind of person who absolutely encapsulates what it funny, savvymart, with the news, the kind of thing that you want your colleagues to be. she is someone that you would love to have your table tonight. was incredibly kind. one researcher who worked for her at the san francisco convention in 1964 tells the story of staying up all night on a project for her, and the next day was surprised with a ticket to the all-star game at candlestick park. pretty good. she had the kind of standards , yearsople saying today later, don't exist anymore. the winners of this award tonight at test to the fact that they do exist. wasn't just smart and tough. she was a good friend to many of us. she loved politics, enjoyed life, the kind of person that you wish you were with. that is why the joan s. barone award is presented annually for excellence in washington-based reporting on national affairs and public policy. here is what the judges wrote about tonight so winners. every reporter has covered conferences with a magic act, and too much there there, but in this series, our winners, news wentey of abc underneath the canopy of washington's questionable spending. they honed in on what may otherwise be apparently meaningless fragments. the they woven together, expenses by members of congress, the cabinet agencies on thematic pilot, even spending cute of and debates in years, it made a lot of sense. donuts, catfish, it may not sound like a broad narrative about government itself, but that is what this correspondent and this producer expose. the washington watchdog serious has also approached spending from the consumer angle, illustrating how millions spent in d.c. is a practical concern to people outside of the beltway. here is an example of their work. the sunlight foundation crunched the numbers for us. the house of representatives on coffee andon food last year alone. this is a true bipartisan effort. leaders hosting their own members. john boehner, $64,000. nancy pelosi, $61,000. >> what do we do about this? of austerity and budget cut, ask them to buy their own copy. >> the biggest spender, the number three republican. kevin mccarthy. even on his facebook page, $95,000. another $4000 for bottled water. enough to pay the salaries of two mid-level staffers. >> and i ask you questions about your coffee and food spending? >> the congressman declined our request for an interview and would not stop to defend his spending. >> $100,000? is that appropriate? noticed were leftovers from a meeting he was attending. a staffer offered us a bagel. [applause] >> you see why we are proud to award this year's award to danielurley and .teinbergere [applause] it is a pleasure. good work. >> congratulations. >> thank you. i never knew joan, but i know bill plante. i can't think of a better traveling mate on many trips to we have done around the world. it is a huge pleasure to accept this award for a man who asked spent the last 50 years at cbs news. thank you. thank you very much. the radio and tv correspondents association. this craft like many of my colleagues do. to provide information to our viewers so they can make decisions about how to live their life, and how to run their country. help preserve this democracy. we are able to ask those in power, those who have the authority, how they are spending our money and what they are doing with our money. when diane sawyer wanted to revitalize this franchise they said we want to know from the people who are spending our tax dollars and the people who are wasting our tax dollars, why they are doing that. we go out and find them and occasionally, as you see, the next majority leader, we find them occasionally. it is a team effort. , i haveteinberger and i a lot of things i do, this is his baby. he has to scour looking for these stories and has read more inspector general reports that anybody in this business should have to do. not the most colorful reading, i am sure. he has done a wonderful job. we try to make it into television. how do we make it engaging? we made it television with some pat,editors and we think kurt, tom, and gary. for doing a wonderful job, and supporting us, and with distinction serving abc news as a division as a whole. i, we would like to thank our wives. from my point of view, i will give daniel the microphone here. we have mentors and teachers who have launched our careers. for me it was professor jim --somebody knows jim hayes. jim passed away on tuesday. he would be very proud, which makes me their he happy. [applause] >> not much more to add. thank you very much. tv, a learned early on, it is supposed to be fun. hard asese stories, as they are sometimes, are a lot of fun. , whong with david curley can write, ask tough questions, pleasure to and a work with, makes it more fun. thank you to everyone here. see you on the next one. >[applause] >> quickly i want to thank the excellent staff of the houston city -- who are here tonight. winky. we depend on you. who in the world would want the job for working for both congress and the press? you do it so well. we have a rear rarity -- real rarity. few of us have seen. he doesn't generally talk to the press until tonight. denis mcdonough has worked across washington, including in congress as an advisor to democratic leader tom dashiell. in the last day i learn more about his earlier careers. politics is his second career. he was first a high school and middle school teacher. bigh, actually was a advantage when you transition to the white house because he succeeded in getting sasha to stop smacking her gum, helped malia with algebra, and you got joe biden to start taking selfies? don't worry. there is a professional comedian coming up later. [laughter] is our honored speaker. white house chief of staff denis mcdonough. [applause] >> good evening everybody. i want to say thank you to nick offerman for hosting us tonight. to senator fisher and representative holmes norton. thank you for sharing the dais. i want to say to lisa, thank you for that thorough introduction. as lisa noted, i once taught middle school and high school. it seems like yesterday i was roaming crowded hallways teeming with unchecked egos, adolescent gossip, and plagued by mean-spirited bullying. actually, i am sure that was yesterday. [laughter] i am thrilled to be here. i consider this part of what i call our ongoing charm offensive at the white house. msnbcs where we leave feeling charmed, and members of congress calling us offensive, and for those keeping score on the president's fifth chief of staff, i asked jack lew for advice about how to manage this relationship. he said, like a marriage, and the president is larry king. [laughter] actually this is an honor for me. ira him or the day i was being offered the position. the president looked at me straight in the eye and said dennis, if you like your current job you can keep it. [laughter] one reason the president and i work so well together, we have a lot in common. one difference is that he is protestant and i am catholic. father, dreams from my and i wrote guilt from my father. [laughter] i have an lucky enough to have some pretty incredible experiences. people often ask what it is like to be there in the room with the president. i say we call those people white house photographers. all fun and games though. the white house can be stressful. my boss likes to talk all the time about how he is going gray. [laughter] really. what is that like? [laughter] it must be hard. there is always new challenges in this job. the president has taken to flipping out unannounced to the interior department to a burger joint, starbucks, and it can get frustrating. on hisnt a boss who was way out when no one expected it i would have tried to work for eric cantor. [laughter] [applause] but, for all the setbacks and obstacles we are seeing signs of progress. the last time secretary clinton joined the president for lunch, the secret service didn't feel the need to taste his food first. that is change right there. [laughter] in all seriousness, nights like this are fun and important. my old boss often says that debate is the music of democracy. it is not always melodious. it is never pretty. functional discourse and healthy debate should always remain at the core of our democracy to keep us moving forward. the people in this room, the ,embers, the staff, the press you are the chorus for this music of democracy. turningis bound to be tomorrow into some robust back and forth. that is how it should be. time, as muchme as the founders urged us to debate, they urged us to action. not just to talk. let's make sure that tomorrow's back-and-forth includes decisions and action. i share the president's optimism and commitment to spend every day in office to working hard at building coalitions and proving leaders in washington can still get things done. this may surprise you. i have recently learned there are a group of commonsense republicans in congress who want to work with us to solve problems. if they are not careful, i will leak their names to the press. [laughter] thank you everybody. thank you for the honor of being here. have a great night. [applause] >> thank you. i want to thank the white house communications staff for making this happen. [applause] now, it is time for our final act of the night. is an antigovernment government worker on "parks and recreation." in real life he is a lover of andory, builder of canoes, one of america's greatest comics. i'm excited to introduce denis .cdonoug nick offerman [applause] >> thank you lisa. good evening. they have left a gavel appear for me. -- up here for me. it is a styled american white owed. if things get unruly i will call this room to order. good evening. it is a great honor to be here. my sisters and i look forward to coming to this event every year. since march of 2011, syria -- sh it. [laughter] excuse me. good evening. [laughter] thank you for having me here tonight. it is a great honor. don't worry. i am being paid significantly to dohan jill abramson this job. [laughter] i grew up in a small town. my late grandfather was the mayor of my hometown. come from a long line of former politicians. it is only natural i would end up here speaking to you this evening. the citizens of our town loved my grandfather. whenever he addressed the townspeople he opened with this job. i thought it was appropriate. i thought i would try to endear myself to you in a similar fashion. bus loaded with politicians is driving down a country road when suddenly the bus ran off the road and straight into old pete's barn. old pete got off his tractor and went to investigate the carnage, which was considerable. after some consideration, he saw no choice but to dig a large hole and bury the politicians. a few days later the local sheriff came out and saw the crash bus and asked old pete what happened to the politicians. pete told him he had buried them. well, the good lord, the sheriff asked, were they all dead? old pete said, some of them said they weren't but you never can trust a politician. [laughter] [applause] i should apologize by the way if you're expecting my mustache. my mustache is with caa. it is engaged in a soda campaign down at the world cup. [laughter] i was very excited when i heard i would get to meet the white house chief of staff. hasurns out that position nothing at all to do with stick fighting. a lot more would get donte in disputes were settled with a bow staff. eric cantor got a job at fox news. [laughter] [applause] he is the first house majority lose a primary sense 1899. it is the last time we were at war with spain. watch yourself, spain. [laughter] tonight's dinner celebrated washington, d.c. itself a city with a rich history of music and art and diplomats getting away vehicle huge dealer -- or homicide. something that upsets him with residentsis that easy have to pay federal income tax despite not having a vote in congress. [applause] we literally fought a revolution over that. it is like massachusetts not letting straight people get married. [laughter] no one requires a little math. between the republicans and democrats among the city has become a noxious stink hole. little actually gets done because of the backstabbing, deceit, and greed. i just want to thank all of you for making a hollywood actor like myself feel welcome. [laughter] i'm right at home. republicans have come around on sex education. i heard they finally decided to teach fracking in schools. can i say that on c-span? is now legal in pennsylvania. in the space of just a few weeks theirarpet of anti-gay law and michael vick. well done. with anti-gay marriage laws toppling so easily, i am starting to worry it is a trap. like perhaps the koch brothers are distracting us while they escape on a spaceship. a jogiant gay spaceship. [laughter] up in a farm family there were early lessons in politics. in illinois we have these two nations black beetles. indestructible. we would have these family picnics that involved frosty mugs and draft beer. dive intoles would your beer so that if you didn't keep it covered, eventually they would all be in there for the free beer. sincerely, these bugs were known as democrats. [laughter] some people assume that because i am a actor i am a democrat. other people assume that because i like to hunt and build things i am a republican. i am neither. i am a proud bull moose. teddy roosevelt was a personal hero of mine. he was a man's man with a powerful mustache, an adventurous spirit, and no patience whatsoever for this sort of nonsense. [laughter] be a bigly wouldn't fan of this room to be honest. the news media speaks very loudly and does not own any sticks. [laughter] i am proud to live in a representative democracy. congress is almost entirely made up of rich, white men like me. i appreciate it. them, comcast and time warner are about to merge, which i think is great. and i'mwned by comcast contractually obligated to think that. [laughter] comcast and time warner cable were just named the two most hated companies in america. pretty impressive. murderedlly people and they aren't in the top 10. you could start a company whose business model was to set docs on fokker -- dogs on fire and they wouldn't be as hated as time warner. corporations are now considered people. i think it is great because it has been my dream to punch time warner in the face. let's be honest. bossesmuch all of our are evil. nbc is owned by comcast. cnn is owned by time warner. fox is owned by an all strong and super potent --super villain. jay carney, the messenger we love tissue. he was in the parlance of old ones.s, one of the ogogood [laughter] you are no doubt aware, georgia has adopted new gun legislation allowing idiots to thed a firearm in church, post-offense, bars, movie theaters, the library, but not the statehouse. a sickly any of the places where people are prone to get excited theo postal, except lawmakers'place of an appointment. if you live in georgia, rest assured you will never need to back down again when wrestling another reader for the last copy of "wind in the willows." you are out of stamps? how about now? [laughter] the second amendment protects our right to own guns, specifically so that we can defend our country from invading armies or from our own federal government should 18 into taking over things and try to make things more royal around here. the second amendment is not there to protect our right to intimidate the teenage cashier at chipotle. i feel like we as a country, present company included, are unclear about the first 10 amendments. if it is alright with you i'm going to run through a brief bill of rights refresher course. [laughter] the first amendment guarantees of freedom of speech, but freedom of speech does not mean freedom from criticism. that confusion is one of the many things that fox news and donald sterling have in common. the government can't punish you for saying something stupid, doesn't mean the rest of us can't. and we will. we as a country in joy punishing people for saying stupid things. that fireworks and the missionary position are the three most american things i can think of. [laughter] the first amendment ensures us the freedom of religion. for anybody out there claiming that america was in any way founded as a christian nation, stop it. it is nonsense. look at the bill of rights itself. it is a meticulously worded contract. if anything this is proof that america was founded as a jewish country. [laughter] come on. believer in the second amendment. i consider myself to be a second amendment originalist. i believe every man or woman has the right to bear arms but only the same arms that our country's forefathers bore in the 17th century. muskets. as a last resort. if you have a beef with me, i am going to expect you to try and resolve it using reasonable discourse, using words and civility. if our tempers are flaring past the point of civil discourse, i expect you to challenge me in an honorable contest of fisticuffs like a grown adult. to remove oneself to the safe range of a firearm to settle a dispute in america is nothing short of cowardly. at the ease of automatic firing capability and i will declare you nothing short of lily livered. for shame. it is hard to shoot you when you're shaking his hand. people in texas but it would be good to bring a gun into a chili's to prove a point. up just reminded how fucked i inis to bring a gun chili's. [laughter] by god. third amendment says soldiers are not allowed to sleep in your house if you don't want them to. amendment.ood confusionthere is about this one. this could be swapped into airbnb. service of the third amendment we have forgotten about together. nsa spille at the barbecue sauce on this one? something has gone terribly wrong. the fifth amendment is mostly for people to invoke during the second half of law and order. 5-7 are things for people to yell during jury shows or lawyer shows. the sixth amendment sets up the founding principles of jury duty. at this point i think of most people had to choose between jury duty and letting a soldier crash on your couch, we would choose the latter. the eighth amendment protects us from cruel and unusual punishment which apparently does not include strapping a citizen to a table and murdering them. that is a judgment call. the rest of the civilized world has stopped practicing capital punishment. meanwhile officials in oklahoma are making legal injections the way and make a barbecue rub. some crushedow there, that ought to do a trick. the ninth and 10th commitments are there to make sure people don't get cute with the other ones. it is like in movies when someone looks in the rulebook and says there is nothing in here that says they can't play baseball. those amendments are there to make sure a champ doesn't get to play baseball because no one thought to explicitly forbid chimps from playing baseball. let's try harder from here on out. you can't pretend that the constitution says whatever you wanted to say. that is what the bible, expiration dates, and speed limit signs are for. thank you very much for having me. i appreciate it. [applause] >> we just have some more thank you's. i want to thank our tireless event planner who made this happen. [applause] joppey, thank you. those of you who heard the reception band, that is the one night stand, another d.c. culture spot. t get you mip cards tha free into madams organ. i want to thank cnn, our bureau chief, my capitol hill colleagues, craig, danna, paul, withealt with me dealing this dinner and could not be better friends and colleagues. i am honored to work with you. it is a privilege. thank you to my friends, megan and kristen. and to my husband, you make everything better. to all of you, i have the deepest thanks. it has been an honor. i would never have imagined reporting to the capital, much less standing up for the world.t reporters in the we will continue fighting for access at the u.s. capitol. we could use it. [applause] finally, thank you to the great city of washington. with that, i would like to turn the gavel over. to my friend and colleague who has been a great help on this dinner, frank thorp. [applause] >> first off, let's have a round of applause for lisa. [applause] i am not going to keep you any longer. thanks for coming tonight. have a great year. see you next year. i love you luke. good night. thank you. [applause] [no audio] >> hillary clinton reflects her inure of secretary of state her memoir, "hard choices." see it live starting at 6:00 eastern on c-span 2. includes davidok lloyd. >> there is something that drives them to this ideal of , it is like so many people i know who served. the intensity of the experience, the intensity of the relationships they have with their combat bodies are so true, and so pure and they look back on those with mourning. i have always asked, do you wish this had never happened? they would do it again in a heartbeat. i think there is something else that goes on. going through a near-death experience somehow seems to give them so much strength and optimism that i think that is one reason they would do it again. waxing read more with our conversation with david wood and other interviews in c-span sundays at 8:00. coming up, the house veterans affairs committee examines veterans health care. after that, president obama and members of congress respond to the situation in iraq as militants captured key areas of the country. that is followed by coverage of the radio and television correspondents dinner. >> coming up on the next washington journal, a look at the situation in iraq. sunni militants captioned key areas. then eric cantor's primary loss and the impact of the tea party on the 2014 midterm elections. the recent article, the case for operations. examining the struggles and treatment of african-americans in the u.s.. the washington journal is live every morning on c-span . the first 100 days in office. at first make the agency more efficient. see his remarks from the center for strategic and international studies here on c-span. waxed one i started covering congress you had people like senator russell long, danny rostenkowski. howard baker. people who were giants in their own way. a couple of those guys got themselves into trouble. but overall, these were people who knew -- they were all intelligent. they knew how to craft legislation. i knew had to do a deal. they work -- they knew how to do with the president was. there was politics. at the end of the day they usually found a way to come together and make decisions for the good of the country. there is still great people. i should malign some of them. they are wonderful members on both sides. they are a minority. increasingly people are driven by the politics and their own self survival. work isthe hardest getting the money. >> next, a house veterans affairs committee hearing on veterans health care. it is 3.5 hours. >> the committee will come to order. thank you for coming to this hearing this morning. we have numerous members who were on their way. we want to respect the time of our witnesses and we appreciate them being with us today. before i begin i want to ask consent to allow our colleague and former committee member to sit atn mcnerney the dais and participate. welcome to the full committee hearing. ipate in today's hearing. without objection, so ordered. welcome to today's full committee hearing and examination of bureaucratic areas to care for our veterans. as we all know very well now, during our committee othersight with the results of a committee investigation that had uncovered evidence suggesting that dozens of veterans died while waiting for care at the phoenix department of veterans health care system. just over two months later, we know now that in addition to 23 veteran deaths at the department linked to delays in care earlier this spring, aft least 35 more veterans died while awaiting care in the phoenix area alone. what's more a va audit released earlier this week found over 57,000 veterans have been waiting 90 days or more for their first va medical appointment and 54,000 veterans who have enrolled in the health care system never received the appointment that they requested. that's 121,000 veterans who have been waiting for care to be provided that they earned. that number exceeds the population of several medication sized u.s. cities like athens, georgia, abilene, texas, or even evansville, indiana. and i fear there is more yet to come. yesterday, i spoke to a group of va providers from across the country at an event for the national association of va physicians and dentists. speaking about the current crisis engulfing the department, they've said va's procedures and processes are inconsistent, inconsistently applied and often prevent efficient use of personnel. the statement echos the serious calls that we've heard from others other recent weeks. during a recent committee hearing, the inspector general testified that va suffers from, and i quote, a lack of focus on health care delivery as priority one, unquote. as a result of several organizational issues that impede the efficient and effective operation of the va health care system place patients at risk of unexpected outcomes, end quote. in an article published last week, a former under secretary of va for health dr. kenneth kaiser wrote that the systemic data manipulation and lack of incident tegty va experiences are but, quote, symptoms of a deeper pathology because simply va has lost sight of its primary mission of providing timely access to consistently high quality care, end quote. all of these remarks go to prove what we have already known. the va health care system and the bureaucratic behemoth that accompanies it and its problems are even more complex. i believe that the majority of va's workforce, in particular the doctors and nurses who provide our veterans with the care they need do, in fact, endeavor to provide high quality health care. unfortunately, va leadership has failed those employees almost as much as it has failed our veterans. in correcting those failures is going to take a lot more than the bandade fixes the department has proposed thus far. it's going to take wholesale systemic reform of the entire department starting with holding senior staff accountable. va hasn't gotten where it is today due to ineffective management or lack of training for professional development for administrative staff or cumbersome and outdated i.t. infrastructure. the department got where it is today due to a perfect storm of settling for the status quo. va cannot continue business as usual. it's very clear the status quo is not acceptable and it's time for real change. again, beginning with accountability up to the highest levels of va bureaucracy, and i hear repeatedly from the va about its delivery of high quality patient center care. but this committee, republicans and democrats alike, will not rest until we hear that same assessment from every single veteran seeking care. it's time for va to tell us the bad news, not just the good news. with that, i yield to our ranking member, for any opening statement he might have. >> thank you very much, mr. chair, for having this very important hearing. examine the barrier toes care for our veterans. this is a unique time in the history of the department of veterans affairs. we as a committee have been responsible for bringing to light systematic problems, many dating back over a decade. but as we are shining the light on these problems, we must also begin to take steps to address them. i'm proud that this committee has addressed these problems in a by-p partisan fashion and i'm hopeful this continues as we roll up our sleeves and begin to find solutions. the va is a sprawling organization with over 6 million unique patient facilities spread all over the country and nearly 275,000 employees and a $56 billion budget. it put va the largest integrated health care system in the country in perspective, dha is roughly the equivalent of five mayo clinics combined. recent admissions of wrongdoing are shameful and the practice will not be tolerated. the systematic collapse confirmed by the axis audit and the va oig points to a bureaucratic bureaucracy that has seemed to have lost its way in its focus. i think with these problems the time is right to begin discussing how best to address these challenges and the time might be now to effect big changes that will put the focus back on the veteran s and away from the culture of complacency. in our discussion of reform, i want to make sure that we are not just rearranging the desk chairs. all the reorganization in the world will be futile without a strong base of value. i do not doubt the commitment of the vast majority of va employees. however, sometimes we all know that we need to be reminded of who we are here to work for. we are here to work for the veterans. brave men and women who have sacrificed so much for our freedom, men and women who right now deserve better. i strongly suggest that vha develop a code of conduct or a caregiver culture that will become engrained throughout the organization regardless of whether there is one vision or 50. working in the va requires an utmost integrity. as dr. roe pointed out the other night, all va employee needs to do without a doubt is they have to be reminded that they are working for the veteran. not a bureaucracy. as with most things, there are tradeoffs when looking at structural reform, centralization versus decentralization, standardization versus innovative. these discussions have been ongoing for years if not decades. i'd like to think vha is an adaptable learning organization that can make needed transformation. but let me be clear. the only way we're going to truly address the litany of problems is to look at the fundamental change within the department. and rightfully, we're all looking at ways to address the problems as we see today. but i'm hopeful that our ambitious schedule of hearings in the weeks ahead will think anew about how best to provide the quality comprehensive care to our veterans in a timely fashion. and i hope that they challenge us to think anew about how to refashion systems and infrastructure, management and personal policy and procedures to address the axes issues head on and to help the va live up to its ideal. i believe it is essential that we look at structural and cultural root causes that got us in this position in the fist place. we have heard that the leadership of the medical center feels disenfranchised. we have real concerns over the effective level of accountability. we need to shorten the feedback loop from the front line provider to vha leadership. and one of the discussions we must have is over the right administrative structure of the vha. how to ensure that policies and procedures follow nationally while making sure that va is not a one size fits all system. we have heard many times about the excessive, intrusive administrative burden providers experience which takes time away from caring for our veterans. we need to do what we can to eliminate this administrative work. many are pointing to the i.t. infrastructure. there is no doubt that an outdated scheduling system contributes to the current problems and needs emergency upgrades. at the same time, we need more detail and what's happening in the millions of dollars congress has appropriated for i.t. before we can look at investing even more money here. i want to know why the va did not do a better job in planning strategically, anticipating the needs of facilities systems population and putting in place actions, including things like i.t. upgrades to address these anticipated needs. the time is right to leverage outside expertise. there is no monopoly on good ideas. i look forward to hearing from the panels today and hope to continue this excellent discussion throughout the coming weeks. once again, mr. chairman, i thank you very much and to yield back. thank you very much to the ranking member joining us today. we actually have two panels on our first panel already seated at the table is the honorable tim mcclain, president of humana government business, mr. dan collard, chief operating officers for the studor group and dr. betty mccoy, chairman of the committee to reduce infectious deaths. we appreciate all of you being here with us today. with that, mr. mcclain, you are recognized for five minutes. >> thank you, mr. chairman. thank you for holding today's hearing to examine bureaucratic barriers to health care for veterans. i will focus my remarks on the very complex of organizational impediments in the veteran's health administration not conducive to the delivery of good health care to veterans. in my written statement that i ask be made part of the record -- >> without objection, all your statements will be entered into the record. i make four specific recommendations to improve organizational alignment in vha. but in this oral statement, i want to address just one and it's probably the one that is most disturbing to veterans in congress. and that's a failure of ethics. there is a pervasive va culture that puts personal gain and the system over the needs of the veteran. and hthis is wrong. and i want to make two points to the committee. let's not have congress and va just put band-aids on the current crisis. without resolving the systemic causes. and, two, i believe any long-term solution must include a cultural and organizational assessment by a nationally recognized company. the current crisis differs from previous va crises by the fact that it reflects a serious cultural deficit throughout va at certain levels of management. this is a -- to the culture of what should be at va. now, i want to emphasize and make it clear that from my experience at va, i found the vast majority of va employees to be competent, professional and dedicated to the primary mission of severaling veterans. but the culture at certain management levels reflects an attitude of personal gain over service to veterans. some major changes are required. but before making any major changes, i propose in my written statement that va be directed to contract with a nationally recognized company to conduct a top to bottom assessment of the current culture. a gap analysis can then be performed to determine the current state and then what is needed to move the va system to a veterans centric 21st century system. the experience will be influenced by what i will call the voice of the veteran, which essentially is direct veteran input into what this culture should look like going forward. if congress of va fails to seize the once in a generation opportunity to deliver a modern va health care benefit system, we will all be back in this hearing room in the future lamenting the then current crisis. mr. chairman, this concludes my oral statement. i'd be glad to answer any questions. >> thank you very much, sir. mr. collard, you're recognized for five minutes. >> thank you for this hearing, as well. thank you for the opportunity to address the committee on the issues of veterans health and the underlying elements of culture and leadership. i listened with interest monday night when i heard mr. griffin from the inspector general's office talk about the fact that if you've seen one visn, you've seen one visn. it seems both the testimony and your questions centered around questions in variance. it's clear that those that implement standardized approaches to care produce the very best outcomes. these organizations build culture of accountability, alignment, consistency and sustainability. we also find that their evidence based approaches extend beyond evidence-based care to a framework of evidence-based leadership. this approach ensures that leaders are not only held accountability for the right goals, but these leaders are given the skills and the tools and knowledge to achieve those goals. these leaders ensure consistency in the workplace for their employees, they also ensure consistency in the care environment for their physician colleagues. and as the public has watched the vha issues unfold over the past 60 days, it's clear that the tolerance for variance is cheap among its ailments. the am of variance has created an unfortunately predictable outcome as we would say what you permit, you promote. the data that demonstrates these connections is quality outcomes, patient experience and lower costs continue to mount. when one reviews the publicly supported data, it's clear better health care is less costly health care. data suggests a strong correlation between patients' perception of care and the clinical outcomes. further, there's data that correlates specific questions like preparation for at-home care with the likelihood of a readmissi readmission. a review of the vha facilities that report show only a handful show a few just above the national mean and unfortunately way too much in the lower ranks of health care. >> you connect this proof with the fact that employee engagement and one begins to see definite trends. a study published recently at the university of birmingham shoeg showed clearly the correlation between the level of employee engagement and the likelihood of the creation of work arounds which equals impact on safety. i was reminded of that as i read the various reports of what we now know from the whistle blowers about the wait list and the related mortalities. largest health care systems in the united states have driven improvements by harvesting and implementing best practices across their system. when organizations like community health systems identify a best practice, they move quickly to put the practice in place across all 205 facilities. this includes patient safety protocols, caregiver to patient interactions about medications and a leader accountability platform. i was concerned when i heard the wednesday on monday refers the amount of time they thaw it would take to make change. as john cotter would have us remember that the biggest okbjet tackle to achieving performance is high confidentsy. no matter what is decided, the va must embark upon change with a never before seen sense of urgency with a proven outcomes based solution. we open at the studor group that it can be as straightforward as transforming the rigger where they compel into an area where they are subpar. imagine if the vha electronic medical record which is hailed ad as cutting edge would be the oomph tuesday for creating the scheduling software which is today archaic at best. imagine in a high performing facility is referenced in the testimony that stand out as models could be toss modeles and indeed replicated with what mr. mccofsky referred to as exceptional leadership and culture. we wouldn't have tolerated the operation of 21 different navys or armys, air forces marines or coast guard when these veterans were on active duty. why do we tolerate 21 versions today? our veterans ensured readiness by putting in place systems of validation for skills for soldiers as well as those leaders. we find safe, effective timely health care to be no different. and finally, we have to make sure that the veterans health administrative doesn't continue to fall victim to this disease process known as terminal weakness. many have large geographic footprint wes a corporate office thousands of miles where the care is being delivered. many organizations serve a large incident gent indigent population and these organizations find a way to survive but thrive. i ask if this committee would propel the secretary and his leadership team to move forward expediently, ensure methods of validation and verification and make sure this supports outcomes leadership development tone sure the consistency. i ask this today not only as a health care professional, but as the son of a deceased marine corps veteran whom i saw all too often let down by the va. thank you. >> dr. mccoy. >> thank you. i'm betsy mccoy, former lieutenant governor -- and chairman of the committee to reduce infectious deaths. i've spent a good deal of my career in prevention of infection in hospitales and i admire many of the achievements in the va in that area. but i'm here today to express my concern that this bill passed in the senate yesterday, the mccain standards bill, will not save the lives of vets stuck on the wait list. this bill, as currently written, is designed to protect union jobs, not ailing vets. in fact, the va is run largely by unions and for unions. and one of the culprits is this 316 page unit contract full of mind numbing rules that prevent assigning an employee to a new task, a new work shift, a new building or reprimanding someone on the staff for misdeeds or just poor performance. nine months ago, the va rolled out a $9.3 billion initiative to allow vets who were stuck on wait lists to access civilian care. but the unions fought it as hard as they could. the american federation of government employees labeled it in their newsletter the worker an attempt to dismantle the va brick by brick. that's not true, but they vilified it that way. and this current bill sabotages the ability of vets to access civilian care in three ways. first of all, it requires -- and i'm referring to section 301 starting on page 21 since i'm sure you'll be reading the bill. it requires any vet wanting to access care get a letter from the secretary of va confirming the vet has waited an unacceptable amount of time for treatment or lives more than 40 miles from a va medical center. good luck getting that letter. i talk to vets all the time who have contacted the va, called them, e-mailed them every day for six months and couldn't get a reply. secondary, if the va does manage to get the letter and get the choice card and get to a civilian doctor, he has to hand the card to the doctor who has to call the va and get prior approval before treatment. good luck getting somebody to answer that phone call. thirdly, most preposterously, this bill states this choice program will end in two years. in other words, a few hours after the va manages to get the hot line up and get the cards distributed to vets, it will be over. there is a way to solve. >> prok and pthis problem and pt the solution in the hands of the veterans. many of these vets are seniors, they're 65 or older and on medicare. if they were encouraged to seek age related care such as angioblasty at hospital, particularly teaching hospitals, it would reduce the baglogs by as much as half solving this national crisis. and in many cases, vets would get better care because the mortality rates at the teaching hospitals associated with many of these va medical centers are much lower. they're high volume hospitals and they do these age-related procedures all the time. what is holing the seniors back is lack of knowledge about that resource and secondly the co-payments, the out-of-pocket expenses. we could give those vets who are already on medicare a special vamedigap card. it's budget neutral. you're already paying for the care. and yet it would allow them to access better care, it would reduce the wait list, and it would allow vets who have fought for our freedom, it would allow them to get the care they need. thank you for this opportunity. >> thank you, dr. mccoy. mr. collard, i'll start with you, but anybody that wants to answer this question, feel free. each member will have five minutes for -- and we also have a round of votes. that's why evening hearings on return nights are so good. we don't get interrupted with votes. but my staff recently obtained an e-mail and a supervisory chain how many levels there are between the scheduler and the secretary and, of course, the scheduling clerks called medical support assistant. it shows 12 layers of bureaucratic and middle managers between those two people. is that surprising? >> it's not surprising. but it's clearly an indicator of the issue. on the private sector, you wouldn't think about care that could be rendered in a safe, timely fashion with 12 layers of leadership between someone in the trenches and someone making the decision. it creates the greater opportunity for the variance in communication, the variance in setting expectations, the layers just create the permanent ation for communication within the va. >> and how about the time it takes, all that communication? this is time. you know, one of the studies that recently came out showed that when an older vet is forced to wait 90 days or more for treatment, it increases the risk of stroke by 9%. that's a study right out of the boston va medical center. so this time is critical to saving the lives of these vets. that's why they're dying in these wait lines. >> tell me, if you would, how does this structure compare to your experience in observing other medical centers or systems? mr. mcclain. >> i don't have a lot of experience in observing other medical centers. human aye for the most part is a health and wellness medicare advantage company. we do a lot of business with va. and we have seen the difficulty that we have as a contractor in also getting certain answers and certain things changed or done for the betterment of the veteran. >> mr. collard. >> we would find traditionally no more than three or four layers. i was with an organization yesterday and it was the traditional structure of a senior leadership team, directors, managers and right to the front line. >> and i think you also -- i think, mr. collard you may have, but others of you may have alluded to this, as well. the number of health care networks that exist across this country, 21? i mean, you've got a large network. i mean, system. how many networks should there be? surely it should be broken up somehow, but 21? >> even if the number stayed 21, the ability to standardize across the 21 is really the key. there are, you know, health care is always local, no matter whether it's private sector or government. health care is always local because we're serving local veterans. but the ability to say whether it needs to be 21 or six, really the underpinnings of that, when you lift up the hood on that is the ability to standardize across no matter how many regions or visns or divisions that you have. >> dr. mccoy. >> yes. one of the problems is really quite simple. .it's been pointed out in many of the reports that have been submitted to congress over the last decade, including the one that was presented on monday and the one that was presented by the general accountability office in march of 2013. and that is that vets are assigned an appointment and months go by and nobody calls them to remind them a day or two before the appointment that they're supposed to come. that is a practice that is always done in private sector medicine. every doctor's office, every clinic, every hospital calls patients and reminds them to show up for their appointment. the result of this failure is that in some departments, like ophthalmology, according to the gao report submitted to you last march, the no-show rate is 45%. so when you say you don't have enough appointments and enough doctors, almost half of them are going to waste. and yet why, every year, does another report have to remind the va to call the patients and nothing is done about it? >> my time is about to expire, but i'd like, if you could, as succinctly as possible, what's the greatest single barrier that exists out there today within the va to providing timely health care? >> and i'm going to go off of what mr. collard said is standardization. you've all heard it. if you've seen one va, one va. and it's too much, i guess, flexibility or variability in how services are delivered and how veterans can access services at each of the va facilities. >> when you standardize your practice, you create greater predictability and outcomes, whether it's an attorney, a finance expert, a health care expert, they all agree when you standardize your mode of practice, you predict greater predictability and outcomes. and it's the outcomes this panel needs to address and not just the care measures that we're talking about. >> dr. mccoy. >> i'd like to to focus on the failings of this bill. because pretty soon you're going to be voting on it or compromising with the vote you took in the house to create a final bill. and that final bill that you create has to remove these practical impediments, otherwise you are not passing a bill to give vets access to civilian care. it will be a charade if they have to get a letter from the secretary and if there has to be a call made to get prior approval for the treatment. just remember that, please, as you compromise with the senate. thank you. >> thank you. >> thank you very much, mr. chairman. mr. mcclain, one of your recommendation is to review all personal evaluation metrics and ensure that all vha employees from clerk to clinicians to senior managers are evaluated based on outcomes for veterans who are seeking and receiving care from vha. mr. collard, you also urged us to focus on leadership. my question to you two is the overreliance on metrics has been mentioned as one of the factors leading to the current wait time problems. how do you explain the metrics and outcomes. >> thank you. my short answer to that would be that most of the metrics that are reported today in vha, and there are hundreds of them, are process oriented. and simply checking a box or doing something is -- versus actually measuring what that accomplishes or the outcome. so my point in making that was that we should be rewarding and measuring outcomes for veterans. >> it's just the sheer size of the number of metrics. if you went the hr route and pulled the evaluation within the va today, you would see metrics scored by the dozens. and if you think about that many metrics, how can a leader give any proper attention and proper priority when you have a way to evaluation around those that are outcomes versus process, you have the ability to create focus and priority and that's what i would say is not just the metrics, but the sheer number of metrics that we're looking at. >> thank you. is it valid to have a strategic metric, mr. mcclain? >> i think it's valid to have a strategic goal. as to what the outcomes might be. and be measured against that goal. i think that's valid. valid. >> look over on the -- >> i wanted to point out. >> many mccullough, would you answer? >> we know the fact that a tactic like a post-hospitalization phone call has the ability to -- in the publicly reportedly websites that you would find, you would find the actual readmission rates for folks within certain disease categories. >> some within the va have raised the concern there are inadequate number of -- this causes physicians to spend undue time with paperwork and routine clinical work. mr. mclain what does the private sector use as a benchmark for the physicians to -- >> mr. collard? >> i would defer to mr. mccklai. >> i'm interested in your comments on the v.a. paying for care for patients already covered by medicare advantage and the potential for the government paying for care twice. what policy changes could remedy the situation? >> well, it's very interesting that such a large percentage of vets actually have insurance. only about 10% of vets being treated at the v.a. are, quote, uninsured. and it's probably tragic that they weren't included in the affordable care act. but nevertheless, many of these vets who are insured, either with employer-based insurance or medicare advantage or regular medicare or medicaid resist going outside of the v.a. system because of the out-of-pocket expenses. as i explained before, if we gave them a medigap card for the seniors, particularly, a medigap card, special v.a. medigap card that absorbed out of pocket expenses, they could seek a lot of care in civilian hospitals. particularly teaching hospitals that are high volume for -- they'd be getting in many cases better outcomes. always always better but often better. it's budget neutral for us as a nation. it's budget neutral. >> thank you. incidentally, under the affordable care act, 3,000 -- were denied access because our governor refused to expend medicaid to the 70,000 mainers of which 3,000 were veterans. >> thank you. >> i thank the panel. my first question is for the entire panel. many have mentioned and stated the v.a. has lost its focus on their primary responsibility of caring for our veterans. do you agree? let's start with mr. mclain, please. >> yes, i do agree. >> also mr. collard. >> yes. >> yes. doctor? >> yes. >> all right. now, tell me where you think their focus has been. we can start with mr. mclain. >> the current focus, i think, has gone off the veteran and has gone into preserving the current system. i think that there's a lot of -- if it's not invented here, we don't want to hear about it. so there is not a lot of invitation for innovation to come in and partner with v.a. in order to move it into a more modern health care system. so where i see it is, it's as dr. kaiser stated, a more insular system right now. >> mr. collard. >> two answers, really. i spent some time with a v.a. leadership group in one of the western regions last year. i heard for probably two hours more reasons about why we couldn't do something versus why we could do something. i also think that sometimes we feel that standardization stifles innovation. and i don't think it could be any further from the truth. when you have a standardized platform in any industry, you actually have pretty fertile ground for innovation. because once an innovation takes hold, you now have a platform by which you can harvest, distill and disseminate those best practices through innovation across an enterprise. i think what happens as i would associate with mr. mcclain's comment, the ability to attach to the way we've always done things is really probably that barrier of focusing on veteran centered care. >> doctor? >> yes. i'd like to point out two things. one is that as i mentioned in my opening statement, in the '90s the v.a. really took an admirable lead in patient safety and particularly attention in hospital acquired infections. lately we've seen less and less of this. dr. jane who has now taken a bigger job at the v.a. has done some wonderful work in the work of meth sillen resistance. in general, that pioneering effort to protect patient safety that i saw in the '90s has disappeared somewhat from the culture. that, and as i pointed out before, how can you have a focus on the patient when you have 316 pages of rules about what employees can and cannot do just for one union? just for one. this contract governs the work rules for 200,000 people who work at the v.a. and it is preventing a focus on the patient. >> thank you. next question, do you believe the v.a.'s shortcomings and failed benchmarks was the result of inadequate funding or management or resources. mr. mcclain. >> i personally don't think it was the result of inadequate funding. the v.a. budget has really increased

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