YouTube Live with Secretary Shulkin


MR. RAUSCH: GOOD AFTERNOON EVERYONE. WELCOME
TO OUR YOUTUBE LIVE EVENT WITH DR. DAVID SHULKIN WHO WAS SWORN IN AS THE 9TH SECRETARY OF V.A.
LAST WEEK. BEFORE THAT, DR. SHULKIN SERVED FOR 18 MONTHS AS V.A.’S UNDER SECRETARY FOR
HEALTH, LEADING THE NATION’S LARGEST INTEGRATED HEALTHCARE SYSTEM, WITH OVER1,700 SITES OF
CARE SERVING NEARLY NINE MILLION VETERANS. A BOARD-CERTIFIED INTERNIST WHO STILL REGULARLY
SEES PATIENTS AT V.A., DR. SHULKIN’S PRIORITIES AS UNDER SECRETARY WERE IMPROVING ACCESS,
ENGAGING EMPLOYEES, BUILDING A HIGH-PERFORMANCE HEALTHCARE NETWORK, IDENTIFYING AND IMPLEMENTING
BEST PRACTICES, AND RESTORING PUBLIC TRUST IN V.A. HEALTHCARE. SECRETARY, THANK YOU FOR
GIVING ME AND THE VETERANS WATCHING A CHANCE TO WEEK WITH YOU TODAY.>>THANK YOU. THANK YOU FOR BEING HERE TODAY.>>OVER THE NEXT 30 MINUTES, WHERE GOING TO
GET TO KNOW YOU A LITTLE BIT BETTER. THE QUESTIONS WE HAVE FOR DR. SHULKIN TODAY CAME FROM VETERANS,
FAMILY MEMBERS AND THE VETERAN COMMUNITY VIA V.A.’S VANTAGE POINT BLOG. YOU’LL ALSO HAVE
A CHANCE TO ASK QUESTIONS VIA THE LIVE CHAT BOX AS YOU WATCH ON OUR YOUTUBE LIVE EVENT
PAGE. SO, WE KNOW YOU HAVE RUN LARGE HEALTH CARE SYSTEMS IN THE NORTHEAST. YOU HAVE HAD
NUMEROUS LEADERSHIP ROLES, AND YOU ARE STILL A PRACTICING PHYSICIAN. WHY DID YOU GIVE ALL
THAT UP TO BECOME UNDER SECRETARY OF HEALTH? AND AFTER BEING THE UNDER SECRETARY OF HEALTH,
WHY ON EARTH WOULD YOU TAKE WHAT IS PROBABLY THE SECOND MOST DIFFICULT JOB IN WASHINGTON,
D.C.?>>I HAVE A HARD TIME SAYING NO. I WOULD LIKE
TO THINK I’M NOT UNLIKE ANY OTHER AMERICAN. I WATCHED AS THE CRISIS UNFOLDED FOR VIA A
— V.A., IN TERMS OF THE WAIT TIME CRISIS THAT UNFOLDED IN APRIL. AND WHEN MY PHONE
RANG, I WAS RUNNING THE HOSPICE AS A CEO, AND I WAS ASKED, WOULD YOU BE WILLING TO HELP?
I DID WHAT I THINK EVERYONE ELSE WOULD DO. I SAID TELL ME HOW I CAN HELP. TELL ME HOW
I CONSERVE. IN A SIMILAR WAY, WHEN I HAD AN OPPORTUNITY TO MEET WITH DONALD TRUMP, HE
SAID THE SAME THING. HE SAID THIS MATTERS TO ME. I CARE A LOT ABOUT THIS ISSUE. I WANT
TO FIX VETERANS AFFAIRS HEALTH CARE. ARE YOU SERIOUS ABOUT THAT? I DON’T THINK ANY OF US
THINK THE JOB’S DONE YET. I WANTED TO BE ABLE TO CONTINUE TO SERVE.>>THANK YOU VERY MUCH. WE HAVE SEEN QUESTIONS
COME IN FROM VETERANS SURROUNDING CHOICE PROGRAMS. YOU HAVE SEEN A LOT OF FOLKS BE ABLE TO GO
INTO THE COMMUNITY AND RECEIVE THE CARE THEY NEED. ONE OF THE QUESTIONS WE WANT TO ASK
IS WHAT ARE YOUR PLANS TO ADDRESS THE CONCERNS OF CARE IN THE COMMUNITY AND MAKE IT SOMETHING
EASIER TO UNDERSTAND, NOT ONLY FOR VIA A EMPLOYEES, BUT ALSO FOR THE VETERAN.>>THERE IS NO DOUBT THAT THE CHOICE PROGRAM
HAS BEEN CONFUSING. IT IS COMPLICATED, AND FRANKLY, WHEN WE TALK ABOUT COMPLICATED VIEWS,
THERE ARE BARRIERS WE HAVE IDENTIFIED FOR VETERANS GETTING THE CARE THEY NEED IN THE
TIME THEY NEED. WE KNOW THAT NEEDS TO CHANGE. THERE IS ALSO NO DOUBT THAT IN ORDER FOR US
TO MEET THE NEEDS OF OUR VETERANS, THE V8 CANNOT DO IT ALONE. WE NEED TO BE WORKING
WITH THE PRIVATE SECTOR. WHAT WE ARE SEEKING TO DO IS REDESIGN THE CHOICE PROGRAM IN A
WAY THAT ACTUALLY ALLOWS VETERANS TO SEEK CARE IN THE COMMUNITY WHEN THEY NEED THAT
CARE. DOING IT IN A WAY THAT’S SIMPLIFIED. WE ARE WORKING HARD NOW WITH THE PRESIDENT,
WITH CONGRESS, TO PROPOSE A CHOICE SYSTEM THAT ACTUALLY IS DESIGNED AND CREATED FOR
THE BENEFIT OF VETERANS. THAT IS WHAT WE ARE COMMITTED TO DOING. MR. RAUSCH: AND THAT INCLUDES ALL OF THESE
OTHER PROGRAMS LIKE PC THREE? YOUR PLAN IS TO STREAMLINE AND MAKE IT THE SAME ACROSS
THE BOARD. SECRETARY SHULKIN: RIGHT NOW, THERE ARE ABOUT
SEVEN DIFFERENT WAYS WE HAVE TO KEEP MONEY TOWARD CALLING FOR — TOWARD GOING FOR CARE
FOR VETERANS. THERE ARE SEVEN DIFFERENT SETS OF RULES, AND THAT’S HER BECOMES COMPLICATED,
NOT ONLY FOR VETERANS, BUT ALSO FOR OUR STAFF. SOMETIMES THEY HAVE TO CALL IN INSURANCE COMPANY
OR THIRD PARTY. OTHER TIMES, A V A MEMBER DIRECTLY. WE ARE SEEKING A SINGLE PLAN THAT
IS THE EASIEST WAY FOR VETERANS TO GET THAT CARE IN THE COMMUNITY. MR. RAUSCH: AND IN THE COMMUNITY, YOU ARE
UP A LITTLE BIT FROM LAST YEAR, WHICH WAS A RECORD YEAR. SECRETARY SHULKIN: ABSOLUTELY. WHEN I STARTED,
ABOUT 21% OF OUR CARE WAS PROVIDED OUTSIDE OF THE V8 COMMUNITY — VA COMMUNITY. TODAY,
THAT’S 31%. MR. RAUSCH: I THINK A LOT OF VETERANS WOULD
BE SURPRISED TO HEAR THAT. I KNOW I AM. TO DEAL WITH AN ISSUE CLOSER TO OUR COMMUNITY,
AGENT ORANGE, WE HAVE A LOT OF PEOPLE WHO HAVE WRITTEN IN TO ASK ABOUT PRESUMPTIVE DISEASES.
CHECK CLIENT WOULD LIKE TO KNOW IF YOU WILL BE CONSIDERING ADDING LUNG DISEASES AND HYPERTENSION
TO THE AGENT ORANGE PRESUMPTIVE DISEASE LISTING AS RECOMMENDED BY THE INSTITUTE OF MEDICINE? SECRETARY SHULKIN: WE ARE GETTING CLOSE ON
THAT. WE HAVE HAD MULTIPLE LONG-TERM STUDIES LOOKING AT THE IMPACT OF AGENT ORANGE ON VETERANS.
THAT IS WHY IN YEARS PAST WE HAVE HAD RESULTED FOR DISABILITY CLAIMS IN MEDICAL CARE. BECAUSE
OF SOME NEW STUDIES THAT HAVE COME OUT, WE ARE APPROACHING, IN THE NEXT SEVERAL WEEKS,
THE ABILITY TO HAVE THAT DATA PRESENTED TO ME, THAT WILL SHOW THE DATA TO SUGGEST WHETHER
IT WILL BE APPROPRIATE TO GRANT ADDITIONAL PRESUMPTIVE’S. IN OTHER WORDS, WHAT IS THE
CAUSATION BETWEEN EXPOSURE TO AGENT ORANGE AND CONDITIONS LIKE HYPERTENSION AND LUNG
CONDITIONS. I AM LOOKING FORWARD TO BEING ABLE TO HEAR THE RESULTS OF THAT. I HAVE NOT
BEEN PRESENTED WITH IT YET. I AM ANXIOUS TO GET IT SO WE CAN GET ANSWERS TO PEOPLE LIKE
JACK, BECAUSE THEY HAVE BEEN WAITING TOO LONG TO GET THOSE ANSWERS. MR. RAUSCH: THANK YOU. AND THEN QUEUE THAT
QUESTION, JACK. — THANK YOU FOR THAT QUESTION, JACK. YOU WERE JUST IN NEW YORK CITY SEEING
PATIENTS WITH THE WHITE COAT AND THE WHOLE BIT. AS REMINDER AT THE TOP, YOU ARE STILL
A PHYSICIAN. I THINK YOU KNOW WE HAVE A SHORTAGE OF MENTAL HEALTH PROFESSIONALS ACROSS THE
COUNTRY, NOT ONLY IN THE V.A., BUT ACROSS THE COUNTRY. RADLEY HAD A QUESTION ABOUT RESOURCES
FOR MENTAL HEALTH. WHAT ARE YOUR PLANS TO TACKLE THIS ISSUE? IT IS NOT JUST A V.A. ISSUE.
IT IS AN AMERICAN ISSUE. SECRETARY SHULKIN: I THINK YOU SAID IT CORRECTLY.
V.A., AS THE LARGEST HEALTH CARE SYSTEM IN THE COUNTRY, TENDS TO SEE THE PROBLEMS THAT
EXIST ALL ACROSS AMERICA. WE HAVE KNOWN FOR A LONG TIME THAT WHILE IN SOME AREAS, THERE
MAY BE A GOOD SUPPLY OF MENTAL HEALTH PROFESSIONALS, WHEN YOU START GETTING INTO OTHER PARTS OF
THE COUNTRY, PARTICULARLY RURAL AREAS, WE SEE SHORTAGES. ONE OF THE WAYS V.A. HAS BEGUN
TO TACKLE THIS IS BY USING TECHNOLOGY. LAST YEAR, WE DID OVER 336 THOUSAND TELL A MENTAL
HEALTH VISITS. NO ONE IS DOING THIS AT THE SCOPE AND SCALE THAT V.A. IS. WE HAVE ESTABLISHED
FIVE TELE-MENTAL HUBS IN THE COUNTRY SO WE CAN PROVIDE THAT CARE TO AREAS WHERE IT DOESN’T
EXIST. WE ARE LEVERAGING TECHNOLOGY. WE ARE ALSO USING EDUCATION. WE ARE EXPANDING RESIDENCY
PROGRAMS TO TRAIN MORE MENTAL HEALTH PROFESSIONALS, PSYCHIATRISTS AND PSYCHOLOGISTS. NOT ONLY
DO WE HELP MANY OF THEM WILL STAY IN V.A., BUT WE SEE PART OF OUR ROLE IN THE COUNTRY
IS HELPING THEM TO FILL THAT SHORTAGE. WE ARE HIRING MENTAL HEALTH CARE PROFESSIONALS.
WE THINK WE HAVE ABOUT 1000 MORE THAN WE NEED TO HIRE TO REALLY BEGIN TO START — THAT WE
NEED TO HIRE TO REALLY BEGIN TO START ADDRESSING OUR WANTS. MR. RAUSCH: YOU BROUGHT UP TELE-HEALTH. I
WENT TO A DEMONSTRATION LAST YEAR AT MY MEDICAL CENTER AND THEY SHOWED US THE POWER OF TELE-HEALTH,
THE IPAD, TALKING TO YOUR PHYSICIAN. IT WAS REALLY REMARKABLE, FRANKLY. IT WAS SOMETHING
I HAD NOT EXPERIENCED BEFORE. SECRETARY SHULKIN: I HAD NOT BEFORE I CAME
TO V.A. EITHER. I SEE PATIENTS IN NEW YORK CITY. BY GOING THERE. I ALSO SEE PATIENTS
IN OREGON, WHICH IS A RURAL PART OF OREGON. I SEE THEM FROM MY OFFICE HERE IN WASHINGTON,
D.C., THROUGH TELE-HEALTH. I AM ABLE TO PUT ON HEADPHONES, LISTEN TO THEIR HEART, LUNGS,
DO MY EXAMINATION. I AM REALLY IMPRESSED BY THE QUALITY OF CARE YOU CAN PROVIDE USING
THIS TECHNOLOGY. MR. RAUSCH: I THINK THAT’S REALLY REMARKABLE.
I BELIEVE YOU ARE THE FIRST V.A. SECRETARY WHO I CAN ADDRESS AS DOCTOR. THERE IS A CHANCE
SECRETARY SHULKIN COULD BE YOUR PHYSICIAN. SECRETARY SHULKIN: OF COURSE, WHEN I SEE PATIENTS,
I AM JUST A DOCTOR. I AM NOT THE SECRETARY. IF YOU DO COME SEE ME, JUST CALL ME DOCTOR. MR. RAUSCH: I WILL. TWO PIECES THERE THOUGH.
YOU MENTIONED HIRING MENTAL HEALTH PROFESSIONALS. ONE OF THE QUESTIONS — WE SAW MULTIPLE QUESTIONS
ABOUT THE HIRING FREEZE. YOU MENTIONED THIS DURING YOUR CONFIRMATION. THERE ARE SHORTAGES
IN V.A., BUT THERE ARE ALSO SHORTAGES IN THE WHITE HOUSE. COULD YOU TALK ABOUT THAT? SECRETARY SHULKIN: I THINK AS EVERYBODY KNOWS,
WE ARE REALLY WORKING OUR WAY OUT OF THIS ACCESS CRISIS. A HIRING FREEZE FOR US, WHEN
WE NEED TO HIRE DOCTORS, PSYCHIATRISTS, AND ALL SORTS OF HEALTH CARE WORKERS, WOULD BE
DISASTROUS FOR US. WE WENT RIGHT TO THE WHITE HOUSE. THE WHITE HOUSE WAS TERRIFIC AT GIVING
US AN IMMEDIATE RESPONSE THAT WHEN IT COMES TO HIRING DIRECT CARE PROFESSIONALS, WE WOULD
BE EXEMPT FROM THE HIRING FREEZE. WHILE WE CERTAINLY UNDERSTAND WHAT THE PRESIDENT SEEKS
TO DO WITH A HIRING FREEZE AND WE ARE SUPPORTIVE OF THAT, IN AREAS THAT RELATE TO PUBLIC HEALTH
AND SAFETY, THERE ARE EXCEPTIONS, AND WE VERY MUCH APPRECIATE THAT. MR. RAUSCH: I APPRECIATE YOU ADDRESSING THAT.
I ALSO WANT TO GET BACK TO THE FACT THAT YOU ARE A DOCTOR. V.A. TRAINS PHYSICIANS AND THERE
ARE MULTIPLE PARTNERSHIPS WITH MEDICAL SCHOOLS ACROSS THE COUNTRY. WE DID A LITTLE BIT OF
HOMEWORK, AND WE KNOW THAT OVER 70% OF DOCTORS IN AMERICA DO A RESIDENCY AT A V.A. HOSPITAL.
WHERE DID YOU DO YOUR RESIDENCY, WHICH V.A. HOSPITAL, AND WHAT WAS IT LIKE FOR U.S. A
DOCTOR? SECRETARY SHULKIN: I THINK THE STATISTIC WHERE
A U.S. MEDICAL STUDENT, 70% OF THEM WILL ROTATE THROUGH A V.A. HOSPITAL, IS REFLECTIVE OF
MY OWN EXPERIENCE. IN MY TRAINING, I WORKED AT THREE V.A. HOSPITALS. IN PHILADELPHIA,
IN MY FIRST YEAR AT THE YELL WEST HAVEN MEDICAL CENTER, AND THEN IN MY RESIDENCY — YALE WEST
HAVEN MEDICAL CENTER, AND THEN AT THE PITTSBURGH MEDICAL CENTER. V.A. WAS ESSENTIAL FOR MY
TRAINING, AND ONE OF THE REASONS I FEEL SO PASSIONATE ABOUT GIVING BACK TO VETERANS IS
NOT ONLY MY GRATITUDE TO THE V.A., BUT BECAUSE MY FATHER, GRANDFATHER OUR ARMY VETERANS.
THIS HAS ALWAYS BEEN — THE V.A. HAS ALWAYS BEEN CENTRAL AND IMPORTANT TO ME. MR. RAUSCH: WE LOVE ALL SERVICES. ONE OF THE
THINGS ABOUT MY TIME IN THE ARMY, A LOT OF FOLKS WHO SERVED, ESPECIALLY POST 9/11, WE
HAVE A NEW G.I. BILL. WE HAVE A LOT OF QUESTIONS ABOUT THE NEW G.I. BILL. JOE ASKED HOW THE
V.A. CAN BETTER SUPPORT THAT SUN CAMPUS. OUR PARTNERS AT STUDENTS OF AMERICA RELEASED A
REPORT THAT SHOWS VETERANS AS ONE OF THE MOST SUCCESSFUL COHORTS OF STUDENTS ON CAMPUSES
ACROSS THE COUNTRY. SO THE TWO QUESTIONS ARE, TO JOE’S POINT, WHAT CAN WE DO TO CONTINUE
TO SUPPORT VETERANS, AND MORE BROADLY, HOW CAN WE TELL THIS GOOD NEWS STORY THAT VETERANS
ARE SUCCEEDING AT A RATE MUCH HIGHER THAN OTHER FOLKS? THAT’S NOT THE NARRATIVE THAT
A LOT OF FOLKS ARE AWARE OF. WHAT ARE YOUR THOUGHTS ON THAT? SECRETARY SHULKIN: THE G.I. BILL CLEARLY IS
AN AMERICAN SUCCESS STORY, AND I THINK IT’S ONE OF THE THINGS THAT IS ONE OF THE WAYS
WE NOT ONLY CAN CONTINUE TO HELP VETERANS SERVE THE COUNTRY AFTER THEY ARE OUT OF THE
SERVICE — BECAUSE THESE ARE GREAT PEOPLE WITH GREAT LEADERSHIP AND MANAGEMENT SKILLS
WHO GO ON TO GET EDUCATION AND THEN GO OUT AND LEAD AMERICAN BUSINESSES AND CREATE JOBS,
AND HELP THE ECONOMY. THIS IS SOMETHING WE ARE VERY SUPPORTIVE OF AND ARE CONTINUING
TO LOOK FOR BETTER WAYS TO MAKE THIS OF EVEN GREATER VALUE TO VETERANS. THERE HAS BEEN
A LOT OF ATTENTION ABOUT SCHOOLS THAT HAVE BEEN NOT PROVIDING THE HIGH QUALITY TYPE OF
EDUCATION THAT WE HAVE BEEN PROACTIVE IN ADDRESSING. WE CONTINUE TO LOOK FOR WAYS TO DO THAT. I
THINK STUDENT VETERANS OF THE STUDENT ASSOCIATION FOR VETERANS IS ONE OF THOSE ORGANIZATIONS
WE REALLY VALUE. SECRETARY SHULKIN: MR. RAUSCH: IT’S GREAT TO HEAR YOU SAY THAT.
WE KNOW YOU ARE VERY FOCUSED ON PARTNERSHIPS AND WE WANT TO TALK MORE ABOUT THAT IN A SECOND.
BUT FIRST, WE WANTED TO ADDRESS THE BACKLOG AND APPEALS. THIS IS AN ISSUE YOU ARE FAMILIAR
WITH. SUZANNE MCCARTHY IS THE WIFE OF THE DISABLED THE A NON-VETERAN. HER QUESTION IS
WHEN WILL THE BACKLOG OF APPEALS BE REDUCED? THAT SIMPLE. HER HUSBAND IS 70 YEARS OLD.
SHOULD HE OR ANY VETERAN HAVE TO WAIT 3, 4, 5 YEARS FOR A DECISION? SECRETARY SHULKIN: I’M VERY SENSITIVE TO THIS
QUESTION. THE APPEALS ISSUE IS CLEARLY UNACCEPTABLE TO US. UNFORTUNATELY, WE HAVE COME TO THE
CONCLUSION THAT UNLESS WE GET LEGISLATIVE CHANGES AND HOW WE DO APPEALS, WE ARE NOT
GOING TO BE ABLE TO FIX THIS THE WAY WE WANT TO FOR FAMILIES AND VETERANS. THE SYSTEM IS
DESIGNED IN SUCH A WAY THAT STRUCTURALLY, THE APPEALS BACKLOG WILL PROBABLY GROW, NOT
LESSEN, AND THAT IS UNACCEPTABLE TO US. WE HAVE WORKED WITH VETERANS SERVICE ORGANIZATIONS,
WITH MEMBERS OF CONGRESS, WITH LAWYERS AND OTHERS TO COME UP WITH WHAT WE BELIEVE IS
A REALLY GOOD PIECE OF LEGISLATION THAT WOULD BEGIN TO ADDRESS THIS. WE HOPE THAT WILL BE
INTRODUCED IN THE 115TH CONGRESS. WE HOPE IT WILL GET THE SUPPORT TO HAVE THAT FIXED.
AND PASSED IN CONGRESS. MR. RAUSCH: I THINK THAT’S AN IMPORT POINT
AS WELL. I STARTED TO BECOME INVOLVED IN THE VETERANS SERVICE ORGANIZATION ITSELF, I WAS
NOT AWARE THAT A LOT OF COMPREHENSIVE REFORMS REQUIRE CONGRESSIONAL ACTION. WE HAVE BEEN
INVOLVED A LITTLE BIT IN THE PROCESS, AND THE PLAN YOU HAVE NEEDS CONGRESSIONAL AUTHORITY
BEFORE YOU CAN IMPLEMENT IT, RIGHT? SECRETARY SHULKIN: YES, THAT’S TRUE. JUST
TO GIVE YOU A SENSE, WE HAVE ONE APPEAL THAT HAS GONE ON NOW MORE THAN 30 YEARS. AND THE
REASON, TO GIVE THE PEOPLE WHO ARE LISTENING — [LAUGHTER] MR. RAUSCH: I AM BARELY OLDER THAN THAT. SECRETARY SHULKIN: IT WASN’T YOURS. THAT’S
THE GOOD NEWS. THE WAY THE SYSTEM IS CURRENTLY DESIGNED, YOU CAN CONTINUE AS A VETERAN TO
ADD ADDITIONAL EVIDENCE INTO YOUR APPEALS PROCESS AT ANY POINT. YOU COULD BE ALMOST
READY FOR A DECISION AND THEN ADD A NEW PIECE OF EVIDENCE, AND THEN IT STARTS OVER. THAT’S
NOT SOMETHING YOU CAN SUSTAIN FOR 30 YEARS. WE DON’T THINK THAT’S GOOD FOR VETERANS. WHEN
YOU ARE TAKING THAT MUCH TIME WITH ONE APPEAL, IT IS HURTING OTHER VETERANS WHO NEED THEIR
CASES HEARD, AND WE CERTAINLY WANT TO GIVE EVERY VETERAN EVERY OPPORTUNITY TO MAKE SURE
THEY ARE GETTING ALL OF THE BENEFITS THEY DESERVE. WE WANT TO FIX THE SYSTEM ONCE AND
FOR ALL. MR. RAUSCH: IT’S GREAT THERE’S A PROPOSAL,
FRANKLY, THAT CONGRESS CAN LOOK AT. NOW, THE NEXT QUESTION RELATES TO A SERVICE A LOT OF
PEOPLE DON’T THINK ABOUT, AND THAT’S MEMORIAL BENEFITS. JUST RECENTLY, I RECEIVED A CALL
FROM A FRIEND OF MINE WHO HAD A FRIEND OF THE FAMILY WHO LOST A LOVED ONE, A VIETNAM
VETERAN, AND I DIDN’T KNOW HOW TO HELP THEM. I CALLED YOUR STAFF TO FIGURE OUT HOW TO HELP
THOSE FOLKS, AND WE FOUND OUT RECENTLY THAT YOU HAVE A NEW PROGRAM RELATED TO MEMORIAL
BENEFITS. ONE OF THE QUESTIONS WE WANTED TO ASK IS HOW DO FOLKS MAKE PLANS FOR BURIAL
IN A V.A. NATIONAL CEMETERY. YOU HAVE A NEW PROGRAM THAT’S CALLED PRE-NEED BURIAL ELIGIBILITY
DETERMINATION. WHAT IS IT? HOW IS IT DIFFERENT FROM PAST PROGRAMS? AND WHAT IS IN IT FOR
THE VETERAN? SECRETARY SHULKIN: WE ARE REALLY PROUD OF
THE SERVICES WE PROVIDE FOR MEMORIAL BENEFITS. WE HAVE WITH US OUR ACTING UNDER SECRETARY
FOR MEMORIAL SERVICES, MR. RON WALTERS, SO I AM GOING TO PASS THE MICROPHONE TO HIM,
BECAUSE I THINK HE WILL DO A BETTER JOB EXPLAINING THIS. MR. WALTERS: THANK YOU, MR. SECRETARY, AND
THANK YOU FOR THE QUESTION. THE PRENEED ELIGIBILITY PROGRAM IS A NEW PROGRAM V.A. INTRODUCED TO
HELP FACILITATE BURIAL PLANNING FOR VETERANS AND THEIR FAMILIES. IN THE PAST, PRE-NEED
WAS NOT AVAILABLE. IN OTHER WORDS, WE WOULD PROVIDE ELIGIBILITY DETERMINATIONS ONLY AT
THE TIME OF NEED, WHEN SOMEONE ACTUALLY PASSED AWAY. THAT CERTAINLY DID NOT FACILITATE BURIAL
PLANNING. IT WAS NOT CONSISTENT WITH PRIVATE SECTOR PRACTICE. IT ALSO ADDED TO WHAT WAS
ALREADY A STRESSFUL SITUATION. WITH THE INTRODUCTION OF THE PRE-NEED ELIGIBILITY PROGRAM, WHAT
WE NOW DO IS, UPON APPLICATION AT ANY TIME, WE DETERMINE THE ELIGIBILITY OF A VETERAN
OR FAMILY MEMBER, AND THAT HELPS TO FACILITATE THEIR BURIAL PLANNING, AND OF LIFE PLANNING,
AND ALSO MAKES IT EASIER FOR THEM, WHEN THE TIME DOES COME TO UTILIZE OUR SERVICE. SINCE
THE INTRODUCTION OF THE PROGRAM, WE HAVE HAD OVER10,000 APPLICATIONS. WE JUST FORMALLY
UNVEILED THE PROGRAM IN DECEMBER, 2016. IF YOU ARE INTERESTED, PLEASE GO TO W WW.CEM.VA.GOV
AND YOU WILL FIND OUT MORE INFORMATION ABOUT THE PROGRAM THERE, AND WE ENCOURAGE YOU TO
DO SO. MR. RAUSCH: I CAN GO THERE AS A VET AND FIND
OUT IF I AM ELIGIBLE. MR. WALTERS: YES. THE APPLICATION WILL BE
SENT TO OUR ELIGIBILITY AND SCHEDULING OFFICE, AND THEY WILL EXAMINE THE RECORDS AND OTHER
MATERIALS SENT IN, DETERMINE ELIGIBILITY, INFORM YOU OF THAT ELIGIBILITY, AND KEEP THOSE
RECORDS ON FILE AT OUR CENTER SO THAT WHEN THE TIME HAD NEED ARISES, — TIME OF NEED
ARISES, IT WILL BE ON FILE. MR. RAUSCH: AS A GUY IN HIS MID-30’S, IT’S
SOMETHING WE DON’T THINK ABOUT MUCH, FRANKLY. BUT IT IS AN IMPORTANT QUESTION BECAUSE, DR.
SHULKIN, YOUR MEMORIAL BENEFITS WORK’S TOP-RATED, NUMBER ONE OR NUMBER TWO IN THE COUNTRY, RIGHT? SECRETARY SHULKIN: ON THE CUSTOMER SATISFACTION
SURVEY WE USED, MEMORIAL SERVICES RANKS NUMBER ONE IN THE COUNTRY, ABOVE MANY OF THE COMMERCIAL
COMPANIES OUT THERE. THEY DO EXTRAORDINARY SERVICE. SENSITIVITY AND RESPECT THAT ALL
OF US WANT AT THAT TIME FOR OUR SERVICEMEMBERS WHO PASS AWAY. MR. RAUSCH: I APPRECIATED BECAUSE WEEKS AGO,
I CONNECTED WITH YOUR SENIOR STAFF AND THEY WERE REMARKABLE. IT’S GREAT TO HEAR THERE
IS A NEW PROGRAM AND IT SOUNDS LIKE IT’S A LOT EASIER TO USE. WE HAVE TIME FOR A COUPLE
MORE QUESTIONS AND WE ARE RUNNING OUT. AND THEN I HAVE A COUPLE FROM THE COMMENTS SECTION.
WE HAVE TALKED TO A LOT OF VETERANS AND HEARD FROM A LOT OF VETERANS. SOME FEEL THAT OVER
THE LAST YEAR AND A HALF SINCE YOU HAVE, ON BOARD AS UNDERSECRETARY BEFORE STEPPING UP
TO BE SECRETARY THAT THERE WAS SOME PROGRESS BEING MADE. SOME VETERANS DIDN’T THINK THERE
WAS PROGRESS. SO TO QUESTIONS, WHAT ARE YOU GOING TO CONTINUE TO DO IN TERMS OF V.A. REFORM
THAT YOU THINK IS WORKING, AND ARE YOU GOING TO DO ANYTHING NEW TO ADDRESS THE ISSUES FOLKS
DON’T FEEL ARE WORKING AS WELL? SECRETARY SHULKIN: I’M GOING TO ANSWER THIS,
AND THEN I AM ALSO GOING TO ASK FOR A LIFELINE TO MY LEFT. THERE IS NO DOUBT THAT V.A. HAD
A COMPLETE FAILURE INCOMPETENCE THAT VETERANS HAD IN US, AND I AM GOING TO DATE THAT BACK
TO APRIL, 2014. THERE IS ALSO NO DOUBT THAT WE HAVE BEEN MAKING TRUE PROGRESS SINCE THAT
DATE IN REBUILDING THE TRUST OF OUR VETERANS. WE WERE AS LOW AS 47% OF VETERANS EXPRESSING
TRUST IN THE V.A. WE DO WANT TO CONTINUE WITH THE THINGS WE KNOW ARE WORKING AND WE WILL
CONTINUE TO MAKE PROGRESS IN THE AREAS THAT HAVE WORKED FOR US FOR THE LAST TWO YEARS.
HOWEVER, THERE IS NO DOUBT THAT WE NEED TO DO MUCH, MUCH MORE. NO ONE ON MY TEAM IS SATISFIED
WITH WHERE WE ARE. WE ABSOLUTELY LISTEN TO OUR VETERANS AND HEAR THE STORIES THAT CONTINUE
TO HAVE OPPORTUNITIES TO DO MUCH BETTER. SO WE ARE GOING TO BE LOOKING FOR SOME MAJOR
CHANGES. WE ARE GOING TO REEVALUATE. WE ARE GOING TO LISTEN TO OUR VETERANS AND WORK WITH
OUR COMMUNITY PARTNERS TO COME UP WITH NEW WAYS OF TRANSFORMING THE WAY V.A. DELIVERS
SERVICES. IT’S WHAT I CALL MODERNIZING OUR SYSTEM. IF YOU LOOK AT THE PRESIDENT’S 10
POINT PLAN. HE IS NOT LOOKING FOR MINOR CHANGE. HE WAS ELECTED — THE REASON I FEEL VERY FORTUNATE
THAT I GOT A 100-0 VOTE FROM THE SENATE IN MY CONFIRMATION WAS BECAUSE THERE IS ONE THING
THE COUNTRY AGREES UPON, AND THAT IS THAT OUR VETERANS DESERVE BETTER THAN THEY ARE
GETTING NOW. THAT IS WHY I AM HERE, TO HELP WORK WITH EMPLOYEES TO MAKE SURE WE DO THAT.
WE ARE GOING TO BE SERIOUS ABOUT MAKING MAJOR CHANGE TO GET EVERYBODY TO FEEL THEY HAVE
A GOOD, CONSISTENT EXPERIENCE WHEN THEY COME TO V.A. I’M GOING TO TURN TO MY LEFT AND INTRODUCE
MR. SCOTT BLACKBURN, OUR DEPUTY SECRETARY, ACTING DEPUTY SECRETARY OF THE V.A. WHO HAS
BEEN WORKING VERY DIRECTLY TO MAKE SURE THAT THE PROGRESS HAS BEEN MADE AND THAT THE EXPERIENCE
VETERANS HAVE IS THE BEST. MR. BLACKBURN: LARGE-SCALE TRANSFORMATION IS NOT
EASY. THE LAST TWO YEARS, WE HAVE MADE A LOT OF PROGRESS, BUT WE STILL HAVE A LONG WAY
TO GO. WE ARE CHANGING THE VETERANS EXPERIENCE, THE EMPLOYEE EXPERIENCE, GETTING MORE EFFICIENT,
LEARNING HOW TO PARTNER WITH OUTSIDE ORGANIZATIONS. WE ARE GETTING TO BE MORE DISCIPLINED IN FOLLOWING
UP WITH STRATEGY AND EXECUTING. WE HAVE HAD LOTS OF PLANS. LOTS OF REPORTS HAVE BEEN DONE
ABOUT THE V.A. IN THE PAST. IT’S THE ABILITY TO BUCKLE DOWN AND STICK TO IT, AND GET THE
ORGANIZATION TO EXECUTE. THAT IS WHAT WE HAVE BEEN CONTINUING. WE PUT IN SOME OF THE PROCESSES
IN PLACE THAT ARE THE BUILDING BLOCKS, BUT AS DAVID MENTIONED, THE PRESIDENT WANTS TO
DO SOME REALLY BIG THINGS. WE STILL HAVE A LONG WAY TO GO. 61% ON TRUST IS NOWHERE NEAR
WHERE WE WANT TO BE. THAT SHOULD BE WELL ABOVE 90. THAT’S OUR GOAL. WE ARE NOT GOING TO STOP
UNTIL WE HIT IT. MR. RAUSCH: THANK YOU AND CONGRATULATIONS
BECAUSE THOSE NUMBERS WERE JUST ANNOUNCED TODAY. WE ARE RUNNING OUT OF TIME, SO I’M
GOING TO BE QUICK AND GET SOME QUESTIONS FROM FOLKS ONLINE. SANDY ASKS, WILL WE HAVE MORE
OF THESE TYPES OF YOU TO LIVE — YOUTUBE LIVE MEETINGS QUESTION MARK 30 MINUTES IS TOO SHORT. SECRETARY SHULKIN: WE ARE GOING TO LOOK AT
THE REACTION AND SEE WHAT YOU THINK. YOU LET US KNOW. IF THE VETERANS WANTED, WE ARE GOING
TO DO MORE. MR. RAUSCH: WE ARE HAPPY TO HELP YOU ANY TIME.
AND LET’S SEE IF WE CAN DO THIS AGAIN. THERE ARE LOT OF QUESTIONS WE WILL NOT BE ABLE TO
GET TO. ONE THING I THINK IS IMPORTANT, WE HAVE THE BENEFIT OF WORKING WITH YOU WHEN
YOU WERE THE UNDERSECRETARY. WE KNOW YOU HAVE A GREAT RELATIONSHIP WITH VETERANS AND VETERANS
ORGANIZATIONS. WE KNOW THAT WHEN YOU SUCCEED, THE V.A. SUCCEEDS AND VETERANS SUCCEED. WHAT
CAN WE DO, WHETHER WE ARE IN AN ORGANIZATION OR AN INDIVIDUAL, TO MAKE SURE YOU ARE SUCCESSFUL,
BECAUSE YOU HAVE A VERY DIFFICULT JOB. SECRETARY SHULKIN: THERE ARE SO MANY THINGS.
FEEDBACK IS ABSOLUTELY CRITICAL. WE LIKE TO HEAR WHEN WE DO A GOOD JOB BECAUSE THAT REINFORCES
THAT BEHAVIOR. BUT WHEN WE FAIL YOU, WE ALSO WANT TO HEAR ABOUT THAT AS WELL. SECONDLY,
I WOULD SAY THAT WE NEED EVERYONE’S HELP IN CHANGING THE DIALOGUE ABOUT V.A.. I HAVE BEEN
FRUSTRATED ABOUT ONLY THE BAD NEWS ABOUT V.A. GETTING OUT. I AM NOT ASKING FOR A PASS. WHEN
WE FAIL VETERANS, WE DESERVE TO BE ACCOUNTABLE, BUT THE CONSTANT PARADE OF NEGATIVE STORIES,
OF ACCUSATIONS ABOUT THE V.A., I THINK HERTZ VETERANS. WHAT I WORRY ABOUT IS THE VETERAN
SITTING AT HOME WHO NEEDS OUR HELP, WHO MAY BE THINKING ABOUT HARMING HIMSELF OR HAS A
PHYSICAL AILMENT HE NEEDS HELP WITH, BUT SAYS, I HAVE BEEN READING ALL THE STORIES ABOUT
V.A. I’M NOT SURE I WILL GO THERE TO GET HELP. THAT’S WHY WORRY ABOUT. EVERY DAY, WE HAVE
THOUSANDS OF EMPLOYEES DOING FANTASTIC WORK AND HELPING MANY, MANY PEOPLE. IT’S HARD TO
GET THAT STORY OUT THERE. I AM JUST ASKING FOR A FAIR AND BALANCED VIEW OF WHAT V.A.
IS SO VETERANS CAN MAKE A DECISIONS ABOUT GETTING HEALTH CARE. MR. RAUSCH: IT DOES TAKE A TEAM. IT IS A TEAM
SPORT. ONE TEAM, ONE FIGHT. THE OTHER QUESTION THAT HAS COME UP IS HOW MUCH LONGER UNTIL
YOU HAVE THE TEAM YOU NEED? WE KNOW D.C. IS SLOW TO MOVE. GOVERNMENT IS SLOW. CONGRESS
CAN BE SLOW. YOU WERE JUST CONFIRMED RECENTLY. WHAT ARE YOUR EXPECTATIONS AND WHAT ARE YOU
TRYING TO DO TO MAKE SURE YOU GET YOUR ENTIRE TEAM ON BOARD SO YOU CAN REALLY TACKLE ALL
OF THESE CHANGES? SECRETARY SHULKIN: FIRST OF ALL, NO EXCUSES.
I MEAN, WE HAVE TO BE HITTING THE GROUND RUNNING AND START THE CHANGES NOW. FRANKLY, THE PRESIDENT
EXPECTS THAT OF US. WE ARE LOOKING TO BUILD OUT OUR TEAM. WE ARE AGGRESSIVELY TRYING TO
MAKE SURE WE GET THE RIGHT PEOPLE ON THE TEAM RATHER THAN JUST DO THIS FAST. AS SOON AS
WE POSSIBLY CAN, WE HOPE TO HAVE ALL OF OUR LEADERSHIP POSITIONS FILLED. I WANT EVERYONE
TO KNOW THAT PEOPLE ARE WORKING AS HARD AS THEY CAN TO MAKE IMPROVEMENTS THAT ARE NEEDED.
WE HAVE TERRIFIC PEOPLE HERE FOR THE RIGHT REASONS. THEY ARE LOOKING TO MAKE THE A — MAKE
V.A. A BETTER ORGANIZATION EVERY DAY. MR. RAUSCH: WE HAVE TIME FOR ONE MORE QUESTION.
WHAT IS YOUR STRATEGY FOR ENDING VETERAN HOMELESSNESS AND IS THIS A TOP PRIORITY? SECRETARY SHULKIN: VETERANS HOMELESSNESS IS
A TOP PRIORITY OF OURS. I HOPE PEOPLE KNOW WE HAVE HAD A 47% REDUCTION OF VETERANS HOMELESSNESS
SINCE THE A STARTED TO — SINCE V.A. STARTED TO FOCUS ON THIS IN 2010. LAST YEAR, WE SAW
OUR BIGGEST DECREASE IN HOMELESSNESS, A 17% DECREASE. WE CONTINUE TO FIND ADDITIONAL WAYS
TO GET THOSE NUMBERS OF VETERANS WHO ARE HOMELESS DOWN, LARGELY, WORKING WITH OUR COMMUNITIES,
OUR CITIES, OUR STATES, PRIVATE ORGANIZATIONS. THIS WEEKEND, I WILL BE MEETING WITH THE COUNTRY’S
GOVERNORS. ONE OF THE TOPICS WE WILL BE TALKING ABOUT IS HOW WE CAN DO MORE TOGETHER AT THE
STATE AND FEDERAL GOVERNMENT LEVEL TO ADDRESS VETERAN HOMELESSNESS. YOU WILL CONTINUE TO
SEE THAT BE A PRIORITY FOR US. MR. RAUSCH: AS WE WRAP UP. YOU TALKED ABOUT
GOOD NEWS STORIES, THE G.I. BILL, AND HOW TO TALK ABOUT VETERANS BEING ROCK STAR STUDENTS.
VETERANS ARE LEADERS AND PROBLEM SOLVERS. WE ARE MORE LIKELY TO VOLUNTEER, MORE LIKELY
TO VOTE, NO OUR NEIGHBOR AND BE GOOD CITIZENS. I THINK IT’S REALLY IMPORTANT THAT WHEN WE
TALK ABOUT HOMELESSNESS, THE V.A. IS NOT JUST HELPING A VETERAN GET A HOME, BUT BECOME AN
ACTIVE CITIZEN, A CIVIC ASSET IN THE COMMUNITY. I THINK THAT’S REALLY EXCITING AND IT FEEDS
INTO YOUR POINT ABOUT — THESE STORIES ARE NOT JUST ABOUT BROKE AND VETERANS. WE ARE
NOT ALL PRO CAN. WE ARE NOT ALL DAMAGED GOODS. YES — WE ARE NOT ALL BROKEN. WE ARE NOT ALL
DAMAGED GOODS. YES, SOME OF US HAVE PROBLEMS. BUT THE V.A. CANNOT ONLY GIVE US THESE SERVICES,
IT CAN EMPOWER US. SECRETARY SHULKIN: ABSOLUTELY. YOU SAID IT
BETTER THAN I COULD. MR. RAUSCH: WELL, THANK YOU. HE HAVE TO WRAP
UP, SO I WANTED TO GIVE YOU THE OPPORTUNITY TO SHARE ANY FINAL THOUGHTS YOU MIGHT HAVE
OR ANYTHING WE DID NOT TOUCH ON BEFORE. SECRETARY SHULKIN: I JUST WANTED TO SAY HOW
MUCH WE TAKE SERIOUSLY OUR MISSION TO BE ABLE TO SERVE AMERICA’S VETERANS. AND THAT THE
V.A., WE BELIEVE, IS A REALLY IMPORTANT NATIONAL RESOURCE. THAT IS WHY WE ARE FIGHTING SO HARD
TO MAKE THE SYSTEM WORK. WE DO BELIEVE IT IS A SYSTEM WORTH SAVING. WE BELIEVE THAT,
LIKE EVERY ORGANIZATION, THAT YOU NEED TO LOOK AT THINGS THAT ARE WORKING IN THINGS
THAT ARE NOT WORKING, AND TO CONTINUE TO EVOLVE AND CHANGE. THAT’S WHAT YOU’RE GOING TO SEE
FROM DISORGANIZATION, A HARD-DRIVING ORGANIZATION THAT’S WILLING TO MAKE THE CHANGES NECESSARY
— SEE FROM THIS ORGANIZATION, A HARD-DRIVING ORGANIZATION THAT’S WILLING TO MAKE THE CHANGES
NECESSARY. BUT WE NEED THE SUPPORT OF OUR COMMUNITIES AND OUR VETERANS TO MAKE THIS
AN ORGANIZATION WE ALL FEEL PROUD OF. MR. RAUSCH: THANK YOU FOR JOINING US, SECRETARY
SHULKIN. FOR THOSE OF YOU WATCHING AND LISTENING IN, IT’S WORTH NOTING THAT YOUR CONFIRMATION
HEARING, NEARLY EVERY VETERANS SERVICE ORGANIZATION WAS REPRESENTED. THEY HAD VETERANS THERE.
THERE ARE CHALLENGES THAT ARE INEXCUSABLE, FRANKLY, BUT WHAT WE KNOW IS THAT IT’S NOT
INSURMOUNTABLE. WE CAN OVERCOME THOSE CHALLENGES WITH THE RIGHT LEADERSHIP AT V.A. AND WITH
THE PRESIDENT’S DEDICATION BEHIND REFORMING V.A. WE THINK IT CAN BE A WORLD-CLASS ORGANIZATION,
AND FRANKLY, IT NEEDS TO BE. WE WANT TO THANK YOU. ON BEHALF OF GOT YOUR SIX AND ALL OF
THE VETERANS AND VIEWERS WATCHING TODAY, I’D LIKE TO THANK YOU ALL FOR BEING HERE. I’D
LIKE TO THANK YOU FOR STEPPING UP, FRANKLY. YOU SAY IT’S WHAT ANYONE WOULD DO. I WOULD
ARGUE THAT THERE PROBABLY ARE NOT A WHOLE LOT OF PEOPLE WHO WOULD TAKE ON THE JOB. IT’S
A TOUGH JOB. WE LOOK FORWARD TO CONTINUING THE CONVERSATION WITH YOU AND WORKING WITH
YOU TO SERVE VETERANS. WE ARE COMMITTED TO WORKING WITH YOU AND YOUR TEAM. AND WE LOOK
FORWARD TO CONTINUING THE CONVERSATION. FOR THE VETERANS STILL LISTENING IN, WE HAVE GOT
YOUR SIX. WE ALSO HAVE THE SIX OF THE SECRETARY. HOPEFULLY, WE WILL HAVE ANOTHER TOWN HALL
SO WE CAN ASK MORE QUESTIONS AND HELP THE SECRETARY MAKE V.A. A MY V.A. EXPERIENCE FOR
ALL OF US. THANK YOU.

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