[ applause ] bob, i just want to point out that half the room did not stand. [ laughter ] he's a dear -- he's a dear friend of mine. christopher shays is here, congressman shays. he's another great one. come here, shays, for one second. come here. come up here. once in a while, you know, even billy graham had a testimony from somebody else every once in a while, so this is my great pal and we serve together on the budget committee, when we balanced the budget, and he actually -- this is unbelievable, he moved to new hampshire to help me campaign. he lives in -- he lives close to here, but he -- right?

>> st. michaels. >> okay. lives in st. michaels. and he went -- so he went to new hampshire and he spent about a month up there and then he had a leave. he had to go overseas. and i was really happy about that because his wife took his place. okay? but, chris, why don't you talk a little bit about our time together? >> the first thing i'm going to say is i've probably attended now 50 town hall meetings and the thing i'm most struck with, john, this is the most important town meeting for you. everything he says tonight, it's fresh and alive and he's done it continually but what you have done for him is you just make him feel so special and make him feel so appreciated, i just love this town hall meeting and i love being with all of you. let me just make this point. john can get you to do things you don't think you can do. i remember when i was in the budget committee, his first budget, supported it and it just

kept growing. and then when we were in the majority, he walks in with his arm around a democrat and says we're going to pass a balanced budget and we're going to do it with the help of the democrats. i thought yeah, right, john. we did it and did it four years in a row. we paid down debt. we got to the point where the bondholders of 30-year debts who used to sell them were unhappy because we were buying them back. we were paying back debt. so the point i would make to you is everything you see is for real, and i ache thinking that he has to even explain to people why he should be president when i see who he's running against and i see the opportunity we have. so, john, you're the best. [ applause ] >> that was exactly the way that

i wrote it. that was perfect. [ laughter ] >> hi, governor kasich. thanks for coming to maryland to meet us with. first thing i want to say is, thank you because for the last several elections, i haven't felt like there's been a candidate with integrity. it's always we're voting for the lesser of evils, and you're the first person in many a year that i feel like -- >> well, look, hold on. >> so -- [ applause ] >> i'm -- look, i'm just a slob trying to make it through. okay? i'm not -- i mean, look, you do the best you can. the great thing about our lord is we get a mulligan every day to clean up our act. so i just want you to know, don't -- i'll do the best i can, but i'm -- don't get carried away. go ahead. >> all right. all right. the -- i have two questions. with health care, everybody

focuses on low-income health care and then there's the upper class that can afford to pay for health care and somewhere in the middle is the middle class where my husband's self-employed and, you know, we pay $14,000, $15,000 a year just in premiums for an hmo that we don't use much. and it just seems like we're working to pay for the what-ifs in the health care, so my first question would be, what's your plan to kind of help us -- >> the plan i talked about -- >> will help us as well? >> will put downward pressure because then your husband is going to be able to shop in a more effective way for better quality at lower prices. >> uh-huh. >> that's what it really gets down to. >> okay. >> and we've had experience, you know, and you're right about this. i mean, particularly low income, the lowest-income folks get medicaid and the upper income folks, you know, they get what they want, although i got to

tell you, i know a lot of people who are very wealthy and they've had very bad health outcomes and i think some of it is connected to the fact that we really don't understand what's out there for us. so the more transparency, the more clarity -- look, when we go to store we know what everything costs and we know whether we like it or not. with health care, we don't know what anything costs and we don't even know if it works. so why don't we just change that, okay? so that will help. >> yes. and then my second question is, fast forward to seven years from now when you've been in office for a good seven years -- [ clappi inpin inping ] -- what are the top two or three things -- >> that i'd like to see. >> what would you like to see as your legacy that you helped all americans from low, middle, and upper class? >> we have to have economic growth. i was in baltimore, i guess last week, and i was talking about so-at problems that we had seen

that we saw, you know, all over the country with baltimore and somebody said to me, you know, if we had job opportunities and job growth, most of these problems would go away. so if i'm the doctor of job growth and you come to me and say, what do i do, doctor, to get better job growth? i say, well, don't overregulate and cut this guy's business. number two, cut his taxes. you know? small businesses in ohio don't pay any income tax, by the way. and -- no, none. we just figured it out. thirdly -- isn't that amazing? well, we cut taxes by $5 billion in light of having an $8 billion hole. so now we have a $2 billion plus and we're up 300,000, 320,000 jobs. i mean, this is not that complicated. you just have to figure it out and finally you got to have a fiscal plan. you can't put your budget together with bailing wire. so if you can get the jobs go g

going, that's what we did when we balanced the budget. that formula works. so if you come back to me and say i'm not feeling very well, i say, what did you do? well, i regulated you out of business, raised everybody's taxes and thirdly we blew up the budget because nobody's doing anything right and i don't know why we don't feel well. because we have lousy growth in this country. so number one is to get the economic growth. secondly, you got to transform your schools. now, when -- let me see. when this guy and i were in school, okay, i'm going to tell you, we had kids in our classroom who'd put their hands down on the desk. remember that? okay. and they graduate and they get a job in the steel mill and they make decent money. okay? those jobs don't exist anymore. so the question is, teacher, are we training kids for the new type of jobs? so, by the way, i was somewhere

and they were talking about -- utica, new york. they were saying, we lost -- or maybe it was watertown. but we lost -- we're losing our o'er y oreo factory, it's moving to mexico. i said, let me ask you a question, what would you rather make, oreo cookies or computer chips? i'd rather make computer chips but we have to have a workforce that's trained to do it. what i said to you about the mentoring and all those things that are so critical and our education system, we need to honor the high school guidance counselor because the guidance counselor is supposed to find out what our kids are supposed to do and help them to get to where they want to get to, and in our colleges and universities, they need to have academic advisers that connects a -- say to a young student, young man or a young woman, what do you want to be? and when they give you a sense of it, you start directing them there. did you get this class, did you take that class? have you had an internship? these are the things that would

transform education. and then i think, on welfare, look, i'm going it give you my philosophy. it was my mother's. it's a sin not to help somebody who needs help but it's equally a sin to continue to help somebody who needs to learn how to help themselves. okay? [ applause ] now, i mean, listen, our inner cities, it's tough, and, you know, what i say about education and lifting people is really critical. and getting people trained for jobs including in things like vocational education, for those who don't want to go to a four-year school. it is so important to lift those people because let me tell you what, and we need to have adult education. education has to be all of our lifetime so we remain current and we acquire skills. but i have to also tell you, in some of our homes, and he'll tell you, and he'll tell you, in

some of our homes, there are kids that wake up in the morning and they're afraid to go outside because they hear gunshots. that's a tough -- that's a tough situation to fix. but we're not giving up on those kids. those boys and girls deserve a future as well. but, you know, this problem of this deep poverty and all that, it's a challenge for us that we have to focus on but he's the answer. the small businessperson that can come into the community and there's also an opportunity to push people out of the ditch. i like to say if you're driving down the road, it's snowy or icy, you see somebody in the ditch, you pull over and help them get out. if every time you turn around they're in the ditch day after day after day you kind of lose interest, but there's a time we have to help to push them out. then what i would also like to see, look, i'd like to see a more engaged and spirited population. i'd like to see all of us caring

more about one another, and getting back to having somewhat of an american consensus about our responsibility to ourselves and to our neighbors. i think that's important as well. and you can't do that by writing laws. and then the other thing i wanted to tell you is we have to lead the world because if we do not, these -- these barbarians are going to -- they're after us. and we have to destroy them and we have to bring the world together so these kinds of people cannot exist and prosper any longer. so you're going to have to rebuild the military and lead the world. [ applause ] so i want to tell you one other thing. we were -- i know we have to go, but i got to do more here. so, so i was in new york and we stopped at this little deli and this lady comes in and she says, i saw on facebook that you were here. i said, that's great.

and -- no, it was nice. and she came -- she came over and she said, i just am sick of all this foreign aid. if we could just get rid of all this foreign aid, everything would be great, basically. i asked her, when there's an earthquake or a flood or anything like that and a country gets destroyed, do you think we should help them? oh, yeah. said, okay, good. i said, secondly, when we give -- when we put our troops in japan or korea, where, by the way, they're spending lots of money to support them. maybe not as much as we would like. do you think we're doing that for them? she said, why, i never thought of it that way. i said, no, that helps us. if we have troops in europe, which we don't have as many as we used to, and we're going to put more there, and we're giving a message to putin that you're not going to come and invade anymore countries, who is that

for? is that for them or is that for us? so -- [ applause ] -- these simplistic solutions to the problems that we have -- i was in pittsburgh today. trump was there. wro you know what he said? i'm going to bring the steel industry back to pittsburgh. i'm like, okay, great, everybody who lives in pittsburgh is going to be a billionaire. i'm not going it tell you how i'll do it, jim just tei'm just by the way. everybody here is going to own their own hotel. it's great, isn't it? let me tell you something. what i worry about in this country is the drift. if hillary or bernie were to be elected, we're at $19 trillion in debt, the debt would be $30 trillion. okay? it would be $30 trillion. i tell these young people on the college campuses, okay, you want to get a job, $30 trillion in national debt, i don't think you're going to get a very good job. and the other guys have never accomplished anything.

so what are we going to do, drift? we have to -- can we fix social security? piece of cake. piece of cake. if you have had a lifetime -- sir, you're going to get social security but not going to get as much as you thought you were going to get. the lady who totally depends on it, she's going to get what she needs. you okay with that? okay. so that's nucmber one. number two, you want to balance the budget? let me show you something. let me have that. see this? my -- my children, number of years ago, when they were, like, 10 or 11, we were on vacation and they said, daddy, what is that box over there? and i'm looking, that's where superman changes his clothes. and i said, and mom and dad -- mom and dad used to put coins in there to make a phone call. and they're like, no way. [ laughter ] so think about this.

everything is changing. let me tell you, the time is going to come, you're not going to go to the doctor most of the time. you're going do be monitored at home. transportation, you can go from one part of manhattan to the other for, like, nothing and you don't even go in a taxi anymore. you know, you get -- you do uber or lyft or one of these other groups. they say we're going to have flying cars. i completely believe it because i saw "chitty chitty bang bang." okay? let me tell you a couple other things. think about medicine. we can complain about medicine. my uncle george came to the duquesne club today to see me. he's 90 years old. he walks in, i said uncle george, did you walk today? he said, yep, two miles, johnny. you think about everything in our country, i mentioned this earlier, you see, when business does not change, it dies. when government doesn't change,

we get punished. and we have to just think about bringing innovation and excitement and change to the way the world works. that's the 21st century. so all those things put together can lift us. let me just tell you, we're not going anywhere but up if we get this done, but if we drift, if we drift, it's going to be a problem and i get more phones this way. [ laughter ] okay. so let me just say to all of you, look, we -- we're competing here in your great state and i even let, you know, the maryland basketball team beat ohio state a couple times this year. and depending on how the primary goes, we'll look at the football program, okay? but i -- i've got to go because i got to head -- i got to head into d.c. or somewhere. they're all yelling at me to go.

so -- oh, i got some -- oh, look at this, huh? >> thanks for fighting for us. >> look at these. hold on. [ applause ] >> remember when you voted for that -- against me on that one -- [ laughter ] come on every own give me a high five. [ applause ] ♪

>> you guys take care of one another, okay? >> i told them you'll be the next president and have twin girls as well. >> and no fighting. okay. thank you. >> thank you. >> thank you. >> thanks again, governor. >> will you take a picture with this guy? >> oh, yeah. yes. how are we going to get him turned around? >> i'm a military wife.

thank you for fighting for our military. >> absolutely. and our veterans. >> i want to take a picture? >> got it. >> thank you. >> i've already voted for you. >> thank you. hope you enjoyed. i thought it was fun. >> thank you for all you do. it's great. >> i voted for you and went door to door all last saturday for you and will do it again this week. >> thank you. let me know what it's like. >> can we get a quick picture? >> thank you for fighting for us. >> can you take a picture for us? >> get over here. >> thank you. come on. >> thanks so much. i appreciate it. >> thank you. >> governor -- >> john, john? i'm from ohio. i'm part of a grassroots non-profit organization that's helping -- i want to know, my

son is in treatment. we've been saving lives there, but i want to know, with the $16 million that you've dedicated to heroin, is any of it going to go to the non-profit organizations? we are going more to help the addicts than anything else. >> okay. you live in ohio now? >> i'm here in annapolis, maryland, with my husband. i had a nervous breakdown. >> oh, i know. >> you know what you got to do, though -- >> no. i am fighting. i'm just like this entrepreneur. i'm a mother that won't quit. >> i agree with you. >> that is why -- that is why we are saving lives. >> i have went through three of these. three of these, myself. >> and you know what, i know so many people like you, gotten started, okay, to some degree. >> we need --

>> hey, you know, we can pray all we want to, but until we get vivitrol on demand and get these doctors -- you know that a first-year doctor can only have, what, ten patients, ten patients on vivitrol. after the first year, he can have, i think, 50. you know, we have more than that. we have more. >> we have probably the most comprehensive -- >> montgomery county is number two in ohio. ohio is number two in the nation. >> you know, we also now, we're busting doctors, we're shutting down pill mills, we're -- >> good, good. >> we're doing all this. >> you know what, they're still dying. >> i know they are. >> in the restrooms. >> the number of -- >> in the mcdonald's. >> i know. the number -- let me tell you something. the number of prescriptions now with opiates has dropped by 12%.

>> we know that. we know that. we've been there. we've been there fighting. every step of the way. will you speak at our rally? >> where, you mean here? >> dayton, ohio. dayton, ohio. >> i don't -- >> governor? governor? >> is this for me? >> you might need it. i almost used it last weekend in baltimore. >> governor, i'm a veteran of the navy. i took the oath -- my son's going to deploy when you're inaugurated. i want to know what you're going to do to keep him safe. >> where's he going to go? >> he's going to go someplace sandy where there's bad guys. >> what i'll tell you, we're going it have to take out isis. we have to do it. >> that's what's over there. >> when it comes to afghanistan, i don't want to spend a long time, i want to get out of there. and when we take out isis, then i want to come home. i really want to come home and let them sort it out once we destroy isis and we need good

intelligence and good communication. so, you know what, i can tell you this about your son, i don't even know him, but he's proud of what he's doing, isn't he? >> i will hold you to your word. >> i saved for 18 years on the defense armed services committee so i understand the issues. i got to go. >> governor, are you going to stay until the end, all the way up until the end? >> governor, for my class. >> thank you, governor. >> real quick for the class. for my class. thank you. >> thank you. >> thank you for the questions. thank you so much. >> can we get a picture with you? >> quickly. >> get in there, guys. >> thanks, governor. >> thank you. >> governor, can we get a -- >> please do that, okay? >> i pray for you every day. every day. >> can someone -- >> i got a lot of people --

>> did you get it? >> say they know you. i talk to people that don't and i tell them all about you. >> okay. we're going to have the campaign call you. >> god bless you. pray every day. >> thank you. >> governor, this young man here -- >> congratulations. >> thank you. >> the only thing missing is the "f." jfk. >> thank you. >> okay. >> can we take a picture with you? >> yeah. >> thank you. >> it's my wife. >> it's your wife? you know her? >> nope, i don't know her. you held my baby the other night. >> where? >> avery. >> governor, can i get a picture? >> we have to get a picture. >> absolutely. >> governor, can i take a

picture? >> of course. >> can you take a -- >> thank you. >> mr. governor. >> mr. governor, sir. >> on this camera. thank you. >> tauhank you very much. >> mr. governor, just one picture. >> don't give up. >> hang in there, governor. >> go get them, governor. ♪ . president obama departs today for saudi arabia where tomorrow he'll meet with king

salmin bin. saturday six persian gulf countries, bahrain, kuwait, oman, udi arabia and the united arab emirates. then the president heads to london for a meeting with queen elizabeth on friday followed by a meeting and press conference with british prime minister david cameron. saturday, president obama has a meeting with british youth. and on sunday, the president heads to germany for a meeting with chancellor angela merkel. our live coverage of the presidential race continues tonight for the new york state primary. join us at 9:00 eastern for election results, candidate speeches and viewer reaction. taking you on the road to the white house on c-span, c-span radio, and c-span.org. live tomorrow on c-span3, a senate rules committee confirmation hearing on the nomination of karla hayden to be

the librarian of congress. that's live starting at 2:15 p.m. eastern here on c-span3. and on thursday the senate finance committee holds a hearing with customs and border protection live thursday at 2:00 p.m. eastern on c-span3. madam secretary, we proudly give 72 of our delegate votes to the next president of the united states. ♪ ♪

vice president biden spoke at the white house last week about the administration's campaign to reduce sexual assaults on college campuses. the vice president honored students who are working to stop campus assaults. this is 50 minutes. >> hey, folks. how are you? i'm going to talk about each of those champions of change but i also want you to meet what we're referring to as the influencers. this group over here you've seen on youtube, you've seen on the internet. 40 million of you in america and around the world watch what they do and these folks have stepped up and are fighting to help promote this whole effort of it's on us. so i wanted to publicly thank them all. i'm not going to ask everybody to stand here. you don't have to. you can go get a seat.

but i just wanted you to see not only the champions of change, but these guys are champions of change. they're having the nerve to stand up and tell the entire community at home and abroad, hey, man, enough is enough is enough. so, thank you, all, very much. why don't you go get a seat? [ applause ] >> thank you, sir. >> thank you. watch your step. folks, look. lisa, first of all, thank you for the introduction. it doesn't make me feel old that you were not born when i wrote the law. i just want to think about this. lisa flew all the way from south africa where she's studying abroad this semester to be here today. and i want to thank you and whoever financed your trip because it's a lot -- it's a

long way and it's an expense and you do us a great honor, lisa, being here today. you know, what you saw standing behind me today represents, and with all of you, you wouldn't be here, my guess is, represents a lot of passion, and lisa is producing a documentary on her experience, the experience of african-american women who are sexual assault survivors at howard and it's powerful. it's powerful. hope you're all going to get a chance to see it. lisa and all the champions of change here today, we owe you. my four granddaughters, one who's graduated from college, and three who aren't there yet, owe you. owe you. every young woman in america owes you.

for calling attention to what is a scourge. folks, last week, matt and i went to pitt and then at unlv for an it's on us event. i think there were 1,200, 1,500 students at that one. i went to unlv, i went to lady gaga, deeply engaged in this for real. it's not a publicity piece. if you heard her rendition of "until it happens to you," you'll have no doubt about how deeply, deeply, deeply she feels it and how she has suffered as a consequence of being abused. you know, by an individual on campus. i'm not sure it's on campus, but being abused by an individual when she was college age. and at the university of colorado, boulder, there were close to 3,000 students, if

memory serves me correctly, and damon johns on let's make a -- not "let's make a deal," "shark tank" was along because, by the way, he has -- he's experienced with his family the abuse that's taken place against women in his life. i traveled to colleges all across the country, from the northeast to the southwest. i've been to everywhere from the naval academy where i met shaq morehouse, spelman college, where i met -- anyway, i went go through it all. clemson. my alma mater, syracuse. ohio university. i mean, ohio state, excuse me. ohio university and ohio state. i get in trouble for that. university of illinois. just all over the country.

and i went for a simple straightforward reason. nothing complicated about it. i believe that we have an opportunity if we commit ourselves to do nothing short of changing the culture as it relates to how women are treated not only overall but on college campuses and in high schools. i honest to god believe we can change the culture. you know, when i wrote the women act, i -- i was absolutely certain even though it had been tried before to focus on this, i was absolutely certain that the american people would respond if it became culturally permissible

to respond. that sounds strange when you think about it, but at the time i wrote the legislation, no one would support it. not a single woman's group in america would support it. not a single civil rights group would support it. seriously. i know that sounds bizarre. because they were worried it would take the focus off of choice or gender equality or other issues. legitimate concern on their part but not legitimate to stand back. finally when a woman who was the founder of now came along named ellie shmeal said, what are we doing? she endorsed, everything started from a place. and i knew what i wanted to do because i literally wrote it, myself. it wasn't like i had a committee to sit and write it with me. one of the things i really misunderstood, i thought if i wrote a law that was strong

enough that would provide more physical protection, police protection, help once abused, medical help, housing, et cetera, that that would be the thing would really make a difference. but it wasn't until -- and the way i was convinced we could change attitudes was to pull back the mask on this dirty little secret that everybody knew was going on but no one wanted to admit. no one -- it's like, you know, i don't want to -- i don't want to deal with that. too complicated. too complicated. well, he grabbed her and he bent her wrist as she went down. well, he didn't really mean that and maybe she said something that made him angry. or when a husband smacked a wife because dinner wasn't on the table. i was told it was a family

affair. literally. go back, as my wife who's a professor says google it. go back and look. biden's violence against women act was attacked by conservative elements, religious as well as cultural because i was interfering in the family. i hate the phrase, domestic violence, because it makes it sound like a domesticated cat. it's the ugliest, ugliest, ugliest form of violence there is. when a woman is abed, or a man, by husband, wife, lover, or someone they knew, an acquaintance, it's the most difficult to recover from. not just physically,

psychologically because all the psychiatric studies show the woman says, well, what did i do to make him think he could do that? what -- what, what, what? and so i started the hearings and i had two really, and i'm not being solicitous when i say this, truly courageous young women who were among the first to testify. and i briefed them way ahead of time. don't move that at all, guys. i briefed them ahead of time because i knew they would be tried in the court of public opinion when they testified. too many women were raped by an individual then raped by the system. and so there was a lovely young

woman named marla hansen. you all are too young to remember, but your parents would. this was 23 years ago. she was a model in new york city. a beautiful person. as a person. bright as hell. and also a beautiful model. and she lived in an upscale -- not an upscale, a first-rate apartment complex in manhattan. nothing down and out about where it was. and on the first floor of that apartment building, like many places in manhattan, chicago, philadelphia, new york, i mean, excuse me, los angeles, it had a restaurant bar. and she had an efficiency and she wanted a one-bedroom apartment. and every time she'd go to speak to her landlord, he'd hit on

her, be suggestive. she decided she was going to get the hell out of there. she was on location, this was her testimony, she was on location, she got a phone call saying that he had a one-bedroom apartment and if she stopped in the restaurant bar downstairs on the way up to her apartment, she could sign a new lease. and so she did stop. but he hit on her again. she got up to leave and as she did, this coward, this thug, had hired two guys with razors, straight razors, to slash her face which they did when she walked out. i remember asking her, preparing her ahead of time knowing so she

wasn't surprised, what did your mom say? she asked me, why was i in a bar? what's your girlfriend say, were you wearing a bra, how short was your skirt? what did you say to provoke him? that's when i realized we had to do more than provide protection. we had to change our culture. change the way we think and talk about women and girls. how many of you know the duration of the phrase "rule of

thumb"? raise your hand. much more than most audiences. the part of our culture, since the president's here, i'll repeat it, i apologize for you having to hear it. the late 1300s, too many women were dying at the hands of their husband because husbands were allowed to chastise their wives because they were property. they were chattel. no different than a dog in the front yard or the horse in the stable. too many were dying. the english common law, those of you lawyers know we developed our law. it wasn't a codification of a code like in france. it was developed over time in the courts. what developed was a man could not beat a woman with a rod thicker than the circumference of his thumb.

western civilization. we know about honor killings that are horrible. genital mutilation. and other things that two go on other cultures. but it's imbued in our culture. so we have to change the culture. and that's when we -- i was very proud of the fact that after i wrote the -- we wrote the violence against women act, i wrote it, we passed it. violence against women dropped over the last 20 years 60-some percent and more women reporting. all good. the one thing i asked the president when i became vice president, he said, is there any particular thing you want? i said, yeah, i want to maintain

control over the violence against women's office. i wanted to bring it in for the first time into the vice president's office. out of the attorney general's office. the attorney general still does the prosecuting but i wanted to be able to name the people who ran the departments. and he happily did that, as did the attorney general support it, last one and this one. so i had a really -- i've had a number of bright women run that show for me. there have been four. three formerly of my staff on the judiciary committee. one is a woman named cynthia hogan. really bright, strong woman. remember when rice is the guy, pro-football player dragged his wife out of the elevator by her hair? the nfl realized they had to get their act together. they hired cynthia, she left me, went over there to begin to get their game in shape.

by the way, had that happened ten years ago, nothing would have happened. so things are changing. so i said to cynthia, i said, check, what she would do every year with the bureau of justice statistics and tell me how we're doing. she came back with the most discouraging news i received as a u.s. senator or as vice president. she said, we're getting better everywhere except girls between 14 and 24. when you wrote the law, one in four of them were being raped or abused on a college campus. the number hadn't changed at all. then it was in 18 years. now 22 years. so went to the president, that's when we started with tina chin who runs the office of women and girls here. a program called it's on us. because what i did was after we did that, i did virtual town meetings with i don't know how many.

hundreds, thousands of young women on college campuses. and some young men on high school campuses. and i asked the question, please let me know what one or two things you think we could do to make it safer for you in your high school or on your campus. i expected i'd get legitimate things like, you know, better lighting and parking garages. more lighting on campuses. more police escorts. campus police from the library to my dorm, et cetera. know what i got back more than anything? get boys and men involved. and i felt foolish because why had i not focused on that more? so that's when we started the program, it's on us. that's why all these folks up against the wall over here who

are on -- who are viewed by millions of people a year and some of the famous, equality famous actors and actresses doing public service announcements. the ncaa and all range of sports organizations doing to call to attention the young men in america what constitutes being a man. what constitutes appropriate behavior. you know, those who have gone to college, my guess is most all of you have, some of you guys and all of you women when you got dropped off at that curb at college by your mom or dad, had exceedingly high hopes for you. that you'd do well academically, learn a great deal, be empowered intellectually.

but they also, every one of them, go back and ask them if you think i'm exaggerating, had this nagging fear in the back of their mind, will she be okay? not a joke. will she be okay? they didn't know the statistics, mo most, they know. they know. everything from binge drinking to flat stranger rape generates excuses and rationales. as to why it's okay for a man to lay a hand on a woman without her consent or without her ability to give consent. i've got a goal and i mean this with every fiber of my being, and when i leave this office, i'm setting up a foundation to

continue this. i've got a goal and i believe it can be met. within your generation, we reach a point, although we'll never end violence overall. when you drop off your daughter or vulnerable son, and homosexual rape is real on campuses. you're not going to have that nagging worry in the back of your mind, is my daughter or son, one in four, one in five, change gender, does she have a 38% chance, excuse me, bisexual, a 30-some percent chance of being a victim of abuse? so, folks, i'm here to thank every one of you, particularly

the champions of change, for us being able to get a little bit closer to the goal. i'm often asked why am i so passionate about this? they think, maybe god forbid my mom was abused or my sister or my deceased wife or my wife. i was passionate about this because i was raised by a truly graceful man who never -- never raised his hand to any one of his children, anybody that i'm aware of. he's a big man. w not any one of why siblings or any of my friends, anybody who hung out at my house, would not be able to repeat my father's mantra. the greatest sin of all sins is the abuse of power and the cardinal sin among those is for man to raise his hand to a woman or a child. someone physically weaker. that's why i wrote the violence against women act.

we held thousands of hours of healin hearings, issued a report, "the day in the life of." we actually went out and took actual cases, 365 days and put an actual report we did this big, the pages, 8.5 by 11 with what some actual case that happened that day, that year, for people no longer to be able to go, you know, well, you know -- they say we held hundreds of hours of testimony, advocates, experts, health professionals, opponents, as i said, survivors. that's when, as i said, not only i but the public begin to realize, you've got to do something about the culture. we have to do something profound to change how we think about these things.

and so, folks, as i said, we have made some progress. since the president and i started this program "it's on us" we're 350 people literally raised their right hand and taken an oath. yoo -- and if i say it, i'll do something about it. if consent is not or cannot be given, it is a crime. a definition of what constitutes lack of permission, whether it's in a bedroom, a ballroom, on a campus green, no means no, no matter when it is stated, even in bed and you change your mind,

no means no. anything that follows after that is a crime. so, the next piece that's happened, and you all are so important in this effort, is no also means no when you can't give consent, so as i say in college campuses, you see if a fraternity brother walking a drunk coed up the stairs, have the gumption to walk over and say, hey, jack, not on my watch, not on my watch. look at this like, if it were your mother, your sister, your

younger vulnerable brother, what would you do? it takes a lot of courage. i'm not expecting everybody to be able to do what some of these incredible folks have gone out and done. but i do think that, i know everyone can do something so just holler, steps away so no one can see, scream, sometimes legitimate worry that there will be reprisals against you. but everybody can do something. there's a recent film being done by a woman in south africa who has the same kind of program she shows a woman being raped and there were seven occasions where

somebody would have said something it would have stopped and it would have ended, or intervened without somebody being intervened, being taken by a doorman and being dragged in an elevator. doesn't require heroics. and by the way, it's not just men who ought to end this. women abused on a campus, only 2.5% go to the authorities on the campus and only fewer than 1%, i think it is a little less than one and a quarter%, report to police. 65 or 67 over 65% tell their roommate, their girlfriend their sorority sister, their teammate,

so you women have an obligation to say something, to find them help. find out where the help is available. as i say on campuses when i was going to law school, there was movie called the "paper chase" by e.a. houseman who was the star and there's a line in it that says "gentlemen look to your left and look to your right and one of you will not be here next semester" don't look to your left and don't look to the right, look in the mirror. look in the mirror and ask yourself, am i doing everything i can and i don't have to be a crusader or a rabbit, i don't

have to be the person that's going to change the world. am i doing everything i can to change this culture. you know, we had a great -- we we have a great secretary of education now. we had a truly great sector of education, the guy has become my close friend, great basketball player at harvard. i think it was harvard he went to. he played basketball at the pros in australia, yeah, australia. his name is arnny duncan, secretary of education. and arnny with the encouragement of the president came up with an idea. we give tens of millions of dollars, hundreds of millions of dollars to universities to maintain their campuses and their students. all the student aid you get, all the direct assistance, everything -- there's a thing called title nine you don't get -- title ix you don't get

-- it started off with sports, but that that unless you have equal opportunity for women. we took a look at it and had our lawyers look at it and we had our lawyers saying, guess what university, if you don't have a system to demonstrates if you were looking out for the physical safety and the mental health after god forbid something happens of your students and acting, we will deny you tens of millions of dollars in aid. you know, we have 172 national universities under investigation right now. you read about it every day, i'm not going to name any particular university because the cases aren't adjudicated. some of the schools you went to, go back and ask, what reporting system do they have? how much do they encourage women to come forward. when they come forward, are they

going to speak to a professional as if you showed up at a rape crisis center, or if you showed up to a professional on the civil side. we have horrible cases of college universities and president's office is asking, what were you wearing? how much did you have to drink? not what happened to you? where did it happen? it doesn't mean we eliminate the presumption of innocence, we can never do that in america. but all things should be taken seriously. you realize more women drop out of college because of sexual abuse than any other reason. so the point is, we're going to keep it up the remainder of our

term here, but we need to engage you all because, folks, once all university start reporting, one of the things we're considering doing is assist -- not done yet -- assisting all universities do climate surveys anonymously. so they can't pretend they don't know what's happening on their campus. every student fill out a form, if they choose to, have they been abused? do they know someone who has been abused? if they were abused, where were they abused. there's a thousand things we can do and just like in domestic violence overall dropping 64%, we can begin to change what's happening on our campuses. there's a -- an old chinese

proverb and it goes like this, it says that, women hold up half the sky. women hold up half the sky. what kind of studies. if as many women were employed not even in equal pay as men worldwide, the international gdp would increase by $27 trillion. president and i are pushing hard for tripling the child care tax care and two wager to $500 tax credit, that will put $500,000 more women in the workplace significantly increasing our gdp. my generic point is, you don't have to think of it -- think of

it just as, how much money averted cost to the public we have violence against women's act, every study points out $12.6 billion a year in averted social cost, medical bills, cost associated with loss of productivity in the workplace. the reason why id said it 22 years ago, i couldn't prove it, but i can prove it now. the ccd in atlanta -- the cdc in atlanta, the center for disease control has done an extensive survey, women who have been abused suffer from long-term immune system compromises, heart disease, diabetes, posttraumatic

stress. if a guy comes home, you're married to him for ten years and every night you're slightly off or he doesn't like the meal on the table, and he smashes your head against the wall, there's no different than that in the military you being held someone smashing your room every night and smashing your head against the wall. my generic point is, you've got to change situation on campuses, not only is the morally right thing to do. we're wasting an enormous, enormous, enormous resource to make us better, stronger and more capable. so the champions of change here, and i'm going to ask each one of them to stand up. i'm going to ask them each to walk on the stage. i'll be very brief. okay. jessica davidson, university of denver.

she had the courage to -- come on up, jessica, challenge the university to adopt clear affirmative consent policies. they didn't want to talk about it. they didn't -- right am i exaggerating? >> no. >> she's a survivor and with the bravery -- and it is not hyperbole, and the bravery to tell your story. >> you're making a difference, kiddo. >> thank you. >> and it was great to see you last night and that's where i met matt who handles the buffalo who pulled a guy off a young woman and had the courage to do it. also, valerie holsted, university of miami. valerie, come on up. if there are any angels in heaven, by the way been great consumer of health care, losing wives and

children in hospitals, they're nurses. doctors make you, but nurses, i'm serious, you're the single most under-estimated profession in the world. you change people's lives in terms of their attitudes and that makes a difference. valerie making sure campus health centers, because a lot of campus health centers you go to, they're not equipped or prepared to deal with the psychological. you may come in and they'll send you to hospital, most don't have rape kits, most don't have, well, guess what -- what she's doing. she's helping schools come up with a standardized procedure whereby you have at the school infirmary qualified people to deal with the problem. my mother would say, god love you, kid, you're doing god's work.

also, we have melana hossman. am i pronouncing it right? >> has manis. >> you can call me joe bitten. [ laughter ] come here. >> a for effort. >> you're getting a for effort. look, talk about taking on a tough charge, she's at grand valley state. she is confronting -- maybe not confronting, engaging the greek community for on campus to step up because there's an awful lot of evidence, not because anybody belongs to fraternities per se is bad, but because the nature of it being either off campus or out of sight and the drinking that goes on, an awful lot of young women are victimized, thank you for making them look in the mirror, it's important, appreciate it. also we have claire kell

virginia tech, a phd statistics, she's about to be, she has a brilliant mind as big as her heart and she's figuring out how data in analytics, this stuff makes a difference. how data in analytics can help us find patterns, patterns, it doesn't mean it provides for a rational of a guilt or innocence in a court of law, because you can't convict in a pattern, you've got to convict on showing specific intent. but patterns as to where, how, what circumstances, these situations occur, to solve what is basically an epidemic. same thing you're doing in cancer research, same thing they're doing in astronomy, establishing the patterns, i tell you what, i wish i was as bright as you were, i would have done a better job than i've done before. thank you for what you're doing.

>> thank you. >> stay with it. stay with it. >> we have selene lopez, she had -- at humboldt state. she had the courage to ask some pretty tough questions to her dog. her dog answers. i want you to know, her dog speaks like mine. if you are not a dog lover, you don't understand. both our dogs talk. she had the courage to ask some really tough questions to change the conversation on her campus about what constitutes consent. uncomfortable conversation to have. literally, to actually put up posters on campus and begin a discussion, what constitutes consent, because, by the way, 10 years ago, that was just private, don't want to talk about that. because you've got to educate young men, even the ones who aren't bad guys. i really mean it. and most aren't.

what constitutes consent. thank you, kiddo. >> also, we have megan yap, university of california, at san diego. when i die, that is where i want to be reborn. i love san diego. i was speaking at the university of california san diego, and is it nazarene college up the road from there. >> it is close by. >> i was speaking at nazarene college after speaking at your college years ago and i was in a natural amphitheater and all of the students were sitting on a hill and the ocean was behind them and below that i learned was black's beach. so i'm standing and i'm talking to all of the students and there are about 300 of them and they are going like this. looking over my head. and next thing i know, three people glide over about ten feet

over my head in kites. only in san diego that would happen. it isn't like, hey, there is charlie. it was like -- keep talking. megan has -- she's an emt. and she literally is on the front lines of caring for victims. she looks the fear in their ize and the damage that's been done. and it's not -- it's hard. it ain't easy. and when you see it, and the compassion and empathy you brought, you're studying campus sexual assault policies all across the country and your intent is to hold schools accountable by making sure they have certain basic standards. thank you for what you're doing. >> thank you. >> thank you for what you're doing. and three ofure honorees are men. who have been leading the way, getting men involved at their universities, or former universities.

pablo dahhes, boston university. he has some steel in his backbone in trying to get the fraternities and athletes involved. and that first conversation you walk in the locker room, i have a great idea and they say, what are you talking about, man? >> exactly. precisely. >> well, it is changing. it is moving. when men stand up -- by the way, you know, as i was saying to some of our folks over there, it used to be ten years ago, if you were -- if there was a business luncheon in some major metropolitan area and a waiter came up with a lisp and said what would you like for an order and one of the wise guys around the order would say, well let me tell you and made fun of it, nobody would say anything. and today if that happened, they would say get the hell out of here. because what is happened, as we've liberated, the movement to liberate the lgbt community,

we've liberated a lot of straight people, from knowing that they are not going to be the ones ostracized, so long so many people thought they would be. what this guy does, when you walk in, and you get athletes to start talking about it, and by the way -- the guy who sits there and the next guy, the two guys i call up know about this and said, man, i did this last night. i got some -- ask the guy who couldn't get a date on a bed. and basically has no sex appeal. you think i'm kidding. am i joking, guys? the men who are like, hey, man. until we end the circumstance where it is appropriate to tell a joke about rape, to tell a joke about vulnerability, until that happens, we're not changing the culture. this guy walking into those locker rooms, this guy walking into those fraternities trying to organize.

you're making a difference, man. we owe you. >> thank you. >> now the next guy is a little guy. he's significantly intimidated by men who might threaten him. but cody mcdavis. he played at the university of north carolina -- or excuse me, northern colorado. is now out. and this is the guy who continued to -- was then and continues now, challenging athletes to step up and say something. as i go around the campus, i was down, cody, at clemson university. they got a guy -- a little bit taller and about 30 pounds heavier and a captain of the football team down there. he's leading -- he's leading the effort on campus. making it clear this isn't about trying to be, you know, cool and the in-house feminist. it is changing. we're changing attitudes.

we want to thank you, man, for stepping up, as you have. >> thank you, sir. >> lastly, but not the least, i want to say -- let me say to -- this is all about cadet first class for the united states military academy, sir, get your rear end up here. i'm still your -- i want you to meet carson warmberg. and he is -- he's taking a case to the academy. you all know there is much too much sexual assault in the united states military. i was just on a campus that is equally as consequential, he won't admit it, annapolis, meeting for four hours with the cadets, the students, the midshipmen, i should say, at annapolis. what is starting to happen now is they are not waiting for commanding officers to begin to change the culture. if you change the culture in the

cadet corp, you have an exponentially greater opportunity to change the culture throughout the military. and by the way, i want to make it clear and i'm not joking about this, a woman can do anything -- anything, anything a man can do. i sat at my home, with my wife, who is involved with military families, we had -- we're a military family. but two women who just went through special forces training. you look at them, they look like two of the young women on the -- on the -- our olympic soccer team. they're attractive, polite, straightforward, look like ordinary people. but guess what? they went through ranger school. guess what? back when i was a young senator, i got elected when i was 29, and it was only then that they

started to allow the academy to accept women. i appointed women to -- i was one of the first people to appoint women to all of the academies. i was out in -- in one of the great honors as vice president, i get to do the -- the president and i rotate commencements. and so i've now done every academy and i'm going back this year and aim going to be -- and i'm going to be up your way and doing west point commencement. but i was out at the air force academy two years ago and they have -- they have an outfit that -- john, what do you call those guys that fly those planes real quick? where is that? i was kidding the colonel. colonel, where are you? it i guess he left. he's gone. any way. you know, they have the thunderbirds and the blue angels. okay. guess what? it takes enormous skill. so they wanted to meet me at the air force academy because they do a fly-over at graduation, for

the night before, i'm meeting them all. and guess what? two of the pilots are women. my generic point is, we have to change -- we have to change the attitude in the military for a whole range of reasons. not the least of which is women are carrying a significant portion of the burden in protecting and securing our country. so, folks, these are real champions. these are people that i'm honored to stand with. i hope you feel that way. and that's what it's on us is all about. it means students, it means faculty, it means coaches, it means your colleague presidents, it means your deans, it means the law enforcement community on campus, it means the infirmary,

it is on every one of us. and if we do just -- just what is constituting being decent, we can change this culture. and my granddaughters are going to be all better for it because of you. thank you all very, very much. [ applause ] >> thanks, everybody. see you all later. [ applause ] tonight on c-span 3, a house hearing on providing health care for veterans. then the editor in chief of baffler discussing the state of

quarterly literary magazines. and later tom price discusses his proposal for reforming the federal budget process. the veterans' affairs undersecretary for health testified at a house hearing today about his department's efforts to improve veterans' access to health care and reduce wait times. congressman jeff miller chairs the committee. this is just over two hours. hearing will come to order. would you like to welcome everyone to today's hearing entitled, a continued assessment of delays in veterans access to health care. this hearing marks two years since this committee exposed the

wait time scandal that has gripped the department since 2014. i'm proud of the work that we have done in those two years, particularly digging into the actions of bureaucrats who -- whose self-interest were put ahead with the veterans they were charged with assisting. the purpose of this hearing is to examine the efforts that va has taken to improve access to care for veterans and to identify where serious issues still exist. based on the bipartisan work of this committee, gao has undertaken an audit of new patient primary care wait times at six facilities across the veteran health administration. gao's review found that veterans at those facilities waited between 22 and 71 days, which is significantly more than the

five-day average that secretary mcdonald has declared to this committee earlier this month. now this discrepancy can probably be easily explained. first v.a. only tracks and monitors a portion of a veteran's actual wait time when tracking access data. instead of considering a veteran's wait time to be from the date when the veteran first contacts v.a., to requesting an appointment to win the appointment -- when the appointment takes place, v.a. considers a veteran's wait time to be from the date when the veteran wants an appointment and the date when the appointment actually occurs. this is problematic because it doesn't take into account the following -- it doesn't take into account the time it takes for the v.a. scheduler to contact the veteran to schedule the appointment. the fact that it is a regular practice for schedulers to negotiate a desired date with a veteran, or the fact that

outright manipulation of desired dates to zero out-wait times is still the most prevalent type of data money ip legislation that occurs in the department today. v.a. continues to ignore the main forms ever data money ip legislation and continues to come to congress and to this committee saying there is no data manipulation. to this point, you will not find what you do not seek. the obvious result of v.a. reporting only a portion of a veteran's actual wait time is artificially low results. i still don't understand how a culture could persist in presenting inaccurate data to this committee. or more importantly to the veterans of this country. a true picture of wait times or more importantly the veteran experience, the secretary speaks about quite frequently, can help

us ensure an adequate allocation of the resources we were asked to provide. but when this committee only hears request for more man power and more space and more flexibility, it is hard to reconcile the additional resources with the reported wait time of only five days. this discrepancy between reality and v.a. claims was captured by gao in its report where v.a. data shows that wait times were, at best, underestimated by two and a half times, and at worst 11 times the full wait time that the veteran experienced. another tactic that v.a. uses to make its wait time appear lower is to combine shorter wait times for the large pool of established patients with the longer wait times of the smaller pool of new patients.

this dilutes the wait-time data making new patients time appear shorter because they have been comingled with the other cohort. for years they have blamed long wait times on training issues, largely because it was warned about those issues as far back as 2005 when the inspector general's office published a report highlighting the improper scheduling practices and poor training process. many oig and goov gao reports since that time have found that the same scheduling problems continue to exist. yet, in the 11 years since v.a. continues to blame wait time manipulation on the very same cause, a control over which v.a. has complete control, secretary mcdonald has repeatedly ask that we allow him to run v.a. like a business. but i can assure you, if an

executive running a company used the same excuse to explain away 11 years of problems in a row with no change to show for it, that individual would be out of a job. but not at v.a. despite years of reports of confirming systemic issues, the department has successfully fired just four people for wait-time manipulation, while letting the bulk of those behind its nationwide delays and care scandal off with no discipline or very weak slaps on the wrist. another issue regarding accountability is how v.a. continues to ignore retaliation against the whistleblowers that we have relied on for some of the information that our committee has acted on. the committee has asked v.a. for all adverse actions where an employee was disciplined for retaliation against a whistleblower. v.a. provided our committee a list showing as of march 15th of

2016, only six individuals were disciplined for whistleblower retaliation. looking deeper, one of the list of employees is sharon hellman, who the committee has already shown was not successfully disciplined for whistleblower retaliation and was in fact successfully disciplined for failing to report accepting gifts. two of the other disciplined employees were listed as housekeeping aide supervisors. who are clearly not high-level supervisors. that leaves three employees to receive reprimand and one receives less than a 14-day suspension. to be clear, according to v.a., provided documentation, no employee has been removed for whistleblower retaliation. this is represented with the

fact that contrary to public statements by v.a. sunshine yore officials whistleblower retaliation appears to be tolerated within the department. so now, two years after what was and is a systemic crisis in care being brought to light, it is time for v.a. to stop using misleading data to tout wait time successes that supply did not show the real wait time experienced by our veterans. i want to hear what concrete actions have been taken, what fundamental changes have been made, and what tangible, cultural shifts are occurring within the department. advertising artificially lowered numbers does nothing to stimulate the change that is needed to improve veterans' access to care. and with that, i yield to the ranking member, miss brown, for any opening remarks that she may have. >> thank you, mr. chairman, for

calling this hearing today. following the wait time scandal of phoenix, congress passed and president obama signed the veterans access choice and accountability act of 2014. in it, we mandated that there be an independent assessment of veterans' health care. the assessment highlighted many of the things we hear from our veterans. we hear that v.a. provides excellent health care, especially health care related to the special needs of our veterans. we also hear that in certain areas, the v.a. is at the forefront of health care in this country. we also hear from our veterans that v.a. care is often fragmented and that it can be difficult to navigate and arrange non-v.a. care. we hear of long wait times and limited access. following the assessment in the

surface, transportation and veterans choice health care improvement act of 2015 we mandated a report by the v.a. reporting a plan for how v.a. could consolidate all purchase care programs into one new veterans' choice program. we received that report last year and this committee is currently working with the v.a. on the best way to implement the legislative requests. the v.a. is on track to see -- listen to this -- 6, 27360 unite patients and 9,428,000 unique enrollment in fiscal 2015. the v.a. completed 56.7 million appointments, nearly 2 million more than fiscal 2014. that is roughly 226 appointments

per day. let me repeat that. that is 226,000 appointments per day. the number of patients that the v.a. sees would put any other health care system to shame. i am pleased that the gao study newly enrollment veterans in their access to primary care in my conversations with veterans time and time again, they said once you get into the v.a. system, the care is the best in the world. let me repeat that. once you get into the system, the care is the best in the world. it is this initial appointment that is so hard to get. i am troubled by the gao finding that nearly half was unable to access primary care because v.a. medical center staff did not schedule appointments for these

veterans in a quick time frame. the gao report goes on to say that veterans access to primary care is hindered in part by data weaknesses and by the lack of a comprehensive scheduling policy. we are at a tipping point right now as to what the v.a. would look like and the services it would provide for veterans in the coming decade. i look forward to hearing from witnesses today as to what this aspect of the v.a. would look like in the future. with that, mr. chairman, i yield back the balance of my time. >> thank you very much, ms. brown. as accustomed with this committee, i would ask that all members waive their opening statement to allow me the opportunity to introduce the witnesses at the table today. from v.a., we're going to hear from dr. david shullky and the department of health and veterans' affairs and accompanied by dr. lynch. assistant deputy under health and clinical operations from the

office of in spector general, we have mr. larry rink meyer, director of oig kansas city office of audits and evaluation and accompanied by gary abe acting assistant inspector. and finally we'll hear from deborah draper, director of the health care team at the government accountability office and i would ask if all of the witnesses would please stand so we can swear you in. raise your right hand. do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth, the whole truth and nothing but the truth? thank you, please be seated. let the record reflect that all witnesses did answer in the affirmative. dr. shullki, you are recognized for your opening statement of five minutes. >> good morning, ranking member brown and members of the committee and chairman, i'm accompanied by dr. thomas lynch, the assistant deposit undersecretary for operations

and behind me the senior adviser to the undersecretary. arrived at v.a. nine months ago and i understood when i came here this axis crisis was a priority and the status quote wasn't acceptable. it is not my objective to say we fixed all of the problems or don't have issues, but we are focused on this. this is my number one priority. this is v.a. number one priority and we're going to stick at this until we get this problem resolved. the first thing when i arrived as the undersecretary was to assess the data on wait times. there were file cabinets full of reports and bookshelves filled with data and i have to tell you, i made it through medical school okay, but i had a really hard time understanding all of this data. very, very confusing. what i didn't see was the ability to clinically prioritize which veterans needed care the first. and i didn't know how to run a health care system unless i understood that you need to see the patients that were as sick

the first. so that is the first thing we did. we changed it to clinically prioritize the veterans and that led to two stand-downs where we opened up every medical center around the country and saw those veterans that needed the care that day, on the day of the stand-down. and that led to real significant sustainable improvement. we had 57,000 urgent consults in what we call level one at the first stand-down. today it is a 77% reduction. there are 12,000 urgent level-one consults. on our second stand down, we addressed 81,000 urgent appointments and we got 93% of those gone through and resolved. this month, we're launching what we call our declaration of in depen dependence, which is the declaration of access which are nine core principles that will redesign the way we provide access to veterans. they include pretty bold moves like same-day access in primary care and same-day access in

mental health. now i will tell you, these are aspirational goals to be done by the end of 2016. but i've never been part of a change effort that started with low expectations. and i'm confident we can get these bold goals done because today we have 34 medical centers in the v.a. system that are currently doing same-day access and primary care. so we can do this, we have to spread the best practices throughout the system. we also have to make the wait times more understandable, mr. chairman, as you said. very, very difficult to understand. and i will tell you that i am -- my academic studies -- i teach my students there are bad systems and not bad people and so i said we have to change our system. and when we identify bad people in the v.a. and people lost their ways, not holding our values, we have held them accountable. we have held 29 individuals

accountable for disciplined actions, and as the chairman said four have been fired. we trained 32,067 schedules and had audited the schedulers. the joint commission has been invited and visited every one of the medical facilities. we have a new training program for scheduled to launch this spring beginning in may. but our measurement system is too complex and where i want to move this to is the veteran experience. asking veterans, are they satisfied with access. and in fact, in every medical center today we have a system called vet link. you come in and go to a kiosk and are asked whether you are satisfied with the access to care. 89% of veterans today are satisfied with the access to care throughout v.a. and i have all of your vid-- yo individual data by the way. but we have to do better. we hired 5700 new employees and

a 10% added, and 2200 square-feet of added space and a new schedule system rolled out called vse, a new veterans application that they could schedule themselves. we've allowed direct scheduling in some areas. we have group practice managers now over all of the medical centers. we are sharing best practices and access across the entire system and as you know we are working much closer than ever to our community partners to provide care. 57 million appointments last year as the ranking member said. 1.6 million more visits last year than the year before. 96% scheduled within 30 days. we're processing claims faster than ever before. 25% increase in claims process last month. we're looking forward to the comments by the gao and the ig. i have to tell you, we are not afraid of criticism. we welcome it. we want this type of transparency. in conclusion, i want to tell you, the v.a. is making sweeping changes. we are making progress.

but there is significant work that lies ahead. that is what i'm here to do. but recall, as the ranking member said, the v.a. provides excellent care every day. in fact, this year alone four peer reviewed studies showing we are equal or superior to what is happening in the private sector. we appreciate the support of you on this committee and look forward to answering any questions. thank you, mr. chairman. >> and doctor you are now recognized for five minutes. >> mr. chairman and members of the subcommittee, thank you for this opportunity to discuss the recent reports that we have issued that have addressed various obstacles to veterans receiving timely access to health care. as you mentioned, i am accompanied by mr. gary abe, the deputy assistant auditor for inspector and evaluations. two years ago, timely access to care became an even larger national focus. in 2014, we published two reports detailing the serious conditions that existed at the phoenix health care system and

provided v.a. leadership with recommends for immediate implementation. these reports brought much-needed accountability over serious access issues. since our august 2014 reports, we have initiated a series of audits and reviews, evaluating the extent to which veterans receive timely care. we have published several comprehensive reports detailing veterans experiences during their initial application and ebb rollment -- enrollment for health care and the improvement of access to psychiatrists and v.a. consult management. in addition a number of more recent reviews are in progress, including work which members of congress requested at the phoenix health care system to evaluate hiring practices of medical support assistants or the scheduleures and continued concerns about timely access to care. the national attention sparked by our reporting on the phoenix health care system resulted in a dramatic increase in the number of contacts to the hotline and the number of inquiries sent by

the member of congress. a number of the hotline contacts continue to allege inappropriate practices by vha staff that undermine the integrity and reliability of wait time metrics as well as alleged that vha initiative to provide care in the community are not working. our audit and reviews and health care inspections have reported challenges v.a. faces in administration of all access purchase care programs, authorizi authorizing, scheduling care and documenting the veteran medical records and timely and accurate medical payments for care. two reports we issued in february of 2016 highlight the problems we see n. our review of alleged untimely care at the colorado springs community outpatient clinic, we substantiated the allegation that some veterans did not receive timely care and non-v.a. care staff did not add them to the veterans choice list or the vcl in a timely manner or in some cases not at all.

this occurred because scheduling staff used incorrect date that made the appointment wait time was less than 30 days which excluded them from the vcl. in our review of alleged patient scheduling issues at the v.a. medical center in tampa, we again substantiated they were not all scheduled greater than 30 days and we also found that staff inappropriately removed veterans from the vcl and the facility staff did not cancel veterans' existing v.a. appointments when they did receive an appointment in the community through the veterans choice program which blocked other veterans from taking that v.a. appointment. my office recent lip initiated a pilot project to audit one facility to evaluate three key components of access. data reliability of wait time metrics, access through the veterans choice program and consult management. our objective for this pilot is to provide comprehensive and

timely oversight for all facilities in order to provide the facility directors within that vision for current scheduling practices. we hope by focusing resources we could audit each facility every three years as we do with our regional offices. we feel this work is important and will help provide a veteran centric view of what management action is taking to ensure things like phoenix do not occur in the future. in it conclusion, the v.a. faces challenges in providing adequate access to health care. we have a number of active projects involving pract is and procedures that ultimately affect veterans' access to the veterans choice program. we will continue to work with the v.a. to provide the independent oversight and recommendations to move the programs and iniatives forward. mr. chairman, this includes my statement. we would be happy to answer any questions you or committee have. >> thank you. miss draper, you are recognized

for five minutes. >> chairman miller and ranking member brown and members of the committee, thank you for the opportunity to be here to discuss veterans access to the v.a. health care. my testimony today is based on the gao ongoing body of work in this area, including most recently a report public released yesterday on newly enrolled veterans access to primary care. i wish i was here today to discuss better news but unfortunately that is not the case. since 2000 and in particular over the past five years we have consistently reported on v.a.'s failure to ensure veterans' timely access to health care. in 2012, we found the outpatient medical appointment wait time data were unreliable, implementation of scheduling policy was inconsistent and telephone access was problematic and scheduling resources were not affectively allocated. in 2014, we found that access to outpatient specialty care was problematic due to mismanagement of the consult process, including poor oversight and the lack of clear policies.

in 2015, we looked at veterans access to mental health care and found that the way v.a. calculates wait time zz not always reflect the overall time a veteran is waiting for care, the lack of clear policies precludes effective oversight and access data may not be comparable over time or between medical facilities. and most recent work focused on newly enrolled veterans access to primary care which is typically the entry point to the v.a. health care system and critical to ensuring veterans obtain needed medical care, including specialty care. for this work, we found many of the same problems as we have previously reported. we reviewed a sample of 180 newly enrolled veterans' medical reports across six v.a. medical records and found for example, for the 60 veterans who requested v.a. contact them to schedule appointments but had not been seen by primary care providers, 17 were not contacted at all because of the veterans did not appear on the

appointment list which is intended to help track newly enrolled veterans needing appointments. medical center officials were not aware this problem was occurring and could not tell us why the veterans did not appear on the list. fir further, for 12 of the 16 enrolled, veterans did not follow v.a. policy for making contact to schedule an appointment which states there should be three documented attempts by phone and if unsuccessful, a letter sent. for the 120 veterans that requested care and seen by primary care providers, we found the average number of days between the initial request that they be contacted to schedule appointments and the dates they were actually seen ranged from 22 to 71 days. about half were seen in less than 30 days. however, veterans experiences varied widely. with 12 veterans for example waiting more than 90 days. delays in care were due to issues such as appointments not being available when veterans wanted to be seen and medical centers failure to follow v.a. scheduling policy.

and this most recent work we also continue to see data weaknesses due to errors such as schedulers incorrectly changing dates as well as the lack of a comprehensive scheduling policy which has created confusion and contributed to the scene. in 2015, veterans health care was added to gao's high-risk list due to the v.a. problems providing timely access to care among other reasons. this list identifies government operations that are vulnerable to fraud, waste, abuse and mismanagement or in need of major organizational transformation. in designating v.a. health care as high risk, we identified a number of concerns, all chf affect veterans access to timely health care and includes, for example, ambiguous policies and inconsistent processes, inadequate oversight and accountability and poor training. it is now over a year since the addition of v.a. health care to the high risk list and to date we have seen at best little progress by v.a. in addressing the issues. we are very concerned about the

lack of meaningful progress and are concerned is heightened further because the window of opportunity under making progress under the rapid administration is rapidly closing if not already closed. the v.a. health care access problems are significant, per sittent and not only a disservice to our nation's veterans but places them at risk for harm. the status quo is not appropriate, nor should it be accepted. mr. chairman, this concludes my opening remarks. i'll be happy to answer any questions. >> thank you very much. dr. shullkin, i know you have been hard at it for nine months and i have a simple question. does it irritate you that even after your nine months, and we're talking about two years from the exposure of the wait time problem, that there is still serious problems and manipulation of wait times? >> um, i am very, very impatient

to get this problem resolved. and i am concerned that we have data out there that is not necessarily understandable by people. i'm concerned when i hear about mistakes being made and wherever we do find that there is manipulation of data, that is unacceptable and we're taking action. and so we're doing everything that we can, but am i impatient, am i upset about it? absolutely. and we are -- this is why it is our number one priority, mr. chairman. >> ex pound on the action that you're taking. because it appears that folks have said for almost a decade that it has been lack of training or improper training. that is ten years that this has been going on, or more. give me some concrete steps as to what you're doing, and have you really analyzed what the

root cause of this issue is? >> yep. well, let me first start -- it's an excellent question and a very fair question. first of all, i want everybody to be clear, we do not have access or wait times in our performance measures. in other words, nobody is getting bonuses. there is no incentive whatsoever to be manipulating this financially as there was in the past. so i think thanks to your committee's work, we make sure that that isn't existing. so i'm going to go back to the fact that in general we mostly, of our 340,000 employees, have very, very good dedicated employees. we have bad systems in place. one of the things that we've talked about is this is our current scheduling system to the right. it is dos black screen. to think this is how we're having our 32,000 schedulers have to schedule appointments, invites confusion and it invites

the ability to do this accurately. so we are putting in now, currently rolled out, the one to the left, which looks like a microsoft outlook calendar and that is important that we give our people the right tools. we're also evaluating a commercial system called mass which offers greater capabilities. number three, we are insisting that our leadership do visits to the schedulers, personally. and where they find that people aren't scheduling appropriately, they are pulling their scheduling keys. and we're doing that on a regular basis. we are talking about this and trying to do better training. we are taking disciplinary actions where we find the people have deviated and so we're just going to have to stick at this. i don't know any other faster, magical way to make this happen. and i'm frustrated by it. >> i think it would surprise many of the members to know, or maybe it wouldn't, we just saw

an example of the scheduling software that is being used, $127 million later, and we're just now looking at -- something that could quick question, gao found that almost one-third of the veterans it reviewed, 17 out of 60 did not get contacted for an appointment because they did not appear on the list. one would assume that directors at these facilities neither knew this was occurring, nor they didn't know why a veteran would not appear on the near list. so the question is, why would a hospital director not know? >> yes. well, when you read the gao report, i think it's pretty clear that we didn't do the best that we could for veterans. so that's why we appreciate the spirit and the information

because it's going to help us do this better. so we are sunsetting the near report. we are moving it towards an automatic system called welcome my va where we're contacting, reaching out to every veteran. part of the problem notice in the gao report, was we had the wrong phone numbers for some of the veterans, we couldn't reach them. when we reach some veterans, they didn't want appointments, they wanted cmp exams, we get them there. other veterans said no thank you. i no longer want an appointment. we have to do a better job, but it wasn't that every veteran that ms. draper just mentioned we failed. we failed too many. but a lot of them, frankly, those facilities just weren't able to get in touch with or when we did they didn't want the appointments is. >> okay. time has expired but i've got one more question i want to ask you. because a lot of folks have talked about accountability at the table and wanting to hold people accountable for things

they have done. in the media, there have been examples including an employee who participated in an armed robbery. a chief of staff that was improperly prescribing drugs to someone's wife a nurse who is being charged with manslaughter in the death of a veteran patient. they're all still on the payroll. similarly, according to the weekly list that va provides to the committee in the wake of the nationwide wait time manipulation scandal, va has successfully fired only four people for wait time manipulation. how is any of this possible? especially those on the front end who have been -- some of them have been convicted of crimes. >> yeah. it seems hard to believe, mr. chairman. so let me try to step through my understanding and if i make any mistake as i will commit to you i will get back to you with that.

you mentioned the director, he is not on our payroll. he's retired from federal service. it is my understanding that the person who was found with some of the criminal allegations no longer at the va. the person -- one of them actually is going through a court hearing and we're following the court's procedures on that. look, somebody who does either violate the law or violate our principles, does not belong at the va. and we clearly take that seriously. we go through a very extensive process of, you know, due process to get them there. sometimes it takes a long time. but we do not want people that shouldn't be treating veterans treating veterans. and i take that very seriously. so if there are some of those

cases you've talked about we haven't acted fast enough we'll go back and take a look at them. >> you talked about the visin director having retired. it wasn't the visin director, it was his wife that was receiving prescription drugs by the chief of staff of that particular hospital. something that hit the press a couple weeks ago, and that was the doctor that was -- had his medical license suspended for emergency reasons by the state. i believe you took action, fired that individual. now a court or a -- it's been adjudicated his license should not have been suspended on an emergency basis you have had to i assume put that person back on the payroll. >> no. >> not on the payroll? >> no. you're correct about the court action, but that does not change our administrative action. >> is that person appealing at this point your firing of them? >> my understanding is they're looking at their options in that

regard, yes, sir. >> because my question would be if that person is brought back on the payroll and subsequently the medical board goes through the normal process of suspending that person's license, how do you get that money back from that individual that comes back on your payroll? >> well, you know, i think we have to let people have their due process. but right now, we've made the decision an administrative decision not to have them on the payroll. we are not planning on changing that decision unless there's new information that comes up we would have to consider. >> okay. thank you. thank you very much. ms. brown. >> thank you, mr. chairman. mr. secretary it seems like you've been here longer than nine months. this problem that we're having with the va goes back more than

ten years, you know, i've been on this committee for 23 years. we've had problems with the va over a long period of time. and it would be a misnomer to act like these things just occurred. but what i would like to ask -- i'm very concerned about -- is the report have once again, just a couple days ago put va on the high risk list. explain that to me and what we're doing to take care of this problem. i want to get to the stand down what you all have done and the positive things you all have done. please tell me about this because i'm concerned. >> yes. well, i believe the va was placed on the high risk list probably well-over a year ago. it was prior to my confirmation. but the gao has been very clear about the reasons they put the va on the high risk list.

we have inconsistent policies and procedures. we have not systematized best practices or best processes across the va the way a healthcare system should. we have out standing recommendations. i think we've gotten some of them down. there is many outstanding recommendations. we work with the gao on a regular basis. the gao was right in this regard. we have policies and procedures that were conflicting. and we're working to fix that because you can't have that. and best practices across the system is what health systems should be doing. we're focused on learning from the best and putting it throughout the system. this will make va a better system. and i thank gao for that. i'm anxious to get off this list fast. i don't agree with ms. draper's assessment we're not making progress. i know we're making progress. it may not be as fast as she

wants us to, but we're heading in the right direction and addressing the right issue. >> the stand downs. >> the stand downs are a part of it. but the stand downs aren't a way that you sustain improvements. they are declarations of emergencies. and when you have urgent patients that aren't being seen, they are emergencies, and we have to act like that. but they've led to sustainable improvement. our nine core principles of how we'll redesign access in the system. so ten we're from now, a year from now we won't be talking about this in the same way. >> when you had the stand downs, how many people showed up in the various areas? >> 100% of our medical centers were open on those saturdays. no exceptions. people asked for exceptions. i denied them. so we acted as a system in the country, thousands of people -- doctor, do you have a number? >> i think we had 5,000 employees that were actually involved in the stand down. there were 10,000 patients or so

that were actually seen on the day of the stand down. make no mistake, the stand down was only a symbol. everything was going on prior to that stand down. so we were actually evaluating open consults and pending appointments, scheduling appointments and assessing patients prior to that. the stand down was actually a way to really bring together the five points that are priorities. we focused on access, we engaged the employees. we looked to the community for help where we needed it. we engaged best practices from across the networks. and we were working to basically restore trust with our veterans. >> i just want to say the next time that you all schedule a stand down, it would be get to let the members know. because we would like to -- i know i would like to be at my center on a saturday when you all are planning. >> i know at the last stand down, congresswoman, i was in

orlando, florida. and there were members of the congressional staff there. so we welcome your involvement. >> last question, what policy directives have resulted from the stand downs? >> what we've done as a result of the stand down, we sequestered a team of people from the field, not from the central office, who have told us what needs to be done to redesign the system, so we don't ever get long wait lists again of veterans who need care urgently. and that led to this declaration of access. the nine core principles that every va medical center is now signing their name to, committing to the principles to fix access in calendar year 2016 with same-day access and primary care mental health. eliminating our recall system, which we've been using for veterans for a long time. and in making sure that we're using telehealth and expanded opportunities to improve access. >> thank you, and thank you mr. chairman.

i yield back. >> there was something i was unaware of a second ago. you testified, i think, at a subcommittee hearing on thursday about the commercial scheduling software mass that you just talked about. and i think your testimony was that it's on a strategic hold at this point. my -- $152 million is what it would cost to do that? and the question is, how in the world could a pilot cost $152 million? >> so, again, the vse, the vista scheduling enhancement solution that's being rolled out now, total cost of the project $6.4 million. mass, which we do have a contract for, it's an idiq contract. so we can implement this. the next step would be to do a pilot at three sites. it would be a ten month pilot

where you have to build the interchanges, and the cost is $152 million. the total cost of the national rollout is 600 and something million dollars. >> with that mr. lamborn you're recognized. >> mr. secretary, you paint a much too rosy picture. the system is broken. for those of us on this side of the dais we talk and listen to the people and the people are frustrated and angry that we have all of this dysfunction here in washington. and more specifically, with the bureaucracy that continues to fail our veterans. people want real reform, real change and not just talking points about how everything is about to be fixed. and i've been told to my face the problems were already fixed at the beginning of the study and what the gao documented -- office of inspector general documented was after the beginning of the study and everything's okay.

we can't have a real conversation if you won't admit there's a problem in places like colorado springs. i'm going to share with you a brief excerpt from a letter i received from a constitchuent. constituent. he wrote a respectful letter. but he's simply beyond being fed up. here's an excerpt. "sir, i speak for myself and thousands of veterans when i tell you enough is enough. he says, "stop the tough talk and for once act on the corruption and deceit going on at the clinics." he's talking about colorado springs. he ends with this letter describing a 14-month run-around with the clinic and says, "when will it stop?" so when will it stop, mr. secretary? veterans take way too much time to get their care. and they're not being able to

really have access to the veterans' choice program. which is especially frustrating because that was implemented by congress to try to stem the tide of some of this dysfunction. so the first question, mr. secretary, according to the oig and places like colorado springs, va staff did not add some veterans to the choice list or did not add others in a timely manner. what we see clearly is that besides the va altering the times for va care like phoenix and other places all over the country, it now does the same thing by acting as a gatekeeper of veterans who should have access to choice. why aren't veterans really being given the opportunity to use the choice program? >> okay. congressman, if you think i've painted a rosy picture, i failed. because i'm telling you right now, i am acknowledging that we

still have significant issues and we have a lot of work to do. and that's why it's my top priority. i'm not going to rest until we get this fixed. i am focused on it. you and i sound similar when i'm with my staff. because i'm hearing directly from the veterans just like you. so i'm with you. what i am saying, and maybe this is where you thought i was painting a rosy picture. i know we're headed in the right direction. where we had 57,000 urgent veterans waiting more than 30 days for care, today that's 12,000. our electronic wait list for level one, down 32% in the past couple months. our veterans are telling us, we can't manipulate this data. 89% are satisfied with their care. the choice program isn't working for veterans. there's no question. al we've told you that. and we need to make this system work better and that's why we have legislation before you to try to simplify and stream line to make this work better. we have significant problems. i'm hearing the same things you

are. we're headed in the right direction. but we are a long way from declaring that we've got this problem solved. >> mr. secretary, your own metrics from february of this year showed that 29% of veterans received appointments in excess of 30 days, 5% waited longer than 120 days. worst of all over 2,400 veterans are waiting on a wait list to receive an appointment. and 708 have been waiting longer than 120 days. these metrics made the clinic in my district the eighth worst in the united states. so -- and i know of at least three people who have died and it could have been because of this waiting problem. it could have been directly a result of these delays. so i don't see the va fixing it, i don't see them being held accountable.

and i just have to agree with the man who wrote the letter to my office, enough is enough. thank you, mr. chairman. i yield back. >> thank you. you're recognized for five minutes. >> thank you, mr. chairman. i'm very concerned that the vha has been placed o ton jos high risk list and that veterans are still struggling to get timely access to care. the va has undergone significant change in the past year, and it will take a continued commitment from those in this room and members of the committee to work together to make sure the va is functioning the best it can to care for our veterans. but i want to move on to some other questions i have.

dr. shulkin, in your testimony, you mentioned that one of the va's top priorities remains legislation to streamline the process for va to work with outside providers. i'm concerned that the provider agreement legislation this committee considers throws out crucial workplace protections in the order of expediency. when we marked up a provider agreement bill to ensure that the office of federal contract compliance programs retained the authority to enforce workplace nondiscrimination protections. it is the only federal office that protects lgbt employees from discrimination in workplace and veterans for their veteran status. your testimony seemed to imply that we can improve provider agreements without undermining workplace protections. do you agree? >> what i agree with is i know we desperately need provider agreements to make this program work better for veterans. it's not working well and we need them desperately to be able

to do that. i certainly don't know if there's an unintended consequence that your talking about, and so i haven't looked at your legislation, but we have no intent of wanting to impose discrimination or to take away protections from people and putting in place provider agreements. what provider agreements do is too many small providers, the doctors and small practices that are today caring for veteran, can't deal with the federal contracting processes. it's way too complex and they drop out. especially our nursing homes and our skilled nursing facilities. so, we need provider agreements to do an easy to do contract to care for our veterans and we have no intent to discriminate against our employees. >> i realize there's a need to get these providers on board as quickly as possible. i'm concerned that in the spirit of "as quickly as possible" that on two counts,

the possibility that lgpt people could be discriminated against and that our own veterans could be discriminated against, that we need to make sure we balance the providers but make sure they're not discriminatory. >> i have to tell you, i don't understand the linkage between what a provider agreement does and how it could potentially discriminate, but i will get back to you and have our legislative people help me understand that because that's not our intent. >> well, thank you. part of providing timely access to care requires having a sufficient workforce. leveraging community providers can benefit veterans, but we must be mindful of the fact there are many years across the country that face health workforce shortages in the private market as well. and that's why i'm supportive of increasing the number of graduate medical school education residencies in the choice act.

can you give us a brief update on how that rollout is going? >> well, i think it is one of the most important things you authorized as part of the choice act. we need to train more health care professionals. there are actually more medical students now than residency spots and so the va expanding these spots is important. you authorized 5,000. to date, we've only implemented more than about 380 of those spots. so, we're continuing to work with your academic partners in your districts to look to expand these. there are a couple of issues. one is the funding. so, we save our academic partners in california, would you like to expand your psychiatry program and they say, of course we would. but the funding is going to be eliminated when choice is set. what happens then. that's one of the problems we'd

like to work with you on. >> i think there are members on both sides working with you on that, as well as the medicare cap issue. >> we believe this is part of the solution. training more health care professionals in areas of need. i know for for example, we are in el paso, we're just working, thanks to the congressman, working with texas tech on the new agreement. >> well, i certainly appreciate my colleagues mr. o'rourke and miss titus and my colleagues on the other side of the aisle working together to deal with this bipartisan issue. >> yes, thank you. >> dr. shulkin, there were two pots of money. 10 billion and then 5 billion. so, the 5 billion doesn't sunset. the choice program sunsets, but the 5 billion is there until the 5 billion goes away. >> yes, my understanding is on

the gme program, it has a five-year, it has a five-ier length of time that you can use the funding for. if i have a correct understanding of that, that would be good news. >> so, it's your testimony today that part of the reason you can't get more slots is because of the sunset and that needs to change. >> the reason we're not going faster is our academic partners need to agree to do this with us. they're telling us there are two things in general keeping them from going faster. one is the medicare cap issue. the medicare cap says if you go above your number, you can't get additional medicare reimbursement and indirect graduate funding. every hospital i've worked for has been at their cap or above. the second is the length of time it take to start a program. when you start a program from

ground zero, starting it often takes two years or so. if your money is going to expire before you graduate your first group of residents, the administrators at those hospitals say i'm not so sure this is a great deal for us. those are the two issues i'm hearing. if i have it incorrect about the moneying running out, that would be good news. >> just now talking about setting up the program, somebody's way behind the curve. i would tend to believe that the bigger issue is the medicare cap issue and the reimbursement rate, but mr. miller, recognized. >> thank you, mr. chairman. i appreciate it. dr. shulkin, you mentioned in your testimony about direct scheduling. i want you to elaborate on direct scheduling. >> yes. >> that it's available to certain veterans for certain specialties. you mentioned ophthalmology and i believe one more. >> yes. >> elaborate. for the benefit of our veterans out there.

who can direct schedule? and why is it only limited to a couple of specialties? >> right, right. the way the va has done this for a long time is you go through a primary care physician, a gate keeper. so you have to be able to get an appointment with the primary care doctor just to be authorized to get a consult. i have to tell you, i practice now, i'm a primary care physician in the va. my first appointment was just to get a pair of shoes. i had to actually approve a consult to get a pair of shoes. makes no sense. so, we've started piloting program where veterans can now directly schedule without going to a primary care doctor, in audiology and optometry. it worked terrifically. we're expanding that now across the system. i think it was done in florida. i want to look as you're saying, other specialties. podiatry. social work.

nutrition. all sorts of things that frankly veterans can make the decisions themselves. they don't need primary care doctors time to do it. >> very good. >> another question has to do with walk in clinics. how many walk in clinics are out there. you mentioneded about access, same day access. is that widespread? we have a walk in clinic in our outpatient center and i think it works very well. >> where i practice in new york city, that's where i practice in the walk in clinics. we're there if anybody needs to be seen, we see them that day. what many, why don't they? >> because many, 34, have same day access in their primary care centers. if you can see your patients through your primary care center, you don't need walk ins.

the other ones do need some type of urgent care visits. we do know that in areas that are challenged, they've begun some pilots with commercial urgent care clinics as well, too, so this is part of our declaration of access. walk in clinics are a strategy to get there. >> do veterans who need same day access, do they all qualify for care? >> we don't have walk in clinics in every -- >> the ones that do. >> i can tell you if there's a walk in clinic and they are eligible for va care, they can walk in. yes. >> thank you. >> next question.

again for dr. shulkin. one of the va's legislation asks is to have flexibility to avoid artificial restrictions that impeded delivery of care and benefits to veterans. however, the va has experienced many issues in which they attributed to lack of training and education. not too long ago, the va found a budget shortfall for the same fiscal year. the va did not submit to congress a formal request for emergency funds until months after the va had already identified a potential budget shortfall as early as march of that year. this was in part due to the employees were not utilizing the $10 billion appropriated for community care by the choice program and utilizing the traditional nonva care account. the va's only solution was the potential shutting down of facilities throughout the country that's unacceptable. the question is should congress

allow such flexibility. what assurances to veterans and taxpayers have that employers will be trained this time around properly so that another budget shortfall, no threats of medical facilities being closed, does not happen again? >> yes. >> so give me some assurances, please. >> congressman, i think you got it exactly right. which is what we had was we had spent all the money in one checking account, so it got down to zero, so we had lots of money in another checking account. in order to be able to give veterans care in the community, we had to come and ask you for authorization at the last minute. what we're seeing is we don't ever want to do that again. it's not acceptable. it's not the right way to run a system. so we want the flexibility to use care in the community funds to support veterans who get care in the community. that means when we train our people in the system how to use it, we can train them there's

one pot of money and now, focus on doing the right thing on veterans instead of following rules for seven, eight, nine different pots of money that are too complex and we've shown doesn't work for veterans. that's why we need this type of legislation and we need your support in getting that passed. >> thank you very much. i yield back. thank you. >> thank you very much. you're recognized for five minutes. >> thank you, mr. chairman, for holding this hearing. the issues we're discussing are wrong in so many different levels. i'm going the talk about three, one, are your goal, two, our data integrity and three is the veterans experience. so, goals are important because it defines your success. it helps you achieve your objectives. setting a goal of 30 days is arbitrary. there is no clinical day to to suggest that's the best practice anywhere in the health care literature. and you had mentioned a term which earlier in the beginning of your presentation about

trying to match scheduling with the clinical practice. right? so, we know that illnesses are urgent, emergent and we need to take care of them right away and some others can be scheduled. maybe more than 30 days like your routine colonoscopies that you get once a year, right. i think you need to start changing your premise and getting more towards a clinical approach so you can take care of your high priorities first and not necessarily rush or take up your high priorities on things that can be done on a routine basis. the second thing is setting up goals of urgent care appointments is nonsensical. why are they urgent if you're going to wait 30 days?

usually, an urgent is what you call your walk ins or maybe within 48 days when you want to match your clinical practice with your scheduling goals. the third thing that i'm concerned about in terms of your goals is the use of the word same day access for all primary and mental health. you're setting yourself up for more controversy by not clearly defining to the veteran what access is. is it going into picking up u the phone and having speaking with a scheduler? is that what access means? is it receiving the appropriate care? is that what access means? so, the second part is your data integrity, now, we use population studies to reduce the chance that errors are done by chance or so that we can get a statistical significant accounting of whether this is a true problem and whether this is systemic. but the only way we can really rely on those population studies is if you're data is accurate.

if your data has integrity and the gao is continuing to find faults in the way that you collect data and how you're reporting it. so, you can understand why we're still skeptical when you tout the number that 96% of all appointments have been seen within this arbitrary goal of 30 days. the other thing is the way you report data. so, you're telling me that by veterans who use vet link inside the hospitals are telling you that they are 89% of them rate their access good, but you're giving me data with a very high reporting bias. of course they're going to rate it good because they're on the inside of the hospital. how about asking those that don't get access that are not inside the hospital, so tell us what their access is going to

look like. so, for those of us who know statistics and know methodologies, we are skeptical when you report some of these reports to us that may not be as accurate as possible. and lastly, when we can't rely on population data, when we can't rely on the integrity, then we go by case studies and case studies depending on the accuracy and write up and details is what oftentimes we're left to look at. so, let me tell you about case of a wounded warrior who actually works in my office who is a hero in my book. went for his yearly check up for the va. he is service connect disabled, manages well. prescribed medication through the va. after waiting 30 minutes on hold, 30 minutes on hold, the veteran was notified that because he had not had an appointment in over a year, he would have to schedule a new patient appointment even though he was not a new patient. he agreed to the appointment,

asked to schedule that appointment as well. they couldn't fit him in until 134 days later. again, arbitrary. as a result, this veteran elected choice, but they said you have to come in and do your new patient appointment before you get to your choice appointment. so, one, what is same day access mean and two, why do these arbitrary numbers exist in the first place. and three, why do they need to have, why do veterans need to have a new patient appointment? after a certain amount of time, even though they've been getting prescribed medications you know, as recent as a month. >> thank you. and i appreciate your skepticism. i think most doctors and politicians generally are skeptical of data and i think

that's a good thing. so let me very briefly tell you. first of all, you said it absolutely perfectly. the va needs to clinically prioritize its appointments. exactly what i brought into the system. we used to have 31 days of ordering a consult. today, we have two. either urgent or it's not. there is no 30-day rule for urgent care. i don't know where you got that. that does not exist. urgent patients have to be seen now. that's why we did the stand downs. i've never had a patient with an urgent care need that i wasn't getting them to be seen right away. that's our goal. get them seen right away when they have an urgent care problem, so acompletely agree and you said it perfectly. secondly, same day access. what does it mean? revolving the veteran's needs that day.

if they need a prescription prefilled, they don't have to come in. we can do that on the phone or electronically. if they need to talk about how to understand how to use their treatments, we can do that over the phone or telehealth. but patients who are sick and need to be seen should be seen that day. that's what we're working to get implemented. we have to set expectations and explain it in a way quicker than we do today. the last thing about the veteran's experience, the only thing that matters, are we meeting the needs of veterans. the vet link system we talked about asking them when they're in the system, you're right. so, we have a second survey called taps. it's what's used by the private sector industry. that asks whether you've been able to see your doctors when needed. so, we compare ourselves to the private sector using caps. internally, we use the vet link system because that's a point of care system. so, all your points are absolutely right, congressman and we take them to heart. >> thank you. >> dr. roe. >> thank you, mr. chairman and you know i have great respect

for you and one of the things i don't think i would have said if i were you is that one year from now, things would be different. not sure they will be. i hope they will, but i'm not convince. just a couple of three points. i'd like to have your answer on. one is if the va is doing its job, why do we need a stand down? why did that need to be done? >> believe me, stand downs are not the way you run a system. dr. roe, absolutely right. the reason is because you reach an unacceptable situation and the day i learned -- literally, the day i learned with 57,000 patients who had urgents consults greater than 30 days, i said there is no nothing to do but declare it an emergency and that's why two weeks from then, we had our first stand down.

because it's unacceptable. but that can't be the way you run the system. you have to put in sustainable fixes. that's what we're doing now. i looked at the numbers of schedulers. 32,000. that's plenty. they schedule ten people a day, shouldn't overwork anybody. that's way past 70 million schedulers, i mean appointments in a year, so you got that fixed. if the system works and i would like to have you guys define what an appointment is. what i finally figured out there this is look, the day i called. you, if your my doctor, i called, that's the day i'm calling to get the appointment. obviously happening was you would tell the veteran, well, we don't have an appointment the day you want it, but we've got one at 6:00, would that be okay. that's their desired date according to you guys. just, lock, just go ahead and say we don't have it until then. if it's a problem, if you

prioritize, as the doctor said, the sicker patients, then see them early. why is that hard? we make this so difficult. >> okay, so a couple things. 3 3267 schedulers seems like a lot. it's got a 25% turnover rate every year. you're constantly circulating people in and out. >> fast food restaurants sounds like. >> right. secondly, seeing the urgent patients first. that's what health care systems need to do. that's what doctors do. absolutely. that was macing from the vavt. that's what we're focused on now. it's p i absolutely agree. i think when you talked about how, you know, we assigned clinically indicated, preferred dates, that's what the chairman was talking about when he says there's this negotiation going on. that's where we're confusing people. so, so look, we need to do better with that. we can't have it be an arbitrary

way of assigning appointments. that's where we really need to move to this veteran experience. you can't manipulate data there, right. that's -- you're listening to your patients, the data is what it is. >> everybody's speaking from the same -- singing from the same song book. completely different information, how are we up here supposed to make any sense of it? question to you. what would you be recommending to the va? because clearly this is not what the va's telling us is happening, this investigation that you did. >> so that report this recent report, we made three recommendations to va. one was to -- because we think the entire period -- from the time they first request care to when they actually receive care, that should be monitored. because there's a lot that can happen between the period a

veteran requests care to when that preferred data's sent. so we made a recommendation to which va concurred that that whole period of time should be monitored. the preferred data is really an artificial measure for the veteran. they don't understand what that means. the veteran experience is when they actually request care to when they actually receive it, so that's one. the second piece is va has been without a scheduling policy since 2014 and what they've done, they rescinded the policy, they implemented a scheduling policy in 2010. it was rescinded in 2014 after phoenix. the way they've provided guidance to the field has been through memos. that's really not the way to do -- it's been really piecemeal effect. it's very confusing because they get memos. they don't know what they're supposed to be doing. you need a really good policy which sets the stage for also

really being able to do effective oversight because if you don't have a very clear policy or you don't have steps that you should be looking at in the scheduling process, it's really hard to evaluate whether people are doing right things or not and we heard a lot of confusion about that. those are some of the things in va again concur with our recommendation so there's a lot that needs to be done. i would say the other thing related to training is, you know, i know they said they trained over 32,000 schedulers. i don't know if they're all schedulers but people with scheduling keys which could be other people as well. have they evaluated the effectiveness of that training? one of the things we saw, we saw schedulers, the same scheduler, making multiple mistakes. we didn't see intentional manipulation. the question to me somehow effective is that training. where is the oversight. and, you know, maybe there's some people that lack the capability or the skills to be able to do this job.

and, you know, they need -- that needs to be accounted for. there's just a lot of things that go into this whole process. >> mr. chairman, i'm going to yield back because i'm overtime but there is one other subject. maybe one of my colleagues will bring it up. the gme implementation. we had a va come over and talk to the entire caucus and i've been walking through that in my local medical center, trying to get this done. 300. we'd like to get them out there. get these young doctors in these trained positions. i yield back. >> thank you very much. and we will. let's go ahead and take care of that. because this -- the issues that you brought up are really the first time that i've heard that and i think it's something we need to go ahead and address as quickly as we possibly can. mr. o'rourke, you're recognized. >> thank you, mr. chairman.

secretary, shortly after i arrived in congress in 2013, i noticed a gross discrepancy between what the va was reporting on wait times in the district i represent el paso texas and what veterans themselves were telling me. in 2014, because we couldn't resolve that based on the data we were given in the va and the assurances from one of your predecessors, we commissioned a third party independent survey of el paso veterans that returned results with a margin of error under 5%. that showed that instead of waiting eight or nine days for primary or mental health care, veterans were waiting over 70 days, over 80 days for those two respectively. the conclusion i arrived at and i still insist upon is that the only way to find out how long veterans are waiting for care is to ask veterans directly. we surveyed in 2015. we will survey again this year.

i'm glad to hear you agree with miss draper's conclusion that the va must measure from the date the veteran first requested help to the day that appointment was delivered. for anyone who hasn't read this gao report, this is illustrated graphically on the first page in a way that anyone can understand. so i have a question about that, when will we receive those numbers and the way va measures wait times so we don't have preferred wait times with multiple points of potential failure and manipulation and we just have -- you asked for an appointment on this day, you received it on this day. number one and number two, you gave a great presentation in october on the way forward for vha that acknowledges it today. we have 43,000 authorized funded but unhired positions within the va. we're going to leverage capacity in the community. we're going to specialize on what the va should be doing best. that is something that needs to happen if we're going to resolve

the fact there's more demand than there is capacity within the va. where are we on that. so those are my two questions. standardizing of wait time reporting and where are we on october plan you announced at the end of last year? >> congressman, i've already acknowledged our systems for measuring wait times are overly complex and difficult to understand. where i believe that we need to go is to simplify this by looking at the veteran experience, by asking our veterans, are we meeting the needs of the veterans in the el paso community and that's the way that it's done in the private sector. they don't have these complex wait times. remember, we went out, we asked the institute on medicine, we've had so many consulting companies. i can't even imagine. tell us the right way to do this. they've come back and said there is no standard. so i think what va is doing is we're measuring so much right now and trying to report

everything, we're confusing the picture. so we have to get better at this and we have to simplify it and we are going to do it. i think what the gao report is talking about is the new enrollees and that's where we've concurred that we will measure the full, full wait time. i'm not anxious to start redefining wait times and getting even more data. i actually want to simplify this. on the issue of what do we node to do to go forward to work with care in the community. we need the legislation to streamline the care in the community. we need the provider agreement legislation passed. because we need to fix this program for veterans. we do need to work with the private sector. we're committed to that as well as our federal partners like the indian health service, federally qualified health centers. we'd appreciate your support. >> so on both of these issues, i would love to follow up with you

to get written specifics on just when we'll have wait times reported and the way recommended by gao and, two, i want to know specifically what is on our plate that we have to finish in order to allow you to implement what i thought it was a very ambitious proposal to make va work for every veteran. and get what you describe. which is outstanding care. which should be the ultimate focus. when it comes to my colleagues. when it comes to measuring wait times. we have introduced a bill. the ask veterans act. the ability to get objective third party confirmed wait times. the va reports for april of 2016 that veterans are waiting 13 days for primary care, 10 days for mental health care. when i say that, i almost get laughed out of the room. when we report back what veterans have told us in the surveys, they all nod their

heads. so we welcome the support and collaboration of my colleagues on this and i thank you for your commitment for making sure we report more honest wait times for veterans in our communities. >> thank you. >> i yield back. >> you're recognized for five minutes. >> my time on here is accountability. i want to drill down on a couple situations that i think are pretty striking examples and perhaps, dr. shulkin, you can clarify. apparently, what i understand, the va in puerto rico has refused to fire an employee convicted of crimes. suggested it was okay for va employees to participate as long as it was on their free time? now, i'm sure you don't agree with that. what is the va doing to take care of this situation in puerto

rico? >> congressman, i am aware of that situation and i don't -- it is my understanding and i'm very careful -- i want to give you accurate information so if i misspoke on this, i will get back to you by the end of the day. but it is my understanding that that person is not currently working at the va in san juan. >> on paid leave? >> no. that's not my understanding. again, i will personally make sure we confirm that with you but no, that is not my understanding, that they are not an employee of the va. >> look forward to that. second one, still has not disciplined the chief of staff at the cincinnati va medical center who was found to have improperly prescribed control substances.

what else the status of that particular employee at the va? >> that situation, i'm a little bit closer to. if you will recall, i made an administration decision to suspend their privileges of the chief of staff and she was actually in an acting chief of staff role. and also to remove her from that role. she is following her due process which means that the medical staff is looking at the clinical privileges and there's a due process going on on the administration decision i made. there was both an administrative and clinical decision but currently she's certainly not in that role and she's not -- >> ci appreciate that. so no access to veterans as it stands today? >> she is not in a clinical role not in that leadership role no.

>> what role is she in? >> my understanding is she's doing administrative reviews like quality reviews. >> and has been found improperly prescribed controlled substances and is still doing quality reviews? >> we had concerns. that's why we took actions. we invited the inspector general. that was my first request to come in and take a look at this. i know the dea has come in to take a look at this. >> and thirdly, going back two years. it's june 5th of 2014. here's a statement. in phoenix, wish in yaited a process to remove senior leaders. as i understand today, a number of those senior leaders are either still on unpaid leave or

are working on the process. is that the case, it's taken two years and mr. gibson has yet to fulfill that process and end that process to remove these folks that were covering up secret waiting lists that harmed up to 20 veterans? >> yeah. i believe apronproximately 30 ys ago, mr. gibson did make a decision on all three individuals. that decision was removal. they were each in their process of due process. he has a shorter period of time in which to do that. the other two are title 5 employees. we talked about as part of the accountability act. >> so june 5th of 2014. the promises made public. cnn. we're going to take care of this. as we sit here today, april 19th, still not completed the process to take care of someone and get them out of harming our

veterans. mr. shulkin, i ask you to pass on to your superiors. for some reason, the senate's still sitting on it. this is absolutely outrageous. whether it's puerto rico, since net or phoenix. still almost two years later. and we can't get rid of the folks that have harmed our veterans. they all laugh. they've lost all respect within the veterans community. and so we hear these numbers and appreciate -- and i didn't get time to ask question because i've gone over but i understand we've had 58 cases referred to the department of justice for possible criminal charges. that would be my fault for the committee if we can find out. and the disposition of those. i yield back.

>> thank you. you're recognized. >> thank you, mr. chairman. secretary shulkin, i appreciate your testimony today to say your intention in your testimony, both written and your earlier testimony, was not to paint, you know, an extraordinarily positive picture but to say it paints' picture we're on track, so i appreciate that. i have to say though in your testimony when you, quote, april 1st, or the wait time for va overall is completed, 96% of the time within 30 days overall and that's data i think from february. when i was reading your testimony last night, i said to myself, oh, gee, it must be my district that's causing the 4% that's not there. so i went back to look at the data.

as of april 1st, almost 30% of our veterans that i represent in the oxnard cbot in ventura county have primary care appointments pending over 30 days. actually, i asked my staff for the data this morning and i think based on the data in that one metric, we are the second highest cbot in the country with dover, tennessee being the highest at 48 days for a pending appointment within 30 days. we had a problem and we've had' problem and i am extraordinarily excited that the va of greater los angeles health care system has finally hired a medical center director who is permanent. but we are working very closely

with ann brown. who i believe is doing a very good job and is very aware of what is going on in oxnard. and clearly we have had trouble hiring and keeping teams there within the cbot. i think we have a contracted out facility that plays a role. the choice program is not really working too terribly much. that's not as large an option as we would like it to be. so we know these things are happening. i guess my question is if i wasn't watching this closely, my question is, is the va watching this closely, and would you have -- nobody brought it to my attention, i just bring it to your attention. so my concern is, is the va looking specifically at regional

problems that is skewing your data perhaps to really address these pockets within the country that aren't doing very well at all? >> yes. we are tracking this. i think you have it correct which is that this is very different depending upon the geography of the country you're in. so that we have some vas that actually don't have backlogs at all. and others like in your district that have significant backlogs and primary care. so we are paying attention to that. we're actually focused on that top 10% to 15%. we're sending our resource center teams out now to work with those most distressed facilities to help them redesign their systems. we're focused on recruitment in areas that really are struggling with recruitment. and so we absolutely are focused

on that. but i think that it's a relatively new direction for us to focus on those areas that have been so -- that really are struggling the way yours came from jesse brown in chicago, is one of those experienced leaders. we knew greater los angeles was one of the challenged facilities. we brought on experienced leader there and i think you're seeing that makes a big difference. but without permanent experience leadership in place it's very hard to address this in a system as large as we are. >> i can rest assured that the washington team is working directly with anne grown to help

facilitate this issue at oxnard? >> i've been out there to visit with anne and the secretary. some people thinks he lives in los angeles he goes there so often chblgs i want to say publicly that i believe anne is working very hard on this and i appreciate her leadership and she's now giving my district office regular updates but it is an eyesore compared to the rest of the country and needs that attention. ms. draper talked about -- or you talked about working directly with the gao now and a team to recognize where some of this -- some of these improvements have come from and i guess i would ask ms. draper, you know, to ask you your feedback in terms of are those meetings productive and are you meeting on a regular basis with specific agendas. >> yeah.

so there are five criteria from removal. this is capacity. a third piece is the action plan. fourth is monitoring and then the fifth is demonstrated progress. what's happened thus far is that va provided us a draft action plan in january and it really addressed one of the five areas and we felt that the action plan was not sufficient. so we have -- we met with them, provided them comments and then we referred them to an agency where we felt like has done a really good job making progress on their high risk status. they've gotten the action plan and we've committed that we'll begin meeting with them starting the end of the month and then monthly. i think they're trying to get on target to get us an action plan, a reliable feasible action plan by august. and that includes having metrics that we both can agree so that there's progress made. there's a lot of work to be done

and i think that we're going to work with them to provide feedback. it's a little difficult for us because we have to straddle the line of independence. but we can provide feedback and direct them to other sathcys where we feel have made good progress on the high risk. >> thank you. i apologize for going other. i yield back. >> that's all right. dr. abraham, you're recognized. >> thank you. my respect for you personally is great and i know in my heart of hearts you want to get this right. my concern is like ranking member brown said, this is way before your time. it goes back ten years plus. so my concern is the culture of the va. this may be a bridge too far to actually fix this problem within the va system itself. and it may be time to look outwardly to a private sector to do the scheduling. if 89% of the veterans are sats fieds with their care once they

get there, we certainly want to enhance your ability to treat those veterans with the expert care that we know the va gives our veterans population. but we're talking today mostly about the scheduling issues where the va has the ability or lack of resolve to get rid of the poor scheduling employees. your turnover rate you said 25% that's hard to keep a quality employee on task with that going on. with the $152 million to implement the software program, you dangle that in front of private enterprise, they are going to be knocking down your door to do this. just a thought and maybe a pilot program or something could be on the agenda just to compare how the private sector does on the

scheduling, not the health care for the veteran but the scheduling for the veteran to get the appointment. just a thought. you said that you guys are hopefully going to each visit every three years and you look at data, reliability, the veterans choice program and implementation. and i guess the first question the data you're getting from the va, the old adage, garbage in, garbage out. if you don't get the data that you need and you don't just the data that you get, it's hard to make informed decisions. the question are you satisfied, are you comfortable to date with the data that you're receiving from the va on this issue of scheduling? >> no. we can't to see the data unreliable which is one of the

reasons why we're going to implement this vision approach, national reviews are great where we sample so many facilities throughout the country. but we think if we can push this down to a local level and feed this information to the vision management and give them an opportunity to take control and make changes, we think that's going to be more helpful. but the 96% and the data that has been discussed today, we don't see it. i mean every facility we go to, it's not accurate. >> and my next question, it's a quote, i want to make sure i get it right. it says in a february 2r5th, 2016 letter to the president of the office of special counsel said that the va oig's investigation whistle-blower disclosures regarding wait times in illinois and shreveport, louisiana, were inadequate.

the oig investigations found evidence to support the allegations that employees were using separate spread sheets outside of the va's electronic scheduling and patient record systems. however the oig largely limited its review to determine whether the separate spread sheets were quote again secret, unquote. please explain why the oig limited its review. >> so that review was conducted but our investigative staff. i was not directly involved in that. i am aware of the concerns and i know my boss has made sure that we try not to interpret the allegations too strictly. and you know, i can ask the office of investigation to get back to you on their response. >> i guess my follow-up question, were there any criminal charges sent it to the doj for prosecution that you

know of? >> i would say no, i don't know. i know there were some and there's been discussions but that's outside of our office. >> thank you, mr. chairman. i yield back. thanks. mr. zel dan, you're recognized? >> april 7th, usa today story starts with supervisors instr t instructed employees to falsify patient wait times at va medical facilities in at least eight states. was that accurate? >> i've reviewed 72 ig reports. 11 of them were found to have intentional manipulation. that would be accurate but it's not representative of the majority of their findings. >> and of the supervisors, how many of them have been fired? >> we have for a tote oval all of the oig reports, when i add up going across that, we have 29 individuals that have been

disciplined. i think chairman miller before had said four have been fired. i'm aware of five who retired under investigations. so rather than letting the investigation go forward, they decided to retire from federal service. >> when you referenced the number of 29 disciplined, that is from this usa today story? >> from the 72 ig reports that i have reviewed. i sort of -- i manually counted them up as we went through each of the accountability actions. >> have any supervisors who instructed employees to falsify patient wait times, have any not been disciplined? >> i suspect of people investigat investigated, there were many more than 29 probably. lots more that were investigated and the evidence did not suggest that there was discipline that needed to be imposed. >> are you saying that there

were supervisors who instructed employees to falsify patient wait times who have not been discipline sdi disciplin disciplined? >> of course the investigations that we've done they found intentional manipulation, we would send in our office of accountability review to do the investigations. everybody that was found to have an a or found to have a behavior that required disciplinary action we have. >> no one hasn't been disciplined. >> i wouldn't say that. >> we're going to circles. of the supervisors who instructed employees to falsify patient wait times, have any not been disciplined? >> you know, i don't know the -- i don't know what your denominator is. anybody that has, accused of

manipulation we've investigated. when we found there's evidence of the manipulation, we've implemented discipline. >> i am not aware of anybody that we found that we haven't implemented disciplinary action. sometimes after the action they've appealed and those actions have been overturned. >> but no supervisor who you have investigated who has instructed employee to falsify patient wait times have not been discipline sd disciplined? >> you know, congressman, i feel like i'm being asked some questions about -- you'd have to ask me individuals. >> i'm asking about anyone. >> well, look. >> has anyone not been disciplined? >> these disciplinary actions have been going on well before i got here. what i -- all the information i

have -- this is not any responsibility to implement the disciplinary actions. when i've reviewed the reports, when i find that other people have taken disciplinary actions against individuals, i'm sure there are many more that have been accused of supervising. i don't know how to answer your question. >> well it's a simple question. there was a usa today story said supervisors instructed employees to falsify patient wait times in at least seven states. you say you investigate it and if you have evidence to back it up then the person is disciplined. i'm skoog through this process if anyone hasn't been disciplined. we're talking about patient wait times while we're here. we have issues with patient advocates, they won't get someone on the phone, they'll leave a message. many times won't get a report back. reports of calling a suicide

hotline and getting a voice mail. a backlog of appeals the committee is concerned about. greatly concerning numbers the denver va hospital construction project. i have a constituent, john mitchell with over 20 years of service, army ranger in vietnam with over 16 years of service with special ops. we suffers from traumatic brain injury directly connected to his sufs. one from an accident in a mail tear vehicle, another bun from a parachute fall. and because the va lost his file he's being denied his benefits, 20-year veteran, vietnam veteran, special ops, he's unable to take care of himself and we're getting all of these different cases but the only time it comes to light to the committee is when the committee brings it up to the va. the va needs to bring the issues up do the committee beforehand. when one example after another

doesn't come to light until this committee brings it to light or the usa today does, if it's not initiated by the department of veterans affairs, it looks like a coverup. so you say that someone who violates the law or violates of principles doesn't belong at the va, that goes straight to the top of the people who are violating the principles of the va. it's greatly concerning that it's this committee responsible were the inspector general, the media responsible for bringing it to light and you don't do that for was. i yield back. >> thank you. mr. coffman, you're recognized. >> thank you, mr. chairman. just a question about the appointment wait time schedule because i think we're getting different summaries of it in you will. so wasn't the -- you said that

it wasn't about cash bonuses but you didn't put a date on that. i guess that the policy had changed. but what was the policy in 2013 when this issue came to light? >> congressman, i wasn't here then, but i believe that there was wait times as part of people's performance evaluations. and so dr. lynch, am i correct in that? >> yes. >> so there was a potential of a financial bonus if people hit certain, certain criteria. >> sure. >> today that doesn't exist. >> so you allowed -- people were allowed to retire who were under investigation, who were complicit in manipulating

appointment wait times is that correct?? >> i think i said the investigation didn't conclude. before the investigation was able to conclude they retired from federal service. >> but this involves fraud and fraud is a criminal issue. how many criminal referrals occurred of people who were involved in this scandal? >> my understanding, i don't know whether the inspector general can help us with this. was we don't have -- i think h was senator blumenthal ask that the department of justice come in to look at this and they ended up declining on looking at most of these cases. but i know there are referrals from the ig to the criminal division. >> could someone comment on that? >> there are referrals and i know in every case where we suspect something we'll make the referral. i can tell you and this is not my area of expertise but i think

a lot of the money that you're referring to, the bonuses, while inappropriate is not necessarily a high dollar amount and there's not a lot of attraction -- >> so fraud is okay if it's a low dollar amount? is that what we're saying today in. >> not for me. >> really? >> the department of justice, i think there's not a lot of traction if it's a small amount. >> that's disappointing under this administration that that would occur. let me state what is current law and that is if somebody commits fraud but is awarded a bonus, there is no claw back provision in current law. is that not correct? who can answer that? >> i'm not aware of the answer. >> there is no provision. in fact there is legislation before the congress and the position of the va is neutral on that which i find is appalling as a taxpayer and a veteran that

when somebody gets a bonus that they clearly did not earn, should not have been given, that the only provision that the va is able to claw it back is if it is given administratively to the wrong person. but if it is given to the person that is the subject matter of the bonus, even if they didn't earn it, there is no provision or clawback. that law needs to change and the secretary needs to take a position affirmative for that legislation. this is about cleaning up the va. and the secretary was giving a speech in denver last weekend, i think it's two weekends ago they was at where he said that the fundamental problem in terms of the appointment wait time scandal was a lack of training of va personnel. is that correct? was it due to a lack of training? >> i think what the secretary

most likely meant was, was that our system was complex and we weren't spending enough time training. i don't think he would have that was the only factor. there were many factors. >> it had nothing to do with a lk of training. it had everything to do with people that were fairly skilled at manipulating the system. what they did was to make the numbers look smaller to get the cash awards is they pushed veterans out on these secret waiting lists who did not get health care. and there are veterans who died on the secret waiting lists. and you know, i don't know how we ever clone up problems in the va if we don't acknowledge their existence. and i really don't believe that the leadership of the va has acknowledged the depth of the problems that exist here and that's why they'll never been cleaned up under current leadership. i yield back. >> you're recognized.

>> thank you, mr. chairman. i have to ask specifically, in the individual va medical facilities, administrators and/or directors basically have the ability to monitor this with their own facilities? correct. make sure they're the ones that are in charge of doing that. >> monitor the wait time? >> the wait times, they're the ones that do that. >> yes, sir. >> the problem is i see right now -- st. louis is one of our facilitie facilities. in the last 34 months every 120 days or 280 days, depending on -- 240 days by your rule, we keep circulating directors in and out. i ran business for years and if

in 120 days i couldn't get all of my employees names down. i definitely couldn't figure out where the problems were. and whenever -- i thought this was only in the st. louis facility. but our research found out there's 40 facilities that are actually interim directors that are cycling through like this. it's very hard to have oversight if someone isn't there for a long period of time and they understand that's their job. is there anything being done right now to try to cure those problems? >> yes. first off i couldn't agree more. you can't solve the problems of the va unless you have the right leaders in place and they need to be permanent leaders. so we're on the same page. st. louis very unfortunately pe actually named a permanent leader who were coming from sh the. >> no longer available. >> coming from hawaii and because of personal issues he retired from federal service. so now you're back in a national search and we have some candidates. so i am very focused on getting

a leader in st. louis. but i don't count 40. i count 34. that's 34 too many. and so we have national recruitments out in place. it's one of the reasons why we've asked for you support for title 38 legislation. we need not only accountability in this va but we also need market rates that will help us attract the very best tool come to take these jobs. right now there aren't enough people who want to come take the jobs. >> because of salary? >> i think the pa bad press that va is getting, the applications are down 78% from the date of the crisis. these are known to be very tough jobs and the salary is not anywhere near where the market rates are for these jobs. >> i'm pretty sure that nobody wants to jump on a ship that's sinking and that's the problem. our maybe needs to be sealed up and then bailed out in the condition that it is right now. and i think, i think this is a possible -- this just causes a

downward spiral and i think it needs to be cured. now i'm willing to work with you on that. and understand the legislation that we're pushing forward gives the secretary 120 day to look over proposals on what it is that we can do and move forward to try to cure the problems. with that mr. chairman i yield back. >> thank you. i'm going to yield myself five minutes to ask a few questions. doctor w as you know we've been aware of this problem with the trainers and procedures with the schedulers since 2005 when it was first reported on 37 and the independenter general stated in its august 14 phoenix report since july 2005, inspector general published 20 oversight reports on va patient wait times and the va has been resistant to change.

i guess my question is, is about the procedure for responding to and dealing with office of inspector general reports. okay? this is something that i've been working on for years in my position here. is someone actually put in charge of responding to a specific inspector general report? >> yes. i did not do -- when i came into office, a major reorganization of va leadership because i wanted us focused on this morning fixing the crisis. but the one thing i did do was i established a new deputy undersecretary for organizational excellence whose position it is to focus on that. >> there's one spern person -- >> one office. >> so that person will be held responsible for making sure that the inspector general reported deficiency is correct snd. >> well, i will be held

responsible and the secretary ultimately is held responsible. >> but it's difficult because, you know, we've had so many inspector general reports where the secretaries agreed with the report and agreed to change it but nothing has changed in 20, 30 years. you realize that, right? >> i do realize that. >> identify the fact this's no central hiring process for physicians at the va. that was reported i think eight times over 30 years. that problem still exists. no one seems to have fixed that problem. so i want to have where one person is responsible for responding to the inspector general reports. let me ask, has there ever been accountable employee assigned to fix the problem if in your history with the inspector general?

>> so there's always someone assigned but quite honestly -- and i was involved with one of the first 2005 report and we reported it and until 2014 there was really no priority place to it. we reported it in '05, we reported it in 2007. the right words were said, actions were, you know, changes were made. but when we came back two years later we found that nothing had been put in place. >> that's my experience as well. they say we're going to fix it but nobody is actually responsible and name of an individual who name it is to make it actually happen never seems to get fixed, you know. you think that legislation mandating that the va assign a specific accountable employee to fix a problem would be an effective strategy? >> i think the doctor was right that ultimately he's responsible and the secretary -- we make our

recommendations generally to undersecretary of health assigning -- i wouldn't think legislation would be necessary but that's something certainly -- >> by saying there was this problem for 30 years with the ig telling the va they need to have a central plan for hiring physicians, they said that six time over 30 years, the va agreed to them but yet nobody was assigned to fix that problem and it still occurs today that there's no plan for firing physicians in the va. you see what i'm talking about? this is something that's a procedural the way things are done. it's given to some committee, some department but then there's nobody who is actually in charge other than you and you say well, we're all working on it. >> but what i'm saying is that is the organizational change i made. i have a brand-new deputy undersecretary whose job it is to do that. and they put together the office

of medical inspector, all of the compliance officers, the regulatory officers. >> what's his name? >> dr. carolyn clancy. you know dr. clancy. >> how many reports has he looked at in that position? >> they've been keeping us busy. we've looked at 72 on the wait times alone and you've sent over a bunch others over that. pi would say probably over 100 sk. >> i would like to see the inspector general reports that we's looked at what he has done to respond to those reports. >> absolutely. >> thank you. i'm out of time and i think everybody has asked their questions. we're just about ready for the closing. ms. brown has a closing statement. >> i want to ask ms. draper a question. you mentioned the scheduleder and that perhaps they're not getting adequate training.

we all know that a scheduleder is an entry level job. do you think that the va kneads to do more to upgrade? once a person is trained in that position, if they see another opening, they want to move up. >> yeah, let me back up a little bit. i think training is an issue but i think it's much more complicated than that. there's oversight. the scheduling system is prone to user error. there's a lot of things that familiar tore in to the errors. the scheduliers is industry level. it's the number one or two position with turns over each year. there's not really a good career path for those individuals and what we've heard is that when someone demonstrates a high level capability they're often scooped up and move somewhere else. i think at one point a couple years ago they instituted in some places a gs 6, there was a

career path and my understanding is that doesn't exist any longer. so i do think -- if you put this much responsibility, a lot of pressure and responsibility on these individuals that it is important that they have the support and the training and you know the oversight. as i said in any opening remarks, if someone continues to do the same errors, where's the oversight and what happens when that continues to happen. that's what we sooef seen. it raises the question about oversight and quite frankly whether some of these people pop are able to do the jobs that they're put into position for. >> thank you. mr. secretary, i've gone to the medical schools in the orlando area with the secretary and i didn't know that there were some problems -- because i know we need additional slots. so i'm hoping you'll get back with us and if there's message on our side we need to do, i

know we want to do it. we need the official physicians. if they train and have the residents, they will probably stay in the area >> we'd welcome further discussion on that. >> and in closing, i'm hoping that the veterans that's listening to what we're doing today understand that we are seeing over 2 million additional veterans in 2015 than 2014, over 224 appointments per day. so if veterans need to come to the system, don't be dumbed down by what you hear in here. go and get assistance. go to your member's office, go to the va. with that, you know, we all need to soldier up and make sure that the veterans are being taken care of. thank up. i field back the balance of my time. >> thanks to the entire panel for being here. you're now excused. today we've had a chance to hear

about ongoing problems related to veterans access -- oh, i guess we're going to have the chairman give a closing statement. >> no, no closing statement. i just confirmed with the caribbean health care system that the individual that we were discussing is still on the payroll. >> thank you for correcting that. >> so again, the question is why in the world was somebody who has been convicted of armed robbery still be working at the department of veterans affairs. >> okay. well, hard for me to answer that right now. so i think we owe you an answer. >> please. thank you. >> thank you, mr. chairman. we've had a chance to hear about the vet answer health care that

occur today. as we've disquds the va has not taken the steps needed to improve access care for veterans. until the va stops using the excuse of poor training, begins holding itself accountable, nothing will change. doctor, it seems to me that the i care in my va access declaration are just 0 words. these ideas speak to an intent but to this committee and veterans, results are what count. it's not good substitution or action. our veterans will have to hope that the va gets itself squared away. as we know, hope is not a plan. i ask unanimous consent that all members have five legislative day to resize their remarks and include extraneous material and without objection so ordered. i would also like to once again thank all of the witnesses and

the audience members for joining us today. and with that, hearing is adjourned.

thursday, the head of customs and border protections testifies. we'll have life coverage at 2:00 p.m. eastern time on c-span3 and c-span.org. madam secretary, we proudly give 72 of our delegate votes to the next president of the united states. ♪ ♪

house budget committee chair tom price talked about the federal budget process and how to reform it at an event host bid the committee for a responsible budget. he's calling for a complete rewrite of the 1974 congressional budget act. following his remarks, a panel will discuss the issue. this is an hour and a half. thanks very much for everybody who came today. very good expert audience that we have with us. we're also filming c-span live. >> turn the mike on. >> hello, everybody. again. okay. so we have c-span with us live which is terrific. we have a broad audience. and thanks to everybody here. i see all of the leading budget

experts in the city in the room. thrilled to have you with us. our topic today is fixing the broken budget process. this is a topic that anybody who knows the budget or the rules that guide it is familiar with that there's a whole lot of improvement that we can do, even get budgets done, to fiscal outcomes that aren't always healthy for the country to the fact that budgeting in our country is separate from any strategic economic thinking you might want to do. swl whether it's the smallest technical areas or the biggest broadest and's the oobjective o the budget, there's white a lot we can do. so we have a great panel of experts today who are going to lead a discussion about a bunch of different topics of where we would look for reforms. but what i'm thrilled to do is to introduce our keynote speaker today, dr. price who is not only

shepherding the budget process, he is also doing some really deep and important thinking about reforms to the budget and what they might look like in terms of process. so i'm thrilled that he's joined us today to lead our discussion. so thank you very much, dr. price. >> thank you. >> nice to see you. >> thank you. thank you. [ applause ] thanks very much for the opportunity to be with you today and talk about something that's near and dear to everybody's heart, right? budget reform. how exciting can it get, you know. probably nothing could be more important and less exciting than budget process reform. so i want to thank all of you for coming out today to discuss and share your ideas about this incredibly important issue as we try to move forward with something that i think has a process right now that clearly is failing not just those participants in the process but

failing to country. and that clearly needs to be reformed. so it's an exciting prospect for all of us to kind of try to shape the way in which budget process reform moves forward. i also want to commend the panelists who have spent incredible time and toil and labor in trying to assist folks in understanding what the budget process is, either why it works or why it doesn't work. they've got some wonderful contributions to make today to this conversation. what i'd like to do is just kind of lay out where we are right now, what the challenge is. and do so in a way that hopefully highlights the reason for budget process reform, the need for budget process reform and then talk about some of the things that can be done and split the way forward in terms of policy and process. the budget as most of you know

does three things in congress. it sets the 302 a number, the number that the appropriators can spend on the discretionary side for the next fiscal year. it lays out in the budget window, the ten-year window. it lays out the vision for the challenges that we face. whether it's the majority budget or whether it's the minority budget or the other budget that's offer. oftentimes it's used an and opportunity to say this is how we address the challenges that we face. finally the third thing that it does is something that's not used terribly often but an incredibly powerful tool, the whole issue of reconciliation. a process that allows the congress to address spending or revenue or debt in a way that doesn't make a whole lot of difference in the house to the process but in the separate it allows us to move a piece of leng las vegas forward with a simple majority.

doesn't require a super majority so you can get around the 60-vote margin in the senator. so it's pretty straightforward. ought to be easy to do, right? last year we passed a budget that balances within a ten-year period of time and agreed to it with a senate that doesn't raise taxes and gets us on a path to paying off the debt for the first time in 14 years. first time in 14 years. so if you're keeping track on a score card now, that's one reason -- this that is the first time in 14 years that we need budget process we form and we'll go through some others. it's a red letter date in congress when we do something like that. it ought not be. it ought to be something we do every year. people at home do it, in their communities, places of work or places of worship to make certain that they're on track

and correct course if they aren't. for those on vant of the process, you will recognize this was the fifth year straight that the house of representatives pass a budget that balancing within ten years of time, gets us on a path to paying off the debt. so the very curious among you will say, okay, how much closer are you to balancing the budget, paying off the debt, getting those programs reformed as we move forward. the answer is not that much closer if at all. and the reason that i would suggest to you that we're not that much closer is again another reason we ought to have budget process reform. it's because the budget enforcement, the thing that's able to allow us to make certain that the congress follows a budget that's adopted is extremely weak, extremely weak. we'll talk about some of the things that can be done.

what's the evidence that this is an ineffectual process. you all have your long list but let's tick through a few of them. the debt, 19-plus trillion dollars in debt, 76% of gross domestic product from debt to gdp ratio which wouldn't be necessarily that bad if in fact we were moving down but in fact we're moving up. congressional budget office projected that by the end of the ten-year window 86% debt to gdp ratio continuing to rise. deficits, we had about $130 billion increase in deficit from last year to this year, about $544 billion that was revised downward a little bit recently by cbo but still a significant increase from last year. that's the annual deficit. that's what gets added to the debt. and then increases that $19 trillion number.

growth in the economy. we've seen significant decrease in growth over the last few years and the projections aren't comfortable for the last majority of the public. the average growth rate in our economy over the past 40 to 50 years has been 3.2%, analyzed growth, the kind of growth that it takes to continue to keep the economy moving and jobs being created, the projection is 2.1% analyzed growth over the next ten years. a 30% to 35% reduction in the rate of growth in our economy. in the interest on the debt, we're now paying $235 billion each year on interest on that $19 trillion in debt and that's at relatively low interest rates as you all well know. the projection within the ten-year period of time is that we approach over $18 billion in payment interest on the debt each year approaching a trillion

dollars. now what difference does that make in why do any of these numbers make any difference? well i guess that's another thing i would like you to take home. these aren't just numbers on a page. these are numbers that affect real lives and real people all across our great land so that every dollar that's spent in covering the interest cost is a dollars that can't be used to buy a car, to pay the rent, to buy a house, to send a kid to school, start a business, expand a business, all of the things that the american people say they want are harmed by the fiscal situation that we find ourselves in that i would suggest is a result partly if not in large part of the budget process that we vo right now. that's another reason that it's important to move toward budget process reform. the larger picture of governance, the power of the purse and the like must be talked about always. there's a sense across this land that the power of the purse is

wained, a that executive branch assumed more and more authority over the past number of years through republican and democratic administrations. the power of the purse is important. jam madison wrote this power of the purse may be the most complete and effectual weapon with which any constitution with arm the immediate representatives of the people for obtaining a redress of every grievance and carrying into effect every just and sal tear measure. it means that this if the folks closest to the people, the representatives of the people do not have in their quiver the kind of opportunities to be able to hold the government to account, to be able to make certain that the hard earned taxpayer dollars out there aren't going for things that the constituents, the citizens of these great land want, if they can't use the power, it's no longer the power of the purse and consequently i suggest we

find ourselves where we are right now. what's the way forward. from a policy side to get things in a better fiscal situation from having to numbers look better on paper, you can basically do three things. you can raise taxes to increase revenue to the federal government. that happens. the pet project of our friends on the other side of the aisle. it tends to increase revenue to the federal government for a short time and decreases it because it decreased the economic activity. you can decrease spending which tends to be which we believe ought to be the most appropriate way from a tax and spending standpoint. but let me suggest to you that the congress has done a good job of holding discretion nal spending down over the past five years. we're spending less right now than we did in 2008.

that's a flat line on total discretionary spending basically between 2008 and now. now the total spending that's occurring at the federal government level is increasing significantly. or the third way to do it is to grow the economy. to get that 2.1% number up to the 3 or more percent number. every 0.1% growth results in a $325 billion reduction in the deficit. every 0.1% increase in growth results in a $325 billion reduction in the deficit. if we grew at 3.1% it's likely we would decrease the deficit by $3 trillion. that's real money staying in people's pockets as opposed to coming to washington to fund programs or to pay the interest on that debt. but let me suggest that the kinds of things that i just was talking about are the symptoms

of a broader problem. and that problem is the process that we utilize to budget and to spend money here in washington. i want to talk a little bit about budget process reform and the topic addressed by the panelists here. we budget in this country under the '74 budget act written 42 years ago, written by a lot of folks who, well-meaning but the effect of the budget act has been in essence to spend more and to grow government. and i would suggest to you that that's no longer the premise upon what we ought to budget. we ought to have a can fault that spends less and decreases government if we don't do our job. right now if congress doesn't do its job the spending continues. it increases more and more. let me raise fundamental questions for budget process we form. the budget committee in the house of representatives is going to be going through a

process in the next months to come forward with a piece of legislation that will bring about what our goal is, a complete rewrite of the '74 budget act so that we have a defult that actually spends less and decreases the size of government if continue is unable to or it's not possible to get them to do their job -- get us to do our job. what are some fundamental questions that we need to answer. first, why is the majority of spending unable to be reached? we spend about $3.8 trillion each year. two thirds of that is on the mandatory side.

at home i get this all the time. aren't those programs unsustainable? yeah. what does that mean? that means they will not be sustained. it's irresponsible and reckless not to address the unsustainable projectio projections. but the budget itself isn't able to touch those because that's on the mandatory side of the budget. the number, the only thing that's able to be enforced on the budget side is that 302 a, the discretionary number. what about the unauthorized programs. we've got a proo says right now where the majority of the nondefense discretionary spending in this country, the majority, over $300 billion each

year is unauthorized. that means that the committees in the congress have not said to the appropriators you ought to spend money on this. this is a priority. you ought to spend money on this. in fact they haven't done -- most of them are programs that have lapsed but significant problems. like the state department for example is an unauthorized department. you can't not appropriate money for the state department. but we ought to at least make certain that congress is looking at the spending that's going to the state department year after year and holding them to account. that's one of is the responsibilities of the legislative branch. what role should the executive take in all of this. a big fanfare every year when the president sends his budget up to capitol hill. we chop down a lot of trees to make sure we're able to print the budget. and then where does it go? kind of sits on shelves. through both republican and

democratic, it's fallen on deaf ears. what is it that we need out of the executive branch in order to have the ledge lay ty branch, the people es a branch to be able to write an appropriate budge. is it just information or truly a budget. what are the forcing mechanisms that ought to be put in place to make sure that congress does or job. right now there's not any significant penalty for not getting a budget done. we're living that right now as we see that the 302 a was set with an agreement last october and consequently that's not the kind of oomph or inertia of members of congress believe that getting a budget through is actually consequential. that ought not be from our perspective. we ought to make certain that they're forcing mechanism to get the job done. what should be role of the

congressional budget be? are there inherit biases? many of us believe so. many believe that it's impossible to get to the right answer with the information that the congressional budget office gives us. not because they're bad folks. not because they're ill equipped. it's because in many instances the rules that they appropriate almost make it so we can't get to the right answer. what should the role of the budget office be. how often should we budget? there's a big push to create a biennial budget. for those folks who have been in congress just since 2010, this ought to shock you, since 2010 not a single appropriations bill of the 12 appropriations bill that have posed to be done annually, not a single one has gone through the conference of the house and the senate and passed and sent to the president. not one. that's 60 opportunities. 60 opportunities to do an appropriations bill and congress

has been unable to do so. so should we make that every two years? so that we decrease by half the number of times that we fail? or should we streamline the process to a greater degree and allow either more time or more focus on the work that needs to be done? what about the baseline? what should we measure or spending against? should it be current law? should it be current policy? should bit zero baseline? should we require the agencies to justify every single dollar that they spend? is that possible? what baseline should we measure against. so often right now we measure against a current law which means if you decrease anything, the increase, even though you're not spending less but you lower the rate of increase, that's considered a cut, which only in washington is that kind of rationale used to describe it as a cut.

what should fiscal targets be. should we adopt fiscal targets. we can only tax this much, only spend this much as a percent of gross domestic product? what should that ratio be? should we have a balanced budget? what kind of fiscal targets should we have. and then finally the whole issue of a regulatory budget. we've done a lot of work exploring what we believe is now an important aspect of governance and government rules coming out of washington. the estimate right now is that the regulatory rules that are in place cost the private economy, costs men and woman across this country in their jobs and businesses $1.8 trillion a year, $1.8 trillion. that's about six times the amount of the corporate income revenue that comes into the country. that ought to be looked at. that's not looked at by and large by the legislative branch. you've got the sense across the country that the bur clatic

system in washington is ever expanding and increasing and coming out with more and more rules and regulations. those are questions we ought to be asking ourself. the budget committee is going to be holding a number of hearing between now and july 15th when we break for the conventions this summer to explore many of these questions, and i hope that you all will take the opportunity to communicate with me as chair with budget staff to let them know what you think we ought to be doing from a budget standpoint. this is a great opportunity and i believe an exciting time to be able to put in place positive reforms in the area of budget process. it's a time when both parties ought to be able to join together and do so. nobody knows who the president is going to be. everybody knows and understands that the budget process isn't working as well as it should. shouldn't we come to an agreement on what the reforms ought to be that would make it so the process would move much

more smoothly and allow us to fulfill the responsibility to our constituents across this great land. thanks for allowing me to share a few words and a dpu issues and perspectives with you this morning on budget process reform. and i'm happy to -- you're certainly welcome to applaud. yeah. [ applause ] thank you. i'm happy to take some questions. i got one right down front. and i think a microphone is coming. >> thank you. i heard your speech before in the aei on some other places. in congress, senator or house, they're busy with legislation, but state or local government, a lot of times legislation -- what i mean is it's not really

working for the general public, except as an appropriation to benefit a few. and currently if you're busy for a budget, the social issues are there, nobody touch it. nobody care about it. so a lot of the crime, not the abuse and other ways, other corruption, including in the budget, maybe they have fraudulent charges, and maybe they have a lot of fraudulent transaction of public/private partnership or economic development. whatever of transportation. can see a lot of problem, the people pay but not really in a way they receive. >> got a question? >> my question is can you really work on the real issues people are suffering, trim those costs

and budget and you don't have to do the legislation budget but cut the budget down. >> yeah. this is a great point. but the concerns that the person people have in so many ways the addressed by congress, the role of the budget committee is not a -- is not a policy committee. and that's one of the challenges that we have in trying to get across to folks why we're having the difficulty in degetting a budget moving forward and getting budget enforcement so that the things that we have in the budget are being approved by the authorizing committees. so all these committees, education and workforce are the committees that are responsible for the kinds of reforms that you have identified. the role of the budget committee is to identify the challenge, identify the problem and say these are some potential ways that you might be able to address them. but the budget committee is not the committee that puts in place

the lettigislation or even props the legislation that the house or other committees work upon, but it's an important distinction, for many folks they aren't quite certain what the budget committee actually does so i appreciate the opportunity to explain that. >> a lot of the people i talked to, that's a no-brainer for them, it should be a balanced budget, why is this important at all? >> we run the gamut in town for those folks who think you don't need any spending restrapt at all, which is why we're where we are $11 trillion in debt. there's others who believe

there's a reasonable amount of debt to carry each year, and that that's able to be sustained over a period of time. and i might actually agree with that if we weren't $19 trillion in debt and 76% of debt held by the public compared to gdp or over 100% of gross domestic product and total debt and not moving in the right direction, i believe strongly that we need a balanced budget. and how do you get there, is the question, what are the rules in place that enforce that, but fiscal discipline is absolutely imperative if we're to get our house in order. and the reason for that is not so that the numbers line up on a page and the bottom line is that money in equals money going out. the reason is that when you're

not doing that, you're taking away the opportunity of americans to realize their dreams, for the greatest number of american dreams to be realized in a fair and compassionate system is what we're after. that doesn't work if you're taking a trillion dollars a year within a relatively short period of time to pay the interest on the debt. that's money taken from the american people to do nothing but pay the interest on the debt that has incurred. so, yeah, i think we must have a balanced budget and i think fiscal targets are appropriate. yeah? >> thank you, pl chairman, i was glad you talked about gdp growth. because all growth from world war ii has come from investment from gdp.

>> these are the resources that we have, and close to the top of that list ought to be money for research and development and to allow young people to realize their dream through an education process that works. sadly, what we do is we get the list of things that we think we ought to spend money on and it just grows, and grows, and for those young americans to realize their dreams precisely because we have not been able to willing to make these decisions in this town. should those things be a priority? without a doubt. are we making them a priority

now, in a responsible way, i would suggest that we are not, and because spending on those types of projects and so many others are actually threatened because we have got a growing mandatory side, growing automatic spending side. the mandatory spending that i mentioned which is now 2/3 of the federal budget that less than 10 years will be three-quarters, 75% of the spending in this country will be mandatory spending, that's something nobody has any control over unless we get with an administration that's interested in reforming those programs, so those ought to be priorities, but they can only be priorities when we have a school of discretionary moneys that we actually have control over and appropriate responsibly and i would suggest that we're not doing that now. one more. you've got some very bright people who are going to weigh in

on all these things in just a moment. >> eric wasson at bloomberg news. there's some very interesting questions, first of all, how do you link the budget with the entitlements. and my question there is there a danger of going over a cliff? and how do you enforce that and how do you force a budget action, institutionalizing no budget, no pay, and are you wishing you had that this year to get your colleagues to go along with your budget? >> i'm looking forward to the hearings that we have on these issues, but i think that it makes sense to have the mandatory spending, for lack of a better term on budget. i think it's important for the people's representatives to be able do weigh in annually or at some interval, to say yes, this automatic program is something that we think needs to be continued and in this structure,

so that we hold the agencies to account and make certain that the program is actually working. there's so many things in our federal government right now where we measure the success of the program by the amount of money going in, not by the output of that program. there's so many things on the social welfare side where we spend more and more and more money that we're not getting the outcome that any of us desire. so the answer to some of my friends here in town is to spend more money, so that means we're not doing our job in terms of holding the agencies accountable. for example, i'm not endorsing this, but these are the kinds of things that have been talked about. if for example the congress doesn't finish their appropriations process and a continuing resolution, which is not a very responsible way to budget, but if a continuing resolution were to be put in place for the next fiscal year or a portion thereof, which is simply spending at the rate that

you spent last year with all of the policies in place, then that ought to tick down over a period of time so there ought to be some increasing pressure on congress to actually do their job, so that makes some sense. thank you for the opportunity to be with you, and i look forward to the report on the discussion and also look forward to your ideas as we move forward on this incredibly important opportunity. take care and god bletsz. . >> as we make a transition to our panel which is going to be led by kelsey mcduff, you can come in and have a seat. and if you really run out of seats, you can take these big comfortable chairs in the back and the speakers will turn around. >> i see there's another seat

over there, maybe two in the middle of this area here, if anyone wants to move over. thank you again to chairman price for doing this. and all of our panelists, i'm going to start out by introducing everybody, and each one of our panelists will have a few minutes to give a presentation and we will go to questions. we have paul posener, he leads the university center on the public service. his mess recent book the pathways to power, which was recently released and he was formerly with gao, leading their budget and intergovernmental work for 14 years. and we have maya mcginnis, wh s who's -- maya is an expert in all things tax and midwesteamer policy and she has worked with

candidates and members of congress and we have doctor stewart butler, he's a senior fellow at the brookings institution, prior to joining brookings, maya spent seven years at the center for policy association, and economic policy studies, he, i'm sure is well known to many of you in this room. and we also have dr. marvin faulk. his research aims to improve performance of federal budgeting by the criteria of efficiency, equity and stabilizations, and w prior to that, until 2010, he directed the pugh reform agency as part of the public trust. and as dr. press mentioned, i am a reporter at "the washington post" and cover fiscal policy here in congress. >> thank you, kelsey, and thank

you all for being here, i think there's one thing that we all can agree on, which is the budget process in some way, shape or form is broken, we wouldn't be here if we didn't really believe that. i start off all of my lectures with my students on my class on the federal budget saying unlike social security, health care or food aid, the budget is the one thing that politicians have to do every year. well, apparently not every year. so there's an exception right there, showing everything about the budget is the exception to the rule. but i think we can tick off a list of things that don't seem to work, the disproportionate attention paid to discretionary spending, even though it's a declining share of the total resources, the fact that the targets we're using aren't necessarily symbolic or -- most of the budget is off-limits, there are walls around mandatory

tax expenditures and the like and there's no concerted review available to bring together how all those programs interact in areas such as higher education, low income housing and all the various other programs that have been policy goals that we care about. we say we have a unified budget, but we really have a vulcanized budget, and in some ways the 1974 apgt had a vision that was very different from this, it was of a comprehensive way that congress would tackle priorities, it would take them on through the special set of committees they created, it was in some ways an experiment creating a shadow set of committees that could somehow bring the rest of congress to bay, turns out it probably was the other way around, the budget committees are influential by exception, only to the extent to which the leaderships adopt them as their pet projects and to affect leadership reforms as the budget committees really gain

leverage, a lot of us would like to see that change to some extent. a lot of us would like to change a budget where we periodically get to enact priorities and change priorities and the like. i'm going to talk about one proposal along those lines recognizing that reformers experiments are likely to take 20 years to reach fruition, so i have a nice longestati guestati period. it's the product of the work of the national budget round table that myself and maya and stewart butler still share where we meet together and talk about these kinds of issuings. basically the question is, can we somehow give renewed life to that vision that congress had in 1974 that we can in fact make hard choices again in some kind

of concerted way of looking at our priorities. the notion that this is difficult particularly for a polarized congress that we all particularly have to agree on. but isn't it better to start working on approaches today to do more rationalized budgeting so that they're on the shelf and been tested rather than wait for that inevitable fiscal crisis. the cao -- show that the debt will grow 20% to 30%. you'll be in disbelief that that kind of thing could happen. it's a question are we going through a period of a continual crisis oriented budget. this process of port stole ofol many other nations do this as an

annual process, the oecd, nations like netherlands, australia, across the board, have taken on pieces of their budget which they look at all -- so we looked at the question of could we do something like this, and i might add that these oecd processes and making real changes that not only achieve substantial savings, in some ways our motto has been inacted by -- the one said that budgeting should be on focusing on weak claims and not weak claimants and ideally we would like a budget process that is performing as well as others and make decisions? some ways accordingably.

we would look at what collective outcomes are they achieving in terms of access by students to higher education, in terms of states and parent spending on education and a variety of other outcomes that we care about and we would look electrcollectivel whether those portfolio programs are working, whether these programs offset one another, as they often do, or whether they complement one another. and whether there are some areas that appear to be more effect tiff than others. that's the notion of this, that we would take pieces of the budget periodically, when i say we, i mean both the executive branch and the congress, to have kind of a special deep dive, if you will, and to look at how we're doing as a nation.

i understand that among budgeteer budgeteers we are often fond of proposals that are not correct and this may be one of them. but let me give you an idea of why this proposal may be better suited to the times than some of the others. when we take a look at areas that -- and tax expenditures. these are broad based areas of reform that many have proposed valuable and valiant reforms that are often olympic divers, they're beautiful and they make no splash, really doomed in some sense to fail in the political life. and they threaten too many interests because they're so cross cutting. what we like to think is that portfolio budgeting could tap into those areas that we agree

on as a nation. we agree that there should be effective food safety coverage in the united states. we just don't agree there should be 15 programs across many different agencies covering it. we agree that we would possibly move to some sort of integrated certified food safety agency, like many other agencies have. we agree that we need some programs affecting higher education. so the question is can we kind of through this portfolio process do a concerted effort, budget reform to really focus and galvanize the congress's attention on this. one other point and i'm going to finish here. recognizing this is not a natural act for congress to do, to bring together a variety of programs under a single roof and for special analysis, i would

suggest that this is exactly why the budget committees exist. they have the cross cutting perspective and really the analytic tools with the budget functions and functions that we really have never fully utilized. to bring about such a review, possibly in concert with the authorizing committees, it's been done before, the budget committees used to convene task forces periodically in their long life, and 2000 being the most recent to focusing and take deep dives on issues, so that's the proposition, that the budget committees could possibly find a new role in this area, acting with other committees to put issues on the table and have what i call a performance based reconciliati reconciliation, where each of these portfolio areas that is given a fiscal target that has the possibility of not only being motivated by fiscal goals but performance goals at the same time. i would like to see the executive branch honing in on this and we all will sing "kumbaya" together.

we'll talk more about this as we go along, i'm sure. >> maya, you're up next. >> thank you, so i mentioned a couple of the fiscal budget problems i see at the outset. when thinking about what to talk about, i couldn't decide. one of the biggest problems is that the budget is not used as a strategy, that's why i'm really intrigued by paul posener's work in this area. there's no mechanisms, there are no consequences, as a result the budget is just no longer taken seriously, and everyone can agree that the fact that this country is operating without a budget on a regular basis, is an unacceptable spot to beginni wi.

we have very few programs that put us on a -- and as a result it becomes very difficult, the whole budgeting process to lead us in the right direction, but i'll put all those aside. i'm going to talk a little bit about budgeting for the long-term. and one of the failures, almost like our political system, but our budget cycle is doing a huge service. our budgets, when you have a budget, there's multiple budgets, there's the president's budget, and the house and the senate's budget. what you're doing each year is always on that first year, and that leads us to a lot of outcomes, a big focus in budgeting is the discretionary portion of the budget. one part of the budget that the appropriations process takes place. we have seen with the sequester that's been going on for the past year, focusing on big

spending is not the area of the budget we need to be concentr e concentrating on. that's not where they take blase, it focuses all the smart talent that's thinking about what's going on with the budget, that isn't as important for the long-term fiscal health and it leaves a lot of the rest of the budget out of the whole process. and it focuses us on short-term fiscal measures, our fiscal health, our country not as good as it was before. our debt is now at record levels, at twice what it was, now that it's 74%, 75% of gdp, we came out of recession where the real concern was what do we do to get the country back on track. we had big problems with the deficits, the biggest problem wasn't reduce those deficits immediately. how do you gin up the economy,

and put those -- we end up having a lot of talk about budget numbers in that year. and that i think kind of ends up -- these two different topics, one which is austerity, austerity is what we have seen on other countries where au austerity be forced on them to get their deficits back down. we haven't had to be in that situation, despite when we wreak havoc on the global economy, we don't have o'have this -- we have the luxury of time, we can think about medium and longer term challenges, that instead of worrying about austerity, raising taxes when it would harm the economy, we can put on medium and long-term plans, but because our budget doesn't focus on that, we end up doing these

short-term measures which are not productive for economic policy. it opens up the door for budget gimmicks, all the time people say here's all the savings we going to have in our budgets. in these first years, we're going to cut taxes more, but in the years to come, what zwael actually is going to help the deficit and the debt, but this first year we're going to make it a little bit easier on yourselves, so you the windows allow for some real gimmicks, so those people who are thinking about budget process reform should really think about the time horizons, the longer term issues there's a bunch of different ways that can be done, i'm not going to mention all of them. the first thing is just make sure that our budget tear numbers are stretched south. let me also say i think this

issue is also more important now because we're in -- it's been going on for a while, but as the aging of the baby boomers are happening, as demographics are guiding our budget so much, we really in the past, and now we're feeling the brunt of it. we should have been looking at all the long-term promises, here we are, the numbers are exploding, we knew that was going to happen, but because we weren't as focused on the longer term, we weren't as focused to get out ahead of that issue. so i think the first thing is just more information. the budgets are such dense documents, weeding through them, it really matters what you put in summary tables, i think we should put in the cbo long-term projecti projections, one of my favorite documents, i'm sure you all love the document as well.

when there's new policy proposals, looking at the long-term effects of those is quite important. when we look at vauf sets for something, something that's oog go to help the committee, what you really went are the kinds of policies that will save more over time and grow with time. you want to have those projections included. third we could think about actually having some requirements that don't permit fiscal worsening over the long-term. so you could put in some budget rules, there are some that exist, you should strengthen them, you could put in more about what you're not allowed to do today that would make the fiscal situation deteriorate over time. the fiscal -- i'm not so worried about the deficit this year, i'm really worried about the fact that the debt is headed up indefinitely, and i would like to talk about ten and 20 year

targets you would want to put on. i always ask why we allow ourselves to have a budget that promises more in spending as a share of the economy down the road than we're willing to support today. so if we have promises in our budget that say spending in the future is going to be 25%, 35% of gdp, but we're only allowed to collect in revenues 19% or 20% today, we are actually forcing future generations that is -- i'm not saying whether the government should be bigger or smaller, that will be a fight that goes on forever. but we shouldn't be able to commit resources that are so sizably above what we're willing to pay today would be a fine budget rule to put in place. budget does seem like a dry, arcain topic. this is not at all an easy issue. i think one of the really big

goals is, don't try to put budget process reforms that stack the playing field for one side or the other, republicans and democrats are going to continue to disagree about a ton of different things, is size of government, the best measures to get there, their priorities, you don't want a budget process that -- budget process reforms that both sides see as sfar, and that will hopefully make it easier to make some improvements. >> we have shuffled seats a bit. but i think the plan was for stewart to go next. >> thank you, kelsey. as maya has just emphasized, process is important, rules are important. rules shape the way the budget happens as they shape other things. and as the chairman said, about roughly 2/3 of spending in the united states right now is in the form of mandatory programs, which have very different rules in terms of how they are

developed as the rest of the budget. and the social security and medicare programs, the major entitlements for the elderly are now roughly half the entire federal budget itself. and that's really important in terms of its implications, it means that these programs are on autopilot, whereas major and important programs like defense, like money for the homeless, for students and so on, are argued over every year in the traditional budget process itself. meanwhile these other entitlement programs, like the mighty mississippi keeps rolling on, without any -- unless there are major changes made in those programs. paul has also mentioned the national budgeting round table that the three of us with maya are on, is an organization that

really kicks around ideas on the budget process, and we argue over them and some of them are -- some are put together in proposals, some of which you have in your documents and one of the things that's not yet reached the stage of being published, but maya and i are working on an idea of the whole area of the entitlement programs with the process of turning the entitlements or taking the entitlements together and turning them into a real long-term budget, a 25 to 30-year budget, which is more similar to the way we do discretionary programs in the sense of that this is a real number as opposed to a projection. this idea really has four elements to it. it terms of what would happen. first of all, a congress would enact a 25 to 30-year budget for all the major entitlements, principally, of course medicare,

and medicaid, so it would enact a 25 to 30-year budget of tax revenue. and taxes in a sense are similar to entitlement in that we make changes in the tax code, we guess at what the impact will be on revenue, but there isn't a budget per se for the revenue side. so in that sense both sides of the equation would be included. the third element is every four years there would be a formal reassessment of that long-term budget, congress would in a formal way re-evaluate it, look at it in compare son to what's going on in your economy, what can be sustained, what other major goals there are, and make kind of mid course corrections to this long-term budget which would give us a real picture of what the major entitlement would ro look like. then the third element is a

trigger mechanism of some form that would keep us to that long-term budget. so if it dropped below or above, there would be a correction that would be built in automatically. unless congress in one of these four-year reassessments made a change to it. so we would have four very fundamental elements which are quite different rules than we currently have today. many countries, they don't have it in quite the form we have talked about, but certainly as maya what mentioned and others have looked at the long-term budget generally for their countries and think about it a lot more than we do in this country. if we were to do this and try to put in place a long-term budget of this nature for entitlements, there's clearly some issues that have to be thought really hard about. i just want to mention two. one is can a congress really bind congresses way into the future as to what should be spent on, say, medicare or

social security or other programs? not in a constitutional sense. the constitution does not allow a congress to do that, to require or to put in supermajorities and to force constitutionally the future congresses to stay on track. it could produce rules, however, and say that unless congress were to change these rules, this will be the rule in the future. the only way such rules can be sustained is for there really to be a broad consensus that they make sense. so part of the reason for including revenue as well as entitlement spending is that both sides of the aisle have a good incentive to see some control, some sense of what these are going to look like way in the future. the second thing to maybe consider, is can you really have triggers, can you in fact effectively keep a budget on

track over this many years? well, i think you can, although it's not absolutely clear what the best way is to do this. some people argue that there should be automatic changes in programs, and in revenue, say, maybe for example automatic changes in tax rates, if the revenue fell short of what was in the budget. or that there might be changes in payments in the medicare program. some of you in the audience might already be thinking, well, that doesn't work too well with the sustainable growth rate and the dark fix and so on. that is one way to do it. another way would be to have an external body that watches over this long-term budget and if it starts to get off track in any profound way, that there this external body would offer some solutions, and these might be subject to an expedited consideration by the congress. a fast track up and down process. we had that in place essentially

for medicare with the so-called ipap. not a popular body, but we do have that. another way to do it might be to combine an external body that might come up with a set of, a menu of way of staying on track for a long-term budget and maybe a supercommittee within the congress itself, a much more powerful version of the budget committee, you heard from the congressman, the limitations that are on the current budget committee. but some kind of either strength and budget committee or some combination of the budget committee and other leadership individuals to say, well, among those options, or if you have the outside body being the default option, then the supercommittee might modify that and put it into place, but if they didn't, then the outside body's default proposal will

take precedence, so there are various ways to do this, to stay on track in the long-term. let me just say in conclusion, that when you look at the budget process in the united states, it's really hard to think that it's a serious process, first of all, if we don't actually pass budgets, as you heard from the very beginning, as you heard from the congressman. but it will be a budget if 2/3 of spending are not really subject to an d a annual analys so in a sense, is this really a budget if spending is not looked at in any concrete way. so that's some of sort -- and rethink that in the kind of proposal that we're developing a that we reach a reasonable compromise between assuring certainty to people who are planning for their retirement, the older i get, the more important i think it is, in

terms of being secure in the future, but also recognizing that you can't just have 2/3 of the budget essentially out of control given the concerns about the deficit and the debt especially in the future. and that's why we think that a long-term budget of this nature for these major parts of the mandatory programs, so-called entitlements is a crucial part of getting a revamped budget act into place that could -- can successfully keep our budget on track and do so realistically within the constraints of the economy and of our other objectives and goals for our federal budget. >> okay, thank you. and last we'll turn to dr. marvin phillip and after that we'll do some questions, i'll ask a couple and then we'll turn it over to the audience. >> so maya asked me to talk about -- so maya asked me to

talk about tax expenditures today and their treatment in the budget and i can only begin to say something about this by first thanking lynne berman with whom a wrote a piece on budgeting for tax expenditures, lynne has heard in papers and a lot of people in this room agree that it is a wonderful experience. it certainly changed my thinking about tax expenditures so thanks to lynne. so the second thing i want to do is thank maya and the committee for setting the five-minute rule. you probably don't know that but today there is a five-minute rule, and there's a woman that you can't see, when she raises a stop sign, i think that's a great idea, especially for a discussion of budgeting, because to have a constraint on valuable

resources, in this case time has a nice way of giving incentive to people to follow the rules. >> and who do you think broke the rules? >> in support of that rule, i actually gave these brief remarks a title. and the title that i thought would be appropriate would be 4 1/2 things to remember about tax expenditures and budget reforms in the hope that i could get in each one in at least a minute. you know what tax expenditures are, they are well known by everyone in this room that they relate to preferential tax treatment afforded some activities relative to a normal tax structure. and by that we include exemptions, exclusions, deductions, deferrals, credits and so on. i think the rule of thumb, the

best way to remember what a tax expenditure is, if you don't mind writing it or entering it on the 1040 form, it's probably a tax expenditure, now we come to the facts of those things we don't mind disclosing on our 1040. the first in fact is that these are really big. a few dollars here, a few hundred dollars there, you add it all up and pretty soon, as someone once famously said, you get to a trillion dollars. so the annual value of tax expenditures exceeds a trillion dollars, which is more than, about 25% of total cash spending, which is more than 5% of the gross domestic product, the value of all economic activity in the country, these things are really huge. they're big. the second thing to remember, and this is what i had trouble with for a long time.

but i am persuaded it's true. they are equivalent to cash spending for almost everything. so almost equivalent, i'll save the almost until later. but david bradford, a deceased economist made this point, i think brilliantly with a proposal that he made some years ago, she whe was proposing to r the size of the benefits, but he didn't want to whack the benefits that people got, and what he came up with was the weapons supply tax credit, so under his proposal, which he offered facetiously, don't take this seriously, what he offered was that the department of defense would henceforth not pay cash for its ordnance and --

supply the -- tax collections drop, outlays drop because all that, we have heard a lot today about things that are in the offoffbudget, tax expenditures are really off budget, they only show up in a budget in fact in a dress allocated reduction in revenues. so in fact, that's exactly, bradford's point, which i guess is a third thing to remember. they're big, they're equivalent to cash spending, and they're virtually, not quite, but virtually invisible in the budget. the fact is, when we adopt these tax expenditures, all that shows up is that we get a reduction in budget outlays, we get a reduction in revenues, there's

no change in anything else. and it doesn't look like these things have any cost. at least to the budget folks, people making budgets decisions. and in addition, we use language to kind of re-enforce our attitude toward tax expenditures, we call them tax cuts, we call them in some cases, letting people keep their own money. and that suggests to me, at least, that these things are costless, that how could it cost something to let people keep their own money? even jon stewart, on the daily show got it right, got it wrong. he was criticizing the president for talking about spending through the tax code and criticizing him to say in fact that's where we raise the money, not where we spend it, what's wrong with this guy? but in fact i think the president had this exactly right. when i say they're almost invisible. i'm not neglecting that portion of analytical perspectives,

which you have all read, is it stable back there? tax expenditures by program, the joint committee on taxation produces another such table, but that information is not salient to budget makers. like a lot of other things that we have been talking about today, like which kind of costs are really controllable in the budget right now with respect to, say, entitlements or with respect to long-term spending that they in fact are missing in action. it's very easy to ignore the existence of those spending equivalents that are large in the budget. so what? so what if they're distorted? if we were all perfectly rational, you know, economic man, economic woman, economic

person, it really wouldn't matter where those numbers were. if they were on the front page or they were tucked in analytical perspectives, rational decision makers would ferret them out, find that information and use it in their decisions, but humans aren't like that, we don't work that way. an example that's -- oops, my time is almost up. there's a common example that many of us have encountered in real life. volunteer firefighters, they're not paid, they're happy with that. they have got these t-shirts that many of them wear that say pride not cash, we're doing this to discharge our civic responsibility, but they incur hahl of expenses, so occasionally, a township will propose to pay them for their expenses, that's hard to get through, especially in this day and age when budgets are stressed.

so you can propose to do that, you can't get that through a legislative body. if you just change the proposal slightly to say we're not going to pay them cash, but we're going to give them the equivalent in tax abatement, either for personal property or real property, you have a much better chance of getting that through. so the point that i'm trying to make here is that if information is not salient, is not present, is not on the table when you're making budget decisions, it doesn't matter if it really exists, it could be, you know, wherever it is, if it's not present, if it's not salient, it's probably not going to be taken into account. and it adds to fiscal illusion, we end up with inefficient choices, probably at least in the article that's berman and i wrote, the bias goes this way. with tax expenditures being

nonsalie nonsalient, you have a bias toward cash spending, you also have a bias in favor of total spending. the bigger point about the treatment of tax expenditures in the budget, is that the way numbers are presented, the way information is communicated to decision makers matters for decisions. we are not all calculating fully rational individuals who get all -- every bit of relevant information. it has to be easy to make better decisions. and that rule is one that i think has application to the control of entitlement spending as well as tax expenditures. and i guess the half is, it doesn't have to be that way.

the way we do budget accounting, the way we put the budget together is not written in exodus or chances are only 1 in 5 they're in leviticus and if it's not providing us with the information we need to make better decisions easier, then we should start thinking about changing it. now thomas soul says something often in writing and aloud that makes a lot of sense too me. he says there are no solutions just trade offs. for every difficult decision. that's clearly the case here. and so what berman and i offer is not really -- we do describe it as the solution, it probably isn't, but at least in this case, it seems to me that the

tradeoffs appear favorable enough that we ought to reconsider how we treat cash expenditures in the budget. >> we have about 15 minutes to go questions and actually i wanted to start with the political questions. in this political climate where we just on friday missed the statutory deadline for passing a budget, is it realistic at this point to be having a conversation about total reform of the budget process or is there reason to think that there are smaller incremental things that can be done now to improve the outcomes that we see?

we know the political leaders are on a supply chain, knowing that threor four years down the road. that's when it will open, whether it opens because of a crisis or a political revolution, who knows? but i think it's incumbent on us as budget enforcers to feed that supply chain now. >> jim, i can't believe you're leaving without a question. we'll all get a long e-mail with all these thoughts later. i don't think it makes whole lot of sense to make a big revision of where you -- you'll make incremental reforms in the wrong direction. we're going to redo the entire

1974 budget act. i think we developed what it should look like, a budget process that lays out a strategy, that includes fiscal goals that has an evaluation of what's working and what's not, that has consequences if you don't act, perhaps that inspires bigger, broader changes, at least you could do what the consequences are of not acting. >> can i follow up quickly? how do you develop that broader strategy, that broader plan in a political climate where you have house members up for election every year, and the moment they are elected, they start going through the process of becoming re-elected. >> we really need process reform not -- put policies in place that are sustainable.

that's much trickier around election cycles and anyone who talks about doing something responsible gets punished during that election routine. there may be an opportunity for people to work together on the hill and actually, especially in a year where very little is getting done, take some time, study the acts and start looking at what the reforms a major overall could look like. >> maya nailed it. >> si think, i agree, maya nailed it in a way. when we describe what maya said, is what yogi bear said, if you don't know where you're going, you're going to end up not knowing where you are. i think the idea of a 30-year budget is very important. it's not necessarily going to take place any time soon. but to get people thinking differently about entitlements.

it's very important to get large constituencies who are affected by any change sort of into the room together, and say, look, we understand your needs and desires and your fears about how changes might affect you. let's start having conversation about how we maximize your hopes and minimize your fears in a way that the country as a whole and the budget system. there's an organization called convergence which is beginning to assemble those groups to have that kind of conversation. and most of us on the table have been involved in the beginnings of that conversation. i think now this actually is in a period, in a sense, because you know you can't get something fundamentally done, it actually does focus the mind in a way, and say, okay, let's now get back to basics and think through, what would you have to

do to prepare the ground, for when the politics are right, you've got the constituents talks about arp, obviously a long-term budget and things like that, so i think it's a great opportunity for actually beginning this conversation. >> i wanted to draw a thread between a couple of themes that came up here. we talk about the long-term budgeting, we talk about looking further out into the future, but the chairman also brought up the concern with what he referred to as institutional bias at cbo, and i assume his point there is about the hammock scoring, my question is how do you address both of those concerns and how do you keep the confidence levels on all numbers at the level that you're seeing, i think across the aisle, there's a -- model that exists right now

and it's ability to correctly predict how we will spend money and what a budget should actually achieve over time? >> i think there's always going to be criticism of whatever model you use, whatever approach. i think that kind of goes with the territory with regard to cbo, i think one possible solution might be for cbo to acknowledge that there are perhaps some alternative models that are good enough, i mean meet the test of reasonableness that the projections of those models ought to be published alongside cbo's most confidence assessment of what things will look like. that would essentially mean that cbo's role is not like the semifinal arbiter, but is the high priest with some other priests, with what it says in

leviticus, and that might be a way of diffusing this so that you keep solid models up being used, but allow some deviation, and some room for maneuver, that might be a way to deal with this. >> it took too many years to say anything more about that, the i think cbo does a great job within the confines of what they have to work with. we need to get -- we need to change those confines, would be my judgment. but that's -- i don't have anymore to add. >> so not snknowing exactly wha dr. price was referring to, the fact that baselines don't treat spending and revenue in a parallel way always. i think you want to look at both of those and you want to, again, back to my belief that budget processes only work when both

sides believe that the outcomes are not prebaked into the rules. when it comes to dynamic scoring, there's no question you need some kind of analysis that shows the growth effects of the different policies that you would be picking and there's no question that we don't know how to do it yet, we don't know how to make those projections, but we should be looking at parallel estimates, you have the traditional static estimates and you also have dynamic estimates but that would bonn the spending and also on the budget side. but public investments are one of the biggest drivers of economic growth and we have a budget that favors consumption, this is not a recipe for long-term growth search you're able to look at the growth -- at least to inform our decisions i think would help us pick more pro growth and sustainable policies on both sides.

>> i mean i would say that i think budgeting has gotten more difficult since cbo was formed, we're focusing more on the long-term, where budgeting is much more focused on the economy, and so the questions that the cbo has to take on are much more -- in my view, it's a miracle that such an agent has been able a to with stand the crucible, but also be the model for national organizations around the world that are increasingly adopting cbos. so i think the challenge really is, how can we create analytic tools but without having them become decision rules, when analytic tools become decision rules, the pressure on analytic -- you really earn your money as an analyst, as maya said, sustain an approach where you're presenting multiple

options and really letting the political leaders make those decisions and that's where they belong. forcing those decisions to made by and an littic agency and having them mechanically be translated into budget figures is a real risky path. >> we'll open it up to a couple of questions, introduce yourself and let us know who you would like too answer the question. >> gary clark, i just wonder your -- i know that senator enzie is doing budget tear price controls, is there any sympathy from the minority ranking members? >> i -- as far as i snow, there's definitely sympathy for it. i don't know that there's necessarily agreement on what direction to head. >> i don't think any of the discussions have been public enough that we have a sense of where we're going, i think

there's a lot of sympathy from a lot of different people that the budget process needs to be improved. it may stop there, but my guess is they'll be able to find some areas to -- >> tax reform is an area that everybody agrees needs to be done, but the goals for both sides are a little bit different. >> back there? >> thank you. hi. my name is tom aerosmith, taxpayer and subscriber to "the washington post." and i thought simpson bowles was a marvelous piece of work and i think maya and her committee had a lot to do with that, it's good to have some ideas in the supply line. is simpson bowles are some suggestion such as simpson bowles still a viable approach

and what would it take to get that dusted off and moved ahead? what you're proposing here as far as budget redpoform, would t be a help in that regard? >> i can speak to sort of what we think a lot about that, wafs i also share your belief that simpson bowles was a tremendous blueprint was a -- growing the committee and protecting the vulnerable and getting us in a fiscal place that wouldn't derail the recovery was an incredible opportunity and there are a lot of people who believe that. and it sort of reflects how broken government is, that we weren't able to move something like that forward. i think there's always an opportunity to go back and look at those policies. we know we have to look at all parts of the budget. we know we need to raise revenues in a way that will help grow the economy, that health care costs need to be

controlled, that we need to do something to put social security back on a sustainable path. one thing i do think is that it may prove and this is the debt issue demonstrates how broken government is right now. it may be easier to do this in'sein's pieces. you can imagine breaking our budget into a number of pieces. what he did last year, we had a budget in place that was supposed to save $5 trillion, but we did was we added another trillion to the debt. stop making it worse, that's the first piece, we know we need to do something about social security, we know we need to fix health care, tax reform, that's something that's getting a lot of attention right now. we need to reassess our budgeting priorities, how our resources are spent, looking at investment, the fact that we

spend 6 on the elderly for every 1 we spend on children, and is that the right ratio. and what we're trying to talk about budget -- let's do it all at once and let's fix this problem for this country and if we were to put ourselves on a sustainable fiscal path, it would open up so many fiscal opportunities, it would be so much better in the medium and the long-term. but if we're not able to do it all at once, maybe we can do it in pieces. i think a key is bipartisanly, each one of those pieces has to be addressed by the republicans and democrats together. >> maya is right on target there. in our history, we really have never had a budget commission that has succeeded. we have had pieces, the base closure, because members of congress wanted to be bailed out on that, they wanted to have someone else make those painful

issues so they could run for cover. one of the other issues is the property and plant equipment for federal agencies, there's a proposal to have a commission, an executive branch to close certain agencies and field properties. but we resort too much to the notion that a process sex with a commission is going to help us out. political leaders getting together, taking accountability for something, ultimately if that old-fashioned form of government we have is going to have to work. >> we have time for one last question. if there's somebody -- right here? >> i'm, sorry, you already had a question, is it okay if we go to somebody who has not already had a chance? go ahead, ed. we can speak after.

>> hi, blake folksman from the federal reserve board governors, i would be interesting in hearing from anyone on the panel if anyone's in support of a balanced budget amendment. just as a taxpayer, i see -- there is a fringe benefit of having both fiscal and flexible fiscal monetary policy. so how would you try to square that circle if you want to have responsible fiscal budget but also wanted to have some flexibility there to address the ups and down for the macroeconomy. thank you. >> do you want to -- >> no, i think there is a need for targets. and i would say the targets should not be pal balanced budget or not, i think the targets are more debt, as the chairman said, he would be for a

deficit of 3% or 2%, if the debt were down, the debt is the critical variable and we have talked about this too. the notion of having debt targets -- i'm worried about a balanced budget that it starts locking away, and even if you have have an exception, we have seen how the politics of gaining approval of a minority that holds you possible is just more difficult. i think the ability to mount the kind of anti-recession programs that we did in 2008, i think our economy would be much less nimble as a result. >> i'm not as opposed as i used to be, but i'm still not there yet, it's too blunt an instrument, what you want to two is have the deficit targets and the debt targets are the things that really matter. and from a political economy perspecti perspective. in this case, i regularly see people talking about budget balance, budget amendments to

avoid talking about how you actually get there. i want to talk about the simpson bowles, when i hear politicians talk about a bba, but they're not sure how you plan to two it. one, i think its too blunt from where we are and i would like to shift to the policy discussions to get us there. >> could i have one sentence? states do balanced budgets and they use rainy day reserve funds. it's not inconceivable that the federal government could adopt a policy that had to anticipate future needs to run deficits and budget it accordingly. >> i mean, i'm also drawn to the idea of a balanced budget amendment principally because others seem to fail. but the other panel itseists ha

made very good points, because it's not clear what you ore aiming at, a sustainable situation, having debt under control. therefore it may be not the right instrument, it's a simple instrument, that people can understand essentially what it means, but it doesn't necessarily make it the ideal. i suspect that the congress would be finding all kinds of interesting and novel ways of getting around such a balanced budget. there's an infinite reserve of innovation when it comes to figuring out things like that. so i think i really come down more where maya has said, it's really important to get the s substance right, what should the budget look like and what are our goals in that budget, rather than locking ourselves into just a balanced budget which may end up with massive increases in taxation at certain times, or

massive -- that's a very blunt instrument when we should be using much more subtle instruments to get where we want to go. >> thank you all for coming today and thank you maya, and thank you for the committee for responsible federal budget. >> coming up wednesday morning,

represent dif robert pit -- he'll tell us whether he thinks the 2016 presidential candidates are well versed on the issue.