that the greenhouse gases emitted by human activities are the primary driver. they continued, this conclusion is based on multiple independent lines of evidence and the vast body of peer-reviewed science. end quote. that, mr. president is the voice of fact, analysis and reason. we are well informed by the real scientists. the scientists have the expertise and the knowledge and the facts. what they don't have is that massive conflict of interest that requires setting up an armada of front groups and gives them the $100 billion motivation to run this scheme. it's time, mr. president, to let the scientists and the facts take their place.

this issue has been thoroughly debated and vetted in the legitimate world. it's time now for us here in congress to wake up to our duty and to at last act. i yield the floor. a senator: mr. president? the presiding officer: the senator from ohio. a senator: mr. president, i rise today to talk about an epidemic that is affecting my state of ohio and every state representative in this chamber. senator whitehouse just spoke. he worked with me over a period of about three years to put together legislation to address the heroin and prescription drug epidemic. we had five conferences in washington, d.c., bringing in experts around the country including my home state of ohio, and we looked at what's working and not working and came up with the best practices from around the country and that's what the

legislation addresses. it's comprehensive. it deals with prevention and education. it deals with treatment. it deals with recovery, longer term recovery we learned was incredibly important to success. it passed this body with a vote of 92-2. that never happens around here. it's because working together with both sides of the aisle, we were able to look at a problem objectively, take the politics out of it and figure out what would work to help turn the tide. it's something that is urgent. we have to address it. i will tell you now nationally it appears that overdose deaths from these opioids, heroin, prescription drugs and now synthetic heroin is the number one cause of accidental death meaning it surpassed car accidents. sadly, it's getting worse, not better. so these changes that this congress voted on to modernize our federal response to prescription drug and heroin addiction are incredibly

important right now. it was evidence based. it was something where we again took best practices to make sure we were spending more money but that money was going to places where it was prfen to work. -- proven to work. now that cara is law and signed into law by the president about six weeks ago, we are working with the administration to get it implemented as quickly as possible because there are a number of new programs, new funding sources. it authorizes another $181 million per year on top of what's already being spent on this issue. but again importantly it authorizes new programs that we think will work better to reverse the tide, to get at the horrible epidemic that's growing in our states. we also need to work with the administration and with congress to ensure that in the annual funding bills that are passed around here, that we are fully funding this new effort. at the year end which is september 30, fiscal year end for the united states

government, there will be a funding mechanism. it's probably going to be what's called a continuing resolution continuing funding from last year. that's good in one sense because we did get more funding in this year's appropriations bill for this issue. we have about a 47% increase in funding for this year. so that would continue next year but that's not enough. unfortunately this crisis has taken hold in a way, it has gripped our country in a way that we need more. and just to be fully fund the cara legislation, we need more. so we are calling on the administration to work with us to ensure that we can get more funding interest whatever is -- into whatever is going to be passed at the end of this month, likely a continuing resolution it provide adequate funding to ensure at a minimum we are funding what is in the cara legislation. when there is a new appropriation for next year which i assume will happen after the election, we also have hope

because both the committee and the house and the committee in the senate went through all their process and they reported out of committee legislation that doubles the funding for opioids over a two-year period. they include funding that is at $471 million, 113% increase over the last two years. so we need to have a process to get this funding done. we hope the administration will work with us on that, even on this continuing resolution. there's a group of a hundred different organizations from around the country. it's a coalition that helped pass cara that recently sent a letter to the white house. it includes recovery advocacy groups, prevention groups, it includes law enforcement, and this group of people who are on the front lines, in the trenches all around the country just sent a letter to the white house thanking the president for signing cara into law but also expressing their support for fully funding it. what they specifically asked for is that the white house include what's called an anomaly or an addon to the continuing

resolution for this purpose. i hope the white house is listening. i hope the they do it. i want to add voice to this coalition so say it's the right thing to do. i also property it up with our leadership here in the congress. there will be some add-ons or anomalies to the continuing resolution. there always are. we have to be sure it's transparent that is makes sense. this one makes sense. we should make it transparent and high enough that it fully funds the cara legislation regardless of what happens with the appropriations going forward. at the very least let's close whatever gap there is between the c.r. and what's needed to fully fund this legislation. because i believe this is a crisis and an emergency, i actually would support emergency funding going over and above what's in the cara legislation. i think we should have debate on that issue. we had one here on the senate floor. i voted for that we were not able to get 60 votes for it but

i do think it's an issue that rises to that extraordinary level, like the ebola issue, like the zika virus, issues that are truly epidemics. and this is. let me tell you why i call it an epidemic. we found out recently that drug overdose deaths in my home state of hoe increased from about 2500 deaths in 2014 to more than 3,000 in 2015. here's the sad news. this clear we're on track to exceed that percentage increase. in other words, we're on track this year to have better than a 20% increase in deaths from overdose in ohio. your state is probably experiencing the same thing. nationwide the number of heroin users tripled in just seven years and number of drug overdoses every year tripled in just four years. since 2,000 the number of opioid overdoses has quadrupled so this

problem is getting worse, not better. one reason the overdoses are increasing even faster than the number of new users is the drugs on the street are getting stronger and stronger. so you're seeing not just more addiction but you're seeing even higher levels of overdoses. more addictive, more dangerous, and more deadly. heroin is already deadly enough. it's extremely addictive but it's now being laced about drugs like fentanyl, car fentanyl. you may have heard of this and wondered what it is. it's a synthetic form of heroin. it's being made somewhere in a laboratory and being added often to heroin to poison the people we represent. it's that simple. this car fentanyl and fentanyl

and more dangerous in ohio. deaths increased from 80 in 2013 to 500 in 2014, more than double to over 1,000 last year and again this year we're on track to exceed that number significantly. just three years ago about 120 overdoses in ohio were a result of fentanyl. then it was one in five. now more than one in three. you can see where this is going. prescription drugs is often the start of this. four out of five heroin addicts in ohio they say started with prescription drugs. this is an addiction that sometimes is inadvertent in the sense that someone might have a medical procedure and then be given these narcotic pain pills and develop this addiction which is a physiological change in your brain. addiction is a disease. it needs to be treated as such. but now increasingly we're seeing these synthetic herns

come into our -- heroins come into our communities to the point that one in three overdoses now, instead of just three years ago one in 20, in ohio are due to synthetic drugs. in my hometown these synthetic overdose exceed the heroin overdoses. drug overdoses increased by 30% from 2014 to 2015 while fentanyl overdose deaths increased 153%. the team and doctor are doing answer lent job under very difficult circumstances. they need our help. these synthetic drugs are incredibly powerful. heroin is already extreme li addictive and typically much cheaper, stronger, and more widely available than these prescription painkillers that we talked about.

fentanyl can be 50, sometimes own 100 times as powerful as heroin. tbhi that. -- think about that. carfentanyl is sometimes 10,000 times as powerful as morphine. so as you can see, as these synthetic drugs are coming into our communities, they are more dangerous, more addictive. carfenal in is so powerful that it is primarily used as a tranquilizer for large animals. the police who have responded to an overdose have overdosed from just breathing fenal in in the air or getting it on their skin at the scene. it is so powerful that sometimes multiple doses of narcan are required to reverse an overdose. narcan is a miracle drug that our first responders are increasingly carrying and thank god it is there because it anniversaries the effects of the overdose. but narcan is meant for a heroin

overdose. sometimes with these other synthetic drugs you need several doses of narcan to reverse the overdose and sometimes it doesn't work. i've heard cases where seven doses of narcan were necessary to save someone's life. these synthetic drugs are taking a heavy dole in my home state of ohio. particularly in my home state of ohio. recently cincinnati, ohio, had 174 overdoses in six days. six days, 174 overdoses in one city. that's less than one week in one city, 174. it's unprecedented, at fleets our state. dr. zimarco has confirmed that it is the result of heroin being laced with other drugs. at least in many of these cases it's carfentanyl. so somebody is actually putting this large animal tranquil icer

into the heroin, mixing it, resulting in this huge spike in overdoses. i was glad to be helpful in providing a sample of carfentanyl for coroner simarco because she couldn't find it anywhere in the region easily. once she found it, we were able to get the comparison of the sample to what had happened and be able to confirm that carfentanyl was behind these huge increase in overdoses. our first responders deserve our praise because they were able to save the vast majority of these lives. so over-170 people overdosing, and yet sadly, tragically, although throrp four or five -- there were four or five people who died, the rest were saved. that's amazing, it's because they responded quickly. they responded professionally. last wednesday i went to fire

station 24 in sing sin be, ohio -- in cincinnati, ohio, which handled the largest number of these overdoses. they talked to me about how they saved lives. i thanked them of course for what they're doing every day. one thing they said to me is, senator, this isn't the answer. saving people by using narcan is necessary. it's absolutely necessary. but it's not the answer. i agree with them. thence is getting people into treatment, getting them back on track, getting them into longer-term recovery, rather than applying n.r.a. kang, again and again. this especially dependic is taking a tol toll -- this epidemic is taking a toll. it's also taking more of the time and resources. last year the number we have is that firefighters and other first responders applied narcan 16,000 times. -- in one state.

this year it will be far higher than that. by the way, this is why cara provides training for narcan, the comprehensive addiction and recovery act. it also provides more resources to our first responders. narcan is getting more expensive in part because there is an increased demand. we've got to be sure there is not any other reason why the expenses are going up. and we've got to provide the resources to our first responders so they can have these resources on hand. firefighters over ohio told me the same thing. i ask the same question everywhere i go. are you going on more fire runs or more overdose runs? the answer consistently everywhere i go is overdoses. more overdoses than fire runs. the scenes they encounter when they go on these runs are truly

heartbreaking. they see families torn apart. during that six period in cincinnati, they saved the lives of two parents who overdosed in front of their two teenage sons. last week in westchester township, ohio, police saved the lives of a father and son who overdosed on heroin together while the father was driving on interstate i-75. a few days later in forest park outside of cincinnati a girl found her grandmother who was baby-sitting her unconscious from an overdose. when police arrived to save her grandmother's life with narcan, the story from the police officer was the little girl asked one of the police officers to please hold her while her grandmother was unconscious on the floor. heart breaking. forest park police again responded to five other overdoses that same day including another overdose in the same apartment complex. this is a small town with a population of about 19,000 people.

two weeks ago the akron journal published a letter from a high school girl to her dad who was addicted to dad. she writes in part -- quote -- "when i found out you got arrested" this is to her dad from a high school girl. "when i found out you got arrested, dad, i was happy. i was going to finally be able to sleep at night without having to worry about whether i was going to get a call the next day telling me that heroin had finally taken you away. i know that being in prison isn't the best life, but at least you're alive. " she went on to say this is what heroin does. it possesses its victim and does not let go until he is dead. end quote. to that high school girl, what we hope is that her father goes through a drug court, get into treatment, get into longer-term recovery and reunite with his

family and get back to his life. we know that many of the drugs that are causing so many of these overdoses in ohio, the fentanyl, u-4 don't come from ohio. they don't come from any state in this body. they come from other countries. incidentally it doesn't mean that someday they couldn't come from this country but right now they are coming from other countries. we believe from all the information we have from law enforcement that the vast majority of these synthetic drugs are being made in labs. laboratories in china, in india, and shipped through the mail to our communities to meet this growing demand for drugs. so the traffickers actually get this poison, this synthetic drug, through the u.s. mail system. right now it's difficult to detect these packages coming from overseas before it's way too late. unlike private carriers like ups

or fedex or others, the postal service does not require electronic customs data for packages coming in to the country. so we don't know what's coming in. this makes dangerous packages containing drugs like fentanyl or carfentanyl or u-4 harder to stop. we have had issues here in the u.s. senate. in june the judiciary committee hearing held a hearing on synthetic drugs. a witness testified that because of this loophole of the postal service not requiring information but the private carriers requiring it getting these drugs into our communities was easier and that the drug traffickers used the mail system. to me it's a loophole. the homeland security on which i sit held hearings and a round table discussion on the flow of fentanyl and other synthetics into this country and we learned the same thing that there is a discrepancy between how the mail system handles it and how

private carriers handle it. today i've introduced legislation to address the threat of synthetic drugs by simply closing that loophole. simply saying that with regard to packages coming from overseas, the postal service should require advanced electronic data so we know what's in these packages. this would include information like who and where it's coming from, where it's going, and what's in it. as customs and border patrol, as the border protection people have told us, this information will provide a much better tool to law enforcement to help them ensure that dangerous drugs won't end up in the hands of drug traffickers who sell these dangerous drugs into our communities. it will make our streets safer and save lives by helping to prevent overdoses. i think it's a commonsense idea that builds on cara. while it addresses the demand

for drugs through education, treatment and recovery, this legislation will help to cut the supply of drugs, helping to cut off the flow of this poison into our communities. i think these two ideas go hand in hand. and if you're one of the 92 senators in this body out of 100 who voted for cara, i hope you'll support this legislation too. again our law enforcement and first responders are doing an amazing job. they're saving lives every single day and they are to be commended. but they need some help. they deserve our best efforts to stop these dangerous drugs from entering the country in the first place. by the way, so do the hundreds of thousands of families in ohio and around the country who have been affected by this epidemic of addiction. they deserve our help as well. they deserve a safer community. they deserve peace of mind. they deserve to know that we're doing all we can to try to keep these dangerous synthetic drugs out of our communities. i urge my colleagues on both

sides of the aisle just as i did with the cara legislation, to support this additional legislation. frankly, if three and a half years ago when we started putting together the cara legislation, this synthetic drug issue had been at the level it is today, i believe it would have been included in the cara legislation. but we're seeing now this epidemic growing. heroin and prescription drugs, yes, but increasingly synthetic drugs, as we've talked about this evening. it's time for us to be sure we're doing all that we can to keep this poison out of our communities. thank you, mr. president. i yield back my time. i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

wit quorum call:

mr. perdue: mr. president? the presiding officer: the senator from georgia. mr. perdue: skilled that the quorum call be vitiated. the presiding officer: without objection. mr. perdue: mr. president, i rise tonight -- i have listened to several floor speeches today, and i'm confused again. i don't understand it. here we are again with problems like the debt, the zika virus, funding our military, and yet we spend the majority of the day in this body talking about something that i think we've already decided on is not going to change this year, and that is the nomination -- potential nomination to the vacancy on the supreme court. i just think that, you know, i need to do this one more time. i've spoken on this before about my position, and i want to rise in support of senator grassley, the chairman of the senate judiciary committee. i just -- i think it's important

that i discuss again why i believe the senate should not hold hearings or schedule a vote on any security nominee until the american people have chosen who they want to be their next president. i would first like to address this issue of the senate's responsibility under the constitution with respect to judicial matters and judicial nominees particularly. according to article 2, section 2, the president has the power to nominate supreme court justices. nothing new there. we in this body have the power to either consent or withhold our consent from this nominee. as the minority leader himself has said when referring to the senate's constitutional responsibility to confirm president george w. bush's judicial nominee at the time sthaid -- and i quote -- "nowhere in that document, the constitution, does it say the senate has a duty to give president denying a vote." unquote. he then went tongue say, "the senate is not a rubber stamp for

the executive branch." there's also no provision in the constitution requiring the senate judiciary committee to hold hearings for a judicial nominee. in fact, the constitution in its provisions laying out the process for confirming judicial nominees were ratified 28 years before the senate judiciary committee even came into existence. therefore, it's clear to me that the senate's action in withholding consent from this nominee is entirely consistent with our rights and responsibilities as a coequal branch of government under the constitution. by choosing to withhold our consent in this case, we are doing our job. juniojust as we've saidawl lon s are laid out in the constitution. the argument that the lack of hearings for a supreme court nominee this year is somehow unprecedented -- that's just nonsense. in modern times, the opposite is actually true. the last time a supreme court vacancy arose in and a nominee

was confirmed in a presidential election was actually 1932. but the last time that this situation occurred where we have a divided government and you have a supreme court justice nominated and confirmed in that year was 1888. mr. president, a lot of water has gone under the bridge since then, and both sides have taken this position. furthermore, my colleagues across the aisle have consistently argued over the years that the senate should not act on the supreme court nomination during a presidential election year. the hypocrisy of this situationt amazing to me. it is what drives my friends and people back home absolutely mad. it was then senator biden, current vice president, who as chairman of the judiciary committee, said that president george h.w. bush should avoid a supreme court nomination until after the 1929 presidential -- 1992 presidential election. then senator biden went further.

he said that the president shouldn't even nominate someone. he made the same point that my colleagues and i are making today when he said -- quote -- "it is my view that if a supreme court justice resigns tomorrow or within the next several weeks or resigns at the end of the year, president bush should consider following the practice of a majority of his predecessors and not -- and not -- name a nominee until after the november election is completed." unquote. i don't know what else to say, mr. president. both sides have made this same argument that we're making today. -- in the past. finally you i believe the decision to not hold hearings for a supreme court nominee this year is a wise course of action in the midst of a presidential election. as i've said awl long, this is not the time that we want to have and the interject in this political process the disoition make a lifetime appointment to the supreme court, a decision that may tip the balance of this particular court.

as then-senator biden also said when discussing the potential of holding supreme court confirmation hearings against the backdrop of an election-year politics, he said this -- and i quote: "a process that is already in doubt in the minds of many will become distrusted by many. senate consideration is not fair to the president, the senate or to the nominee." agree that the confirmation of a lifetime appointee to our nation's highest court is far too important to become entangled in the partisan wrangling during a presidential election year. as a member of the judiciary committee, i'm, therefore, proud to stand with chairman grassley and my colleagues of the committee in saying that no supreme court nominee should be considered by the senate before the next president is sworn into office. i also believe that it shouldn't be taken up in a lame-duck. you can't have it both way, mr. president. with that, i yield the balance of my time and i have one other

topic that i would like to cover, mr. president, if i may. that the other conversation that we hear today is from back home, and that's about obamacare. we just spent several weeks back home working. i spent the last three weeks touring our state. i can tell you this. i get one question out of every group to which i speak: that is, what can be done about obamacare? my premiums are going up, my insurance was canceled. it said that i could have my doctor, i could keep my doctor if i wanted to. it said i could keep my insurance company if i wanted to. yet i lost my doctor and i'm losing my insurance. i really believe this is a very, very critical issue that we need to talk about. americans have never settled for failure, except right now people are saying that we need to accept obamacare, that it's the law. yet i'm telling you, it is collapsing under its own weight.

in four decades of business, i don't think i've ever seen anything as perverse as obamacare and the effect its having not only on our business community but on the people back home. we're still talking obamacare today, mr. president, because it's a complete disaster. it's failed the very people this president and the democrats in this body claimed to champion, the working men and women of america. it did nothing to go after overall cost and the spiraling nature of health care costs. which continue to explode. and are the number-one driver of the fact that in the next ten years, unless we doin do someth, this president has a budget that will add $10 trillion more to our current debt. it did nothing at all to deal with the number of doctors in this country. it inserted government between patients and their doctors, create add shortage of doctors. right now we're averaging around 10,000 -- we're losing about 10,000 doctors a year, mr. president, under obamacare. in fact, projections show a doctor shortage in the next ten

years could top 90,000 doctors. that's staggering. it raises taxes. it increases premiums. and it choked out our choices. not only that but deductibles are up dramatically. in my home st -- in my home state of georgia, united health care and significant in -- and cigna are leaving obamacare. last month aetna announced it was joining them. mr. president, at the start of this year, this is an astounding number -- we have a lot of counties in georgia, 159. in all of these -- i'm sorry. at the start of this year, all 159 counties had at least two carriers to depend on. now, this is just after nine months, only 96 of the 159 counties in georgia have one option. 96 of 159 only have one option. georgians are being charged of

health care choices and being robbed of higher premium and deductible costs. premiums have risen in georgia by an average of 53%. blue cross-blue shield, 21%. allyiant, 21%. ambetter, 13.7%. kaiser 18%. harkin health 51%. humana 67%. in 2009 president obama railed against fewer choices while selling obamacare, he said -- and i quote -- "in 34 states, 75% of the insurance market is controlled by five or fewer companies. and without competition, the price of insurance goes up and quality goes down." unquote. well, gee, it sounds like he knew what was coming, except he was complaining about that at the time, and today it's gotten worse. that's exactly what's happening in georgia because of obamacare.

and these problems are not limited to just georgia, mr. president. aetna is leaving ten other states as we speak. today 31% of all counties nationwide compromising almost 2.5 million americans enrolled in obamacare exchanges are more likely than not to have just one provider. that's what the president was complaining about in 2009. insurance companies across the country are facing hundreds of millions in losses. it means fewer choices and higher costs for patients. the g.a.o. recently reported that the pre-obamacare plans available in most states were more be affordable and had lower deductibles than the options available in obamacare exchanges now. profound. nationally premiums have risen by an average of 26%. deductibles have risen for individuals with an average income more than 60% than when obamacare became law. premiums are up 26. deductibles are up over 60. there is no way around it,

mr. president. obamacare is a washington takeover of our health care system that isn't working for average americans. when they were talking about this back in the day, my comment all along was how do you feel about obamacare? i said if you like the way the v.a. is being run, you're going to love obamacare. those words are coming true today. it's collapsing under its own weight and its failing the very people that the other side claims to champion: the working poor and the working middle class of our country who are bearing the burden of this nonsense. monopolies are festering and prices have skyrocketed. as i said, obamacare is yet another example of liberal policies failing the very people they claim to champion. the diagnosis is in. none of these problems are going away. that's our problem. in fact, they're getting worse. obamacare cannot be allowed to stand. this is not a question of tweaking it around the edges. it's profoundly, profoundly built incorrectly. we have to reveal the individual

and core minutes and pass an alternative that -- core mandates and pass an alternative that goes after spiraling health care costs. instead we should offer transportability, insurability and accessability, all the things that were missing prior to obamacare but have been proposed fixes have been in for over ten years on the republican side. accessibility is one of the main things to those who want to purchase coverage without mandating it. this would ensure no one is priced out of the market including those with preexisting conditions. we should offer more access to health savings accounts to help drive down costs and allow for the purchase of insurance across state lines to increase competition. and finally, mr. president, we've got to address the frivolous lawsuits that force some doctors to practice defensive medicine out of fear of being sued. all these steps are within our grasp, so don't believe those who say there isn't an obamacare alternative out there.

my friend and georgia representative tom price has championed house bill 2300, the empowering patients first act, for years. it contains all the solutions i just mentioned and more. and i'm proud to cosponsor that with john mccain in the senate. our health care system is too important for too many americans and too many to settle for this failure. i wasn't sent to the united states senate to settle for the status quo, and i want to say one thing in closing, mr. president. in the last eight years we've been told over and over again that the status quo is the new normal. this is one where the american people are telling me and telling you that they're not accepting this new norm. thank you, mr. president. i yield my time and i note the absence of a combowrm. the presiding officer: the clerk will call the roll. quorum call:

mr. perdue: mr. president?

the presiding officer: the senator from georgia. mr. perdue: i understand there are two bills at the desk and i ask for their first reading en bloc. the presiding officer: the clerk will read the dietle of the bills for the first times. the clerk: s. 3296, a bill to amend the internal revenue code of 1986 to provide an exemption to the individual mandate to maintain health coverage for individuals residing in counties with fewer than two health insurance issuers offering plans on an exchange. s. 3297, a bill to amend the internal revenue code of 1986 to provide an exemption to the individual mandate to maintain health coverage for certain individuals whose premium has increased by more than 10% and for other purposes. mr. perdue: i now ask for a second reading and i object to my own request all en bloc. the presiding officer: objection is heard. the bills will be read for the second time on the next legislative day. mr. perdue: mr. president, i ask unanimous consent that when the senate completes its

business today it adjourn until 9:30 a.m., thursday, september . following the prayer and pledge, the senate observe a moment of silence in remembrance of the lives lost in the attacks of september 11, 2001. further, that the morning hour be deemed expired, the journal of proceedings be approved to date and the time of the two leaders be reserved for their use later in the day. finally, that following leader remarks the senate resume consideration of senate bill 2848. the presiding officer: without objection. mr. perdue: if there is no further business to come before the senate i ask that it stand adjourned under the previous order. the presiding officer: the senate stands adjourned until senate stands adjourned until

the current standing keeping the government open until the end of the month. inning without congressional action by september 30, the government will shut down. on capitol hill, democratic vice president nominee tim kaine attended the lunch meeting. that is senator mccain's first since becoming hillary clinton's running mate. chris murphy posted this photo on snap to. senator mccain at the meeting. also c-span capitol hill producer craig kaplan tweets that senate minority leader harry reid said when the vice presidential nominee returned to meet with the senate a tear or two was shed. >> he is described as hillary clinton's invisible guiding hand hand, a a statistician between her most important strategic

decision. he is joining us from new york city. thank you for being with us. >> thank you for having on. who is eli kriegel and how did you come across this gentleman? >> he is hillary clinton's director of analytics and while that is sort of a strange sounding title, it really does put him at the epicenter for the campaign because she is running a data-driven campaign. he is the guy in charge of the data, not just parsing voter data, but television watching data, e-mail open read data, volunteer frequency data, how often you are volunteering for the campaign, all manner of data and he is the guy in charge of it. it's interesting looking at the clinton campaign and how they are preparing for this option. the the trump campaign is not engaged in this. he ran through the general

primaries on his gut instinct but this is quite different. the trump campaign is hardly doing anything at all at least comparatively. >> let me take that one step further. you say he is precise and efficient, meticulous and effective and like hillary clinton, more mathematical been inspirational. >> yes, watching how the role says a lot about how hillary clinton is running for president the way she defeated bernie sanders step-by-step, state-by-state, delegated, it's the real story that it's an algorithm that they created basically and ran her entire television act by which makes him one of the most important people in determining where her cash went. almost every single dollar after those early states was determined by his logarithm.

that wasn't looking for who has the most viewers are what's the cheapest show, it was looking for who's the most viewers in a congressional district where hillary clinton would be predicted to be at a threshold near where they would flip the district to give her an extra delegate. a really complicated delegation. one of the viewing habits of those voters and then to be able to say, we are going to invest $1.2 million which is what they did while bernie sanders invested zero, not because. [inaudible] they wrist a ton of money in small markets because they thought that was going to flip delegates in their favor. at the end of the day that's how they beat bernie sanders. they won more delegates than all of these states won. >> one of the issues that arose, they could not match the analytics, it was put in place, where does that put the

democratic party generally speaking hillary clinton specifically in 2016 and conversely, conversely, where does that put the republicans? >> the democrats are forehead, most of the responses i have gotten today have been democrats more despondent about the state of affairs. he is not investing in the operations. it's not just impacting this year but he was elevated to become the director. the trump campaign doesn't have a deputy or director, they have hired a consultant firm that works with ted cruz in the primary so they're doing something but very little comparatively. >> one of my favorite quotes in the story was by a guy named zach moffat who was the director and mitt romney's campaign. he was telling me that whoever emerged was going to be completely handicapped compared

to hillary clinton and he said the discussion he had when they got out of the primary and they were so far behind they couldn't catch up. his quote was you can't have a baby in three months, that's that's just reality of life, i've tried. >> let me ask about the issue of analytics and data. how important is that to a campaign? you point out your story donald trump is calling it overrated. just what can it do in a national general election donald trump and hillary clinton are on the news and cable channels almost 247? >> the closer the race the more it matters. have a presidential campaign or any senate race is decided by ten points or even eight percentage points they have a better data operation. what it does make a difference in is a close race like the iowa caucuses were ted cruz had a better data operation than

donald trump was able to win despite trailing in most of the polls heading into the race. if you can identify your voters, know what to say to them to motivate them, identify the swing voters and motivate them and get all those folks out to the polls, you can move a couple of points but that's of campaigns are doing it. really it's mostly the trump campaign and not the clinton campaigns. in the closest races those make all the difference in the world. we learned that eli kriegel has a corner office that oversees two views of brooklyn and new york city, what else did you learn about him and what he brings to the clinton campaign? >> one of my favorite elements on that corner office, on those windows he has scribblings in marker almost like the beautiful mind scene where he starts crafting the equation to run some of their logarithms.

that's one thing and another interesting thing about him, the campaign manager is usually data-driven. they were very close and work together on the governor's race in 2013, he's an unlikely people to be a senior clinton advisor. ten years ago he was a producer for fox news bill o'reilly sort of at the peak of his anti- clinton fervor, he was an antagonist and that was his first job related to politics for bill o'reilly of all people. it's pretty fascinating. he went back to school and study to statistics. >> at politico.com, hillary clinton's guiding hand and his work available online. he's joining us from new york.

thank you very much for being with us. >> thank you. >> coming up thursday morning we will hear from majority and minority leaders in the workforce committee and the top issues on education that they're focused on. we will hear first from congressman bobby scott from virginia and joe courtney of connecticut. watch c-span "washington journal" live beginning at seven eastern thursday morning.esentai join the discussion. >> our first guest of the morning is joining us and that's the secretary of veteran affairs department, mr. secretary, welcome. >> it's great to be here. the hearing today, what does it deal with?h? >> it deals with something

called the commission on care. this is something that was part of the choice act which the fall of 2014 when congress asked the va to carve out over $60 million of our budget in order to pay a group of consultants money to study what should be done at the va. this committee had commissioners appointed by members of congress and the president and they metom over a period of time. we met with them and they came up with 18 recommendations and of the 18, we said we agree wit1 15 of the 18 and in fact we said 12 of the 15 are already underway or already completed.er for us, the commission and their findings reinforces what we areh trying to do with our my va transformation in transforming the work of the va to better care for veterans. >> one of the points of the commission, although care delivered by the va is comparable or better to the care

available to the private sector, the facility can be compromised by problems and poorly functioning operations and processes. how would you respond to that. >> the biggest issue when i came to the va was not consistency.th you had some with outstanding service and some that were leaders in technology, as an example and you had others that had never heard of lean and so what were trying to do is defuse best practices across, just like any good business would do. i came from the private sector.d i was 33 years with procter & gamble and i was the chairman and ceo of that company for my last few years. we are diffusing best practicess across the enterprise in order o to make sure we raise the level of care for all veterans. >> one of the concerns about the commission and before that, even for members of congress was the wait time for a veteran to get care. tell what was it, before you

started? >> we did have wait time problems and most of it was in phoenix where we had a long line of individuals waiting for care. we had weightless and what we have done is we have added the capacity, we have had more than 4 million more completed appointments, we've added 1200 new doctors and 2300 nurses and we've expanded clinical hours. we've done more telehealth, we have about 700,000 veterans involved in something called telehealth which is providing healthcare to them in their homes so we've done a lot of things in order to expand care. we need to do more because as we are improving care, more veterans veterans are coming to us for care. there are no co-pays generally o with the va system. if you have a choice which the majority of veterans do, 70% of

majorities have a choice between medicare, medicaid, private insurance, let's say you want to get your knee replaced and that's a 25000-dollar operation. co-pay might be 25%. if. if you do it at the va it's free. as worm proving care more comin here. that's why it's so critical that we get the congress to pass a budget for this year so we can continue to increase our capability. it's also it's critical that 2 congress authorized the 24 new leases we have waiting to be authorized. they have already been funded. these already been funded but they've not been authorized by a our authorization committees. we need those to be funded so we can open up those new spaces and provide better care. >> this deals. [inaudible] >> i've not been invited to testify. it's kind of unusual to have a

hearing determining the future of a department but the secretary has not been asked to testify. also, the invitation that was given to the american legion ant many other veteran service organization was rebuffed. >> why do you think that his? >> i have no idea other than i provided written testimony. as i said, a lot of what they came up with is consistent with what we are doing as part of our my va transformation. it's very simple. when i joined, i had been on over 300 different trips too different facilities to learn what i need to do, do, to talk to members of congress and veterans and veterans service organizations. the plan we put together is not my plan. it's the veterans plan. if the plan that the veterans and members of congress help me put together. i'm trying to execute it. i'm putting in place new leadership, 14 of my 17 top leaders are new.

many of them with private sector experience. i put together next journalthe advisory committee and the former ceo of the usaa, connie who is the former doctor to the president, former surgeon general in vietnam, they they are advising me on this transformation because i need help transforming this organization and we are in the and t of doing that. >> if you want to ask questions of our guests, we've invited those to call and ask questions. you're also invited to post questions to our twitter feedess and also on our facebook page@facebook.com sass facebook.com facebook.com/cspan. does transformation in your mind

>> we been doing that, about 22% of our appointments today, ever day are in the private sector. the ability to do that 4 million more appointments did rely on using private sector capability. we don't give up responsibility for them going out to the private sector, but that was part of the choice act.ce act fr even before that we were using the private sector but the choice act formalized that in a particular bill. >> does the report cite any case for more reliance on the private-sector? >> it was very clear on something we agree wholeheartedly and so does thee present. we need to set up a broad network, and integrated network of both private-sector medical capabilities for veterans.

we don't think we should have up responsibility for taking care of the primary care nature of the veterans needs, but we should continue to use the private sector. the commission did not go as far as to say they wanted to privatize the va. there have been some political ideologues that suggest differently and i think that's a bad idea and veterans think that's a bad idea. generally it's not a veteran suggesting it. i'm am of veteran print i went to -- the va is important to all americans.eakthrou the va has done research that has resulted in breakthrough in medicine. the implantable pace maker, the first liver transplant, kidney

transplant, take an aspirin a day to ward off heart disease. i haven't even gotten into more recent things and things that would be were related. in the last few months we did a study with a titanium rod in the femur and snapped the prostatic device on. one of the veterans i had a chance to meet after the operation told me a week or so after the operation he could feel the grout cracks in the tile of his shower with his prostatic leg. he also said he improved his golf score by 15-point so he was quite pleased. these are the kind of breakthrough operations we are having. this operation is not yet fda approved but we are in the process of getting fda approved. >> one more question for you before we go, one of the recommendations was the establishment of a board of directors that would be

accountable to the president and responsible overall for the system. is that something you agree with? >> i think that's a bad idea. i come from the business standpoint. we need more bureaucracy. we have a board of directors. cs in the president's 2017 budget,o we gave congress 100 pieces of legislation that we need. forty are new this year. they are simple things, thingsd both sides of the aisle agree on. we simply need to get more aggressive. we need them to pass a budget. o we don't have a budget yet. i told you we have leases remaining from fiscal year 2015 that we need authorized.d. we have simple laws, things like an appeals backlog. right now we have over 500,000 appeals waiting to be adjudicated. that's way too many and it takes too long. rather than throwing more people with more money at it, we've brought other service organizations to devise a new law. we created a new law and it's

ready to go and we've had hearings in both the house and the senate, we simply have to get it passed. to the senate's credit, they have put together a bill called the veterans first act and it went out of our committee unanimously in fact both sides of the aisle hold a press conference to praise each other for bringing up.p. we can't get it to get voted on. it's time to not have veterans be political ponds. it's time, rather than sayingnd thank you for our service, let's actually do something that allows us to transform the vae and look back on 2016 as the year that we really turn the corner for veteran. >> we have calls lined up for you. the first one is mike from minnesota. he is retired and you are on with robert mcdonald, go on. >> good morning gentlemen, i'm going to the va today. i think one of the worst things

we could do is privatize the va system. i've had several surgeries and i prefer the healthcare i get there. i would rather use the minneapolis va rather than the mayo clinic's. they do an excellent job. i would hate to see a privatized. >> thank you so much for your comments. whenever somebody approaches me and says they like us to privatize the va, i asked them three questions, number one are you a veteran, generally they are not and certainly not a disabled veteran, number two have you talked to veteran, and generally they have not, their thoughts comes from politicalts ideology and number three you have any interest in a private healthcare system that would benefit if the va was privatized and as you may recall they called out the fact that many of

the commissioners on the commission for care actually ha: interest but they did not stay privatized. >> from north carolina, diana's next. good morning. >> caller: good good morning, thank you for taking my call. my husband is a retired vet and he has just recently become disabled. he had been for a while but finally got in the process and now has been declared. my concern is with the education benefit.ns we have three sons, two in college and after going through all the process thing going through everything, we were awarded the benefit just to discover two days later that he was not able to use it merely because he was disabled.me it felt in a bad way that my son, whose father had given so

much for his country not to be able to use the benefit because he's in and intellectually developed program called young academics that the federal government just recently is accepting and offering pell grant but the va process is not caught up with that and therefore it's on the list not to receive funds. this is a four-year certification of the university at greensboro and i want to know what do i need to do in order to get them on academics to give them an opportunity for the war veteran, bronze star medalist the funds he needs to go to college? >> that's a great question. e i have a lot of empathy for your statement. many of the limitations that we have on the benefits we grant are baked into the law so what we need to do is go back to the law and see what changes we need

in the law to be able to see if we can get that change. please e-mail me at bob.mcdonald@va.gov so we can look into your case personally and see if we can help. >> host: of you are asked how in your opinion could the va become better at taking advantage of the technological innovations to provide better service and support for veteran. >> guest: one of the things we're doing is we have over 40 apps for smart phones and many of our veterans are finding these apps very helpful.l. for example, we have an app that helps for post medic stress treatment. these are things were trying to do. one of the things i did, knowing that if you're going to transform an organization, you need to eat or ship, i said earlier, i changed 14 of our 17 top leaders. one of the leaders abroad and was brought in with the new head of it who has been the head of it at johnson & johnson and

dell, her name is laverne and she's excellent and has transformed our it organization. systems is a big big problem at the va. our scheduling system was a problem in phoenix. our financial management system by which we manage what we are given by congress is written by cobol from 1971. we are changing all of these things. technology is a big part going forward. i mention telehealth. we deal with over 700,000 veterans in telehealth. telehealth is the way to the future in american medicine. as i said earlier we've always been on the cutting edge of american medicine and i think we need to continue that. >> how do you stay competitive with the private sector when it comes to facilities and people with technological innovations and procedures and updating those procedures? how do you factor that into your

budget?ar on in >> we spend about $1.8 $.8 billion a year on innovatioh and that's a big part of what we do. i've talked about the operation, but a big part of it is the relationship that we have with the best medical schools in the country. when omar bradley was the head of the va in 1946, he set up a system of affiliation where many of our va hospitals are right next to the very best medical schools in the hospital in the country. if you go to north carolina our va va facilities across the street from duke university medical school.we share we share doctors, we share hundreds of doctors at duke. we share over 300 doctors with the university of utah where we do this osteogenic ration operation. >> we are getting the very best doctors in the country who are doing the research, who are teaching because we train 70% of the the doctors in the country. again if you talk about

privatization, who's going to train them, we train 70% of them. the great news for our veterans as they get doctors who have to teach it every day and have to do it. >> robert mcdonald is joining us >> good morning everyone.ivatiz privatization is killing us. privatization is killing us, but the private sector cannot take care of us veterans. the cost is high. now as you have been, you have come from cincinnati and you know the dayton area real good. >> one of the issues that we need help recruiting doctors, dentists, nurses, nurses. one of the things i did as i

started going to medical schools to recruit doctors. i've been to over 24 medical schools to recruit doctors and nurses. in doing that, what i discovered was was we are not competitive with the private sector we work with congress to make sure all of our medical personnel is title 38 instead of title 35.in i also looked at this salary band and i increase the increase the salary band so they would be competitive. we also worked to double our loan reimbursement. this was done in 2014. these are the things that we are trying to do to be able to recruit more doctors and nurses. i must tell you, we are being successful. one of the things obviously that's holding us back is the

way sometimes our doctors and nurses get treated, they don't necessarily like the politics of working in the va. >> dave, your next. >> good morning mr. sec. >> i have a couple of questionst i was wondering if you everthe thought about turning all the bureaucrats in the va into auditors and have the auditors audit them for two years. my second question was, have you ever thought about getting the watson program from ibm to help with diagnosing and treating patients? >> thank you.yees on the first question of bureaucrats, the percentage of employees in washington d.c. head office is lower than it was in the past. one of the things we are working on is putting more more people

in charge of care of veterans. we have an outstanding inspector general and he's doing a great job auditing us. we also get a lot of help from the gao who audits us, we have lots of overseers.at we do have a partnership with ibm and were working with ibm and watson and where the computing power of watson shows tremendous capability in something we call our million vets project, this is something where were leading research not just in the united states but in the world. we have over 550,000 veterans who have given us their blood samples including my own, we have 22 years of medical history, we are mapping their genome and through that mapping of the genome, we are going to

be in the position where we can predict future potential diseases and solve them before they become a problem. if i can share one story, i was with a lady who unfortunately we had a hysterectomy because she had cancer of the uterus. then through mapping her genome, we discovered that she was susceptible to colon cancer. we've increased the frequency of her colonoscopies and discovered precancerous polyps and we been able to remove them. literally she was on stage with me at the white house and we were talking about the cancer moonshot which the vice president is leading and he said the va saved my life in this new technology has saved my life, we need new computing power for that. partner with the department. >> let's hear from anthony in north carolina. good morning.

>> good morning. i had a unique question, i'm a veteran with an honorable discharge and i've arty been seen at the va because basically the situation as they determine or their beginning to determine that was was considered abrupt and stupid behavior on my part from when i was 17 was actually the start of schizophrenia which i am now dealing with now. the va website states that anybody with anything other thae a dishonorable can actually get va care, but whenever i go there, they give me trouble at every end, even though i'm still being seen, i'm just waiting for them to determine if i'm considered honorable for va purposes and i wanted to get your take on the whole issue of people with honorable discharges. >> thank you. that's a great question. other than honorable is a

relatively large category and it's a very diverse category of discharges. there's not one answer so we need to get in to your situation, your individual situation. e-mail me at bob mcdonnell the va.gov and work take a look at it. we are currently working withinn va in order to be clear on the regulations. we are going as far as we can based on the law because the law is what prohibits us from dealing with dishonorable discharges. we need to make sure we can do as much as we can for veterans like yourself. ultimately what we like to suggest as well is that you should apply to the department of defense to have your discharge reviewed because back in the day when i was captain in the army, many of the times people may have had something like posttraumatic stress and bipolar conditions, it's a for any of that we know something about today that we didn't know di

then and you may be able to get your discharge changed. we would be happy to work with you on that. >> host: this is tracy from facebook who asked what's being done to rectify rectify the overprescribing of pain medications. >> tracy, we have a state-of-the-art program that i would actually say were some experts in the medical field would say were actually leading the country because we actually track the dispensing of opiates, we track it by dr., by facility, we track it on a national basis, faci and the trend is down and that's good. what we are finding is alternative methods of treatment are as effective if not more effective than opiates and we are using them. things like acupuncture, we are the largest user of acupuncture in the country. chiropractic, equine therapy, using animals, yoga has been

shown to be effective. what we are trying to do is develop a library of database evidence that shows that these other treatments are effective and basically we will try whatever treatment the veteran requires unable to find something to get them off of opiates. >> here is a retired that from jefferson city. >> i'm not a retired vet, but in 1975 i got an honorable discharge but 1973 i buried agent. [inaudible] because i do not go to south vietnam they are refusing to label me with it and i've had major heart attacks in diabetes and cancer. my primary doctor put a request for years ago for a testing ofot agent orange and they did not

give it to me. >> again, email me and let me know because one of the things we have to do is we had to go back to the department ofthe prt defense and get the proof that agent orange was used at your facility. once we have that, we are able to help you, but the department of defense holds the information on where agent orange was used and not used. >> go ahead caller. >> caller: i have two quick questions. >> were listening mark, go ahead >> they use to pay veterans to go to facilities and when you got there, after you saw yourr s doctor, now they've changed it to where you get paid the following month and a check, but a lot of people can't or don't

want to ride the bus and it's really hard on the individual to come up with that individual money to go down there. i don't know why they changed it. the other thing, as far as opiates, i agree they were overprescribed at one time, but they don't drop that person 40 milligrams all at one time and it was a shock to me and it took me six to eight months just to get over that, and they still won't completely get me off opiates. i'm a 63-year-old disabled veteran, and i don't think that's reasonable. : on transportation, transportation is a big issue for our veterans.

work withrd, we disabled american veterans to provide transportation. we are working on finding ways to make sure people have available transportation to get to their facilities. , if you arees unhappy with the care you are getting from your provider, please raise the issue within your facility. >> and that is terribly important this is paul working in the v.a. system. >> caller: i work with

housekeeping and one of the problems we have almost every night about 34 rooms are clean and sterilized and we are understaffed pot cal't ce in under fmla and i'm natalie doing my job i am doing somebody else's job. is somebody drops something on the floor they looked at us like the underbelly petro stefan the comeback on the floor and we constantly havemi to cleanup behind them and a lot of times last night i was doing isolation. for so then we have to suit

up to clean that up so when can they get people to come to work consistently sought, to do my job and somebody else's? that is almost every night. >> guest: thank you for your service to veterans. i think housekeepers are heros add-on notify met him when i was there i was in milwaukee recently but, they are heros and that prevent infectious diseases from being transmitted throughh the hospital's.v.a. v.a. as one of the best records in the country for lack of infectious disease going to the hospital. these housekeepers make sure things like ebola and hiv and that they don't transfer it sounds like there is a personnel or discipline problem and i will look into

that when i get back. employees need to come to work. >> but that has prompted a letter sent from the house barons affairs committee that said in part, those that call the scandal there removed, said of properly hold them accountable they simply make excuses for their misbehavior. >> since i have been secretary about two years we have terminated 3,755 people if you talk to an individual or the v.a. employee and a gust dead georgia who is currently facing off five years in jail and hundreds of thousands of dollars of fines to manipulate records records, i think you would see we are holding people accountable. of course, when you change

the culture you have to hold people accountable. one of the first things i did was ask everyone to retrain and recertified on the mission of the organization we do this every year i was criticized by some members of congress in fact, by one member, on the floor for spending money on training you cannot transforming organization unless you train them. we spent time on a program called lieder developing leader and then we cascade that brought the organization. you have to train people to want a new culture. >> is that part of reasoning not haviave a local board and in part to that was put into place with that undercut your job quick. >> anything get would lead am part of the way the boards was recommended or our

lawyers suggest we be unconstitutional because someone would be in the way of the three branches of government. i don't think we need morere oversight but we need everybody to do their job. i have been the ceo of a large corporation avoided the most admired companies in the country or the world in making the transformation happen now but everybody has to do their job. i talk about i need multiple pieces of legislation. i need a budget is almost october 1st and we have no budget yet. everybody hasted do their job congress has a big role of accountability as well to get the bills passed too allow us to transform the organization. >> that hearing takes place today dealing with the possibility of looking in subpoenas and of the purchases made by the v.a.

in colorado. what is the interest and how do respond quite. >> many of these have been before i became secretary. but we have done investigations on all of them and in cases of the art work we discovered there was no centralized policy as soon as we discovered one facility had gone further than wanted to purchase outt artwork. >>, etch quick. >> it depends what number that you use that would get to the subpoena part. we could not place a policy to stop it. the reason for the subpoena we provided the information to the committee that they ask for which was the cost of the artwork. they were not happy with the answer we provided the

number was lower than what they quoted publicly it was a budget line item that included furniture so we are clarifying that so they understand how much was spent. in the meantime we put in place a policy to limit the amount of money spent on artwork however art therapy is a way to deal with post-traumatic stress and hospitals will find art although we get that cheaper but it is a part of that. often times it will make masks as part of their therapy to deal with the experiences they have in the past. the other potential subpoena is building on the denver hospital.a the organization did make mistakes to build the denver medical complex it is large over one dozen buildings as a result there were cost

overruns and in my opinion were built in to the designed there was going to be a problem. we have done an investigation as to created i those mistakes to make sure we discipline those. if they were enroute to be disciplined chose to leave government service beforein the discipline became activenedr based on the letter we turn over the investigation. what we have not done, is turned over the verbatim civil the interviews nor have we published themem publicly. i need to hold people accountable i need to have the ability to do the investigations the vice start turning over to congressional committees all verbatim transcripts of every interview we do that will chill my ability to do investigations because oftentimes these are used for political reasons and

that would chill the ability to do these investigations. >> so would you not testifying to do you ever have the conversation about not testifying quick. >> know i have not. chairman miller have each other cellphone number and i called him and he calls me.call. i went to the house and the senate many months ago, maybe january or february and said instead of a holding a hearing about what occurred four years ago i cannot do anything.re. let's hold the hearing onle the future to talk about the transformation i will talk to you about how we will provide same day care and access for veterans by the end of december if you pass the legislation we need. i will tell you how we will

improve veteran trust with the v.a. and compensation pension exam if you pass the legislation. the senate held the hearing it was a great hearing it can the veteran's first act bipartisan but i have never gotten that hearing in the house of never had a hearing in the house focusing on the future transformation. i have not been invited and also the service organizations have not been invited. >> georgann go-ahead. >> caller: i am retired army. good morning.great job. you we're doing a great job it takes time but thank you so much. i applied for compensation of pension july of last year. i have been unable to work and blast two years and i cannot seem to give any information on my claim.

no information from the v.a. on my claim.bu my second question is on the choice program west sent out for the choice program but the information doesn't get to the v.a. by have sleep apnea i have been to the sleep clinic but the word doesn't get back so i can get the machine. thanks for your service. >> please e-mail me we will look get your individual situation one for the exam and the choice program. one the choice program was passed fall 2014 we were required to set up a national program to provide care to veterans in 90 days. obviously the law was put together so quickly it was an emergency and we in the stand that and there are things wrong with that but we have changed it so now we

make it driving distance and- that should have doubled theou number of veterans available . we have done a lot of things to try a to improve it working with third-party administrators.months ago but couple of months ago we had a couple hundred thousand authorizations' through the choice program and it is continuing to ramp up.o get but we have to get betterth between the handoff between the v.a. and private sector and back we used to require the medical records to comeback from the private sector provider before we would pay the bill balata veterans are going into debt with that and as a result we have given that up is no longer requirement people are paid that is an improvement but the standoff is important.

as anybody knows the handoff and from dr. to dr. is very important. >> good morning. i am just calling with a very simple question. my husband was in the service during that korean war in his impression of eligibility would be only if one ever was wrong with him was combat or service related. now i can't believe all of these people who were using the veteran system r combat or service related. lot of them have one regular problems. what is the story quick. >> is a little more complicated than that. i would suggest first of all go to the website if you don't get an answer there

because the eligibility criteria are there thenel please e-mail or call and we will answer your question directly. your husband service in korea is a lot more complicated if he didn't have a disability that came out of that service its passenger with in, and other things as well but let's deal with your case offline and we will get you whatho your husband has earned. >> washington good morning. >> caller: good morning mr. secretary. 100 percent disabled veteran but i haven't worked since the end of 2012 several times i have made appeals inue the issue is total and

permanent pricing could v.a. was doing a wonderful job for me. but the issue is m i expected even if i do get better, which i have, will i get better to the point where i can go back into employment but still struggle with the issues being around people. is compensation and pension brought up by the medical side to make a determination because to be honest i do need to improve my in, and i did try to apply for social security disability and i am disabled. >> the caller dropped. >> this is an exam badges veterans first palm

introduction to the v.a. the exam that the doctor goes through with the patient to determine their degree of disability. one of the first things i did is i went iran -- aroundnd attending the exams with the patient's permission but this is something we have to fix. we brought in some experts of human centered design which is what good customer service companies use to design a delightful experience we redesign the process it is now in the field being expanded and so we are hoping his experience will be improved upon in the future but it is a very important part of the process to make sure we are demonstrating empathy to the veteran during that exam and the conclusion the veteran and v.a. agree upon. >> florida. >> caller: good morning.

i of service connected to afghanistan and iraq but first of all, but what i have noticed that v.a. changed into a health care system would think was mandated by congress during the afghanistan deployment so that might be part of the system that is how clogging it up is no way health care system also i want to say that are you aware of the toxic water issue in camp lejeune that national guard have been exposed to 1953 through '87 if they attended annual training and how you could make this a where to the guardsman better out there? >> i am very familiar with that i have been working hard center have becomee

secretary i have taken a look at all of the up problematic issues that haveim been around for some time. for example, c. 123 those used in vietnam's dropping agent orange we have been able to make a new rule of regulation that allows those crews to get care. also with camp lejeune those that serve there are able to get medical care through the v.a. that is part of the law also should there be presumptive conditions and we're hoping to have some news on that in the next few weeks. >> georgia retired last call >> caller: yes secretary i give you kudos' you came into a mass and you are working through it.

with that travel scandal with employees transferringild each other to build the system of money so how do they maintain positions of any influence cannot be sent somewhere else? sanders standard is hard too fire a federal employee but if they inflate numbers and, take bonuses they don't deserve our you not sitting and a rubber room like any york teachers association? >> talking about a situation in philadelphia. we proposed a punishment and mary system protection board overturned that punishment we can back with a different punishment.legislation the legislation i talked about will solve this situation. it would allow us to take a

number of employees, a large number, and move them into title 38 which would allow us, not all employees, but those that would allow us to have an appeal process rather going to the mayor is system protection board and. we think that is the appropriate process those working in a medical facility. never the less we will continue to hold people accountable and suggest thesh punishments we think are appropriate. we have terminated 3,755 people and will do what it takes to create a culture of a high performing organizations. >> howdy and other specifics to say you made the changes necessary from what was suffered previously? >> the word of the veterans

more are coming into the system and that is good 21 million roughly a 9 million is the health care system we want more to come but we also measure veteran satisfaction and trust and satisfaction and happiness with the wait times. right now primary care is about five days on average nationally mental-health care is to wirth three days. we measure satisfaction and that is how we know. >> veteran affairs secretary >> it has been fun to be with you this morning obamacare reality.

and what is the reality today? the reality is that obamacare is the reality is that obamacare is >> the reality is obama care is unraveling had a rapid

rate without structural changes there may be entireto states with no insurer willing to sell plans under the atomic care changes in 2018. we're talking 10.8 million americans who buy health insurance for themselves or their families created in each state with the law passed in 2010. we say there are whole states with 10.8 million americans who have no options to purchase health care. this unraveling happen sooner than anyone thought the it is a short-term and long-term. if we don't take action in the short term many americans will have fewer options with the skyrocketing premium cost. if we don't take action to address the of longer-term structure, we could have a

complete collapse of the insurance market. that and what we need is you may be living in a state where you cannot buy health insurance if you rely on the obama care subsidy. the reality today is alarming even for those of us is critical through thousands of pages of regulations even before it became more republicans warned the president and democrats that obama care was bad news. february 2010, more than six years ago bespoke republicans at a white house summit on health care and warned the president of premiums for millions of americans individual insurance would rise under his proposal. i was right to. republicans warned it would

increase the cost of health care and people would lose their choice of doctors. policies canceled. w people would lose jobs. taxes would go up and medicare beneficiaries.da we were right about all that. today and alarming number of insurance companies are leaving the obama exchanges. forced to pay much more in premiums this might be what republicans predicted and it is happening to the even faster than we imagined and nobody is happy about being right. unfortunately i don't need to look any further than the home state of tennessee took see how bad they have become on august 24 and read the front-page of our newspaper they saw the headline very near collapse wasn't about a

bridge or a dictatorship it was our state insurance commissioner and her description of the atomic care exchange in tennessee that wanted to hundred 30,000 members that would buy health plans last yearmean t was very near collapse mean? this november when tennessee is setting up the 2017 plans there will be fewer plans to choose from, much more expensive. that's what it means and this is the same across the country. next year tennessee residents will pay intolerable increases on average between 44 and 62% more than deal bombing care plan than they paid last year. even for a healthy 40 year-old nonsmoking with the

list plan premiums increased last year to under $60 a month next year $333 a monthicye . if you are the policy holder don't pay that then the taxpayer will because a large portion of the obama care premiums are subsidized with tax dollars it is no valid excuse to say just because taxpayers pay the bill that justifies having the inflated insurance market where it is a lot of control porno insurance a company is willing to sell insurance under the exchange. allow tennessee had to take extreme measures to allow the increases because they told the state if the old lettuce file for the ratepe increase we have to leavee then tennessee maybe only had one insurance to choose

from that is what isou happening all over the country mr. president as a bombing care reit may only have one exchange to choose from. and from the entire state known as south carolina and and wyoming finding a growing number of states heavily one insurer with the policies and a majority of counties last year tennessean could choose a bombing care plans between at least two insurers can all 95 counties in the state

but now cheer is says 60% of the county's only have oneth ensure off the plan. so in other words, no choice. . . publish an article with the headline, main health insurance cop oive leaves new hampshire market reeling from markets. and the main