 I would encourage you to move up so that you can hear this important conversation that we're going to have. I know a lot of you are just returning from lunch. We went a little long this morning. Come on in and take your seats. This is a unique opportunity that not many people get to have. So come on up. Hope you're taking notes. We need you to take this message back to your respective states, to your cities, to your communities, to your chapters. Because today you're going to hear the truth about what's happening with the VA, not only from a VA perspective, but from a very important guest from the hill. Just a couple more minutes for people to come on in and get seated. Plenty of seats up front. Just like in church, everybody wants to sit in the back, right? Okay. So last year, we had the idea to bring in the secretary. He was very gracious about giving us more of his time. And Chairman Jeff Miller from the House Veterans Affairs Committee. And they sat for a couple hours in the afternoon of our convention. And they talked about their things that they were agreeing about, things that they disagreed about. And both of their views of what needed to be done for the VA. So it was so successful, we decided that we would do it again this year. And the secretary very graciously accepted our invitation again to come in and sit with us and have a great conversation about his view of the future of the VA. And we also invited a very special person that we work with very closely on the hill, who's a very strong advocate for veterans. And that's Senator Johnny Isakson from right here in Georgia. And he is the chairman of the Senate Veterans Affairs Committee. And has been very proactive in having hearings and doing what's necessary to dig in to find the truth. And get to the bottom of the issues to make sure that he knows the facts before he acts. And he has put forth some legislation he's going to tell you about I'm sure today that is being considered on the hill and we're very excited about it. It's an omnibus bill. A lot of good veterans issues in there, many of the issues that we have championed. And I will let him let you know what those are as he talks to you a little bit throughout the afternoon. So we're very excited about this. There's no questions brought forth from the audience. The questions have already been developed and they're going to be asked by our own Jim Mars-Elec, National Service Director and Joy Elim, our National Legislative Director. They will be putting forth questions to our guests. But before that, they'll both have both the Secretary and the Senator will have a chance to come up and give a little opening to you and let you know what's on their minds. So let's have a great round of applause for our guest and I'll turn it over to Jim Mars-Elec. Thank you, Gary. It is my privilege to introduce the 8th Secretary of Veterans Affairs, the Honorable Robert M. McDonald. Secretary McDonald was sworn in two years ago after being nominated by President Obama and quickly confirmed by the Senate. Prior to joining VA, Secretary McDonald worked for more than 30 years at the Procter & Gamble Company, one of the largest consumer product companies in the world, rising all the way to become Chairman, President and CEO before retiring in 2013. Secretary McDonald is a 1975 graduate of the United States Military Academy at West Point and later earned his MBA from the University of Utah in 1978. He's an Army veteran who served with the famed 82nd Airborne Division and was awarded the Meritorious Service Medal. In recognition of his outstanding leadership from the moment he was sworn in as Secretary and his demonstrated personal commitment to ensuring that all veterans received the services and benefits they have earned, VAV presented him with our very first Outstanding Federal Executive of the Year Award in 2015. Please join me in welcoming Secretary Bob McDonald. Thank you, Jim, for that kind introduction. Gary, I'd like to thank you for hosting this event again this year. This is a tremendous opportunity for both Senator Isakson and myself to talk about the future of VA. But before I do that, I'd like to make an announcement. It's been an honor for me to work with my good friend, Johnny Isakson, on helping veterans since I arrived as Secretary. And I can't think of a better place to make this announcement than here in Atlanta, standing and sitting right beside Chairman Johnny Isakson. The number of veterans receiving mental health care from VA has increased by about 80% since 2005 to over 1.6 million veterans. And the Veterans Crisis Line is part of keeping our sacred trust to help veterans in need. As we have continued to serve veterans in crisis, we've needed to continue to expand the Veterans Crisis Line offerings and capacity. As a part of that ongoing effort, I'm happy to announce that we're going to be opening a second Veteran Crisis Line call center right here in Atlanta, which will be online by the end of this calendar year. That's going to mean 200 more responders ready to talk, chat, and or text with veterans in crisis, 24 hours a day, 7 days a week, 365 days a year. Now before the floor is open to discussion, I'd like to make a few quick points about where VA is in caring for those who have borne the battle, our veterans. We have the opportunity right now to make 2016 the year we turn the corner for veterans. Here's what I mean. In my confirmation hearing two years ago, I pledged to work to transform the VA. And I pledged to work with our Veterans Service Organizations, with other stakeholders, members of Congress, and with Congress in that transformation. After confirmation, I consulted thousands of veterans, VA employees, other stakeholders, Veterans Service Organization leadership, and members of Congress. Those discussions shaped our my VA transformation, so VA could best serve veterans. Our five long-term my VA strategies are the framework to transform all of VA by combining functions, simplifying operations, and providing veterans care and services so that they see VA as their own VA. World-class, customer-focused, veteran-centered organization and service. Our five strategies are very simple. First, we need to improve the veteran experience. We want every veteran to be delighted with the kind of service they get. Second, we need to improve the employee experience. It's no surprise that the best customer service organizations in the world are also the best places to work. Third, we have to achieve support service excellence. Four, we need to establish a culture of continuous improvement. And five, we want to enhance strategic partnerships. Now, people still ask if VA can be fixed and if it can be transformed. As I said earlier this morning, the answer is a definitive yes, absolutely. Transformation is well underway and we're already seeing results. And we're doing a lot on our own with what we're given. But the fact is that there are still some things we can't do without the help of Congress. So we asked our two congressional committees to hold a hearing on the MyVA transformation and our 12 breakthrough priorities for 2016. 12 quick-win priorities designed to improve the delivery of timely care and benefits to veterans as fast as possible. We thought it was immensely important that members of all committees hear what we had to say and about the transformation we were going to make. And importantly, Senator Johnny Isaacson, the Chairman of the Senate Veterans Affairs Committee, was the first to step forward and say, let's have that hearing and let's bring this transformation to life for all members of their committee. Because Johnny wanted to know exactly how are we going to transform the VA and how the Senate committee and VA could work together to get this done. It was important to all the subsequent decisions and to help shape legislation that serves veterans. Johnny led it, he did it, and in January we appeared before the Senate Committee on Veterans. In the hearing we discussed in detail the legislation necessary to transform the VA. Chairman Isaacson, to his credit, assigned a member of both parties to work on each piece of legislation, a thoroughly bipartisan effort. The product of their hard work is the Veterans First Act, and it was passed unanimously by the committee, unanimously. How often does that happen? This important omnibus includes many of the legislative solutions we've been urging and nine of our top legislative priorities. For instance, it provides enhanced leasing authority so we can implement the master plan for our West LA campus. That will greatly expand our ability to end veteran homelessness in Los Angeles and elsewhere, and will serve as a model for the whole country on what it takes to end veteran homelessness. Veterans First will go a long way in bringing the best private sector talent to VA to serve veterans. These are critical compensation reforms for network and hospital directors and flexibility on the 80-hour pay period maximum for certain medical professionals. The private sector has this flexibility, and it makes sense in running a hospital. It provides the Secretary of the VA some measured spending flexibility to respond to veterans' emerging needs and overcome artificial funding restrictions on providing veterans' care and benefits. The biggest thing missing in Veterans First is appeals reform, and this is big for veterans as we discussed this morning. Why is it missing? It's not a fault of the committee. At the time, we didn't have the Congressional Budget Office's scoring, but now we have the CBO scoring, and as I said this morning, appeals reform is free, so we plan to include it as the bill goes to the floor. Here's why appeals reform is so critical to veterans. Last year, the Board was adjudicating an appeal that originated 25 years ago and has been decided more than 27 times. Under the current law, with no significant change in resources, the number of veterans awaiting a decision will soar by 179% by 2027, from 500,000 to nearly 1.3 million. The legislation costs nothing, and it would be more efficient and less costly over time. In five years, veterans could have their appeals resolved within one year of filing. What's the alternative? Devote more resources to the broken system, fund more employees to administer the broken system, and veterans will be waiting 10 years for a final decision on appeals. So if the Veterans First Act becomes law, VA will have 75% or so of the most important legislation we've been advocating for for transformation. The act will be instrumental in turning the corner for veterans and critical to get the transformation done, and all we need to do is take veterans first and add appeals, which we hope to do as the bill comes to the floor. As I said earlier in my remarks this morning, VSOs can get it done. Veterans need VSOs to tell members of the Senate to get the Veterans First Act to the floor, to add appeals, and VSOs can get it done as they have done historically. To close, let me once again publicly thank Chairman Johnny Isakson for his strong support of veterans, his leadership, his ability to bring both parties together for VA transformation. He's been incredibly proactive holding hearing after hearing for truly productive discussions that can go a long way in helping veterans in creating a VA that we're all proud of, and his leadership has shown that a bipartisan Senate can work. Veterans First proves it. Thank you. Thank you Secretary McDonald, and I'm very pleased to introduce Chairman of the Senate Veterans Affairs Committee, Senator Johnny Isakson. Senator Isakson is a successful businessman with 40 plus years in the real estate industry who has built a respected record of public service to Georgia. A veteran himself, he served in the Georgia Air National Guard from 1966 to 1972. He is the first Georgian since the 1800s to have served in the State House, State Senate, U.S. House of Representatives, and the United States Senate. He also served as Chairman of the Georgia Board of Education. Senator Isakson was elected to the Senate in 2004, re-elected in 2010, and was selected by his colleagues to chair the Veterans Affairs Committee in 2015. As chairman, he has worked diligently to change the culture of VA. Earlier this year, as noted by the Secretary, he introduced the Veterans First Act, sweeping reform legislation supported by DAV and the veterans community. This bill would increase accountability at VA, improve care and services for our nation's veterans. Let's please give a warm welcome to Senator Johnny Isakson. Okay? Well, thank you very much, and welcome to Atlanta Georgia. Welcome to Georgia. I'm home. I'm a native Georgian. We're glad that you're here. There are 750,000 veterans that live in my state. As you may know, because most of you probably at one time or another served in Georgia, either at King's Bay, the nuclear submarine base in Camden County, Moody Air Force Base at Val Dosta, Dobbins Air Force Base in Atlanta, Robbins Air Force Base, the Air Logistics Center for the East Coast in Robbins, Georgia, or maybe it was at the Marine Depot in Albany, or maybe it was at Fort Benning, or maybe it was at Fort Stewart, or maybe it was at the Cyber Command now at Fort Gordon. We're totally invested in the United States military. We represent the greatest country on the face of this earth, and you represent the greatest fighting force America's ever had. And in mentioning fighting force, you've got a fighter at the head of the VA in Bob McDonald. Now, I have been in business a long time and was in business a long time before I got to Congress. I know what it takes to close a deal. I know what it takes to run a company, and I know what it takes to sign the front of checks, not just the back of checks. I know how hard it is to make something work and I know what it takes to bring people together. I've never worked with anybody in my private professional career or in my public career more accomplished, more easy to work for, and more committed than Bob McDonald. Together, he and I and Jeff Miller are going to see to it we get to the Veterans Administration the changes and reforms they need to see to the services that you need are there and their fare forever. Now, when I made my introductory speech at the American Legion earlier last year when I became chairman, I established five goals. Goal number one was to see to it we made the Veterans Choice Bill work. Number two was to see to it the transition from DOD service and health care to veterans service and health care was seamless. Number three was to see those that victims of sexual trauma in the military had the type of services from the VA health system they needed to have. Number four was to make sure that the homeless issue in the veterans services went down and ultimately was prevented, and as Bob has noted, we're on the way to doing that. And lastly, and most importantly because of the announcement Bob McDonald made a few moments ago, to see to it those in need of help for mental health services, particularly those at risk for their own lives and suicide, had instant access to the Veterans Administration and the type of services they need to save their life, and to see to it they got everything they needed when they needed it. They gave us everything we needed when we needed it. By golly, we owe the same thing to them. The call center that will be established in Atlanta later this year will see to it every veteran when they dial the phone they get someone on the other end who knows what to tell them, how to advise them and how to handle them. Now I can tell you something on a personal note. I have dealt with the trouble of suicide in my family days. I've dealt with it in my service in the United States Senate. Two weeks ago I dealt with it in my own office when we had a veteran at risk called Sheila Robinson, my staff who does all VA things, and he was at risk for taking his life. And she talked him into getting help rather than taking his life. There's no important services you can offer. And this Veterans Hotline is going to see to it that less veterans die at their own hand. We begin to reduce the rate of veterans at 22 a day that are taking their own lives, and we reduce the number 8 million a year that have been taking place the last few years. Bob, I want to personally thank you and Sloan Gibson for your commitment to our veterans for doing that. You know, public service is a team sport. I've always believed in the 80-20 rule. If you can find common ground 80% of the time, take it. Don't wait to get 100%. And in politics it's getting where everybody wants to be 100% or nothing. But there's got to be reform in the Veterans Administration. Your services have to be more accessible, and the access to those services needs to be more seamless. And the Veterans First Act does that. And just for a minute, I want to make a few points. One of the problems Bob McDonald has had, and one of the challenges the leader of that agency has had before Bob McDonald, was the inability to affect change in the agency and have the type of accountability of the management of the agency that they really need. First and foremost, the Veterans First ability does that by giving the 434 senior executive managers in VA, being subject to the hiring and firing by the secretary. If the secretary determines they're not doing the job they need to go, they can go without having to go before the Merit System Protection Board. That means that your senior management will be held accountable for the leadership they give to the 314 other thousand employees that operate in the VA. Second is that whistleblower protection needs to have a centralized office in the VA, where whistleblowers are protected and the type of information that can be brought forward about something that's going wrong in the agency, can get to Bob's attention without the fear of reprisal on that individual using the whistleblower protection center. Those veterans who served in Vietnam and in wars prior to 9-11, 2001, deserve the caregiver benefits the 9-11 veterans have had and we're going to see to it they get them with the passage of this bill. The over 390 acres gifted to the VA by a veteran in West and South Los Angeles is going to be converted, is going to be implemented with the authorization in this bill to see to it we have major homeless benefits and healthcare benefits in Southern California. As we've already reduced the rate of homelessness in the veterans population by a third, we're not satisfied and we get to 100% elimination and this veterans first bill will do exactly that. Now in terms of choice, my commitment when I took this job was to make choice work and I think we've done a great job and the VA has done a great job of moving choice towards a seamless and effective delivery of healthcare services along with regular VA service. But I want to be patently clear with no equivocation once ever because I'm getting ready to ask you for some help but before I ask you for it, I want to explain to you what you're given. The VA provides great services to our veterans, they drop the ball some of the time, we work on improving those things but there's some services veterans could not give it without the VA. 72% of the physicians who practice in the hospitals of the American public today trained at the Veterans Administration. If we didn't have a VA health system, we wouldn't have the physicians we need already to train people in the public and the private sector. The VA is an important asset to make sure we deliver on the promise we gave our veterans when they signed on the dotted line, went overseas to the continents around the world, put their life on the line for America, we're going to put ours on the line for them as veterans. We're going to see to it they get the services they need. If we were to privatize the VA and remove it entirely from the veterans, they would not have the services they need, the access they need, or the unique injuries that they need cannot be addressed nearly as well. On the same token, we must recognize we need to supplement the staff of VA services and service providers in terms of physicians, technicians, and other types of providers by opening up choice as we did to see to it that veterans could get more timely appointments and they could get specialized care when it wasn't available at the VA. VA is a perfect way to have a force multiplier for the delivery system at the Veterans Administration without doing away with VA health services. Now lastly, what I'm going to ask you for is this. The veterans first bill is a major bill that contains 148 bills that were introduced in the Congress of the United States, everyone sponsored by a Republican or a Democrat, and I think we're at about 50-50 parity in terms of who took credit for what in this legislation. It gives Bob what he needs in terms of the hiring of firing authority at senior management. It gives West Los Angeles what they need in terms of access to the homeless and expanded health care. It gives our Vietnam veterans the same caregiver benefits veterans of other wars and conflicts have had. It gives whistleblowers the protection they need to tell when something's going wrong and the VA, the clout, to make a difference. And it sees to it that we provide our agreements in the private sector where their services veterans need and they can't be provided by the VA. It sees to it that nursing home access and things like that are better for the veterans when they need it, public or private sector. In other words, it addresses just about everything you could possibly imagine. And it's comprehensive and it's sweeping. And because of that, it's not going to be the easiest thing in the world to ever pass. Sometimes Congress can't even pass a kidney stone. Well, this year we need to make sure we pass. I've done that one time and it's hard to do, but you've got to do it sometime. So here's what I need you to do. Your leadership, your board of directors, your professionals in Washington are giving us tremendous support. But when we go back in September, I'll be working to get the veterans first bill to the floor. There will be people who want to change it and enhance it. Nobody's against improving veteran services. The problem is perfection is never possible. We're at a point where we've gotten 80% of what we need to get to improve the veterans administration, give Bob McDonald the clout that he needs, give our veterans the need of risking their own lives, the type of services they need. And by golly, it is time we passed it and passed it now. So I want to enlist you in a new volunteer military service. Between now and the end of this year, help me to convince those who come out against us or who fight us or are reluctant in the fall to come on board with the veterans first bill and let's pass it. For one simple reason. There are no Republicans on the battlefield. There are no Democrats on the battlefield. There are only Americans on the battlefield. Those who risked their lives in thought, for us, need us to resist our politics, leave it at home at the back door, come back to the United States Senate and say it's time to act for our veterans. It's time to improve the VA. It's time to take action. It's time to do it now. And God bless you. I will be there doing everything I can to see to it. We deliver you. So God bless all of you and God bless the United States of America. Thank you, Chairman. As Kerry said, today's seminar is an opportunity for us to have a conversation with two of the nation's most important leaders on veterans issues. It will be a chance for us to discuss the real challenges facing veterans and talk about real solutions. As we did last year, we'll give each guest, we've given them each an opportunity to make remarks, and now we'll get started with our questions. Secretary McDonald, you've talked about the progress made to address the access crisis and VA's plan for consolidating community care programs to expand access in the future. As you know, more than six and a half million veterans rely on the VA health care system each year, and some of all of their care, including most of DAV's 1.3 million members. How do you plan to ensure that with the greater use of community care, it does not erode VA's ability to provide a full continuum of care for veterans who choose and rely on the VA health care system? That's a good question, Joy. Last October, we came up with a plan to create a consolidated network, a consolidated integrated network, and David, as he talked this morning, is working on building that network out. This would be a network of providers, including VA, including Department of Defense. As you know, we have many joint facilities in Alaska and San Antonio and elsewhere, Indian Health Service, because our Native American communities tend to disproportionately serve in the service, and then private sector providers, including our academic institutions. As you know, we have 1,800 or so medical schools, which Johnny referred to, academic institutions we're allied with. This network would be pre-approved, and then we would work with the veterans to decide where they should go for their care. As Johnny said, the focus would be that VA would continue to have the specialties that are required for military service, things like post-traumatic stress, prosthetics, and so forth. But what we would also do is work with the private sector providers that would be pre-approved to make sure they understood the military culture, and that also they would be good communicators with us so that when the appointment was over, it would be the quality of a VA appointment and the record would come back to us so we continue our integrated holistic care for veterans. That's part of the Veterans First Act. It's what we're already working on. It was written up in the Commission on Care, although their views a little bit differently, and that's how we've moved forward. I'm sorry, you were going to say. So it's a real extension of VA care. You see it as integrated care with the VA. Absolutely. I mean, one of the things we've talked about within the VA is just because a veteran goes to a private sector provider, we still have to own that experience. We own that experience as much as we own the experience within the VA. We can't outsource that customer service of that experience. When I look at the original execution of the Choice Act in the fall of 2014, I think the biggest mistake that was made and it was largely governed by law is that we were outsourcing that customer service experience. We can't do that. We want to be the number one rated customer service organization in the federal government. We can't do that and outsource the experience. So VA would really coordinate that care? Absolutely. VA's got to coordinate that care. Your primary care physician, as David talked, which leads this PAC team would be responsible for making sure you got that care from the appropriate provider. Great. Chairman Isakson, would you care to comment? I agree with what Bob said. I think my remarks were pretty much in sync with what Bob said. We do the VA train 72% of our physicians in the country. It's important to recognize that. The comments on the care report that came in talked about a network of cooperation between the private sector and the VA. But I think Bob casted exactly correct by taking the maximum benefit of the VA and expanding access to the private sector where the VA is the trigger man. Make sure that we have full access for our veterans and delivery of our services in a timely and good fashion and I support that concept. Great. Thank you. Chairman Isakson, this one's for you. There have been a number of proposals to expand access and increase veterans options for care. However, there's been little discussion about the cost of expanding choice which economists estimate to be extremely high. Given the fiscal challenges facing our nation and the limited funds available to the federal government, how do we pay for expanded choice and modernization of the VA health care system at the same time? This is going to be a little bit of a long answer and I apologize, but this is the meat of the coconut as they say. I don't care what it costs taking care of our veterans and giving them what we promised in terms of health care we got to do. That's not a debatable issue. How we do it is what's so critically important. The Commission on Care did a good study of what they recommend on the networking combined with what Bob has said about access to VA health care and being a network situation but controlled by the VA is a good thing to do. It will cost more money. But let me tell you one thing. CBO, which scores these things, scores them in a static environment. And I don't want to get too technical here, but a static environment means they say if it costs one more dollar to go to a private sector doctor then it costs one more dollar that you got to add to the appropriation. They don't deduct the savings that you might get by not going to the VA but going to the private doctor. So the scoring ends up being static so every additional cost is a net loss to the government without any benefit being associated with the benefit that's given. So what we need is a better scoring mechanism. I would submit to you this personally that every veteran, if they're going to get their health care services and nobody's going to walk away from that, just because you changed the delivery doesn't mean you're going to compound the cost because it's still the same service to the same veteran at a parallel cost. So I don't think the scoring that's come out of CBO has been as honest as it should be in terms of what it is. CBO says to repeal the sunset on choice and leave it in full place would cost $50.4 billion. I don't think that's true but I've got to be able to prove that and we're working on doing that now. It will cost more but as I said in the end, if it costs more, if it's what you promised the veteran they sewed up, showed up and signed up, you're going to still deliver that service no matter what and we've just got to find a way to do it. I think DAV has made it really clear at hearings and various times we've spoken about it that we want to make sure that veterans do have access to choice or community care access when needed but we really want to make sure that the VA health care system is fully funded as needed for all of the improvements that the Secretary's been talking about. Some of the modernization things with infrastructure, the IT system, all of those things really need that attention to make it a world-class facility. Because of your great lobbying effort and the work that DAV does and I know you know this but the average and Bob correct me if I'm wrong here but during your 10-year VA appropriations have gone up 9.2% a year or about that which is bigger than any agency of the federal government. In fact while the DOD is actually going down the Veterans Administration Health Services has gone up and that's an excellent thing and we're going to make sure that we're able to pay for and provide whatever health systems are necessary. That's for sure. Joy, if I may, the way the commission on care proposal was written I would disagree with because it appears to be almost a Trojan horse for privatization. Somebody's got, somebody I think the VA has to be able to create this network so we know where to invest. If I'm asking the senator to invest in a facility in Dublin, Georgia I've got to know what the demand for that facility is. If we simply were to allow willy-nilly private sector providers to be involved without a pre-approved network I think it would lead to a chaos and have us not invest efficiently on behalf of veterans. So I think we have to be a little bit careful on how these, this force multiplier is discussed. I think the senator and I are aligned in the way we see it. We still need a very strong VA. I'm glad you brought that up because just getting the briefing from Nancy Schickling, from the chair, the commission on care just for our audience, you know, the way they stated in there is the veteran would have the option to choose either the private sector or VA in that primary care setting regardless of, you know, even if VA was able to provide that care. So I'm glad, and I hope that there'll be continued discussions. I know there's going to be a hearing. We understand in the House and I'm sure probably in the Senate when we get back from the recess about this, because I think that's an important point that... I think Nancy, the chair of the committee did that perhaps to get a larger consensus. And I think you all at the DAV did a very good job of pointing out in the letter that you and, I think, 24 or so other veteran service organizations wrote that many of the people on that commission were private sector providers and they would gain from basically unfettered access to private providers. Right. Thank you. Jim, I'll turn it back to you. Thank you, Joy. Secretary McDonald, as you discussed this morning, there's been tremendous transformation of VA claims processing system with the backlog dropping from over 600,000 to less than 75,000 today. As the claims backlog went down, the number of appeals rose. Over the past year, VA worked closely with DAV and other VSOs to develop a new appeals system, which is now a bill in the House and could be introduced into the Senate. Can you talk more about how this legislation will make the appeals process better for veterans? Yes, Jim. I think this bill is absolutely necessary and, again, the only reason it wasn't included in the Veterans First Act is we had to wait for the CBO scoring. And in fact, I worked with the chairman. I literally went over to the CBO office myself, met with the director and sat in his office waiting for them to score it because I owed it back to the chairman. We were trying to get it in the Veterans First Act. We're hoping to put it in as an appeal or as a separate piece of legislation. Incredibly important, 2% of all veterans create more than half of all appeals. The percentage of appeals has been relatively constant at about 10% or so of the claims. But as we've dealt with more and more claims, gone from 950,000 in 2009 to 1.6 million today, that 10% becomes much larger. What the new appeals process does is it gives various tracks that the veteran can choose. And depending upon what track they choose, it can lead to a very, very quick disposition of the case. This was some great work done by veteran service organizations. There were members of the committee staffs there, VA employees there. I just thought it was a terrific way to come together and bring together this new legislation. So I'm hoping to get it passed quickly. And I think veterans will like it. What we've said is we get this passed, we get the black backlog down. In five years, a veteran can get their claim decided within a year. And that's versus the alternative, which is about 10 years. So I think all of us are for this legislation. Yeah, we couldn't agree more. And we spent a lot of time in that work group, DAV participating in that work group. You know, it just is such a significant issue for our veterans in the audience and all injured and ill veterans. What can we do to help try to get this done this year? Well, I think as Senator pointed out, as Chairman pointed out, is you need to let your members of Congress know that this is critically important. You need to support it both in the House and in the Senate. And hopefully we can get it to be part of the Veterans First Act as an amendment or as a subsequent bill, but I think it absolutely needs to be done. As we started approaching this, we had lots of discussions that this was the moose on the table or the elephant in the room. This is the thing that had been hanging around for 80 years and everybody thought it was too hard to do. Well, Sloane Gibson, who's my West Point classmate, as most of you know, and we live together our senior year next to each other, you know, we're always guided by the West Point cadet prayer. Choose the harder right rather than easier wrong. This is one of those harder rights. And by golly, we can get it done. I honestly believe, and you can see the unanimity here between the Chairman and myself, if we, you know, this is the time. Let's get it done. But for us to get it done, we need everybody in this room pulling together, making the phone calls, as the Senator suggested, writing the letters and making sure that every member of Congress knows how important these issues are. Let me add, just so it's memorialized for the record, when we were finishing Veterans first and getting ready to bring it out of the committee, Bob and Sloane did everything they could to get us to wait a little bit to see if they couldn't get their language finished on the review process and the appeals. We told them we weren't going to wait, but as long as the bill was pending, we would put it in at the last minute if they could get their act together, or not get their act together, that didn't come out right. If they get there, all the dies dotted and tees crossed in terms of the language, which really was less the Veterans Administration and more CBO than the others, and we'd be glad to include it. So we're ready to go. We think the claims process ought to be reformed. I'm going to tell you something else. The 445,000 pending claims right now that are waiting years to get there in answer, that needs to be cleaned up too. So part of our effort to add a new process for the future is to deal with the problem of the present, because there are 445,000 pending appeals out there, and as Bob said, some of them may be as old as 25 years. That's uncalled for. We got to change that. Excellent. We agree. Yes. Thank you. If despite all of our efforts... And they always have their act together. If despite all of our efforts, and this is for Chairman Isakson, Congress is unable to pass Comprehensive Appeals Reform legislation this year, are there other more modest reforms we can get enacted into law this year, and then come back next year for the full bill? I hope so. Dan Sullivan, the member of our committee from Alaska, has a demonstration project which we included in the Veterans First bill. So if nothing else, either on its own is to stand alone or include in Veterans First if it didn't have the reform disability language, we would move in the right direction and be moving incrementally. But I don't want to move incrementally. Bob ran a big company. Incrementally it's harder to do than Comprehensive is. So when you do Comprehensive, all the internal working parts you can deal with, I'd rather do it that way than do it one piece at a time. We agree. I think that's the brilliance of what Chairman Isakson did. As each one of these legislative proposals came up, I was there at the hearing and he said, he picked a Democrat, he picked a Republican, and he said, you get together and you get this as part of the omnibus. Because it's the omnibus, and because Veterans First is the way it is, it's really an up or down vote on whether or not you're going to take care of Veterans. And if you pick apart any piece of it, if you start to unravel it, I think we risk not getting it done. So I would rather think about adding the appeals to it and then getting the whole thing done rather than looking at any future date. That's why it's so critical, every single one of us, right call our congressmen, our senators, and let them know we need to get this done. Right. And I will tell you, Secretary McDonough, because like you said, the elephant in the room addressing appeals and getting everyone together, all the VSOs, all the stakeholders, and coming together and hearing everybody's ideas, that was the best idea. Well, I felt sorry for the people in the room because I said lock the door and we'll slip the food under the door. But I think it demonstrated what collaboration can do. Absolutely, we agree. Joy. Secretary McDonough, just over a month ago, as you noted, the commission on care issued its final report, which contained 18 major recommendations for reforming the VA health care system. The president is now considering those recommendations and must decide which are feasible and advisable. What's your overall opinion of the commission's report and are there any specific recommendations you think should be implemented before the end of the year? Well, Joy, as you said, there are 18 recommendations. I've been through the whole report. In fact, I've prepared my analysis for the president and what I've said is there are 12 of the 18 that are consistent with our MyVA transformation. In fact, many of them are already done or in process, but they're 12 that are totally consistent with the MyVA transformation. That doesn't surprise me because we worked very closely with the commission through their deliberative process. There are three that I think require further study. They're consistent with what we want to do with MyVA, things like our facilities, how do we upgrade our buildings? 60% of our buildings are over 50 years old, so there are three that we need to study, but we see them as being consistent with the MyVA. So that leaves us three others. There's three that we totally disagree with. Those three are the one about open choice for everyone without regard to guidance or piloting from the VA. The second is the creation of a board of directors to replace the role of Congress. I don't think that's necessary. I think the Veterans First Act shows very clearly that Congress can work with the VA on behalf of veterans. I don't think a surrogate is required. I also question the Department of Justice's question the constitutionality of that, because it's in a sense Congress controlling part of the executive branch, but leave that aside for a minute. And then the third is about our treatment or our qualification of other than honorable discharges, and that's something that we're working on. We're trying to look at those veterans with other normal discharges, seeking changing their discharge through the Department of Defense, but I think going to a wholesale opening up of the VA system to everyone who got another honorable discharge is not a very good policy right now. So those would be the three that we would disagree with. Great. And I'll just, since you mentioned it and more for the benefit of our audience who may not be as totally familiar with the report yet, they did recommend this independent board of directors that would govern the VA healthcare system and actually the secretary then would have a seat on this board but VHA would no longer be under your control basically. That's right. It would separate VHA from VA and what we're trying to do right now with my VA transformation is actually integrate VA so that the veteran can go to any employee of VA and learn about any other part of VA. That's a training we do called VA 101. The other thing that I've done since I became Secretary is I set up, as I said this morning, an external advisory board that includes people like retired Major General Joe Robles, former CEO of USAA Connie Moriano, the former doctor to three presidents, Rich Carmona, Special Forces veteran, Vietnam, Purple Heart recipient, and they have been advising me about the transformation of the VA. So I'm getting that external perspective. I want that external perspective but to create a board of directors that has some legal authority, I think would be a mistake. Back when I was leading the Proctor & Gamble company, I often used to use the analogy that I borrowed from Jack Welch who ran GE and he said, you know, if you create layers in organization, it's like putting on a sweater. It can be cold outside and you don't know it's cold outside. One of the things I talked about this morning is I've been to over 300 VA facilities learning about what's going on in organization. Creating another bureaucratic layer is not a smart way to deal with it. But what we need to do is work more closely with Congress to get what we need in order to better care for veterans. I think that was a really good point that we had the same feeling with regard to the board. It seemed as if the commission on care didn't fully understand the integration between VHA, VBA, and NCA, but it's such a comprehensive, integrated, and interconnected, you know, from healthcare to benefits and... Oh, it's a big frustration for veterans when they go into a hospital and they find they can't learn anything about benefits. We want one-stop shopping for all veterans in all locations. Right. Senator Isakson, do you care to comment with regarding the commission recommendations or the board? I think the commission recommendations basically were good. In most cases with Bob, I would say this about the board. You don't want a committee running it and you don't want an executive given the job of running it, but it ends up being subject to the committee, but there is an issue that will come up this year as in every year when you have a change of administrations because of the limit on terms about continuity in the Veterans Administration. I'm saying this so Bob knows I've said this because I said it Friday publicly. We've got to be sure of the continuity in terms of the Veterans Administration Health Services from one administration to the next, no matter who gets elected because so much has happened in the last two years for the good to implement the MyVA program and we're this close on the Veterans First program. I would hate for us to lose that momentum based on the outcome of the election, none of us knowing what that outcome is going to be. So one thing that makes us... And you had a board at prior... One makes the sense is to have some... And you had an advisory board now. And that's the partnership that transcends the administrations under which the Veterans Secretary serves. So we see to it we don't lose the ground we develop because once we solve some of these problems, why go back and recreate them again? That's my point. So that's the one thing we've got to be sure and try and see to it that we provide for and that idea has some merit in having done so. But I agree with Bob's recommendations on the 12 that he approved. When I agree with the chairman said too, I mean one of the things we're doing is to embed it in the organization so that whoever comes on, it'll take them six months or so or whatever to get acclimated that it continues. It's the right thing to do. I mean as I said in my remarks this morning, this isn't my plan. This is your plan. I've spoken to you, I've gotten your ideas. We've gotten Johnny's ideas. We built them in. And so what we've got to do is make sure that it goes on. I mean I borrow a phrase from my friend Jim Collins who's probably the best business author there is. And he says you know leadership is about building a clock and not telling time. What we're trying to do is build a clock. And if we get veterans first act passed, we get appeals passed, we continue this transformation. We will have built a clock that will, you know people will look back on this moment in time and say this is really when we turn the corner for veterans. And let me add one other thing. You know one thing I can tell you from my 37 years in public life, 18 of them in Washington, the operators of government services, the bureaucracy of the government, a lot of times we'll sit there and fold its arms and say well these guys are only there for two to six years. We'll wait and see what happens after they leave. And when you're implementing change like Bob has done and like we've tried doing the committees, you've got to have that chain has to have the inertia and the impetus to get it done and transcend any bumps and grinds. And that's why it's so important to have that continuity. Yes. And we appreciate your collaboration with DAV and the other service organizations. You've really made us a part, whether it's VBA or VHA issues that you listen to our ideas, you're willing to take and have the back and forth that's needed to really get what's best for our veterans. There's no pride in ownership in the My VA Transformation Plan. It's really veterans speaking to us as to what they need. Great. Jim. Great. Secretary McDonough. It's great you just brought up My VA and the next question is all about My VA. And you've talked about it this morning and it's about improving the delivery of benefits and the services to veterans and its importance of changing the culture throughout the VA. Can you talk a little more about what changes in particular will have the greatest impact on the veteran experience and when they can start to see some of those changes for our audience? Well, based on the comments I'm getting back from my cell phone, Jim, and as you know, in my first national press conference in September, I gave out my cell phone number and my email address and the comments I'm getting back say that some veterans are already seeing the difference. So that's good. We're starting to publish those reports every Friday within the VA and I'm also spending more time now recognizing those employees who have delivered an outstanding experience. What we're really trying to do is improve that veteran experience and we are using the best technology of the private sector. It's called human-centered design to really outline what we've done is we've looked at the entire life cycle of a veteran from the time the person enlists and gets sworn in to the time we bury them in a national cemetery. We look at all the touch points of when we interact with that veteran. We say how can we better design that experience in order to better take care of the veteran and to delight them and their family and we get groups of veterans in together to teach us how we can do that. So we redesign those experiences. At the same time, what we're trying to do is change our culture. Our culture previously was what I would describe as a rule-based culture. A rule-based culture is an organization that operates based on rules that nobody wants to deviate because they're afraid of being punished unless they have a rule. So in Seattle we had a medical specialist who got a call from a veteran in the parking lot. The veteran in the parking lot said, I can't come into the building. Can you help me in? And our employee unfortunately said, well, I'm sorry, we can't help you in. There's a rule about that. Please call 911. And we had a fire truck show up. We had an emergency medical vehicle show up. And they literally helped the veteran come into our facility. We immediately use that as an example of the kind of rule-based culture we don't want to be. Contrast that with a values-based culture. We do training every year now on our mission and our values, and we force every employee to recertify that mission and those values. I just went through the training last week myself. Everybody has to do it. If they don't do it, they come to see me. And in that, we emphasize the importance of those five values. You know them, the I-Care values. And we tell stories like this. There was a nurse in White River Junction, Vermont, where her veteran did not show up for mental health care appointment. She knew that that was unlike her veteran, even though around 20% of our mental health care appointments are missed. It's pretty typical in a medical system. She got the VA police involved. They got the local police involved. Make a long story short, they went out to his house. They discovered no footprints in the snow. This is Vermont. They broke into his house and they found him unconscious, in a wheelchair and they saved his life. Now, how did she react? She didn't wait and look for a rule. She relied on our values. Integrity, commitment, advocacy, respect, excellence, those values. And she knew that if she had made the wrong decision by breaking into his house, even because her intent was right, that we would have her back. And so what we're trying to communicate to our employees is work on the values, do what you behave according to the values, and as long as your intent is pure, we will have your back even if there's a mistake. So every veteran should be expecting to see more behavior, and I talked about some of it in my talk this morning, the lady that takes the holiday meal to her veteran because he can't get out of his house, but veterans should be expecting more of that kind of behavior in the future. And it's great to hear those stories. I know sometimes people focus on the negative stories and we know those are the exceptions so we can menu for the job you are doing. Can I add one thing? Absolutely. This is a perfect time to chime in and give the current secretary and his administration, Dr. Shulkin, a lot of credit. In August of 2013 at Georgia State University, we had a field hearing with Dr. Petzel who then was charge of health services over the outbreak that had begun to take place around the country in terms of veteran suicide. And we started identifying the things that we were wrong, and one of the things that were wrong was the veterans could not get timely service either by phone or in person with the VA. The announcement that Bob made today of the call center that will go into Atlanta, Georgia sometime this fall is an enhancement and came from that exact hearing where they identified a problem, knew what the solution was, and this administration has worked forward to do that. I commend you on doing that as secretary of health whose lives are saved because of the accessibility they'll have beginning in November. Thank you. Thank you. We know, you know, the collaboration on all the things that we do together, is there anything that DAB can help to try to help the success of my VA initiative? Well, I think again all of us have a role in advocating for the VA. The senator brought up the fact that over 70% of doctors in the country are trained for the VA. Dr. Shulkin brought up earlier this morning that the nicotine patch, the first implantable cardiac pacemaker, the, you know, the work on osteo integration. By the way, I don't know if David said it, but Brian, one of the two veterans who had the osteo integration operation of Salt Lake City, I had the joy of visiting him a few weeks ago and he told me that he can feel the grout cracks between the tile in his shower with his prosthetic leg for the first time ever. Imagine that. He also told me his golf scores improved by 15 strokes, so I need that. I don't know. We need that is what the chairman said. But, you know, who's going to do that innovation? I mean, I ran a for-profit company, so did Johnny. I mean, I can't imagine somebody coming into me and saying, you know, you need to do research on spinal cord injuries, and I'd say, okay, what's the rate of return? You know, how many people have it? It wouldn't get done. It wouldn't get done. So, there is no alternative to a strong VA, and I think it's endemic upon all of us, all of us, to make sure our members of Congress know that. And if you hear a politician using veterans for political reasons, speak out. Don't tolerate it, because they're probably not a veteran, and you got two veterans sitting in front of you right now. I think Secretary McDonald in that vein, the research program is so important in VA to veterans, because they really focus on veteran-centered issues specifically. I mean, women veterans is one of the key things that nobody else is doing research on, but we have a group of women veterans coming back from combat experience. There's a whole new, you know, looking at how that impacts their healthcare throughout the rest of their life. And VA has done a tremendous job, and I don't think people know in the community how much research the VA does that really benefits not just veterans, but the American people as well. Well, I'm so thankful for our partnership with DAV, because the study that you all published last year I thought was groundbreaking on prosthetics for female veterans and how pregnancy can affect that, and I was reading this morning, I think, about a new study we're working on about high heels and using high heels of prosthetic devices. This research is critically important. I'm hoping every veteran in the room will go to our booth outside for the Mayan Vet project. This is part of the President's Precision Medicine Initiative where, imagine this, if each one of us suffered from heart disease, our doctor would generally say, okay, you get 10 milligrams of a statin, you get 10 milligrams of a statin, you get 10 milligrams. When the reality is, all of our bodies absorb them differently depending upon our genetic structure. So what we've done with the Mayan Vet project is we have now, soon to be, I hope, 500,000 veterans, half a million veterans who have signed up, voluntarily given their blood sample, we have 20 to 40 records for all of them. This is a rich treasure trove of research. We already have seven pieces of research going on right now that will help us understand how did your gene make up lead to that cancer and what can we do about identifying it earlier. We had David and I were in the White House doing an announcement and there was a young lady who was a veteran. Unfortunately she had uterine cancer. We had to remove her uterus. But when we did the genome mapping, we discovered that she was susceptible to colon cancer. So we increased the frequency of her colonoscopies. Not surprisingly, we discovered pre-cancerous polyps. We were able to remove them before they became cancers. So she sat in front of everybody there in the White House and said, VA has saved my life. This kind of research will not get done in the private sector. And we needed to get done. And veterans are continuing to sign up to give these samples because they're used to serving. And this is just another dimension of that service. A great program, exactly. Jim. There have been several accountability bills introduced in both the Senate and the House over the past two years. What do you consider the key principles for strengthening accountability and how should it be balanced to avoid hurting employee morale or weakening recruitment and retention of lower employees? That is a fantastic question. Because a lot of people use the fear of accountability like being disciplined by losing your job and being the supreme accountability. To be in a turnoff for people to want to come to work for an agency, I will tell you this. When your children are growing up, your children raise the expectations you set for them. The higher the expectations, the better your children do. I can tell you from having run these organizations, if you have high expectations and high accountability, you'll have high performance in a profitable company. People who fear being held accountable and not the kind of people you need delivering the health care services to the veterans of the United States of America. What happened in Phoenix, which brought about this whole issue a few years ago, when we had veterans die waiting for appointments, what's happened since that time is the only discipline in the United States of America. We're taking an illegal retuity, not really for the malperformance of the job. Most recently, the attorney general ruled under the constitutionality of veterans accountability now, she can't represent the administration in a firing. What you've got is a situation where Bob McDonnell cannot go to a department and have an individual who's running that department, senior executive now, who's not accountable by them losing their job because he knows he can't be backed by the attorney general and because the merit system review board would be the appeal mechanism the veteran senior executive would have. So my answer is this, rank and file employees of the system have nothing to fear about accountability. The leaders of the organization ought to have everything to fear about accountability, beginning with the chairman of a committee and the higher the expectation standards are within the organization, the higher the performance is going to be by the employees up and down the line. I made a speech in Philadelphia at the Republican convention. I was only there for a day but was asked to make a speech that morning to a group and I pulled out a letter in my office the night before I left to fly up there from an old friend that I was rereading because I remembered it had something in it I wanted to tell you about. I remember when we were having a lot of trouble with the initial terrorist attacks he wrote he said remember Johnny well we as adults tolerate our children will embrace. If you tolerate less than good performance people will embrace less than good performance. If Bob McDonald tolerates only the best performance the employees under them will come to rise to that and they will rise to that because you have accountability to enforce the law. Nobody should fear accountability unless they don't want to be held accountable. That ought to be a promise face the evidence why they shouldn't get a job in the first place. Some of the other work that the veterans first act does in addition to keeping accountability within the department amongst the senior executive service employees is allows us to use title 38 compensation for the employees in the medical system right now our medical system directors who are not doctors we need to make sure that they don't have to do what they would in the private sector. We need to get competitive externally and the chairman has put this together in the act and that's an important part of it. We've got to have fair compensation. There's also another part of the veterans first act on this 80 hour pay period. When I was going around the country to my 300 plus sites I discovered we were outsourcing emergency rooms. And what I discovered was there's this archaic law in the federal government that forces well it's called 80 hour pay period but in essence says you can't work 12 hour shifts. Every medical corporation in the country works 12 hour shifts in their hospitals. We can't and because of that we have trouble hiring doctors and nurses for our emergency rooms. So there's a lot to like about what's in the private sector. It cleans up a lot of these archaic laws that exist that will help us be more competitive to hire the best doctors and nurses in the private sector to serve veterans. There's a lot to like and there's nothing to fear. Yes. And I think senator Isaacson you worked very hard to have a bipartisan bill in terms of the accountability provisions in there you worked with the ranking member and I know you worked with the community and I think that's fair and balanced. Appreciate that. And regarding the veterans first act we've been talking a lot about that today but could you tell us is there any progress on the House and Senate in terms of negotiating you know a final package of veterans bills for the fall. We know there's so little time left on the congressional calendar when you come back with the elections just ahead of us. We're really hoping you know there's a lot of time left on the congressional calendar and we're really looking forward to that. So what do you think there's possibility you're going to be able to move that forward. Well here's where we are and some of this is going to be led to speak and I apologize so I'll try and translate as best I can but we were in a situation where we have a great bill notwithstanding the fact it's coming out of my committee it's a great bill in the Senate so I have not yet gotten it to the floor for a debate although I'm trying to get a unanimous consent to do that when we get back which is a process of the Senate where in the Senate you can ask unanimous consent to do anything as long as nobody objects and it's unanimous which is very rare then you can get what you want we aren't to the nobody objecting point yet but it's on varying degrees of change they want to make not on being against the accountability portion. I'm not going to get away from earlier in the year they've now introduced another accountability bill which is very similar to the veterans first provisions in terms of accountability so my hope is that under the leadership of Jeff Miller in the House or under my leadership in the Senate one of us will get it moving so we can get it to the other body and then once it's in the other body we can have a conference quarter we can have a pre-conference agreement to come out and talk about the other things Bob's worked on so the main thing you need to do is when your organization says hit the telephone to tell them to encourage the members of the Senate or the House to vote for whatever if you all will do it and be our voice we can get it done this year. Great I know you can count on DAV we have one of our grassroots are really committed and we're having actually a special workshop this year to be able to talk about our benefits with our benefits so we can get it out throughout the country and I promise you we'll put the word out and we'll help facilitate that to make a big push for that as soon as you come back. Thank you very much. Secretary McDonald you often talked about the need to have more flexibility to manage your budget there are also other budget and appropriation rules including pay go sequestration and budget caps that often make it more difficult sometimes impossible to fully fund all existing programs. Are there changes that you like to see made to the budget and appropriations process to ensure that veterans programs services and benefits are fully funded? Oh I would you know I've got over 70 line items of budget that are inflexible Jim I can't move money from one to the other so while we all have agreed to give veterans choice and they have choice to go here or go there I can't move money from one to the other. In fact you know some of the there was a politician recently who mentioned that we not this one but you know who said that we spent money of the ten-billion-dollar choice fund you know on something it wasn't intended for well what we spent it on was curing hepatitis C tell me which veteran I shouldn't have cured in hepatitis C with a new miracle drug from Gilead okay so if I'm at fault for that okay fine take me to jail right because curing veterans is what we're about but this is the lunacy I mean we had to go back to the congress to ask permission to spend funds that were set aside for curing the community because our curing the community budget in the VA had gone dry I mean that's a waste of time I mean sure it creates political theater but that's a waste of time in the veterans first act we have provision for giving the secretary more flexibility than we have today you know I don't think we'll get all the way to where it was like a private sector company and we could do what's best for veterans but that's really what we're about I also worry about the sequestration and the impact on veterans I mean in my mind as a veteran if we're going to decide to go to war we should decide the cost of that war on the veterans and their family after the war before we go to war we shouldn't wait until after the war is over and say gee I'm surprised by the cost of this in the VA so I worry with all these caps that they create artificial dampeners on the benefits that veterans have already qualified for that wasn't told to me when I signed up right exactly Chairman Isaacson would you care to comment and are there any specific congressional budget rules or laws you think should be changed say the last part again do you think there's any rules that should be changed I was hoping I was going to get that question I know it was possible we didn't plan this but I think we ought to pass the Isaacson budget bill which has been pending in the United States Senate for six years which says the following instead of appropriating for a one year cycle you appropriate in two year cycles you do appropriation in odd numbered years you do oversight in even numbered years that's when everybody's running for reelection that way you're going through justifying why you're making savings rather than why you're going to spend more money Bob will tell you when we the first challenge I had and he had really I think when he came to the agency was finishing the Denver hospital we lost overrun 30% finish was going to be closed and boarded up working together as a committee and as the agency we found the billion dollars within existing appropriations to the the Denver hospital is being finished today that was the kind of example I've envisioned by having a two year process where you have a year to do nothing but do oversight see where your money is going ask yourself the question do we still need to be doing X, Y, or Z is there a place this money would be better appropriated so the next year when you come back you're appropriated appropriately in businesses Jimmy Carter started with zero based budgeting that was his big deal in 1976 instead of doing continuation appropriations which we do now which says we're going to continue everything we've done for 100 years and just add on to it instead you do zero based budgeting where you start with zero and say what do we need to do and in those cases you end up saving or reprioritizing a lot of money there are a lot of things that need to be done in our country today by our government that have been proposed that haven't been done because of lacking funding that would have been done and we had the ability to move funds from somewhere it shouldn't be spent somewhere it could be invested so I think working as a team you can't give a secretary unbridled authority to give them a big number and just have them do whatever they want to but on the same token passing an appropriation bill that says this is where you're going to spend it and never looking back there's a happy balance in the medium and if you work together as a team you can solve a lot of problems with that flexibility one of the most important legislative priorities for DAV and the auxiliary is extending the comprehensive caregiver support program to govern caregivers veterans of all areas that you've mentioned and that is in your bill we appreciate your attention to that issue it's something that's really important our members so many have cared for their loved ones for years and years and we know that originally it was only passed for post 9-11 veterans due to budget concerns so these are some of the things that really give us pause when there isn't the funding to do and make it equal for all veterans and on that point and Bob correct me if I'm wrong if I miss a number here but that's a $3.4 billion expenditure in expanding caregivers we pay the bill that we're introducing pays for everything we're doing by making cuts in other places or reprioritizing money I have been criticized because one of the pay-fors for caregivers and some of the other things was to put the VA reimbursement for housing in the GI bill equal with the active duty DOD reimbursement which some people have purported to have been a cut it is not a cut it's something you apply for in the future and you get on an equal basis with the DOD recipients on active duty and I'm saying it right if I'm not mistaken so there are a lot of people that are misusing the term cut or oversight to say we're taking something away from veterans we're not taking a thing away from veterans what we're doing is reprioritizing and bringing in line DOD reimbursement and veterans reimbursement to create a part of the money that pays for the $3.4 billion in cost for caregivers that's a good investment anyway you cut it and it's the right thing to do and I'm proud we did it I think this whole initiative to expand caregivers pre-911 is only right only fair should be done and one of the things I'm trying to do as secretary is to make sure caregivers always have a seat at the table for everything we do we've partnered with the Elizabeth Dole Foundation in fact I was with Senator Dole this week even we've got an upcoming summit on caregiving which we're going to be doing in conjunction with Elizabeth Dole Foundation this is a critically important issue our veterans are aging 1975 the year I graduated from West Point we had 2 million veterans over the age of 65 in 2017 we have 10 million veterans over the age of 65 that's a five times increase in what I would argue is a pretty short period of time and what's that's resulting in is a lot more caregiving a lot more pressure on caregiving and this is going to be a national calamity not just a veteran calamity if we don't figure it out so again relative to integrated healthcare VA is leading the way in figuring it out we're partnering with the Elizabeth Dole Foundation to help figure out what is it the caregivers need and so we can give them the proper training the proper respite in order to make that system viable and I hate to go back and interrupt I apologize but this is one of those things where when you have a robust caregiver program it actually saves you money it's going to cost you more money in the VA to provide health services somebody who doesn't have caregiving benefits then somebody who has those benefits so I'm a big believer a big believer in home healthcare and it is a net savings it's a better environment for the veteran and it's the right thing to do VA is the largest purveyor of home healthcare in the nation and we're working very hard to increase that and to make sure we understand what we learn from it gets turned back to medical science so it affects the private sector as well but the chairman is right this is the future thank you Jim Secretary McDonald as you know veterans who rely on disability compensation and survivors who rely on DIC payments have seen either no COLA increases or very small ones in recent years the current COLA formula does not take into account the rising price of gasoline or food to very significant cost for most veterans what are your thoughts about the current COLA formula and is there anything VA or congress can do to ensure that veterans receiving disability compensation and other benefits are provided manual annual COLA increases Jim I think we need to make that COLA you know commensurate congruent with what the real cost of living is it's really that simple I think that will require a change in the statute but you know as I've said and chairman has said too we'll do the harder right and easier wrong so we need to dig into it with you okay and chairman Isaacson as a follow up I mean would you care to comment and would you be supportive of legislation to raise compensation rates even if there's no so security COLA increase put you on the spot a little bit so well we stay on the spot in my business the spot's getting narrower and narrower as the question is getting longer I think Bob said it right it's a when you change that formula you shouldn't pay for it you shouldn't design the formula to withhold a benefit somebody should be getting but on the same table you can't necessarily change it in one point in time because of the circumstances of that point in time and then have to pay the price later on when things change they're all you know chain CPA we've dealt with so many different formulas in terms of Social Security in terms of Medicare in terms of veterans benefits one decimal or one number the domino effect that it caused through the system makes it very difficult so when I will promise you this I watch this stuff every day I'm a veteran I now have a disability and I'm a United States taxpayer I'm in the Congress of the United States and I'm on Social Security so I got a vested interest in all this stuff but I want to take care of you just as well as I can but make sure we can take care of the whole country when we change things for the better so we're going to this is one of those commission level things we're going to work on all right thank you Chairman Isaacson and Secretary McDonald we've talked a little bit about suicide among veterans and trying to reduce that and the great program with the call center and all that you're doing and the importance of really providing timely health care services for our nations both service members and veterans what more can be done to improve access to mental health care for all enrolled veterans in particular for war veterans struggling with post deployment readjustment issues I mean I know VA is really committed you know there's been an increased number of staff that you've hired I know that all the programs within the mental health services have ramped up trying to address this issue because it's been such a big concern and one veteran suicide is just one too many so do you see anything in particular I guess it's really when somebody becomes in crisis that's such an important time and you now have peer to peer support and there's various programs you're really trying to do to address this but do you see is there anything more that you I think there are some things we held a suicide summit in February and we developed an action plan and we're following through on that action plan number one is all of us play a role and the civilian population plays a role in getting people in need connected one of the things we've learned is anyone at risk in isolation is a bad thing we have to get them connected and as you know we have the crisis line to do that and all of us play a role it's not just veterans playing a role or just the civilian population everybody's got to play a role secondly is as you said Joy we've hired more mental health professionals but as I really dig into this we have a systemic problem in this country and if I don't solve the help solve the systemic problem I won't solve the VA problem the systemic problem is this we are not graduating enough we need to have professionals in this country when I go around to various medical schools and I've been over two dozen now recruiting medical professionals for the VA and we've hired over 1500 new doctors it's hard to find a mental health professional I was in Boston not too long ago at Massachusetts General Hospital and the CEO told me every mental health patient that walks in the door they lose 100 dollars which means we have an issue with reimbursement rates so what I would love to do is continue to work with the chairman and others to get the ability to repay medical school loans that may incent people to go into mental health versus just going into dermatology or some other practice which may have better hours let's say so I think we've got to deal with the whole systemic issue third I would I would have to say that when you look at how mental health is practiced most mental health professionals will tell you VA does it right because we do it through primary care you meet your mental health professional through primary care so we avoid the stigma that exists in this country around mental health we've got to get beyond that stigma as a society I was in El Paso, Texas not too long ago and there's a new hospital there and there was a neon sign on one of the buildings that said mental health clinic there wasn't a car in the parking lot so I sat there for a while what I watched was people parking next door walking over to the mental health clinic because of that stigma we've got to get rid of that stigma and culture change is up to all of us so I think we've got to work to eliminate that culture change but I'm excited about what we're doing I think we all have a role in getting people connected and I'm also convinced that if we get people connected as the numbers have shown we can eliminate this dirge of suicide that we have I mean in the United States I think the wraparound services that VA provides and the mental health services that they provide and the committed and dedicated people that do that work it's just second to none and it's rarely spoken about but really in working with them we just see how much you have the connection to not only a specialized service for post-traumatic stress but substance use disorder you have judicial and as you know we are willing to try anything that works and I mentioned in my remarks this morning whether it's acupuncture, yoga we have found so many alternative approaches that allow us to treat post-traumatic stress mental illnesses without the use of opioids I mean we are on the cutting edge of this and we're in the midst of validating all of those methodologies so they can be used in the private sector and hopefully make a difference in the mental health culture of our country in general I think the chairman wanted to say something I just wanted to add that some of the things we've already talked about are falling to this category the caregivers program helps with suicide for this reason the largest number of suicides are non-Ara veterans a lot of people think it's Afghani and Iraq war veterans that's not true a caregiver program is closer to that patient being the bridge that saves their life what Bob McDonnell is doing in Sloan Gibson in terms of putting that new call center in Atlanta this fall where we'll have 25 million dollars invested and being able to be more accessible for VA health care providers is a huge thing as well so as you can see and then the provider agreement provisions if we have communities that are shy of having providers in health care services we're creating mechanisms to get those services to those centers so we're trying to do everything we can because as I said earlier time is everything and somebody in crisis for taking their own life and you've got to be quick and accessible to be able to save those lives there are if I can just add one other thought there are many states in this country without medical schools and when I was in Florida I learned we're missing 17,000 primary care physicians in Florida we're short today 22,000 in California short today Duke Medical School or the average medical school graduates about a hundred and seventy five hundred and eighty students a year you can't square that circle you can't square it so what I'm trying to do is get the medical schools to graduate more people for them to do that they want us to have more residencies and during the choice act and others were kind to give us more residencies so we can increase the throughput but frankly you know we've got to increase the throughput of mental health professionals we've got to increase the throughput of primary care physicians and frankly we've got to create more medical schools again if I don't look at this as a total system problem not only will we not solve it for the VA but the American public so we're working to stand up a new medical school in Las Vegas in Montana one in Utah these are necessary in order to get the throughput of doctors that this country needs and nurses thank you Secretary McDonald in 2014 DAB released a special report on women veterans that you mentioned and we appreciate that it offered 27 key recommendations to ensure women veterans have equal access to all VA healthcare services and benefits you've placed on improving the veterans experience for all veterans are there any specific actions that you've taken to ensure that the unique concerns and needs of women veterans have been addressed well we've looked at the female experience in isolation I mean we've studied that and we said what can we do to improve that so obviously hiring more gynecologists hiring more women's health experts training people in our facilities to be women's health experts creating individual women's clinics as you may know here in Atlanta we have we've used an old building that was on Fort McPherson used to be Fort McPherson as our women's clinic I've turned that toward that facility if you haven't seen it I would suggest all the women that are here go take a look at it it's an outstanding facility we also have in Columbus another great Georgia location we've inherited a building from Martin army hospital that we've turned into a women's clinic so these are the kinds of advances that we need to make we've been able to get more women's health equipment from the Department of Defense we've bought more ourselves but these are we're learning every day we have a new leader of a new advocate for women within the VA named Kayla she will be here speaking I think tomorrow if I'm not mistaken I mean this lady's a rock star this is a lady who learned Arabic and went on patrols with the infantry in Afghanistan and Iraq so guys be careful she's tough as nails and she's really good I'm really looking forward to her leadership in this area because she's going to lead us to a new location and I'm proud of that yes we're very pleased to have Kayla Williams coming she's going to be one of the guest speakers at our women veterans seminar and I agree the two books that she's written about her experience as a woman veteran also the second book focuses on her experience she's married to a disabled veteran as well and talking about I mean what better person to have there that really understands the most important thing that any of us can do as a leader I learned this at the Prokren Gamble company I'm sure the chairman learned it in his business is get the right leaders in place that's why 13 of my 17 top leaders are all new in the last two years that's a huge turnover but I would argue we brought the right people in like Dr. David Shulkin like Jennifer Lee who was with David to get the job done you get the right leaders in place and a lot happens Kayla's one of those Chairman Isaacson would you care to comment I know I want to say first we appreciate the hearing that you held last year and the support that you gave to DAV's report as well and I know women veterans are an important priority for the you know for the committee as well you know as I said in my opening remarks when I outlined the five things I wanted is when I took over as chairman the five things I wanted to focus on victims of sexual trauma and women's issues were one of the most important and I think the department is doing a good job of recognizing the unique differences that women female health care bring about and seeing to it that our veterans centers are rearranged and reconfigured in such a way that privacy, accessibility things of that nature are good for our women veterans and when they go to our facilities and it's going to grow I think last year 10% of our veterans being server women now it's 13 or growing to 13 it's going to continue to be a bigger percentage of VA services and we have to make sure it is on parity and equal in every way to men's services while in meeting the needs of women. Obviously our extended hours which we've done to improve access has been a big help to women most of our facilities now have some kind of child care or day care place those are all things that we've got to continue to move forward on. Wonderful Jim. I see we're just about out of time as Joy promised earlier we like to give both of our guests an opportunity to make some closing remarks and chairman Isaac and we'll start with you if that's all right. Well it's an honor for me to be with Disabled American Veterans and I want to thank you for what you have done to help my first year and a half as chairman be effective and meaningful I take this job as your servant not I'm not the chairman of your committee I'm a member of your committee working for you as a chairman and we appreciate DAV and your professional staff in Washington is second to none and I mean that they do a phenomenal job and I want to do what I did at the beginning I want to thank you for your service to our country. There are lots of reasons why America's great but none greater than the men and women who volunteer to serve our nation around the world in times of crisis and threats to democracy peace and liberty so I will close by saying this I'm as accessible if you can read a phone book you can find me I'm in the DC phone book I'm in the Atlanta phone book the press will tell you they don't ever harass me because they know they can find me when they need me so I'm there when I when you need me call and let us know if you have a problem I'll promise we'll do everything we can to solve it if we don't solve it will never be for a lack of effort so thank you all for your service thank you for having me today and thank you for supporting Bob McDonnell and the great job our VA health services do for our country Chairman McDonnell any final comments Chairman really really said it all but I would I would like to thank DAV members it's been great being with you today I look forward to tomorrow when the President United States is here and I think his presence underscores all of our commitment to to the veterans of the country I'd like to thank Chairman Isakson we would not be where we are today with the opportunity to take the second half of 2016 and make it the turning point for veterans in this country if it weren't for the bipartisan work that chairman did on the veterans first act and now on appeals we wouldn't be where we are today and I would just simply like to underscore what I said earlier this is a unique moment in time I don't think again we will have the unanimity that we have nor the clear-sightedness about what needs to get done to really get a lot of things done that have been around for many many years like appeals 80 years and have the opportunity to get it done with with the leadership that we have today so thanks to DAV for your leadership thank you to Johnnie Isakson for his leadership and all of us at the VA are totally committed to the veterans of this country and obviously many of us are veterans so thank you very much and I'd just like to say thank you so much to both of you so busy but for taking your time with spending with our membership and having this conversation we're very excited about the future what the future holds with you know with VA you've moved the ball forward making change and with the right people all working together for the same thing to really improve the experience the services the benefits for our veterans so I'll let Jim make our final goodbye and I just want to thank you both again for being here and taking out your time I know both of you are very busy it's very important to our membership here so thank you again and this concludes our seminar thank you thank you Jim thank you thank you so much