Israelis. On augustongress is break, cspan prime time will feature a wide range of political views and topics. These programs include the National Association of latino elected officials and western conservative conference and will have a update on 2014 senate races. Cspan prime time monday through friday at 8 00 p. M. Eastern. A discussion about improving Veterans Health services. This is just over 40 minutes. Washington journal continues. The first guest of the morning is alex nicholson. Good morning. For those who may not know about your group, what would you want people to know . Ours is the first Large Organization of veterans of the conflicts in iraq and afghanistan. We are growing exponentially and we represent the interests of that constituency here in washington and around the country. I assume you have been closely watching the a reform bill process. When it was finally passed by the house and the senate one of the things they referred to was the bandaid falling off soon. Guest we have been closely involved in it. Yes. It is intended to basically be a stopgap measure. An Emergency Response to a crisis. It is not everything that is needed to respond to the crisis and Congress Certainly has more work to do when they get back, but it was meant to be a first step to stop the bleeding and repair the damage that has been done. Host some of the elements go to paying doctors within the system , establishing an independent committee. Breakdowns, are those figures enough . What about using private doctors rather than building up the doctors in the system now . There are shortterm fixes, intermediate term fixes, and longterm fixes. The issue with ringing in and for theseoutside care providers is the reason they are in this position is they clearly dont have the capacity to deal with it right now. So, allowing the v. A. To expand capacity by utilizing private Community Providers is a way to get those who have been on the secret waiting list to come out of the shadows and for them to come into the care and treatment that they need right now. There are longerterm infrastructure Capacity Solutions in the legislation. Including expanding the number of health care providers. It is something that the v. A. Needs for longterm sustainability. One of the reasons that we ended up in this position to begin was we dont have the capacity to deal with the demand for care, treatment, and service. There are shortterm, intermediate term, and longterm fixes involved. Just to clarify, who would qualify to go outside and who stays within the system . It is about whether the v. A. Can serve them in a timely manner. For those folks living over 40 miles from a facility or being forced to wait over 30 days, they will be authorized and facilitated to go outside the system and utilize a network of private Community Providers. Host in your opinion, what is the longterm fix . In your view, what has to happen in the long term in terms of manpower and money . Guest v. A. Has been underfunded for a long time. Congress has given the v. A. Every dime it has asked for and more over the past five or six years. We strongly suspect that the budget requests from the administration and ba every year have testified as repeatedly sufficient to meet demands were lowball. The v. A. Is going to first of all have to do a more realistic assessment of its own resources and need moving forward. The infrastructure capacity augmentation that is a part of the bill and conversation moving asward will have to continue they dont have the capacity to deal with the population. So, they will have to increase their number of providers, increase the infrastructure facilities and lease and build out more. They will have to partner with private Community Providers. Basically, the v. A. Has some serious, serious cultural problems. Accountability is another big issue. One of the reasons we are where we are today is because of the ofture of the lack accountability and essentially a culture of moral corruption amongst some at the v. A. There are a lot of great employees there doing a lot of great work, but scandal after scandal it has become clear that there are some in the v. A. For too long who have not been accountable and have gotten away with very likely criminal some fromreventing getting the treatment that they need that sometimes. Going to have to be a multifaceted, multidimensional approach. One of the aspects of the bill just passed by congress is the new accountability provision that will allow the secretary to fire underperforming or negligent Senior Executives. That only affects Senior Executive service employees. 400 to 500 folks within ba. Certainly in most cases i would imagine that those are not the most Senior Executives actually doing the reactions on the ground that led to the v. A. Not being able to serve veterans like they should, so there will have to be more accountability provisions further down in the v. A. , getting at what we call the title 38 employees who are , doctors,e providers general schedule employees, admin folks who manage these lists and create these workarounds, who have to have more bunker busting accountability mechanisms deep down in the system to attack the culture. Host our guest is here to talk about the Veterans Affairs reform bill that was recently passed in the house, alex nicholson, of the iraqi and afghanistan veterans of america. One to give him a call and add comments or ask questions . We have set aside a line for veterans this morning, 2025853883. Were you surprised that a deal came forward from both sides . Honestly . Est in this situation i was in. I thought that there would be hell to pay of Congress Went on recess and went back to their constituents without having something done. The typical thing to do these days is to try some partisan things dont get done or evolve the way that some a risk that that would happen, procedural tricks, blaming republicans and democrats. However, in this environment, with the recess coming up for so long in august, i would have been shocked if they had not come to an agreement. Senator sanders and jeff miller, leading the charge. What do you think about their efforts . Guest we were disappointed that it took a long as it did. Congress started on the package of fixes to the crisis in early june. They were originally talking about being done by the july 4 recess. Been. Ould have there was grandstanding in the beginning. There was blame passing back and forth in the beginning. Staff, of course, are the ones who really sit down and allow the deals, the terms to the deals like this. There was some obstruction in the beginning, i think. The senate works very differently from the house. Some of it was the constraints and politics of the senate. I believe. From what i saw, not only talking and working with them, we have seen the results. We are nonpartisan and i am fiercely independent. But you know, i mean, if you look at the objective evidence of how many hearings the house has held and the oversight conducted by the house, the bills conducted out of the house side and passed the floor compared to the lack of productivity in all of those dimensions in the senate, it is hard to conclude that the house we talked about congress generating bodies. In this case, on these issues, with these committees it is hard to lump those together when there is such a disparity between the productivity of the house on Veterans Issues and the lack in the senate. Host host first call for you is paul in South Carolina. Caller i have a main question. First of all, i would like to say this. I did not know you had a line for veterans. In any case, i go to the Veterans Administration or the va hospital for some treatment. I find that most of the people working there are veterans. Problem, in ae lot of cases. But my main question calling in this morning they have all of these outfits working for veterans groups, working for veterans. I would like to know if these outfits are audited to see where that money goes that people send them . Host thank you, caller. Guest good question. A couple of different points there. I am originally from South Carolina there. My father lives there and goes to the ba there as well. V. A. As well. There are a significant number of veterans that work in the v. A. The vast majority of folks are honest, hardworking folks who want to serve vets and do right by vets. It depends on what paul means by outfits working on behalf of veterans. There are elements within the v. A. And outside advocacy organizations. If there is a nonprofit, most of those are independent. But most of them are rated and audited. You have Veterans Services organizations and veterans advocates organizations. Theres a slight distinction. You also have the genre of veterans charities. People tend to focus on that when they talk about organizations taking money on behalf of Veterans Services. When they are wrong, they are usually exposed. Host jerry is a veteran from Point Pleasant beach, new jersey. Hello. Caller good morning, gentlemen. Thank you for taking my call. The main forgets this i am pointing out is the corruption, not only of the ba system. I served in 1961 to 1963. The only thing that is ever going to solve v. A. Or Health Business it is a Health Business in this country. If we do not start addressing the overall problems, which is greed of the twoparty system. We just cannot deal with these peacocks down here in washington strutting around with reams of paper. I want results. I am sick and tired of these osturingostering ps over all these committees, doing nothing, putting on the back burner constantly. I take care of myself. I take vitamins, i exercise. I see the people affected by agent orange. The afghan veterans with s hots and uranium. This is a government that is harming our own citizens. Host thank you. Guest that has been one of the biggest problems we face, the frustrations. The bureaucracy, the politics, just getting to this emergency sure to try to stop the bleeding took almost two months, way longer than it should have. The reason was grandstanding, it was politics, to an extent. This is a largely complicated bill. There was clearly more politics involved in this bin should have been. And a significant delay resulted. Host if we are adding more private doctors, who is responsible for oversight . Guest v. A. Will have to be the court nader of all care for making sure that vets go out and get the care that they need and following up and getting medical records, making sure that the actual care and treatment is delivered. Host if there are concerns about things happening within the v. A. , do you extend that outside the walls . Guest there are jeff only concerns about all this. Ultimately, it is a matter of personal belief. V. A. Is going to have to improve its game pretty quickly. The alternative there is to just some people mistakenly think that is what this bill will do. The alternative is to turn everyone loose in the private sector. I cannot happen. Some folks will not get the treatment they need or not know where to go. The response developed in phoenix. Some veterans were discovered to be on waiting lists and were not in the system. They were some letters and said, we will pay for it. Go off and find the treatment you need now. That was some solution. V. A. Is going to have to be involved in coordinating the care for the people who need it. Host heres another from hershey, pennsylvania. Caller i am listening with interest. There are so many issues here. My question has to do with the way the system works now. And though it worked after world war ii. I am old enough to have seen both sides of it and i am a veteran. I think that, as i understand it, in the days before this current time a veteran to go to the v. A hospital had to have a serviceconnected injury or i believe and, today, that anybody who is a that can claim the need to use the ba system and it is just overwhelmed by it. In turn, i think that implies that the Current System is just inadequate. We are trying to Service People who do not need that system. The need should be based on whether or not you have had a serviceconnected injury or disability. Host guest his point is a good one. The v. A. Was setup up to deal with serviceconnected injuries. In order to get a determination, one has to submit a claim and be evaluated. Usually, that involves a disability determination and payment as well. Is of the issues that v. A. Dealing with is that it has had a severe backlog of actually making those disability and Service Connected injury determinations. One of the things that was done a number of years ago to try to help that need care especially those that deploy to combat, where they may have had any number of injuries in addition to physical wounds essentially the criteria that you have a predetermined injury for a certain number of years after you get off of active duty. It used to be 90 days theyve could go to the a for treatment. I was extended to two years, then five years. Theyre trying to extend that to 5 for mental injuries and visible injuries like ptsd that might show up 10 years later. Right now, it is still five years. If you get on active duty and you want to serve, you can go to v. A. Without a serviceconnected injury determination for up to five years. That may change with some of the legislation changing now. V. A. Has steadily had a huge increase in numbers in terms of the patients who use v. A. The system has not kept up. They have been lowballing numbers. Estimates of that offer a couple of years. One of the interesting things we have seen is a failure to acknowledge and predict or acknowledge predictable spikes in future v. A. Usage. That is one of the things going on now. We are drawing down from afghanistan. The army is drawing down. We will have a lot more activeduty troops becoming the vets. Has notast, the v. A. Done a good job of increasing resources relevant to the numbers coming off of active duty. That is one of the reasons, certainly. In additions to the others we have talked about. The system has been overwhelmed. Host you are hearing from alex nicholas. Mike, ottawa, illinois. Hi. Are you there . Caller hello . Host you are on, go ahead. Caller i am from ohio. You know a marina general wrote a book hello . Host go ahead. Caller butler, a marine general, wrote a book war is a racket. Remember the old saying, he spilled the beans . We need to look back and think about what he told us. Eisenhower warned us about the militaryindustrial complex. Co saidspector slum there is no database for the money spent that we have handed out. All these weapons, we dont know where they went to. What bothers me is the language being used. Patriotism, democracy and all of that business. Asse soldiers are being used Corporate International spearheads. That is a problem. Guest you touched on a good point there. The lack of accountability with the money that is being given out. Especially with respect to dod. There have certainly been issues with unaccountability. To same thing applies v. A. They just came back and asked for another 17. 8 billion, trying to plug the holes. Theyre trying to make up for these budget shortfalls and lowb alling. Pages ofe two or three budgetary justifications for that 17. 8 billion. One of the things the chairman of the committee kept making was this is late for the secretary, who has a background in business. You cannot get a loan for 100 with two pages of data and justification. A grant for 17. 8 billion for the american taxpayer, with two pages of justification for what that would be sent on. Is evidentlyv. A. Very good at wasting money. That has been one of the problems as well. Some of the investments in technology and infrastructure have gone wasted. Systems that have been purchased have been an enormous cost to taxpayer and have been abandoned. Wasted and accountability is another big issue that the new secretary will have to deal with. Host that is robert mcdonald, the new secretary. What do you think of the choice . Guest it was an interesting one. We expected the president to look outside of expected circles. We expected him to look for someone who had a business background. There was even consensus from what i can tell on the hill that it did not matter if a candidate had health care in his background. That has been a big issue, managing the health care system. But i think the main criteria was going to be someone who had an excellent accomplished Business Management background. That is what we found in mcdonalds. Mcdonald. We did not know he was on the shortlist. They did not consult us about it. We had some other candidate so we had heard about and names that had floated. We had some people we thought may be under consideration. Was big onelli suicide prevention, which is another big issue they will have to deal with. Host does he have a military background . Guest he went to west point and served as an officer in the army early on in his career. Theoon left and went into private sector and spent the majority of his career in business leadership. Host as far as the qualifications you are looking for, did you look for someone with more of an afghanistan experience . Guest we wanted someone whoe is a huge cool now have served in iraq and afghanistan with Senior Leadership backgrounds who could have been qualified. We think the president was not going to choose someone who was a veteran from iraq or afghanistan, who had significant experience with that exposure to the community. As we talked about earlier, youre going to have more and more folks coming off of active duty. This is going to grow. It is quickly going to become the largest group. Experience with an exposure to the community, the issues and trends this generation of veterans is very different and unique from our generation. They have unique challenges. Their associated with the tech savvy, for example. At least experience and exposure with this generation will be key. It is something we were pressuring the president for. Host here is another vet, patrick from california. Caller thank you for your service. I