Washington Wednesday: VA reform

MEGAN BASHAM, HOST: It’s Wednesday, the first day of August, 2018.

Glad to have you along for today’s episode of The World and Everything in It. Good morning, I’m Megan Basham.

MARY REICHARD, HOST: And I’m Mary Reichard. It’s time now for Washington Wednesday.

The U.S. created the Veterans Administration in 1930, but it only became the cabinet-level Department of Veterans Affairs in 1990. Its purpose is to provide benefits to military veterans—including near comprehensive healthcare for some 9 million veterans.

With nearly 400,000 employees, the VA has never had a reputation for efficiency. But the appearance of adequacy dissolved into scandal in 2014.

ABC7: Veterans are at risk of being lost or forgotten… BLITZER: They’re dying needlessly because of long waits for care at some U.S. veterans hospitals…

News reports forced the VA to admit its hospital in Phoenix had about 1,700 veterans waiting an average of almost four months for care. At least 40 vets died waiting.

It quickly became clear this problem wasn’t limited to Phoenix.

ABC7: Scandal is growing this morning over healthcare at Veterans Administration hospitals… ABC11: A new audit shows wait times for primary care in the VA hospital in Fayetteville are the nation’s third longest… CNN: Yet another VA hospital, this time in Wyoming…

Numerous investigations found a culture of complacency and false record-keeping—sometimes to ensure employees could get performance bonuses.

The VA’s top doctor resigned in May 2014—followed soon after by VA Secretary Eric Shinseki.

The Obama administration overhauled VA leadership, including bringing in David Shulkin from the private sector to act as undersecretary for health. Upon taking office, President Trump nominated Shulkin to lead the VA, but his tenure lasted only 14 months. Amid scrutiny over a taxpayer-funded trip to Europe, Trump fired him in March.

After four months with an interim secretary, this week the VA got its fourth permanent secretary in the last five years.

TRUMP: These heroes deserve only the best, and they will have it under Robert Wilkie. I have no doubt about it.

Wilkie is a lawyer and naval reservist who previously served at the Department of Defense under presidents George W. Bush and Trump. During his confirmation hearing in June, Wilkie vowed to improve the agency’s culture and increase access to care.

WILKIE: Mr. Chairman, the prime directive is customer service. When an American veteran comes to VA, it us not up to him to employ a team of lawyers to get VA to say yes. It is up to VA to get the veteran to yes—and that is customer service.

Implementing several veterans bills Congress has passed will be a top task for Wilkie. One of the lawmakers involved in those legislative efforts is Congressman Doug Lamborn. He’s a Republican from Colorado and a member of the House Armed Services Committee. The U.S. Air Force Academy sits in his district, which covers several counties just south of Denver.

WORLD Radio’s J.C. Derrick caught up with Congressman Lamborn at his Washington, D.C., office to discuss recent efforts to turn things around at the VA.

J.C. DERRICK: People are familiar with the 2014 scandal. I think probably a lot of people are not as familiar with what’s happened since then. And so I’d like to start with the 2017 report from the VA itself, which I think rated 14 of the 146 hospitals still rate as a No. 1 on a scale of 1 to 5. So not doing well. Is it fair to say that the VA scandal is still ongoing?

DOUG LAMBORN: I think huge strides have been made to fix problems. They’re not 100 percent fixed but strides have been made. And the Choice Act was the first step in that direction. It was a bipartisan act and it gave veterans expanded ability to choose their providers if they lived a certain distance away from or had a certain waiting period that they had to endure before they could get traditional care under the VA. Now, we’ve recently made that even better with the VA MISSION Act so that the providers out in the private sector would be reimbursed. And veterans would have this option. I would eventually like to go and I have a VA Empowerment Act even more in the direction of choice. Not doing away with the VA or privatizing the VA, but giving veterans the ability to choose any private provider that they want, if that was better for their condition. So the VA is making some progress, but we still have waiting times that are unacceptable and some of it I believe is just inherent in the bureaucratic structure but even with best efforts, there’s too much red tape and that slows down treatment. It restricts treatment and is not the best way forward, I don’t believe, in the long run.

DERRICK: You mentioned three bills there. And so I want to ask you a question about each of them. First though, I know you are — in your district is the highest population of veterans in the country, actually. And so I would assume you hear often from veteran constituents with stories of encounters with the VA. Do any of those stick out, any particular stories that you’ve heard?

LAMBORN: I’ve heard the good, the bad, and the ugly. In Colorado Springs, which is a military area, we have a new super clinic there, and an hour to the north we have the new VA hospital. Although, unfortunately, it’s had its troubles being built. It had a billion dollar-plus cost overrun and huge time delays. And they blew it. In that case, they showed they couldn’t handle large construction projects properly. So we had to bring in the army corps of engineers. So, it’s going to be a good facility in many ways. But even with that, we have some unacceptable waiting times. And I hear some unfortunate stories of people that have been made to wait too long.

DERRICK: Now, in the aftermath of the 2014 scandal, Congress passed a law to address some of the VA issues, correct?

LAMBORN: That’s exactly right, J.C. The Veterans Choice Act, we did that several years ago. House and Senate, bipartisan, got signed into law by Barack Obama. This, for the first time, gave a lot of money toward an expanded veterans choice. There were a few limited community care options, but this for the first time really put choice in as an option because of the waiting scandal.  

DERRICK: More recently Congress passed legislation making it easier to fire bad employees at the VA. How is that implementation going?

LAMBORN: Well, the VA MISSION Act does make progress and makes it easier for the director of the VA to fire people that are not performing. It’s still not as easy as it should be. It’s certainly not as easy as it is in the private sector to let someone go, because we’re talking about the federal government here. But it’s better than it was. We have people that even were under criminal indictment that couldn’t be — or found guilty of criminal charges that couldn’t be let go without a very lengthy process, including appeals that would just stretch out for months and months at a time. So that was unacceptable. And finally, now the union is very strong, the bureaucracy has its backers within the Congress that want to do what they asked. So it hasn’t been an easy struggle, but we have through the VA MISSION Act that was recently passed, we’ve taken some big steps toward giving the secretary of the VA enhanced ability to let people go.

DERRICK: And speaking of the union, earlier you mentioned possibly streamlining, combining, and even closing some facilities that aren’t used as much and that’s run into some bureaucratic inertia. I would assume the unions would also be opposed to that. Is that where some of that resistance is coming from?

LAMBORN: Well, you do have the unionized employees. You do have the higher-level employees that are not in the union, but they have a lot of influence in Congress in certain quarters. And then you have veteran service organizations that are very respected, very well intended. Sometimes they’re more committed to the status quo because that’s what they’re used to, that’s what they’re comfortable with. And it’s not as easy, perhaps, to think outside the box. But, ultimately I want to bring — I’d like to see all people come together and do some thinking outside the box, to go beyond — to include but also go beyond the current way of doing things with the VA and the structure that it has currently in place, because I think veterans need that for their best healthcare.

DERRICK: Well, and that was going to be my final question was in terms of where you go from here, you’ve talked about some of the things that have already passed, make it easier to fire bad employees, give veterans more choice, streamlining processes, things like that. What would you see as the top priorities moving forward in terms of things that need to get done to get the VA where it needs to be?

LAMBORN: We’ve had a lot of turmoil and turnover with the VA. I just want to make sure that the person running the VA is a committed reformer. We have to have true reform. We have to look at all options. Let’s build on the best legacy of the VA, but I think that that keeps us back in a 20th century way of doing business that’s not best for the health care of our veterans. Some veterans are very used to and very comfortable with and want to stick with the VA. That’s excellent. But we have others who, because of their medical condition or just their lifestyle, their age, they would rather have their own choice for healthcare.

DERRICK: Or, I’m sure, location too, depending on whether they’re close to a VA. Correct?

LAMBORN: Yeah. They want to have their own provider, they want to have a provider where they live, which may be a distance away from a clinic or hospital. Or that clinic or hospital may not provide this specialized care that they’re really looking for. So we have to accommodate them as well. Not try to put everyone inside the same box.

DERRICK: Okay. Congressman, thank you so much.

LAMBORN: Thank you.

(AP Photo/David Zalubowski, File) In this May 20, 2016, file photo, U.S. Rep. Doug Lamborn, R-Colo., speaks in the state Capitol in Denver. 

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