 Good afternoon everyone So I'm sure that when you are coming out to DC you're hoping you wouldn't have the kind of blizzard or cold weather We sometimes have here, so I'm sure you were looking forward to warm weather probably just not inside So There's any way to turn the air conditioning on for a little bit. We'd appreciate it And I'm sure you enjoyed the video, but now you know what it feels like when they're always robbing Peter to pay Paul As I get started I wanted to say that's joy did what we're here to do is to help you on your visits to Capitol Hill To try to answer some questions give you some information help to arm you and hopefully you're all going up there Maybe Tuesday morning. Maybe you've got some other appointments and hopefully you've got time even to see a little bit while you're up there I know they've got some great sites obviously and you can always get some very good tours of the Capitol particularly a planet in advance I remember when I worked on Capitol Hill the first tour I got we had a great guide Took us around through the Capitol. I remember when we were going around He stopped at one point and said you see that tall benevolent gentleman over there. He said that's the congressional chaplain And I said well, what is the congressional chaplain do does he pray for the house or pray for the Senate? He said no he gets up every morning Looks out at the house looks out at the Senate and prays for the country So and I also want to remind you that as you see the PowerPoint here Please don't try to write down all the words. You'd never keep up with me. These will be online So I put a lot in there. So when you go online you can go through it But I'll try to go through it a little bit quicker than what it looks like Assuming there we go Okay, it's been a dramatic several years as you're well aware In 2014 the waiting list Scandal erupted came up into the newspapers early in the year particularly out in Arizona and Phoenix and what a lot of people We're starting to report on and people in Congress started to talk about with something Many of us have known for a very long time that in fact there were many veterans on lists waiting Okay, it wasn't a surprise for a lot of this but it jumped into the consciousness But it led to a cascading series of events. There was changes in the VA leadership And by the end of the year towards the end of the year Congress took an emergency action to create the choice act the veterans access to care and accountability act and The idea was to very quickly provide new and emergency funding to make sure that anyone who's waiting for care could get the care in The community to make sure we took care of any of those needs in 2015 was the year where they really implemented the act Okay, they had a very short window and many of you know that created some number of problems during the implementation from the mailing of the choice Cards to the confusion over how they work including for the folks who worked inside the VA It's also last year is when a lot of people started to begin a debate that's been continuing about What is the next evolution of the VA health care system or as we'll talk about in a little bit some of those who Think it's time to get rid of it completely Which could be a disaster for those who really rely on the system So this year is really going to be the year we're going to find out is Congress going to bring us a new choice plan Or is there going to be serious reform legislation to take care of the VA and bring it forward to another System that takes care of everyone But to go forward we need to understand where we've been and that's too often the problem is people don't look at what really caused The crisis or what problem we're trying to solve so let's talk for a couple minutes about that Some of you may go back a little while and may recall that actually waiting was a lot worse 12 years ago 13 years ago 14 years ago at that point There was actually at one point over 300,000 veteran veterans waiting six months or longer for their first appointment They put together a presidential task force the task force confirmed From their measure in January 2003 over 200,000 veterans waiting six months or longer What they concluded was what we had been saying for years was that's because there's a mismatch a Mismatch between the funds given to the VA and the demand for resources if you don't line those up You're not going to have the ability to take care of those seeking medical care So for years the DAV as a part of the independent budget group that we work with has been pointing this out But once again, even though after the crisis they infuse some more money It started to decline and that's what really contributed to the 2014 crisis It's very simple if you don't have enough doctors nurses or other providers or you don't have enough treatment space You have to put people on lists to wait It's not the only problem, but you can't solve it without it as Joy mentioned there was an independent assessment put together The independent assessment came to a very interesting conclusion. They said there's a misalignment of demand with resources So we went from a mismatch to a misalignment 12 years later the same problem Still dogging the VA system and they talked about you need more resources You need more doctors examination rooms and so forth and it wasn't just for the for the personnel It was also for the infrastructure They pointed out what we have been saying and what VA's own internal numbers have been saying which is there's a large gap To take care of the hospitals and the clinics and all of the affiliated structures Compared to what VA's been getting billions of dollars a year and until they take care of that again You're gonna have this problem and many of you even see it's not even the building sometimes It's the parking facilities, you know, some of you have trouble getting parking spot I remember hearing this story about a congressman on the way to a town hall meeting That he was holding at a VA medical center and he was running late driving around looking for a parking spot for five minutes Couldn't find one he finally stopped Put his hands together looked up at the sky and said Lord, please help me find a parking space if you do I will go to church every Sunday and I will give up drinking He looked around a car backed out of a space He pulled in stopped the car put his hands together looked up at the sky and said Lord I just found a parking space on my own never mind But you do know this these are problems if you don't have the the spaces inside and outside You can't provide the care But what we also know and what's been confirmed time and time again is that the problem the biggest problem is The access not the quality and again the independent assessment We talked about which was done by Rand Corp done by other major think tanks and very independent groups looked at it They looked at the best measures They could find and said VA's qualities as good as or in many cases better than the private sector when you look at this system And that's not perfect because no system is but they measured it They've got this brand just said again They confirmed that at a briefing last week that we were at VA provides the care quality that's necessary And so really what they saying and what we're saying is we need to build on that strength while addressing the other areas So that's the that's the core of the problem. Where are we today? As we know there is a choice program that's out there. It was put into law 2014 it was a temporary program they were given ten billion dollars for the choice program and said the program would expire when either the money Runs out or three years passes now the money is expected to run out near the end of this year So that's why Congress is going to look at this and have to make some decisions And again, many of you who know who may have had experience know that they set these parameters You had to be 40 miles from a facility and then they started changing the definition Was it 40 miles as the crow flies or as you actually drive on a road? And they talked about it has to be for those who are waiting 30 days or more for an appointment And they set up a system of third-party administrators But let me ask a question. How many of you probably most of you got a choice card in the mail show of hands, okay? How many of you have used the program? Okay How many of you had any difficulties using the program? And and one of the biggest problems have any of you had trouble that you've been billed by the doctors you saw Okay, this is a problem that even a member of Congress Tammy Duckworth who many of you may know DAV member She gave birth to her child and then she got bills from the doctors that VA wouldn't wouldn't pay and eventually Collection agencies started sending her notices now imagine if a member of Congress gets this what is someone out in the country to do? So we know there's difficulties with the choice program and the coordination and care What do they do when you're sent to a community facility to the records come back? Do they keep them together? These are the kind of issues that for a temporary emergency program. It may have been necessary, but we can do better than that We can and we will Now there's also a commission on care that was referenced That's looking at this their job is to say what's a 20-year vision of what VA should become VA health care There are 15 members appointed as was pointed out our Dave Gorman is on the commission So we've got a strong advocate there and Philip Longman the author of the book best care anywhere is another member So we've got a couple But there are a lot of other people on the commission that don't have that knowledge or experience In fact, there's only a couple two or three combat disabled veterans on the commission There's not a single doctor nurse or clinician who worked in the VA system in the last two decades There are five senior executives of private health care systems. So we've got concerns about the direction is going So we've been putting together. What would a plan be and we said, let's start with some principles Let's just reaffirm that it's our nation's sacred obligation to make whole the men and women injured in service to the country Let's make it clear that it's a federal responsibility to ensure that veterans have access to the full array of benefits and And when it comes to health care, it's not just any health care We need to make sure that we get the health care that you have earned and deserve that it's high quality accessible Comprehensive and veteran center. I'm gonna talk about those just for a second We consider these the critical attributes of a VA health care system to be high quality I think it's pretty pretty a basic idea. We understand we want to have the leading edge on everything that they do There's no reason VA shouldn't have the best technology the best treatments or whatever health care system. We're designing We know that it needs to be Accessible okay, it needs to be where veterans live it needs to be within timeframes that take care of your medical needs and convenient whenever it's possible Those two most people understand but there are a lot of people that don't pay attention to a comprehensive system Is it holistic does it take care of the whole veteran? Does it provide the full continuum of services? Does it understand that it's not just physical health but mental health because it's really not a clear separation They're connected and does it provide the other sort of supports that veterans can get from a system that also has benefits And it needs to be one that's not just any health care system, but that's veteran centric and there's many important aspects VA for example has doctors who practice veteran medicine. They see veterans all day long They understand what to look for what questions to ask Another health care system may be good But if they have only a very small or no veteran patients, do they ask questions about exposures? If you came in and you were a recent veteran coming back from Iraq or Afghanistan And you had some sort of respiratory condition where they ask whether you had been near burn pits Do they ask these kinds of questions? It's important that it's veterans medicine that we're talking to and again the connection between the health care and the other systems is very important So DAV and we've been working with a lot of our other colleagues and other VSOs to try to build consensus have looked at a plan that we've got four pillars And I'll go through them again quickly on the next several slides, but it's to restructure realign rebuild and reform We people like to do things in groups. So we've got this as our four Rs So what do we mean? Well, we know we need to restructure the way that the community care programs work with the VA system In the past it's been the case that there's been some facilities use the fee basis Some facilities started using things like P triple C these may be familiar to some of you But there was never a good linkage and there was never a good set of rules So they created a lot of confusion What we need to do is create networks that make sense so that the community care Designed to supplement where VA can't be or where VA doesn't have enough Facilities need to be put together in a network But VA needs to be remain accountable for the care for the coordination of the care and to be accountable for it Not just putting people out giving them a voucher and putting them on their own To make the system work we need to realign and make sure that the resources are where they need to be when they need to be and That's been a problem for years But we need to do that we need to make sure that access is consistent across the country and urgent care is a key Aspect that dr. Shulkin talked about that we need to make sure that people can see Physician or provider the same day if they think it's necessary So we need to create a real system not emergency care and not the primary care the urgent care in between We've talked about it, but we then we also need to rebuild the VA system where it's fallen down We need to make sure we've got the doctors and the nurses Make sure that we've got the facilities where we need them and make sure that the VA research program Continues to be as strong as it is That's the the future of medicine for veterans and becomes the future of medicine for all people in this country So we've got to make sure that's there, but we also know that money alone won't solve the problem And so we do need reforms. We need to make sure that budgets actually tie to outcomes We need to make sure that there's transparency and we need real accountability as The deputy secretary said firing people in cases is necessary, but that doesn't solve the problem We need to make sure that we get the training we get the problem solved for the veterans That's real accountability And we need to make sure we can hire the people we need Make sure that we can get them in and keep them in VA the good people so that they're not pulled away So our plan is very similar actually to the one in many ways that the VA has proposed And we're not surprised because we were giving them a lot of feedback throughout this process So the VA plan which legally had to be called the new veterans choice plan would Consolidate the existing community care programs into a single set of rules a single set of Guidance to the field to the offices to make sure it becomes a smoother more consistent experience They talk about again creating a network so that you start with a core of the VA, but you bring in I mean why not make sure there's real seamless connection with DOD facilities where you need to share capacity? The academic affiliates that VA works with and then get the best of the folks in the private community Facilities to bring them in into a network with VA So it's the same experience for a veteran when he comes in and needs an appointment It may end up being in the network provider in the community But we've still got the same coordination of records of scheduling and billing to make sure that the bills Don't come to you when this provided and as part of this plan We need to make sure that VA keeps its core competencies VA should do what VA does best But what a lot of people in this town and the media don't understand is that it's not just the specialty areas Which they are world-leading and most people acknowledge it the poly trauma TBI PTSD amputations prosthetics vision a lot of areas VA is clearly an undisputed the leader But it's also the way they do primary care particularly where they're now integrating mental health care Because we know what an issue this is and you can't separate it So VA's model of primary care with mental health care is in fact a leading method of providing treatment and providing preventative treatment That's what makes sure that you don't end up with worse conditions because they're looking at you now unfortunately As has been referenced by Joyce the debate that goes on has not been very helpful And in fact it's been based on a lot of Misinformation in the media and Congress and believe it or not sometimes they don't dig very deep Okay, sometimes they take very simplistic views and they simply say oh VA must have terrible quality Because I saw there was a story in the paper that said somebody had a problem or the private sector They'll say can take care of everyone and it's going to be so much less expensive and we can eliminate all that red tape and bureaucracy Well, that's just not a balanced and fair perspective The private sector is not necessarily better health care. It's just sometimes Sometimes you can't see the problems there because the VA has to report publicly The private sector they make as many errors and more than they do in the VA In fact, there's one study that says that every year between a hundred thousand and four hundred thousand people die in private hospitals because of some type of medical error Now we'll try to figure out how that compares to VA, but that's a huge number The idea that some people put forward that they could take care of all the veterans again in the private sector again How many of you have ever had to wait to get an appointment with a non VA doctor in the private sector? I mean There's not the kind of excess capacity. That's just sitting there after all It wouldn't be efficient if they had doctors waiting around all day for a new appointment The private sector is based on trying to keep everything as tight as they can and The same kind of difficulties that VA has in recruiting nurses and doctors occurs in the private sector They've also got tremendous shortages for nurses nationwide and for all sorts of doctors and specialties in various areas around the country And if we think that things would be a lot simpler If you just had insurance instead of a VA system Think of all the new rules about your private insurance if you use it of what doctor you can see how many times when where? Lifetime limits deductibles donut holes and all the other things you deal with the for the prescription drugs that changes every month When they or every year they change their formulary and you have to switch a drug It doesn't solve the problem. It just shifts the problem and in fact People are talking about moving the care to the private sector are talking about cost sharing They're talking about copayments and deductibles Their plans would end up increasing costs and again, frankly the private sector will chase you really hard for those like they did congresswoman Duckworth And again, this is not the cast dispersion But the fact is the private health care system is based on trying to maximize revenues and profits And that's why the an average appointment in a private Hospital you may see the doctor for 10 or 12 minutes as they run from one to the next and you may get more time at a VA facility So it goes to the to the core of that there's a lot of people think that this is a great quote I love this one which is for every complex problem. There is an answer that is clear simple and wrong I mean that that is just too often the case And that's why as we've talked about DAV we've been watching this we've decided enough is enough And so we're putting together a campaign we call setting the record straight on VA health care Because we want to make sure that as this debate goes forward that people are held accountable for the real facts and the real situation So if we could go ahead and move to the video At this point we're going to show you another cartoon without Peter Paul When it comes to veterans health care reform, it's hard to separate the noise from the truth So DAV is setting the record straight Some politicians political and veterans groups have suggested VA should only focus on operating specialized centers of excellence To treat things like amputations blindness spinal cord injuries burns PTSD and traumatic brain injury VA should focus on areas of expertise and build centers of excellence around these disciplines We can develop centers of excellence and replace the VA So why is this such a bad idea and how could it possibly hurt veterans? To start the VA's current system of 150 plus medical centers and 1000 plus outpatient clinics would shrink significantly Forcing veterans into the private sector for all their remaining care as VA facilities would be located further apart and in mostly urban areas Hundreds of thousands of veterans would be forced to travel farther and wait longer for the care They need in addition splitting veterans health care between VA specialists and private routine care providers Creates a disconnect thereby diminishing the quality of veterans overall care and making it much harder to coordinate their treatment So what's a better solution? Rather than downsizing the VA to address access issues We should provide new access options by creating VA urgent care centers extending operating hours tonight's and weekends and Continuing to expand the use of telemedicine and web-based health care to make the system more convenient efficient and responsive to the needs of veterans Don't get lost in the noise Learn more and get involved in the effort to reform veterans health care at DAV dot org slash setting the record straight That's what we intend to do is to get the record straight. Oh, you can clap. It's okay And by the way, just so you know this video in the other video was done by done by our own communication staff Ashley Burns and Todd Hunter to the lead people. So we do this in-house. That's the kind of quality work We get out of our communication folks So I don't want to go back through this but again a simple idea centers of excellence VA has lots of them They have them for poly trauma. They have them for vision. They have them for spinal cord They have them for mental health for geriatrics clearly centers of excellence are good But they exist connected in or within a VA hospital connected to a network of VA clinics They don't operate in isolation on their own And these are the things that we need to make sure that Congress thinks about before they would try to go to a policy like this So over the coming weeks We're gonna have a number of these to provoke conversation to start a debate and to make sure that people again who throw out Simplistic ideas and that may even have other agendas are held accountable I'm not gonna go through all of these now, but why are vouchers a bad idea? I think some of you understand That already but again, it starts to put a situation where you end up Saying that veterans are on their own if you live in a rural area of the country It's not just that VA is remote. Sometimes there's no medical facilities or specialties that are near you So it's not a solution. It also starts to again lead to problems with the coordination of care And again, we're gonna offer solutions. We think if you want to increase access, it's not vouchers It's by changing the way you access by building the network and putting the decision in the hands of veterans and doctors When you leave a VA facility, you should have your next appointment based on what you and the doctor decide Not on what some scheduler decides. That's the way it is when you go anywhere else If you need to be seen in one hour or one day or one week, that's the standard not 30 days as they try to do now We talk about Treating only service-related conditions or some people only combat wounds Again, they think that's a way to core down what VA should be doing But it does two things it splits your care between VA and the private sector and again You lose that benefit of having a team of doctors who are talking and keeping track of you It also again says that we should treat part of a person not the whole person and that's not the model of medicine That's not anywhere today Again, folks are talking about turning VA into an insurance program as I mentioned before Think of all the thousands and thousands of pages of regulation insurance companies and insurance programs require That is not going to be this simple choice They create a false myth that oh if you get a card or an insurance program, you can go anywhere anytime you want for anything That's just not the way it's going to be everything would have limits and of course privatizing VA healthcare even privatizing the way the governance of it or creating some new Semi-independence structures being talked about like the post office or like Amtrak well Yeah, a couple of things again if that makes them less accountable That makes you have less of what how much voice do we have with Amtrak when they shut down train lines? Almost in every rural state in the country When the post office is shutting down facilities now, maybe those are different circumstances But you can bet if this is a corporate run entity and you don't live near a major urban or other Population center, you're not going to see a lot of VA So what's ahead for the year that's coming we've got a lot of work and again, we've talked about it VA has their plan and they're continuing to develop it. Dr. Shulkin talked about what they need to do Commission on care report is due June 30th. We're going to be watching that very closely Congress is working to develop the legislation that follows the choice program Presidential candidates have jumped into this debate offering their own plans again Very simple and simplistic and there are political groups pushing for privatization some with very political agendas So we're going to need to get through this. We know that the year ahead. There'll be partisan battles in Congress There'll be the typical gridlock and finger pointing that happens So that's going to slow down what happens And we know that since it's an election year that it's going to be a very shortened calendar and Again in an election year It gets a little rough out there So it can sometimes be hard to make good policy but we are going to need you up on the hill and again Washington's a great town to walk around especially Capitol Hill because Sometimes you just cross in the street and you run into your congressman or senator and you get the chance to talk to him In fact again, I'm reminded of a story of a barber Who would see people coming in a priest would come into the barber shop same day and a couple days later a policeman I mean he told the story about the priest coming in the priest goes in gets his hair cut When the priest is done he says how much and the barber said no, that's okay. I don't need anything for you I do this for the good of their art community and the work you do the next day The barber found on his front door a dozen prayer booklets and a letter thanking him Couple days later the policeman came in Got his haircut when he was done He said how much do I owe you and the barber said no that's nothing the work you do to keep us safe in our community I don't want anything and the next day the barber came back and he found a dozen donuts and a nice note from the police officer A few days later a senator came in He got his haircut and said how much do I owe you and he said no the work you're doing for our country I don't want any payment the next day the barber came in there were 12 more senators lined up So with the Academy Awards the week away, of course, it's always good to ask what's the difference between Congress and Hollywood Hollywood only had three stuages