are we going to find the medical professionals? .. >> thank you for your testimony, s. now we'll recognize mr. nicholson for fiven minutes. >> vice chair bilirakis and distinguished members of the committee, on behalf of the iraq and afghanistan veterans of america, we appreciate the opportunity to share with you our views and recommendations on

what changes and reforms should be made to the department of veterans affairs and on v.a. collaboration on advocate is city organizations. in recent months revelations about extensive wait times, a systemic lack of accountability and even preventable veteran deaths within the v.a. system have undermined the trust of the american public in our v.a., and it has had a particular impact on the trust and confidence of iava's members in the system. while it is true that many of our members have expressed general satisfaction with the quality and delivery of health care they receive, many have also expressed frustration with the v.a. system. iava is eager to see more structural reforms pursued in the areas of accountability, the adoption of best technologies and increased capacity to deal with future needs. we've reacted swiftly in the

area of accountability in response to the system wide v.a. scheduling scandal by passing the v.a. management accountability act. our members want to insure that the secretary actually uses it once it is signed into law. we would even welcome an extension and application of similar authority to title 38 and gs employees as well within the v.a. with due process protections, of course, as a part of that. we would also like to see more user-friendly technological platforms -- especially those that are veteran facing -- i but we believe the organization needs to given a shift in the way it looks at its technology needs and how it dose about acquiring -- goes about acquiring/or designing -- and/or designing those systems. the v.a.'s portals are, frankly, a joke to many iraq and afghanistan era veterans. finally, our members want to see an increase in capacity to

deliver critical services to veterans especially in the realm of mental health care. the short shortage of mental health professionals must be quickly remedied. some of these and many other reforms and actions are actions the v.a. could have pursued at least partially all along. unfortunately, the v.a.'s level of communication, cooperation and collaboration with new generation organizationings over the past five years has been severely lacking. in fact, prior to the outbreak of the v.a. scandal, the current v.a. access scandal, the former secretary of veterans affairs had only met with us on one occasion during his swire ten your -- his entire tenure as secretary. if the prior regime within the v.a. did not like what they were hearing from its nonprofit partners or those partners refused to tow the party line, they were shut out from top level access entirely. v.a.'s interim leadership, however, has been much more

communicative with iava and other vsos and veterans advocacy groups and the new liaison immediately prior to the access crisis has done a phenomenal job in working to retear the relationship -- repair the relationship between v.a. and the nation's largest organization of iraq and afghanistan veterans and their families. in addition to the above, we also want to take the opportunity to let members of the committee know that right now iava is releasing the results of its 2014 member survey. iava's policies, positions and priorities are compiled every year, and the data overwhelmingly revealed that suicide and mental health care access are the top issues facing this generation of veterans. our staff and research team led by dr. jackie -- [inaudible] in our d.c. office would be happy to brief you and your staff on our detailed 2014

findings in the near future. mr. vice chair, we appreciate the opportunity to share our views on these topics and look forward to working with you and your staff to improve the lives of veterans and their families moving forward. thank you. >> thank you, mr. nicholson. thank you all for your testimony, and i'll recognize myself for questions for five minutes. first question for the entire panel, mr. robert mcdonald, as you know, has been nominated by the president, president obama, to be the next secretary, permanent secretary. i'm sure we all agree that, of course, he'll face -- he's got his hands full to restore the trust in the v.a., but what is your opinion of the president's choice to have mr. mcdonald run the agency, the d. -- the department as the permanent secretary of v.a.? does his lack of experience running a health care system concern you? we'll start with the gentleman -- actually, ma'am, we'll start with you, ms. jones. >> the american legion stands ready to assist anyone that is

appointed as the secretary. whoever the choice is, the american legion has a history of add sew candidating for -- advocating for veterans, and as we've stood by the previous secretaries, the american legion will continue to stand by and let mr. mcdonald know that we're here to assist him with whatever he needs. the lack of experience, the american legion's been around since 1919, and we're going to be here to help as we've always done, whatever veterans need. >> have you had any contact with mr. mcdonald? be. >> i have not, sir. >> okay. what is one piece of advice you have for him or area you would like him to focus on the most? >> transparency. we'd like to see more transparency. so things like the scandal doesn't happen again, so we know what the v.a. needs so we can advocate for those needs. we'd like the secretary, whoever that may be, to let us know what's needed and to be transparent.

so as long as we know what we're working with, it'll always be fixed. we can work towards making sure the veterans are taken care of timely and they receive quality service. >> mr. galuci? same question. >> thank you, mr. bilirakis. the vfw has been supportive of the selection of mr. mcdonald, the nomination of mr. mcdonald for the position of v.a. secretary. we think it's time to do something a little different. we think the expertise he brings has the opportunity to change the mindset of the vice president a. system. this goes beyond v.a. health care. the secretary's responsible for coordinating the myriad of veterans programs that millions of veterans rely on whether it's post-9/11 g.i. bill, disability compensation, home loan program. and really think that the corporate mindset might be beneficial for the v.a. system. and your other question, we think from the vfw's perspective

it would be improved business processes. from what we've seen and heard from our veterans, we know the system shouldn't be patient-centric when it should be. but by improving wiz processes and streamlining decisions within the v.a. system, we can improve the delivery of service to veterans. >> [inaudible] mr. blake, please? >> mr. bilirakis, we don't typically take official positions on nominees for secretary, but what i will said having said on the confirmation hearing, i was very encouraged by the things mr. mcdonald had to say. he certainly addressed the concerns about transparency a number of times. and i'm sure one of the first things he will tell you is he will give all of you his cell phone number, and he will call you at all hours of the night. so he certainly seems to be willing to be actively engaged with the committee. so, hopefully, that will fix transparency. i think his first priority ought to be culture. i think the bad actors, the bad

attitudes and the bad prophesies stem from the culture set. secretary gibson has done a good job trying to change that, but you can't change that overnight. the question was asked about, you know, the challenges, and certainly secretary gibson made it clear that the challenge of firing people is a tough one. i won't argue with this. somebody did something illegal, wrong or immoral or whatever, somehow, in some way it harmed the health care delivery for veterans, they should be fired. but that question ignores the fact that the congress put in place federal rules that make that a difficult process. so if congress thinks that that should be changed, then so be it. and i know the committee is looking at legislation that will address that issue. it's going to take -- and mr. mcdonald seemed to be committed to changing the culture, and i think that's going to be first in his mind. >> mr. value yen today, give me your opinion of the secretary and what piece of advice would you give him?

>> i was also at the confirmation hearing, and i was impressed with his responses to the committee's questions as well as oral remarks. i just hope he can accomplish most of what he said. in my mind the one important thing that he said i was transparency, and that, i think, more than anything else we need to see at v.a.. i don't know that we'll ever see it accomplished, but i think it's a goal that the new secretary should try to achievement and so that we know -- achieve so that we know what's going on and what needs to be done. >> mr. weidman, what should the secretary focus on? >> i think the most important goal is what people have already said, and as a means to that, they've got -- i forget how many hundred communications folks over at central office of v.a., and most of those folks need to

be assisted in finding a way to contribute to good in the world, and you need two or three really smart press people. kurt does a better job than all of them put together who is the pio for the committee. and what it does is that things that ought to be on the web suddenly become foias or freedom of information act and drag out for months. an example is just asking for job descriptions of major positions within the v.a. which happened to me last year, took five months to get the darn thing. i had already gotten it another way, but -- and one of them they said they didn't have because it wasn't available at 810 vermont avenue, and that was the job description for the director of the national center of ptsd. you don't have a job description? how could that be? and, of course, it budget, but you have some -- it wasn't, but you have some attorney who could

be put to use, and that should be the litmus the test certainly for everybody in vha is how much do they and how much do they contribute to accomplishing the mission, and vha, all those middle, middle people -- almost all of them -- need to go away because they just get in the way of the mission. >> mr. nicholson, last question. again, does it trouble you that mr. mcdonald lacks health care management experience? >> it does not necessarily. he has a phenomenal business background and, like i think ryan mentioned, business processes is certainly something the v.a. needs to focus op. we were not consulted on the selection process of the nomination, but he was sort of an out of the blue pick for us, so we had to do a lot of catching up and learning about him and are still in the process of that as is everyone else, but we're generally supportive of him. we would agree that accountability and transparency

are top priorities but tech upgrades as well. >> i yield back. >> mr. bilirakis, could i add one thing? earlier i noticed in the audience the honorable harry walters, and when he came in in '82, the veterans administration was so mad that everybody was chewing on nails. and he came in as a businessman, no experience, and took over the v.a., restored confidence in what they were doing and straightened out a whole lot of problems including assisting vietnam veterans truly for the fist time. so it is possible -- first time. so it is a possible with that business background to be one heck of an administrator at that time, and today we call it secretary. >> i yield back, mr. chairman. >> i apologize to the panel. we were having a conference committee meeting, and i would say, rick, that i'll be meeting with mr. walters this afternoon. at 3:30 to gain some insight from his time as the administrator.

mr.-- [inaudible] you're recognized. >> thank you very much, mr. chairman. before i ask my questions, i do want to commend secretary gibson for still being here. it shows that your commitment to listen to the vso tos, i think this is the first time i've ever seen a secretary sit through another whole panel. so i really want to commend you for doing that. it shows that you're taking your job very seriously as well. and hopefully, we'll see action as well. for each of the panelists, as you know, congress continuously asks the v.a. about what they need for services, you heard my comments about secretary britain accept by was first secretary that showed the disconnect between what the needs were and what the administration asked for. my question is to each of you -- if you could keep it short, it'd be great -- do we need to do an

independent audit to properly plan the v.a.'s budget? my biggest concern has always been, and i've made it very clear over the years, is i don't care how big of an increase it is within the v.a. budget, are you taking care of the needs of our veterans? as you heard the secretary mention earlier, it's always been budget-driven, not outcome-driven. i guess we'll start with mr. nicholson first. should we have an independent audit to properly plan the v.a.'s budget? >> sure, you know, the first thing that comes to mind is in a way we already do, many of the vsos sitting here play a prominent role in putting together. i know carl is sort of our community budget tear expert, and we defer to him on a lot of these issues, but i think it's certainly helpful. please keep in mind that we don't have to reinvent the wheel. please use resources that already exist and give credible weight to those as well. >> v.a. has reached out to some places like the mayo clinic, but, in fact, nobody's really

reached out in a systematic way to all sectors of our society. the one thing we do know when the issue is veterans, people will step up from industry, from the not-for-profit sector, from the medical sector, etc., and we need to tap into that in an organized way and including organized labor, by the way, in a way that makes sense in order to get where we need to get in terms of designing a system that actually can estimate the needs and then put it together in a way where people are held accountable as it moves back down the chain. >> i disagree with my colleague, with rick, what he said earlier about the actuarial model. i mean, when we were still pushing for mandatory funding for v.a. health care, we went in a number of times to talk to the v.a. budget people, and at that time they told us that the model which was based on a civilian model was revised to, you know, to be specific for veterans'

use. and i believe if there was transparency in the process and we could see what v.a. was putting into that model and what comes out without omb having a shot at it, that we would be better off and know exactly what the needs are because that's all we want to know, is what v.a. needs. i don't care about building an empire for anyone, i want veterans to be taken care of, and the only thing that's important is to make sure that their needs are met. >> first, mr.michaud, i'm not sure i want the distinction as being recognized as the community budget expert. from the perspective of the independent budget, the difference between what we do and what the administration does -- and secretary gibson hit this on the head -- managing the budget versus managing the need. we take what information we have available and figure out what we believe the cost is. we don't take a budget number and try to fix, smash the services down into the available budget that is given. what's what the v.a. is required

to do. you asked about an independent awed audit, this was one of the ideas we had wrestled with, having a type of independent audit of the budget. not sure if that's going to get us where we want, but that's the idea. i think we agree with what your notion is there, and we would like to see it enhanced, perhaps. >> i think the vfw yenly agree -- generally agrees with that concept, and we testified to that back in may. the real problem is we've assessed what v.a.'s workload could be or what their problems are, but as we've learned with the scheduling system, it's software that's decades old, and v.a. by their own administration says they have no accurate measure of wait times, no accurate measure of wait lists, thousands of veterans waiting for initial appointments based on their independent review

conducted. i think being able to evaluate the need is difficult. i've seen myself, as my colleague carl said, he's a patient at the v.a., many of us use v.a. for our health care, and i've seen it waiting for a specialty appointment. you call in, the next thing we have are 60 days from now. well, what are my options at that point that? that demonstrates that the capacity isn't where it needs to be or they haven't fully value wailed what the need is -- evaluated what the need is in their community. >> the american legion wants all available resources used to make sure veterans are okay. that means an independent audit of the budget, absolutely. we want to make sure that there's enough resources, enough of everything so that veterans are taken care of s and they don't have to suffer like they're suffering right now. >> mr. huelskamp. >> thank you, mr. chairman, i appreciate, ladies and gentlemen, you that are here

today. i first want to thank mr. nicholson for the whistleblower hotline. i believe that your association set up, and what is stunning to me -- identify served on this committee for three years -- and we've heard from the v.a. again and again, and usually it was always that things are fine. and then have whistleblowers step forward. i'm just tour yous, were you all hearing that from your associations, from your membership, about these secret waiting? i never heard that coming from your groups, so i'm just curious about how this can happen. i was looking through the life magazine article of 1970 of how that suddenly burst on the scene. folks were suggesting there were problems then, and suddenly it happened. just a few months ago, boom, here it is. and in this committee we've heard warning signs from folks inside. we'll talk about the budget question, but, first, what you were hearing from your members and did that match up with what whistleblowers had reported to us. >> i'll say as i mentioned in my

oral statement, the one luxury we have is our site visits that we conduct, so we don't necessarily have to rely on what we hear from our members, we have trained medical staff who go into the centers and see what's going on, and they see firsthand what the shortages are. the difference between what has happened with this and what we do is we have an agreement with v.a., and we work those differences out to come to a resolution that will benefit the veteran. in the has all sort of played out more in the public eye which is fine inasmuch as maybe by drawing attention to the larger problem, we get real reform and real fixes. these, again, are not shocking. we've seen these, we've identified them -- >> but the secret waiting list, i mean, here's what i saw in one facility. we had the director of the v.a., a v.a. facility in wichita on friday said everything was fine, and within five days they admit they had secret waiting lists they knew about, and so my

question is -- and i can't go look through the data. are you looking through the data and actually talking to the schedulers? because this is the thing, they went in and falsified the data, and then they presented to us. so i'm trying to see how we can have you continue to help with these visits and how far you can dig into that to help provide some more transparency. >> we have been complaining that they were underresourced all along, and certainly to the former undersecretary that you're spending way too much money on people who aren't direct service providers. congress, we're not speculating that's why congress gave you more money, that's exactly what the appropriators told us they were giving more money for, was more people who are hands-on delivery of service, and you guys are spending it on people who never lay a hand on a patient. >> sure, sure. and, again, i appreciate that. because we get reports -- and, again, if you heard on the other package in the last month every

single bureaucrat from the v.a., every undersecretary, every bureaucrat came here and said we have plenty of resources. it's a cultural problem, it's how we're spending them. and so either they're totally wrong or you're totally wrong, and we're trying to figure out what we can do about it. what mr. gallucci said at the end was very interesting because, you know, how as policymakers when the day is unclear, there's a lack of integrity, how are we supposed to make a decision to give more money? in the past decade on roughly it's been a 250%, 256% increase. meanwhile, the number of veterans are 30-40 %. and try to say, well, why didn't that get -- maybe that's what's happening, it went to overhead rather than direct care. what's frustrating to me is when they lie about the data, they make it up or refuse to be transparent so we can't make good decisions. and then we say the way the union rules work we can't get

rid of somebody until we get all the facts. right now we don't have all the facts when the claims are we need more money. we want to make sure that happens. one of the other things we heard which is interesting, why can't they stay open til 5:00? why can't they do that? you mean to tell me they all go home at 4:30? immediately, we just had that report would fix additional resources without making significant changes. those are the kinds of things that make sense. appreciate your input. but i appreciate particularly the whistleblowers bravely showing up and saying, hey, we're going to tell you what's happening so we can improve the situation. with that, mr. chairman be, i yield back. >> i would just like to make a comment about the fact that, you know, secretaries come in here and they say they have sufficient funds or undersecretaries. i've been doing this for a long time, and with the exception of secretary principi who said that he got less, i mean, most of the time that's what we hear. and, you know, other than three years during the clinton

administration when they were flatlining the budget, congress agreed with those numbers. up until recently, i mean, congress always provided more than what the administration has asked for. you know, they're part of a team, and while it's frustrating to hear them say they have the resources, i mean, i don't think they'd be in their position very long if they told you as secretary principi did -- and at that time we were asking for over $3 billion more when he said he needed $1.2. so i would be a little bit leery of asking them that question and expecting an accurate response unless you put 'em under oath. but, i mean, it's just a concern. >> mr. violante, are you saying that secretary principi, in fact, did tell the truth? >> i'm saying that he admitted that he asked for more. what i'm saying is that at that time we were asking for almost twice that amount for v.a.'s needs. >> so would you say the other

secretaries were not being truthful? >> i would -- >> just, mr. violante -- >> they're not under oath. >> they can tell the truth whether they're under oath or not. >> yeah. but when have you heard anyone admit to you as part of another team that they didn't get what they asked for other than secretary principisome. >> okay. so mr. violante says the other secretaries lied. thank you, sir. [laughter] mr. tocano, you're recognized. >> thank you, mr. chairman. i used to be on the board of trustees, and, you know, all the administrators come to me, and they all kind of tow the administration line. it's not a matter of lying or not lying, it's a matter of just that's just the way it is in the administration. and that would be true of a republican or democratic administration. you'd want loyal people underneath you. so, you know, real quickly if you could answer almost yes or

no, would you say that your organizations and your members basically want to mend, not end the v.a.? ms. jones? >> yes. we'd like to restore the v.a. and restore the veterans' trust in the v.a. >> thank you. >> we absolutely want to restore trust in v.a. and build the system that has the capacity to care for the needs of veterans. >> mr. blake? >> yes. >> our members want the v.a. >> we want to save the v.a. but fix it. >> absolutely. we're all in favor of mending and not ending the v.a. >> let's just return the other way starting with you, mr.-- i can't -- nicholson. mr. nicholson, does your organization support the $17 billion supplemental requested by the v.a. recently by secretary gibson? >> sure. iava certainly supports giving the v.a. more resources. whether or not $17.6 or 8

billion is the exact number, i don't know, and i don't believe we know. our concern with the number is just making sure that it is well justified. but making sure the v.a. is well resourced -- >> i just want to know in general, i mean, if that's what's on the table, if you're supportive or not, mr. weidman. >> the 17.6 number we're not going to defend because we have no idea how it came there. the point isn't really from our point of view how much additional is appropriated, it's tracking how it's used. you remember when there was in '99 $319 million appropriated specifically for hepatitis c, and a year later they couldn't tell you what happened to the money. >> great. >> we support the approach of a supplemental versus what's going through conference. >> great, thank you. >> i can't say for sure whether $17 billion is the appropriate number. i can tell you what the iab has

done over the same period of time. i think the idea of strengthening the v.a. through more doctors, more nurses is part of the approach that needs to be taken. >> thank you. >> i would agree with a lot of what my colleagues have said, it's not necessarily about a dollar amount, but we cosupport providing v.a. the resources they need if they can demonstrate they need it. like i mentioned before, just as end users of the v.a., it seems clear to us and from what we've heard from our members that something is needed. >> sure. >> the american legion supports veterans having what they need, but we don't have enough information right now to sport or not support. >> okay. i sake take that -- i take that information very, very -- i appreciate it. i see the conference as fluid, and, you know, we need to really get down to the business of finding out what that appropriate number is. now, the shortage of doctors is something i've been very much

concerned about. i'm host skeptical about an approach which only funds access to more non-v.a. care as part of the solution. i think it's part of the solution. i'm skeptical of us being able to find there are shortages in many communities unless we increase the supply of doctors. mr. weidman, i appreciated your sense of let's grow our own, but even if we send these medics to medical school, they're still -- we're still frozen at 1996 levels of graduate medical school education. the education that is basically what we call residencies. would you all consider supporting the expansion of, you know, there's a bill that would expand residencies by 2,000, let the secretary designate where our greatest need is especially, say, in mental health care. >> iva would absolutely support anything that increases capacity to hofstra.

the important thing to keep in mind is those are intermediate to long-term solutions. it takes a while for those folks to actually become practicing physicians or providers within v.a. the support for private sector care is intend to be a short-term solution, and that's why we strongly support that. one's a short-term solution -- >> i agree with you. i think we need to support non-v.a. access. i understand we have 2000 medical students presently that aren't matched with residencies. we actually have people in the pipeline who could get into residencies right now. mr. chairman, i'm, i've run out of time. >> thank you. thank you. if i could just ask a question, you know, because every one of you answered, and this is an issue that has been thrust into the middle of the conference committee. and that's the $17.6 billion request. it's not even a request. okay? it's not. it's an unfunded list.

with all of your resources and all of your people and all your expertise, you sit here today and you tell me exactly what we're saying, is there's not enough clarity to know whether or not this is a good request or a bad request, too much money, not enough money. and i don't think you've heard a single member of this committee say that they're not willing to fund what's necessary. so is i just, you know, i want to make sure folks know that nobody up here's trying to tear the v.a. down. we're trying to get the v.a. to serve the veterans that each of you represent. and i hope you understand that. you know, but there was a letter that was signed yesterday, and while you may not have intended for it to say you supported the

entire $17.6 billion, you put the full weight and support of your folks behind that in the middle of very tenuous negotiations between the house and the senate. we just went over and made a very prudent offer. unfortunately, the senate democrats were not there. you guys, thank you for holding the fort back here and covering, and ms. kirkpatrick was there. and i think that the reason that we did it the way we did it was we have not had a public meeting for four weeks. and our intent was to publicly say that the house's offer -- i say the house, my offer -- was not cheap on the money in regards to what cbo had scored.

just so y'all know. the offer was take up the senate bill, pay for it by putting $10 billion in emergency funding, mandatory up front, a good, solid down payment. and if the second number's 25 which is what cbo said, and also extend that 10 billion out as long as it will go because i don't believe they'll spend it in a year. i think it'll actually go into the second year. and for the second 25 billion we go through regular order which is, rick, exactly what you were saying a second ago. oversight, what's it for? each of you probably not on purpose has said we need more docs, we need more this, we need more that. but i haven't heard, and you may

have said it before, maybe in your testimony, look for efficiencies within the system. efficiencies in the system whereby doctors are only seeing six, eight, ten patients a day. that's not enough mental health providers that are only seeing patients two hours out of a day. as my colleague has said, expand the office hours so that infrastructure that's already in place can be used to supplement the doctors that are there. and so we're all in this trying to work together, and we said let's do the $25 billion through normal appropriations process, regular order. and look, we're right now negotiating -- well, i don't know, has the senate passed their bill?

yeah, the senate hasn't even passed a v.a. bill. the house has. but we want to begin negotiations, and if we need to interject or inject additional dollars, that's where we should do it. it's not that we don't necessarily think that the money may not be needed, it's we don't know and you don't either. so we're asking for clarity from the v.a. the secretary and i have talked about it. two pages of documentation for a $17.5 billion request. and then we have an undersecretary come here yesterday, and when asked particularly about the request, she can't know how to answer it. she says whatever they're calling it. we can't work that way. you wouldn't wallet us -- want us working that way.

you couldn't do your jobs working that way. we've got to know what the money's going to go for, what it's being benchmarked against so that we get this right. this is not a partisan issue. it is not partisan. the other members on the democrat side and all of the republicans have done everything that we can to make this a bipartisan issue. i have tried not to walk too far out in front of my ranking member when it comes to subpoenas or letters or anything that i do as the chairman of this committee. and if he's comfortable with signing something, i ask for his signature. in be and if he's not -- and if he's not comfortable, that's just fine. not a problem. because we do come from different districts, with serve in different caucuses, and i get where that comes from. but all of a sudden this morning

it's being said in the press that this has devolved into a partisan negotiation. no, it's not. no, it's not. it's an american negotiation. it is for the men and women that you serve. it's for the men and women that we serve. we cannot fail them, and we cannot get it wrong. we have to get it right. and sometimes it takes a little bit longer to get it right. but we're going to get it right. i promise you, we're going to get it right. and we can do it with your hope. every one of you, because you've all been great help to us as we've gone through this process. can we -- >> we comment, mr. chairman? >> if i can -- met me go to

ms. brown lee. and, again, i thank you. that was my five minutes. >> thank you, mr. chairman. and i guess based on what the chairman just said, you know, i think that's good segway to hear what you have to say in response to some of his comments. would be my questioning. so i can start on either end. >> mr. chairman, i was just going to say i don't think i'd disagree with anything you had to say. if we have a concern, it's that i'm not sure there's been enough focus other than on the culture hofstra. there's within a lot of discussion about fixing the culture of v.a., and i think that's probably the first thing that needs to be fixed. but i'm not sure i'm convinced there's much of a discussion about what to do about the capacity problems in the -- >> will the gentleman yield, if you allow him to yield? >> absolutely, mr. chair. >> dr. wenstrup sat right up there a few nights ago and asked how much does it cost the v.a. to serve a patient. they couldn't answer the question.

we asked the question, what is the typical panel of docs, how much does a doc see on a daily basis, and some people couldn't answer the question. so, yes, the focus is on doing whatever we need to do. and that is efficiencies inside and capabilities outside, and that's why the choice piece may be -- and you guys, i'll, i'm going to be real honest with you, some of you, thankfully, have not gotten really spun up about the choice piece when you could have because a lot of people in the past have said that's a way to tear it down. that's not what we're trying to do, and i don't think there's going to be this fleeing out of the system. i think many, many people are going to stay in the system. and so we have focused from an oversight perspective. we haven't been able to get the answers that we've been asking for, and i'll be glad to share with you the list of information that we've asked for and not

received. the secretary gets it every week. and, you know, so, but i agree. and, yes, there has been a lot of focus on the outside, but there has been focus on the inside. i yield back. >> mr. chairman, my one point i would make about the point you made with dr. wenstrup was about how much does it cost per patient, what the hell does the information that they publish in their budget books? there's a particular line item that says priority group one and the cost associated with that patient. maybe i don't understand what that mean, but i interpret that to mean exactly what the question was you asked. >> then why can't they answer the question? >> i don't know. i could have pulled that number out in a second of the budge. >> you need to go work for v.a. >> from a vfw perspective, we certainly understand everything that you're talking about, chairman miller. but our members are frustrated. i just returned from our national convention in st. louis where the membership passed a resolution insisting that congress pass that bill and send

it to the president before the august version. and -- recess. and the frustration comes from the fact that this was a major priority two months ago for each chamber to get together and outline its priorities, get them down on paper and start moving on it. and what our members have told us is that they don't see progress. in fact, what they've seen is the narrative changing where it used to be about caring for veterans, and now it's about costs. >> will the gentleman yield? >> i'm sorry? >> will the gentleman yield? >> yes, mr. chairman. >> whether we had a meeting today -- we had a meeting today for the first time in four weeks, and the senate boycotted. we were trying to tell the american people exactly what we were doing. quit trying to negotiate behind closed doors. i will tell you this, there has been a tremendous amount of work that has gone on behind the scenes in an attempt to negotiate this. and i think everybody has said the intent is not to leave unless this is finished.

and we appreciate the urgency with which vfw expressed in their resolution, but, again, there's been a lot going on, and today we hold a public meeting, and the senate boycotts. yield back. >> mr. chairman -- >> i yield my time to mr. wolf. >> and i didn't mean to take ms. brownley's -- >> thank you, ms. brownley. we're using her time on. [laughter] this is a bipartisan effort, but -- and the chairman and i are friends, and he knows me well enough, he knows nobody does passive-aggressiveness like minnesotans. i was actually in bed before notice of that meeting was even put out. and when i asked this morning what was being put out, we weren't given -- that's not a conference report -- >> will the gentleman yield? >> i will yield to you from ms. brownley and back.

[laughter] >> through mr.-- >> this is our time to be honest. >> yeah. okay, i'll be very honest with you, all right? let's go all the way back to the very beginning and how this conference started, all right? the last conference committee that was held, many of you were probably here in 1999. the senate chaired that conference. so it comes to the house to chair this conference. all right? and at the begin ogg of the -- beginning of the conference there was some discussion between myself and mr. sanders as to who was going to chair. i said let's be co-chairs. all right? let's be co-chairs. i asked the senator earlier this week could we do this yesterday, and he said, no, didn't want to do it yesterday. ..

and i asked him to the share it with everybody here. it is not a conference report. it is an offer. it is the, our offer is on the same amount of paper that va's justification for $17.5 billion is on. and it wasn't done as a partisan

move. we met at 9:30 -- >> secretary sitting in front of us. >> we met at 9:30. look, it was an offer. it wasn't intended to be a house offer. it really wasn't. i wasn't trying to get y'all's buy-in because i know you can't do that but it was to say the house is prepared to put money -- $10 billion has been in the negotiations from probably the second day. hard money. have you seen it in the press one time? probably not. what you see is the house is trying to do it on the cheap. and so today it was an attempt to bring it forward and say look, here's where we are. the house position is, it is difficult to fund any of the $17.6 billion without more

justification. in the offer i think we put 102 million in to finish out through the end of 2014. so, you know the intent is, i will tell you this, i will go ahead and notice. i wrote a letter to the senator and i asked him, you know, be prepared to meet on monday. don't know when, don't know where but just so everybody knows, we'll be back in time. it will be back in time for everybody to be back here and coming back but, you know what has happened in by negotiating behind closed doors and we've gotten pretty darn close, you know, this whole thing, i just saw reported in the media a little while ago, you know this thing is doomed. no it's not. it is not doomed, as long as we work together in trying to resolve it but i didn't want to put you in a position to say, you're making us decide whether we want it or we don't want it.

this was an offer from me, from me. and, i, i get it. and, yeah, i could have told you, i didn't know till, you know, probably 8:00 last night, what the offer was actually going to be. i just knew it needed to be done in public and that's why we did what we did. it only lasted 15 minutes. >> my commitment to you, chairman, is to do this together because i think what these folks know or the public knows they don't careit is the senate's fault or our fault, it is our responsibility. they have seen this song and dance. we've got to get it done and i stand with you to get it done. thank you -- >> thank you. >> who yielded to you? >> no one. mr. brownlee has -- [laughter] i did lean over to the chair, asked him what his proposal. i'm an optimist. the bottom line now we know what

the chairman's proposal is. we also know what the chairman's proposal on the senate side we've never seen in black and white either. so i think we know where you're both coming from and hopefully we'll be able to work in a bipartisan manner to get this thing done. i'm not interested in blaming anyone. my concern is, how do we take care of veterans we have to take care of. i hope that both sides, everyone on the conference committee will focus on that particular issue as well. and with that, mr. chairman, i just say, probably ought to give miss brownlee her five minutes back. >> without objection. >> thank you, mr. chair. just to chime in on this conversation i, i agree that we, this must be, should not be, must be a bipartisan approach to this and we must collectively solve this problem.

and i will say, that when the house passed a bill almost unanimously and when the senated a passed a bill almost unanimously, i think the expectation we would go to conference and resolve the smaller differences and move forward. and i just don't want to take a large step backwards but i think, we're making progress. there's movement here. we're making progress. we've got to continue, we've got to continue to work to make sure we do indeed have resources to make sure that we can serve our veterans well, once and for all. and we all know that this has been a problem that has not, it is not, this crisis has been specific in terms of wait times but we know that we've had, issues with capacity and our ability to serve our veterans, in the proper way for a very, very long time. and we, but this is our opportunity, i believe, very, very strongly, for us to move forward and for once and for awe, to be able to really try to

make a difference and, how we serve our veterans throughout our country. so, i wanted to ask a specific question. i think mr. weidman, i think it was in your testimony, the fact that you believe that you current leadership and the, the change in culture and the change in the leadership and, it is beginning to permeate at the upper levels but not necessarily permeateing throughout the va hospitals throughout the country, so on and so forth and i think obviously that has to happen for culture to change, that has to happen. i am wondering if there is anything that you believe we should be doing to assist the va, to making sure that that

communication does get to the vin level, hospital level, cboc level, every corner of the country where you think we're serving our veterans? is there anything you think we should do? >> suggest you get the district staff with veterans advisory committee, i know most of you have been, give them a copy of act terri secretary gibson's memo that you will meet with the vsos every month and jointly put together the agenda for those meetings because we're getting back, i know the memo got out there and the people aren't responding and our folks aren't hearing much. the best ombudsmans persons you have at the va are the veterans in your district, ma'am. if you give them the right information they will pick up the ball and start to run with it. and if it is real wrong, they

will go to the press. >> thank you for that. and mr. blake, you're the budget guy. the anointed budget guy here. i mean, i, the vsos, i mean you have done, you must have done done assessment what the ta needs and what it costs. you have that information. >> i think it's a lot of numbers and gobbledygook, as mr. wide man said i glad to share with the your staff. we meet with the staff of the committees and we put out the same invitation for the legislative assistants for all the offices to discuss this very issue, discuss what we recommend. >> based on your needs assessment can you give me a ballpark figure what you think the needs are budgetarily to meet those needs. >> for this year or overall? i can't project in the way the

va said they need $17 billion out through 2017. what i can tell you the recommendation is approximately for all medical care, $2 billion more than the va recommended for fy 2015 which will be starting soon and something less than a billion dollars, don't quote me on that, approximately billion dollars more for fy-2016 as an advance. what i will say the difference between what the ib overall recommended for medical care is $8 billion more than what has been appropriated. i can tell you for the most part what has been appropriated is virtually equal what has been asked for by the administration. there hasn't been a whole lot difference in those two. basically over that period of time. what i would suggest if that kind of commitment made over that period of time, maybe we incrementally built capacity in. what is hard to stomach about $17 billion now is this gets to

chairman's concern about spending resources appropriately, can they spend $17 billion in short period of time to get the right staff in the right place to do the right thing. that is the concern. whereas if it was done incrementally over greater period of time, incrementally it would have been done at least. >> i yield back, mr. chairman. >> mr. cook. >> thank you, mr. chairman. appreciate everyone here. i tried to keep up with the many of the organizations. the four of you, i paid my dues. and i get my magazine. i always make my joke about the calendars but i won't. i'm going to ask you the same question that i've asked other veterans organizations. i will probably ask them if i'm still around in six months or what have you. you know the military environment, whether a unit is combat ready or not combat

ready. very, very simple. as of today, is the va combat or mission ready or not mission ready? mr. nicholson, you want to start? >> i would say it is not fully mission ready, absolutely not. >> at least half the hospitals aren't mission ready. >> i would say they're not mission ready at this time but they're moving in that direction. >> when i was in the army we had x and circle x for maintenance concerns. i would say a lot of places are circle x. >> i would agree. not mission ready. i think veterans who contacted us share that concern. >> not mission ready and we've seen evidence of that throughout the crisis across the country. not mission ready. >> thank you. your organization, organizations. you have a lot of credibility throughout the united states,

with this panel. do you rate different hospitals by region, one, two, three, four, five, you know? and do you give a reason why one is, you know, great care, fully staffed, what have you? and before you answer, the reason is coming from a military environment whether you like it or not you're always rated. fitness reports, everyone here, we get, somebody scores us on this bill. this bill just a way of life but it almost is, you know, you call attention to them. back when i got out of the marine corps i became a professor and i tell everybody, rate your professor.com. oh, boy, who disgruntled this week and who loves me this week. probably gave everybody as but, i won't go into that. do you think, do you right now rate hospitals and rate other

aspects of the va and publish them in your magazine, sir? >> we don't have the capacity. we might be on "hannity" and maddow every night but don't have the staff and resources the others do. >> okay. >> we do not, sir. >> dav does not. >> we don't rate but we certainly evaluate the sci centers specifically. while we don't publish a list but i'm sure i could put that question to every executive that oversees that and rank every sci system from best to worse. >> we do not rank hospital systems. >> the veterans don't necessarily rank systems but we have task force that go out to different facilities across the country and provide site visits. we look at each individual hospital what is going on and hold a town hall meeting to talk to veterans in the local community to understand their concerns as well and then we meet with leadership.

>> the reason i brought that up, obviously the previous panel, i meet with some folks, is trust and confidence and you know, i was very honest. i have props with trust and confidence in the va. i got a lot of trust and confidence in you guys, maybe because we go back a long ways and what you. you have helped me and -- so i'm not trying to get you involved in a situation like this, that but, you do have credibility. and, you got, at least with me, and so it is, it is something to consider. now, mr. weidman, i want to ask you about the vietnam veterans. one of the issues that i have, and maybe because i'm a vietnam veteran, i always felt after the paralyzed veterans and people that needed care right then and there, i always felt like the va

was, vietnam veterans, and this is something that vietnam veterans told me, you guys are at that stage, you will probably be dead before you're seen before an appointment, let alone treated. i'm wondering, i actually do think, because of the age factor and they probably have more debilitating illnesses and what have you but i'm very, very concerned that whether that is perception with your organization? this is based on the history, what happened years ago, where the country turned its back, oh, you served in vietnam, you're a baby killer, et cetera, et cetera. so i'm, specifying exactly if you could address that issue. >> let me just say that because of that, our founding principle is really straightforward and really very simple. never again will one generation of american veterans abandon another and we don't. so we put a lot of resources

even though we're by choice a bunch of old guys and gals. >> easy now. i'm one of those. >> and, but we do a lot of things for the younger vets and we do things for our father's generation even though they basically told us to go pound salt. now having said that much of the care at the va is, most of it is good. some of it is very good and sometimes excellent. the problem and the perception that we're getting back from our members is, particularly when it comes to ptds and -- ptsd and neuropsychiatric wound, that they are being pushed out. on a triage, i was a medic with the 196 american and hardest thing i ever done in my life have to triage for real under fast-changing circumstances.

and maybe they are triaging but that's, the way in which we regard that is, if you don't have the resources you need in order to do all the job, ask for it. if they don't give it to you, this begins a the clinic level, then hospital, then vsn and national, they don't give it to you but shame on them but if you don't ask, shame on you. >> thank you. i yield back. thank you for what you do here. thank you. >> thank you, colonel. miss titus, you're recognized for five minutes. >> thank you, mr. chairman, i think we all agree there are serious problems at the va but i was very clad to hear you ask you mr. takano's question, mend i, not end it. i appreciate hearing the claim say we're not out to do away with the va. i appreciate a very articulate statement you made, mr. blake, expressing some concerns that share with you about this push to privatize. now i can't help but believe

this part of an agenda by many so, not by all, but that just to kind of dismantle the federal government and leave citizens, in this case, veterans, out there to fend on their own in the so-called, private sector. now if you look at what is happening here with the private care and the push to private care, maybe this is a short-term fix as one of you mentioned but specifically some of the concerns i have about that are things that we need to address before we go pell-mell down this direction. one of them is just as you raised, there are concerns that doctors and hospitals, as they admitted themselves, don't have the culture of the va. they don't have the expertise of the va. they are not used to dealing with kind of problems that veterans have, whether ptsd or agent orange. if we pushed them out there into the private sector, we don't know that the quality of care is

going to be any better. second, this committee asks over and over, give me hard facts. give me numbers, give me this. yet there is no evidence out there to sew that if you put, patients in the private practice, that it will be cheaper, faster, or better. and in fact, we just don't have that information. and in fact, if you looked at kind of a roughly parallel situation like medicare advantage, would you find that the evidence is actually to the contrary. third thing, mr. takano mentioned this, the lack of doctors in many parts of the country. i'm in las vegas. there is rural nevada. we just don't have physicians. we're at bottom of every list for different specialties and just general practitioners. if we send them out to the private sector, that doesn't mean they will get it faster even if they find the care. yet if we pass this conference bill, that will be the national

news. veterans sent to private care. veterans can now use private care. that is not going to be true. i wonder how will you tell your members what to do now under this new scenario? anybody? >> well, i think first and foremost one of the important things to look at in the access and accountability bill that we have far too many veterans straighting far too long for care. i'm strong defender of the va system. to be perfectly honest i wouldn't be in this position if it weren't for the help i received from the va system when i returned from iraq. that being said as patient of va system i had appointments canceled. i showed up to clinics where they said we can't see you today. i had months long waiting periods for appointments. i'm just one example. we need to balance it correctly. outside care can be appropriate but we can't use it as catch-all

as i outlined in the testimony. or supplement for the competencies va has especially on issues like combat related mental health care or prosthetics or specialty services as my colleague rick weidman related to toxic exposures in the war zone. >> you know, you're exactly right about private care. i have a secretary in my office who went into a doctor almost four weeks ago now. she need surgery. the doctor recommended she have two appointments she needed to make before she could have the surgery. one was scheduled at that time for this past tuesday. the other one for in august. and so she need to have both of those appointments met before she can go in before surgery. she is waiting over probably eight weeks in order to do that. private sector isn't much better. it is frustrating because we

have acting secretary putting for the a plan to insure the capacity of va and build up, you know, the number of doctors that need to be there. plus take care of veterans on the outside when necessary. for an amount that's, a fraction of what cbo has cost estimate on for the bills pending in conference. i mean, they claim 30 billion for the first two years and another additional 54 billion after that? and, i mean that is what i don't understand is why we're, you know, condeming va and their numbers when cbo is saying it is even going to be more than that. just frustrating. >> i would say this, you know, from the perspective of a pba member, doesn't matter what bill you pass because at end of the day, the only and best option for our members is the va. there really isn't another option out there. yes, there are places out there that can meet some need they

have. there is no option. almost unfair to answer that question a little bit. what i would say, we never said they shouldn't be contracting out pour care at all. i said many times that the va did terrible job using that authority in the past. they're seeming to more judicious manner in accelerated access to care initiative. triple c, all these different things. there is certainly avenue to go there. one. concerns, and you mentioned this about the doctors that are out there in private sector, one of the hearings, one of the oversight hearings, i'm not sure if it was one of the midnight hearings or day time hearings that the committee had, but mr. ruiz made a point at one of the hearings, his district is pretty rural but not unlike many districts in the country, when they did analysis of his district there was approximately one physician for every nine thousand people in that district. i would suggest that is probably underserved district by and large and probably a lot of other places in this country of the there are a lot of under

served veterans in many of the same areas. what happens when you put them into that situation. >> exactly. >> so there is certainly a concern there. >> thank you, mr. chairman. >> thank you very much. and also, it's 17.6 billion over and above the cbo score. so the fact that it is a lower number, i understand but it is 35 approximately, plus 17.6. mr. walsh. >> thank you, mr. chairman. i think, that is a valid point. i think all of us, you get it. we're trying to separate adequate resources from effective use of resources. if we conflate the two together we end up going in the wrong direction. i want to thanks, i want to point out though, i don't know if it happened since i've been here but certainly for me gratifying. often types people are testifying and you guys standing behind them, figuratively and

literally standing behind them as veterans, acting secretary of state in this whole thing. i don't know if we seen that before. i want to make note actions speak loudly. words are cheap. especially sometimes around here. this is pivotal moment we're at. pivotal. the decisions that are going to be made over the next weeks and months i think could have decades-long impact. that you're absolutely right to apply pressure points to get situations done. keep in mind, and you're right to have, when you can turn up the heat or whatever, but now there will be a race to get something done by next friday. getting it done and getting it right are not necessarily synonymous. my concern as we work together and as we bear down on this, no question we want to get it right. the spats you're seeing here are fairly healthy in this committee, they're open and they're there. i need all you to think deeply and how we get to that point. here is my biggest fear. we pass something.

everybody goes home in august, pound our chest, there is more money in the system and va is taken care of. we have to multitask. his point on suicides. which of i think the hunt bill is critically going forward. and now the va work is done we'll move on to the next crisis of the day whatever it would be and forget that. we need to make sure we need to looking at the long game. we need to look at national veterans strategy and we need to figure out a way and you guys have said this bill, alex, when you said you weren't consulted who the next secretary was going to be, don't feel left out. i was not either. so, and i bring to that not necessarily facetiously, i bring it to the point is, you said it and i think carl, you might have been you said it we're all responsibility for it. you took responsibility as organization and i take responsibility. the question i have, i'm okay taking responsibility and until i have to teeth to effect what is being done. i would suggest to you and in

trying to figure this out, this committee is your entry point into this system, in many cases. you're right. va appropriations, i don't even know who is on it. at that is what happens on that. good luck getting in over there and or having, armed services come over here. so i'm making the decision, ben making decision, i will take responsibility but why is the second largest agency in the federal government have one of the smallest committees? how come we don't have resources to do more on that? how come we have the ability to get out there. how come we're not adding you in as partners for va? if you look at major reform, look what the long-term implication is, don't forget that if the people's influence is going to be felt, it is going to be felt through this committee. and, we have to have the resources. we have to have the ability and have to have your partners getting this done. so with that being said, i'm going to leave it all to you. what do all of you hope to see come out of the conference and

it will get done? chairman miller's leadership, mr. micheaux's leadership, work with senator sanders, we'll get this thing done, what has to, what is the red line has to come out of that? what has to be done before we go home? because as your organization said, don't worry about coming back if you don't do it. we're going to come back what do we have to get done next week? >> thank you, mr. waltz, for the question. our members are very frustrated by what we've seen. we certainly echo the frustrations of chairman miller and the rest of the committee in how we get to a quality product. i think from the membership, from the perspective of vfw, what we want to see come out of this is adequately funded or adequately resourced, i don't want to say funding, adequately resourced va health care system capable of delivering health care in a timely manner to veterans. when it is incapable of delivering that timely care to

veterans that he have resource and procalls in place to deliver either through contracted care or non-va care coordination. in addition to the accountability side, the va has ability to properly sanction and fire poor-performing employees and replace them in a timely manner. there has been a lot of talk about that front end, about how many people have you fired. how many people have you fired? i outlined in my testimony. i've been talking about this for the last two months. i think va makes tradeoffs many times the way they evaluate their employees. if you can't hire a quality replacement in timely manner, why, are you really going to give a poor performance review to somebody or try to fire somebody if you can't replace them or threat of them leaving? if you have a clinician seeing two patients when they should be seeing five, are you going to fire them when it takes another year to replace them. then those two patients go without care. >> my time is up. maybe on second round, it is

important to us. at end of the day we'll vote yes or no. we need to know what we're going to do. >> mr. o'rourke. five minutes. >> thank you, mr. chairman. i want to thank you for being here and thank you and your organizations for me being as new member get up to speed for the veterans i serve in el paso. on bills we'll be voting on and bills we're offering, are instrumental. they improve the legislation we have been working on. i have been making better decisions for your feedback. i want to thank you. i especially want to thank miss jones and american legion as we were discovering about the awful the crisis in el paso and wait for disability claims and wait time on appeals for disability claims. we're hoping to get some kind after response from the va, which since then has come. you and your organization stepped in to if i the gap literally, set up a command center and saw hundreds and thousands of veterans there,

connected them with benefits. connected them with care. i can not thank you enough for doing that. so, really, really appreciate what you're doing. let me follow up on, on one of the achievements that the secretary cited and, that i'm very grateful for, which is, removing that 14-day deadline and moving it back to 30. accelerating access to care. putting money in into local vas to make sure we access that. by that same model, thinking about el paso where i mentioned earlier if you were here we had 20 full-time vacancies in mental health. we had 20-full time say canses. commitment from our va director and dr. jessie, that we had those filled by end of this month. we checked this morning. they will not be filled. ptsd, mental health care, being able to help somebody who is in need who may be a danger to him

or herself to spouse or loved one or community, and at best may be suffering without help, is a critical unmet need within the va certainly in el paso but i certainly understand throughout the country. guide me through this idea proposed by a panel week before last, that the va focuses and prioritizes and becomes excellent in care for ptsd, tvi, pros at the time sicks -- prosthetics, the kind of combat and war-related injuries we're seeing from all our engagements, especially post-9/11 and refer other care that is not combat or war-related out into the community. in other words, give me the ability to say to a veteran in el paso, if you have ptsd, you will come to the el paso va you will be seen quickly. consistency in care. see a psychiatrist.

access to medication. i can say none of those things right now. part of my suspicion we are trying to do too much. and whether it is 17 billion or 30 billion, we can not spend enough to sustain a system serving nine million veterans. many more years from now. walk me through my thinking and how i could approach this idea and problem of balancing, creating excellence within the va with accessing resources in the community. i will start with miss jones and work down the line for anyone who would like to respond? >> you know i think if we could answer that question and walk you through it we wouldn't absolutely be here today. that is an excellent question. there is so much need to be done. as a matter of fact, the american legion, we have a tbi, ptsd committee full time to research ptsd and tbi, and what needs to be done next. there are so much veterans need, especially evidenced while we've been out across the country with very rans who have been in crisis. i think there are times when

veterans need to be be, when purchase care is necessary. depending on veterans, how far they live away. depending on conditions. advantageous to veterans outside the particular time. harmful for them to drive in. all those things taken into consideration. i think what has to happen, the va has to become experts in every area, where veterans need things, tbi, ptsd, women veterans issues, all kind of specialty clinics, veterans have conditions that need to be taken care of and need to be able to come to the va to expect excellent care in all areas from the va we can not use purchase care as a substitute for what the va needs to do. that is a copout. the va needs to be able to do excellently what they have been created to do. >> anyone else want to comment essentially offering fewer services but doing them better an referring remainder out into the community? we have 10 seconds left. with the chairman's indulgence maybe go over a little bit but?

five seconds. >> i say this, mr. chairman. thank you, mr. o'roark, i rest. i would say this, let's not forget the va is fully integrated health care system and all the components of it support one another. if one of our members with spinal cord injury gets primary care and gets that in the va and he need good care. you can't send that sci veteran out, if they need audiology which is basic service purchased in the community that should be provided in the va. if they do orthopedics which is very common, the expertise should reside in the va, those things prop one another up. that veteran depend on all of those things over the course of their life. the concern becomes, if we send them out for primary care, audiology, what have you, is the care coordinated? is the va managing it? are we keeping track what is going on? all the aspects of that veteran being treated are being properly managed. if you start sending out pieces

you lose a lot of that i think. you ultimately put the overall and long-term health of veteran, particularly veterans with the most complex need in jeopardy. >> great feedback. thank you. thanks again. mr. chairman, thank you. >> mr. walz have additional question you wanted to ask? >> if anybody follows up if we make a decision next week what will we come out of this. >> mr. walz, i say this. i thought somebody would pass. paralyzed americans have something of concern with the choice act and those decisions. great oy ronnie of this, both committees went into conference with probably the most difficult part of the legislation virtually mirroring each other. the rest is other provisions in the senate bill but the heavy lifting has been done because you went into conference with business very close to one another. somehow you're going farther and farther apart on your own. i don't even know how that happens. that is just amazing. so i kind of assumed that the choice act or whatever the final name is going to be was going to

pass. my concern is not that bill, we just assumed it. my concern is what happens next. i don't want this to become of the end of the debate. mr. chairman that's why i made the point. we don't want tomenta this our chest you said. -- thump our chest you said. go home and great things we done for veterans and lead into the election and we forget there are still serious problems that have to be addressed in va not just what comes out of the legislation. i assume you will pass legislation pretty much like it looks. it will be what are we going to do after the fact. >> as long as something gets done, i think that we're under tremendous pressure just like all of you are under tremendous pressure to enact something. and, to start to really truly, address it, but really truly addressing the crisis is, in terms of it, not being repeated anytime soon, is going to be a several years of effort, not just a funding but of effort, to

rebuild a management structure that you can have faith in. and, every time i talk to va employees, they say, what do you think about it? i said i think, this is before all this blew up, that we need va management as good as most of the clinicians and workers within va. we don't have it. we haven't had it for a long time. didn't begin with this administration. and so that really needs to get really the primary focus. one last thing and miss brownley as well, there is no fixing it once and for all. it is not a widget. it is an institution of people that will change as the needs of the people change, and as a nation itself changes. and, so, we regard it much more as a garden. that you need to continue to plant to fertilize and weed. and, the weeding hasn't been done in management in a long

time. that is what needs to be done now. >> mr. walz, my concern is again as my colleagues just said, this is a temporary fix. i think we're heightening the expectations of veterans and not going to be able to meet those expectations. i think, in the end, i think we could even be weakening va instead of making it stronger. we need to make sure in the end that va is stronger and they're able to fulfill their mission to veterans. >> can i say briefly, my biggest concern with the conference right now, is the house and senate passed several really good bills. you went into the conference with our understanding being that the jurisdiction of it would be to merge those two bills, make some tweaks and pass it out. now everything, it seems like, everybody and their brother is wanting to throw in extra things because they see this as one of the only, if not only moving trains on vets issues perhaps before the end of the congress. now, in you all could focus on,

and you certainly have our support doing so, americaning and tweaking finalizing what you passed, getting that done and not throwing in all these other provisions that people want to put on moving train, 17 billion extra, i think if you guys could pass what you have in front of you now, within jurisdiction of the conference committee and then, in my opinion, and then tackle the supplemental, that we would come out with something for sure, whereas if we're adding in everything else and considering everything else and having to fight over and to discuss whether or not to pay for it and how to pay for it et cetera. we may end up with nothing. if we go into august and doesn't get done and new secretary is confirmed and comes in and make adjustment to 17 billion, and add another 17 billion who knows what, we'll not get anything done. i rather see you all finish what you started with, get that done and move on to step 2 and 3. >> i appreciate that. that has been my position. we triage this. deal with access to crisis care. work with you as we start to

deal with some of those and breathe a little bit. we have a long-range vision, put that in place and continue to follow through. because i too have, as you all expressed have this great fear. you know how this is going to go. you're already done with this. this one bite off the apple. it is don't come back asking for anything. you're done. rick, i say with the v and health care it is journey and not a destination. we need to keep moving forward. there is danger, i hear from people if we don't do this and don't do it now and window will close and not get done. i think they're missing passion of american people to get this right and this is our time. a little bit of patience. awful lot of collaboration, continuing this on. the help from you would be, as help us keep the realistic expectations on that. don't have the all or nothing but next friday but better sure do something you better get results out of it. keep the momentum to keep moving forward. i yield back. >> thank you, mr. walz. i appreciate the panel for being

here today. and precisely what occurred last week, when the $17.6 billion was injected into this conversation, is when things started going sideways. we were very, very close to resolving our differences. and, senator sanders feels that the only time that he will ever be able to get this money done is in this bill. and i have assured him that is not the case. if va can make the case for the dollars in certain areas that they're asking for, that we will go to work to see that they get those dollars. unfortunately he has convinced other people that this is the only way to get this $17.6 billion put into this emergency bill. that is not the case. the house had actually narrowed the scope down in our bill to

access and to accountability. ours was much narrowly crafted than what the senate had but we were giving and taking, adding things in, taking things out. the house was receding to positions that the senate had. so again, as i understand senator sanders just held a press conference. i can't believe he unilaterally held a press conference without letting me know he was holding a press conference or asking for my permission but he did. i think the thing is, we're not done. we did not give a take it or leave it offer. we just want to make sure that those those on conference committee understand that the house is not trying to say, everything has to be paid for. we're going for the same number. the house is actually gone to the senate number. we did that when the cbo came out with the second score, instead of holding to our number which was higher because we had a 14-day trigger, we went to the

30-day trigger. so understand, just as mr. walz already said, getting this done right is important. it is critical. and that's what we're committed to doing. i have a ad sure everybody on the conference committee if it takes staying through the weekend this weekend, i'm prepared to do that. i was supposed to be at normandy for the 70th anniversary. as chairman of the committee that has oversight over the american battle monuments and i did not go because i stayed here to help negotiate this bill. i stayed in washington and entire week. and so, i am committed, as our all the members of this house committee, to making sure that we get it right and with your help, we will. and we'll get it done in a timely fashion that serves the veterans. remember, the veteran is the most important thing, not va. and with that we're adjourned. . .

[inaudible conversations] >> michele flournoy is our guest on this week's q&a. >> in government you're dealing with the daily tyranny of the in box. you're focused on the crisis of the day.

part of my responsibility as undersecretary was representing the secretary of defense on the so called the deputies committee which is sort of the senior level group that's working through the issues, developing options for the principles and the president. a lot of crisis management focus. when you're in a think thank you are real -- your real utility is not try to second-guess the policymaker on the issues of the day, but help to do work to raise their day, help them look over the horizon to see what are the issues i'm going to confront a year, five years, 10 years from now and how do i think more strategically about america's role in the world. >> former undersecretary of defense and cofounder of the center for national american security michele flournoy on the creation of cnas, its mission and current defense policy issues sunday night at eight eastern and pacific on c-span's q&a. >> for over 35 years, c-span

brings public affairs defense from washington directly to you putting you in the room at congressional hearings, white house events, briefings and conferences. and offering them -- all as a public service of private industry. we are c-span created by the cable tv industry 35 years ago and brought to you as a public service by your local, cable or satellite provider. watch us in hd, like us on facebook and follow us on twitter. >> here on c-span2 we are live on capitol hill wher with house foreign affairs subcommittee will be holding a hearing considering two resolutions that will address the israeli-palestinian conflict. the two resolutions, one would condemn the murder of israeli and palestinian children in israel. the other would address the ongoing violence in the region and would condemn the use of innocent civilians as human shields. that is ileana ros-lehtinen, the chairman of the subcommittee former chairman of the whole committee and they're waiting for other members to arrive.

the hearing should get underway shortly. it is an earlier day on capitol hill initially. the house was to come in at 9 a.m. eastern. they pushed that back a bit to 10 a.m. eastern. this bill last day of legislative work for the house. republican conference meeting this morning to talk about the issue of the ongoing escalation influx of immigration, on the u.s.-mexico border. that meeting will wrap up shortly and other hearings are going on on capitol hill as well. on the issue the president living with the presidents of honduras, guatemala and el salvador today. this afternoon officials from those countries met with democratic and republican leaders on capitol hill yesterday. waiting for the subcommittee to gather to mark up these resolutions and should get underway shortly live here on c-span2. [inaudible conversations]

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>> on the left, ileana ros-lehtinen, the chair of the middle east and north africa subcommittee of house foreign affairs, and on the right, ted deutch, waiting for other members. they're considering two resolutions today addressing the israeli-palestinian conflict. there will be votes later this morning in the house. this markup session may recess. also let you know about our live coverage on c-span2 a bit later on. josh earnest will be holding his briefing. that will be live here on c-span2 at 1 p.m. eastern.

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[inaudible conversations] [inaudible conversations] >> this is the house foreign affairs subcommittee. the chair, ms. ros-lehtinen and the ranking member, mr. deutch, they are gathering today to mark of two resolutions dealing with the ongoing israeli-palestinian

conflict. one resolution would condemn the murder of israeli and palestinian children, and the other would condemn the use of innocent civilians as human shields. the committee is marking up those two resolutions today. this is the secretary of state john kerry is in the region proposing a weeklong cease-fire between israel and hamas. meanwhile, "the wall street journal" reporting that the u.s. and its allies pressed for a halt in the fighting in gaza. othe journal writes israel is prepared to support massive investment to rebuild gaza but only in return for disarming of gaza's hamas rulers. that is from "the wall street journal." "the associated press" reporting israel's parliament has sworn in rubin as the country's new president. he replaces nobel peace laureate shimon peres whose term ends as

israel is fighting a war against hamas in gaza. the swearing-in ceremony came amid a particularly deadly day in the conflict which corrupted on july 8. so far the associate press reports over 750 palestinians including many siblings have died in the war on the israeli side to produce will become to civilian and a worker have also been killed. >> [inaudible conversations]

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>> here on c-span2 we're live waiting for the house foreign affairs subcommittee on middle east and nort north africa to gl in. it will consider two resolutions, marked up two resolutions dealing with the conflict between israel and hamas. one would condemn the murder of israeli and palestinian children in israel and the ongoing escalating violence in that region. the other would condemn the use of innocent civilians as human shields and the report from yesterday, a barrage of shells struck a united nations run shelter thursday in a densely populated area that residents had been under is with us all for days, killing at least 16. "the wall street journal" writes the israeli officials said they did not yet know what it is showed in the northern gaza town but acknowledged that the war is really firefights with hamas. islamist group that rules gaza in the area, reporting from "the wall street journal." the u.s. house will gavel and in

about 15 minutes at 10:00 eastern, and on their agenda today and measure dealing with, dealing with iraq. this is a resolution supported in part by wall street journal republican -- bar the president from deploying or keeping u.s. armed forces in the ongoing combat in iraq and lessig its authority from congress to do so. that resolution is one of several set for house debate today. they will have votes sometime early afternoon and that will do for legislative work for the house today. they are back next week for one final week of legislative work before the august recess. [inaudible conversations]

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[inaudible conversations] >> we are not sure what the delays in getting the markup session under way. we do know the house are broken conference been meeting regarding another issue, the issue of the influx of migrant children at the u.s.-mexico border so that could very well still be going on. we will have this for you live once it does start here on

c-span2. in the meantime we will bring you a senate foreign relations committee hearing from yesterday. they looked at the issue of the escalating violence in syria and iraq and u.s. policy there. >> we meet today pursuant to notice to mark up to bipartisan measures. as your office over previously notified is the intent of the chair to consider the following items en bloc, and members will have before them. you have them in your packet.

h. con. res. 107 announcing the use of civilians as human shields by hamas and other terrorist organizations in violation of international humanitarian law. number two, house resolution 665, condemning the murder of israeli and palestinian children in israel and the ongoing and escalating violence in that country. and thirdly, ros-lehtinen amendments and the nature of a substitute h. con. res. 107 which provided to your offices yesterday. without objection these items are considered as read and will be considered en bloc. after i recognize myself and the ranking member, to speak on these measures i'll be glad to recognize other members are also seek recognition. without objection all members may have five days to submit statements for the record on today's business. the chair to recognizes herself for her opening statement. >> today we have before us to time and important resolutions.

the first is h. con. res. 107 which it introduced alongside with the ranking member, congressman ted deutch from florida, that denounces the use of human shields by hamas and other terrorist organizations. the second is h. res 665 offered by david mckinley of west virginia and our middle east and north africa subcommittee colleague from california, mr. juan vargas. that resolution condemns last month's murder of the three israelis teenagers by members of hamas and the murder of palestinian teenager mohammad, israeli extremists and the escalation of violence. it should be noted that while israeli authorities moved swiftly to arrest the suspects in mohammad to murder, the other

murderers are still roaming free yet to be brought to justice. but these measures are significant and their timing is not an accident. in light of the recent events that transpired in israel and gaza over the past month and a half it is extremely vital that attended congress serves as a counterweight to those who seek to delegitimize israel by pushing a false moral equivalency measure. make no mistake, there is no equivalency whatsoever between israel and hamas, a united states designated terrorist organization. we need look no further than the mockery that is the united nations human rights council, unhcr, to see the dangers of these efforts to delegitimize israel. just two days ago that council passed a resolution to form a commission of inquiry into what it calls war crimes and human rights violations by israel in

gaza. it should come as no surprise to any of us of the one-sided mess of the unhcr, and this is the same body that gave us the deeply flawed and unabashedly biased anti-israel goldstone report in 2009. yet remarkably there was no mention of hamas' indiscriminate rocket attacks on innocent israeli civilian populations, but surely firing rockets into israel from and placing missile batteries in densely populated areas and near schools, hospitals, near mosques would merit a mention, perhaps using men, women and children as human shields to protect militants and the rockets will draw the proper amount of outrage? no, not a word. but this has been the standard operating procedure of the unhcr. it has been an anti-semitic, anti-israel, pro-terror group of

far too long. there must be some member nation on that body that would've had the moral outrage that we in congress feel and that they would have voted against such a resolution. alas, the united states was the lone voice of reason. the only nation willing to say that we do not support this, that this is completely insane. where were our european allies? those european countries that always tell us how much more enlightened they are than us. deafening silence are they couldn't even stand by the courage of their convictions and vote either for or against the measure. know, they all abstained from voting, perhaps thinking they took the moral high ground. but theirs is the worst crime of all. their refusal to stand up for what's right. so here we are again, another unhcr one-sided inquiry that

will do nothing but embolden hamas because hamas sees this and it thinks the world supports what it is doing. i commend the u.s. representative to the unhcr for standing up against the resolution this week. ambassador harper rightly said that this vote will undermine achieving all of our objectives, to end the hostilities and bring peace to the troubled region, and acknowledge that once again the council fails to exhibit in the a semblance of balance. if they council truly cared about human rights it would condemn hamas' use of human shields and its indiscriminate rocket attacks against israel. it would take a look at hamas' call for citizens to ignore israeli warnings to evacuate, or hamas' insistence that palestinians stand on their roads to prevent an attack putting the citizens directly in

harm's way, and accounts would call upon hamas to accept a cease-fire, which i believe it is now refused to accept, at least three of the four of those attempts at a cease-fire, while israel has accepted each one of them. it would launch an inquiry into hamas and its supporters, like supposedly our u.s. allies, qatar. not only is qatar a major benefactor of hamas, but it has also been working actively to undermine egyptian and other nations cease-fire efforts, further emboldeniemboldeni ng hamas. qatar, the same country that we entrusted to watch over the taliban and five that has been supporting terrorists and radicals all across the globe, and offers them sanctuary. qatar, the same country that we just signed an $11 billion arms deal with, $11 billion, is the very same country that serves as hamas' mouthpiece through

al-jazeera, airing propaganda that then gets broadcast to the world. perhaps that is something the unhcr could look into, but it won't because it doesn't fit nicely into its agenda. and that is why passing these two measures will send a strong message that we will not allow israel's enemies to undermine the security of our democratic allies, or its legitimacy, but that we will continue to support israel and do whatever is necessary to help you eliminate the terrorist threat, the hamas or hezbollah, or any other group. i urge my colleagues to support these measures before us today. and now i will turn to our ranking member, congressman dutch, for his remarks. >> thank you, madam chairman. i want to thank you for moving forward on this time and resolutions day. annexed in my sincere gratitude to you for being a tremendous partner in a joint effort, h.

con. res. 107 announcing hamas use of seven children i want to recognize mr. vargas on his work on h. res 665 condemning the murder of israeli and palestinian children in israel and the ongoing escalation of violence. chairman ros-lehtinen and i were in israel tonight the world wants the tragic fate of the three is really teenagers, naftali frenkel, gilad shaar and eyal yifrach. we mourn with others at the joint feel. we were there just days later when 16 year old mohammed abud khdeir was brutally and tragically murdered. in the wake of these heartbreaking deaths, violence escalateescalated as hamas begin industry by launching rockets in southern israel and central israel, tel aviv and jerusalem. thanks to the iron dome missile defense system, hundreds of thousands of israeli lives have been saved. israel has the right to defend her people against these

attacks, and she can't be criticized for making the investments in the iron dome to save her citizens while hamas continues to invest in rockets aimed at killing israeli citizens. in the weeks since the start of the operation protected is, israel has uncovered and was plots by hamas to infiltrate israel via terror tunnels and to launch attacks on israeli civilians. i ask you to imagine what you want your country to do if rockets rained down on your hometown. if tunnels were built under your house, your children's nursery, your grandfather's senior center, for the sole purpose of making it possible to pop up in those places and slaughtered the people who live there. as president obama said, no nation should have rockets being fired into its borders, or terrorists coming into its territory. look, we all mourn the loss of innocent life on both sides of this continent. it's tragic, but it's hamas, a

u.s. and european union designated terrorist organizations. terrorist army, that is embedding its terrorist infrastructure in densely populated civilian areas. as usual makes every attempt to warn of incoming strikes via phone call, text messages and leaflet drops, hamas spokesman going to be and encourages civilians to stay in their homes and act as human shields. hamas hydra rockets in schools. in the past week rockets were found into you in schools. it hides them in mosques. as the washington reporter on july 17 when it witnessed in northern gaza, moving small rockets into the mosque. madam chairman, i know that emotions run high on both sides of this conflict. but there is no path that leads to peace and a palestinian state living side-by-side with the jewish state of israel that includes hamas. the greatest impediment to peace

for everyone who wants peace in the region, the greatest impediment to peace between israel and the palestinians is hamas whose charter is founded on the destruction of the state of israel. president bill clinton said in an interview this week, hamas was perfectly well aware of what would happen if they started raining rockets in israel. they fired 1000 of them and they have a strategy designed to force israel to kill their own civilians so that the rest of the world will condemn them. it is hamas they chose to investment in underground bunkers for its leaders, rocket launchers instead of investing in jobs and schools and health care for the people of gaza. the siege of people like to talk about in gaza has been brought about on the people of gaza by hamas. it is hamas that uses its own people as human shields to

protect these rocket launches. the use of civilians to protect military objectives is a direct violation of the geneva convention. look, this week, just this week we heard from a hamas spokesman. if there's any question about what's really happening here, we heard this statement. he said, we will keep tormenting the zionists and tell the last zionist leaves the soil of palestine, all of palestine, any column that is temporary, periodic column. we don't talk about a long-term peace agreement. column in the resistance dictionary meets preparation for the next war. the resistance will keep developing, manufacturing and stocking its arsenals with new surprising components for the next wars until the zionist enemy leaves our country, and all our land. that's the hamas spokesman. it's really simple, madam chairman. any