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The Department of Veterans Affairs recently launched a major expansion aimed to improve veteran health care by opening up access to private doctors. But critics say the program offloads government responsibility to the private sector. Judy Woodruff sits down with the department’s head, Sec. Robert Wilkie, to discuss that issue as well as mental health, homelessness and supporting female veterans.
Last month, the U.S. Department of Veterans Affairs launched its Community Care program, a major expansion designed to give veterans access to private doctors to decrease wait times for health care.
But veterans rights groups say the program's goals are unrealistic, and off-load the department's responsibilities to the private sector. The $51 billion measure signed by President Trump builds on legislation passed in 2014 called Veterans Choice, which allowed veterans to seek private care.
That came in response to a scandal at the Phoenix, Arizona, Medical Center, where at least 40 veterans died waiting months for appointments.
The Department of Veterans Affairs is the government's second largest agency, with more than 300,000 employees and an annual budget of $200 billion.
Running it all is Robert Wilkie, the secretary of veterans affairs.
And we welcome you to the program.
Thank you for having me, Judy.
So, you stepped into this job. You were at the Pentagon in a high position.
You moved over to the VA. You have been there now coming up on a year.
Have you been able to make significant progress?
I hope so.
I think what we have seen — and I think validating those changes — is that VA's been pretty quiet. We have just finished embarking on the most transformative period in our history, at least going back to the G.I. Bill.
And I want to say something that our reform is not. It is not libertarian VA. It is not me giving a veteran a card and saying, go out in the private sector and prosper.
What it does do is, it puts veterans on the same plane as their neighbors. It allows them for the first time access to urgent care, to keep them out of emergency rooms, and promote holistic health by doing that.
The other thing that it does is that it offers veterans the option of going into the private sector, only when we can't provide them what they need.
Well, as you are, I'm sure, well aware, a number of veterans advocacy groups are saying the intention may be good, but what's happening is that veterans, many of them may end up in the hands of private health care providers, whose care is not as consistent, not as — frankly, as competent as what they might get at the VA, that the VA needs to do a better job of overseeing all of this.
Well, I think we are.
We don't allow that people into our system unless we have fully vetted them. The other thing that…
You mean in the private sector?
In the private sector.
We have just certified 4,500 urgent care facilities across the country. My goal is to certify 7,000.
But what we are seeing is, veterans are voting with their feet. I have seen the explosion in requests for urgent care. I haven't seen that in the explosion and requests for other medical care in the private sector.
Our statistics show us that our veteran satisfaction rate is at an all-time high. It's about 89.7 percent. So they're voting with their feet to stay with us.
But, at the same time, you have veterans groups, they're — we talk to them.
A number of them are saying the responsibility here ultimately lies with the VA, and they want to make sure the VA isn't trying to push this responsibility off on somebody else.
Well, it's an interesting argument, because it's a variation on the privatization argument, which was raised when MISSION was brought up in the Congress.
And this is an act that only had four negative votes in the United States Senate. I just presented the largest budget in the history of this department to the Congress, $220 billion, calling for 390,000 employees. That's a very strange way to privatize care.
I think we're expanding care, and we're expanding care in a good way.
Mental health, a big part of this story that we're talking about.
Mental health problems for veterans, we know, are still enormous in this country. Suicide rate among veterans has been — has stayed at a disturbing number, 20 a day.
Why has that been so hard to tackle?
Well, I think it's been hard to tackle because the majority of those veterans who are taking their lives are not part of the VA system.
Now, some of them are on active duty. Some are in the Guard. A significant number come from the Vietnam era and have never had any contact with us by their own volition.
Our job is to do a couple of things. One, it is to begin a national conversation. And if we just focus on the last tragic act in a veteran's life, we're never going to get anywhere. We have to look at mental health.
I have said that we're not even at the Sputnik stage in this country when it comes to talking about mental health. The other thing we need to do is take a hard look at addiction and how we treat those who need care for pain, and make sure that they're not addicted to the medicine that's supposed to help.
So, we know President Trump signed a proclamation made, moves with regard to suicide among veterans last spring.
But, still, this is an entrenched problem.
Should President Trump make a high-profile speech, raise the level of visibility of this…
Well, I think he has.
And I think by calling attention and calling forth a whole-of-government approach to suicide in a way that we have never had it, he is raising the profile of this issue.
I sit at the head of a task force that includes HHS, HUD, NIH, Indian Health, and the goal is to have this national conversation at the end of the process, open the aperture in terms of financial and educational support to all elements in the country, tribes, states and localities, to help them help us address this issue.
One thing we are doing, though, that has changed, we provide same-day mental health services. We have spent tens of millions of dollars on outreach. We are taking it seriously. It is our number one clinical priority.
A piece of this, as you know, is homelessness.
It's one of the ways those with mental illness deal with what they're going through.
And President Trump made a comment not long ago. Wasn't just talking about veterans. He was talking about homelessness broadly when he described it as a new phenomenon. He said it's only been around for two years. He described it as something almost politically aimed at him.
Do you agree with his interpretation?
Well, I agree that homelessness is part of this continuum that we have to deal with when it comes to not only taking care of our veterans, but also in addressing suicide.
I will say…
But that it's new?
Well, no, I wouldn't say that it's new.
But I will say that the numbers have gone down. Several years ago, we were looking at hundreds of thousands on the street. Today, we're looking, tragically, at about 40,000. But cities that you know very well, Atlanta, Houston, New Orleans, have eliminated veterans homelessness by getting in partnership not only with the VA, but with charities and non-governmental organizations.
Most of our homelessness is concentrated in one area of the country. And that's the West Coast.
And — but do you — and you feel progress?
Oh, I — much progress — 40,000 compared to the hundreds of thousands a few years ago is progress.
But we still have to work on it.
Women, they are the fastest growing demographic in the U.S. military, more women serving in combat than ever before.
That means more women becoming veterans, coming under the purview of the VA.
Again, what we're hearing from some of these veterans groups is, women veterans tell them, when they go into a treatment center, they often feel disrespected. They even feel hostility toward them.
At the same time ,a month ago, there was a study done by an internal government watchdog group that found more harassment of women and men at the VA over a recent two-year period than any other government agency.
Pull that together.
Well, if you look at that study, that harassment is not coming from VA employees. I can't — I can't change the perception of older veterans who are not used to seeing women in uniform.
What I can say is that, in this budget, $9.5 billion is set aside for women's care. Each one of our hospitals has a women's clinic. The culture is changing rapidly. The notion that I, as a youngster, would have ever seen women wearing the red beret of my father's division, the 82nd Airborne Division, would have been — that would have been unheard of.
Today, they are. And I think the military as a whole is changing with that culture. And VA now, with 10 percent of those we serve being veterans, and having those clinics in all of our hospitals, is changing with those times.
But how do you change those attitudes?
Well, you change that by — it's a cultural change.
And you also change it by confronting those who engage in that kind of behavior. Again, it's not our employees. It's people who come in. And there are still elements in this country who refuse to accept that the times have changed, that women are warriors on the front line in numbers that we have never experienced before.
And what about the harassment inside the Veterans Administration?
Well, that's one — if we see it, we act on it.
And I read that report. And, again, it is an instance of people who have not caught up with the times. But it's certainly not a part of our employee makeup.
Robert Wilkie, who is now coming up on one year as secretary of veterans affairs, thank you very much.
Thank you, Judy. Thank you very much.
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