was promised by some, nor the express lane to climate disaster proclaimed by others. let mestrate this, briefly comment on some of the reasons why the state department rejected this pipeline. first, the pipeline would not make a meaningful long-term contribution to our economy. aboutcongress is serious wanting to create jobs, this was not the way to do it. what wet to do it, but should be doing is passed bipartisan infrastructure planned that in the short term to create more than 30 times jobs per you than the pipeline would and create a better economy for workers for years to come. our business has created 262,000 new jobs last month. they created 13.5 million new jobs over the past 15 months, the longest streak on record.

the unemployment rate fell to 5%. this congress should pass a serious infrastructure plan and keep those jobs coming. that would make a difference. the pipeline would not have made a serious impact on those numbers and on the american people's prospects for the future. the pipeline would not lower gas prices for american consumers. in fact, gas prices have already been falling steadily. the national average gas price is down to about $.77 over a year ago. it is down one dollar over two years ago. it is down one dollars twice seven cents over three years ago -- $1.27 over three years ago. a gas stationnd selling gas for less than two dollars a gallon. politics has been consumed over a debate on whether this

pipeline would create jobs and lower gas prices, we have gone ahead and created jobs and lower gas prices. third, shipping dirtier crude oil into our country would not increase america's energy security. increased america's energy security is our strategy over the past several years to reduce our reliance on dirty fossil fuels from unstable parts of the world. goal toars ago, i set a cut our oil imports in half by 2020. between producing more oil here and home and using less oil throughout our economy, we met that goal last year. five years early. and fact, for the first time in two decades, the united states of america now produces more oil than we buy from other countries. the truth is the united states will continue to rely on oil and gas as we transition, as we must

transition to a clean energy economy. that transition will take some time. but it is also going more quickly than many anticipated. think about it. since i took office, we have doubled the distance our cars will go on a gallon of gas by 2025. triple the power we generate the the wind, multiplied power we generate from the sun 20 times over. our biggest and most successful businesses are going all in on clean energy. thanks in part to the investments we have made, there are already parts of america power from the wind or son is cheaper than dirtier conventional power. the point is the old rule set that we cannot promote economic growth and protect our environment at the same time. we cannotle set that transition to clean energy without squeezing businesses and , but this is

america. we have come up with new ways and new technologies to break down the old rules so today, homegrown energy is booming and energy prices are falling over the past decade, even as our economy has continued to grow, america has cut our total carbon pollution more than any other country on earth. today, the united states of america is leading on climate change with our investments in clean energy and energy efficiency. america is leading on climate change with new rules on power plants that will protect our air so that our kids can breathe. america is leading on climate change with other big emitters like china to announce reduceulations to greenhouse gas omissions. american leadership with more than 150 nations representing global omissions have put forward plans to cut global

pollution. america is now a global leader when it comes to taking serious action when it comes to fighting climate change. frankly, approving this project would have cut that global leadership and that is the biggest risk that we face. acting. today, we are continuing to lead by example because ultimately if we are going to prevent large parts of this earth from becoming not only inhospitable our uninhabitable in lifetime, we have to keep some fossil fuel in the ground rather than burn them and release more dangerous pollution into the sky. as long as i've president of the united states, america will hold ourselves to the same high standards to which we hold the rest of the world. three weeks from now, i look forward to joining my fellow world leaders in paris where we have to come together around in them vicious framework to protect the one planet that we have got a we still can. want to prevent the worst

effects of climate change before it is too late, the time to act is now. , butater, not someday right here, right now. i am optimistic about what we can encompass together. i'm optimistic because our own country proves every day, one step at a time, that not only do we have the power to combat this threat, but we can do it while creating new jobs, while growing our economy, while saving money, while helping consumers, and most of all, leaving our kids a cleaner, safer planet at the same time. that is what our own ingenuity and actions can do. that is what we can compass. america is prepared to show the rest of the world a way for goo thank you verward. thank you very much. [indiscernible]

>> with the paris climate conference, the administration and president obama announcing the rejection of the application to build the keystone xl pipeline. quick reaction from presidential candidates. marco rubio tweeting "when i'm president, keystone will be approved and president obama's backwards energy policies will come to an end." leadernie sanders, as a to keystone xl from day one, i strongly applaud the president's decision to kill this project once o and for all. pat roberts says, "yet again, the in ministration shows in the longer cares what can congress or the make and people have to say." shelly penn greece, "please to hear that potus will reject

keystone xl, a project that's bad for environment and long-term energy securit y." the republican congress may try to override the presence efforts to previous efforts have failed. transcanada may try to recoup the more than $2 billion and has spent on the project development. we will show you the presence comments again. the announcement coming up tonight at 8:00 eastern here on c-span. weekend, c-span futures programs on politics, nonfiction books, and american history could as a nation commemorates veterans day, saturday at 11:00 a.m. eastern, american history will be live at the national world war ii museum in new orleans as we look back 70 years to the world -- wars and. we will take your calls and tweets. starting this week and every sunday morning at 10:00, our new program "road to the white house

rewind" take a look at past presence of campaigns archival such -- footage. ronaldek we will look at reagan's presence o announcement. and then at 8:30 p.m., the legalization of marijuana dated. and then our road to the white house coverage continues with martin o'malley, who will speak at a town hall meeting at the university of new hampshire in durham. saturday afternoon on c-span 2's book tv, it is the boston book festival, featuring jessica stern on the terrorist group isis, joe klein and his book "charlie might," about to iraq and afghanistan war veterans who use their military discipline values to help others, and james would and his book "the nearest thing to life," on the connections between fictional writing and like it sunday night

at 11:00, a book discussion with former first lady of massachusetts, ann romney, on on book "in this together," her journey with multiple school sclerosis. get the full schedule at c-span.org. >> coming up in 50 minutes, we will take you live to the national press club. veterans affairs secretary robert mcdonald is there to talk about his efforts to reform the v.a.. he will answer reporters questions. our coverage of live at 1:00 p.m. eastern. until then, more about the veterans administration with the chair of the house veterans committee. this is from the brookings institution's. for coming to you discuss the important subject of veterans affairs as we continue to recognize how much our men and women and uniform -- in uniform have done throughout our history. many of them leaving the military service with challenges. and also, even those more

generally who do not have challenges, we still of them a debt of gratitude that veterans affairs system is designed to address these needs. today, we have two congressmen from the committee on veterans affairs. they also happen to be on the armed services committee. with brookin nlon gs into my left is jeff miller from pensacola, florida, who has been in congress for a good chunk of time. i met him a dozen years ago when he was preparing for a trip to north korea. many interest in his national security and foreign affairs portfolio. he is chairman of the veterans affairs committee and also a member of the armed services committee. it was really in many ways the impetus for today's event because he has a lot of ideas that he would like to present and discuss about addressing and

enduring needs and the department of veterans affairs. in that spirit, he is just like his congressmen colleague tim walz from minnesota. he is also on both those committees and a five term congressman now, the democrat joining congress later today. we have a good bipartisan discussion with the underlying motivation for all of us really being that we want to take better care of our men and women who have worn the uniform. the department of veterans affairs covers issues ranging from the g.i. bill and many other issues to acute health care problems to enduring chronic health care problems to mental health challenges. in its entirety, it's an enormous and expensive part of the federal government, pushing $200 billion a year now in its annual budget. that is not part of the defense budget. if it were a separate defense budget, if you thought of it as such, it will be roughly tied with china for the second-largest military budget in the world.

it is a very expensive system and we uphold the a lot of resources into it, especially since 9/11. we know that many problems and working that is my way of introduction. but we would like to do is really focused most of the time on discussion first up here with ourselves and then with you about the problems that are still within the veterans affairs system and we know we need to do better in order to help our men and women in uniform before we get to that, congressman miller and congressman walz are going to do a little bit of a primer on where we stand in the evolution of the department of veterans affairs. the question i like to post to both of you gentlemen if i could well and whatoing aren't we doing well? we know we have not done well enough yet, what we have presumably made some progress in the last decade or 15 years. wewe can begin, what are doing well and where are the

most severe problems remaining today? the miller: thank you for invitation to be here and it's great to be with my friend, tim. the department of veterans affairs -- and you set the scene well. part of the story needs to be that it is also about 300 30,000 individuals that work with the department of veterans affairs. they have gone a long way from their original mission, which abraham lincoln said was to care for those who have borne the battle, their widows, and their orphans. now, they do everything from just about a tizzy. a-z from home mortgages the g.i. bill to homeless reinvigoration, obviously health care and disability benefits. those are things you hear a lot about. what you are hearing a lot in the media these days and the secretary is real quick to remind me is that we are not bad at everything we do. that is very true. good.o a lot of things obviously, the national cemetery

administration does things extremely well. they do great with the v.a. mortgage side of the world. i come from a home-building background. we use the v.a. loans in the northwest florida area significantly. that thel tell you biggest problems that exist out there still remain within the disability side, the veterans benefit administration, and the vha, the veterans health administration. is a bad story, but some of the things that have occurred obviously, according to the ig, are systemic. we still have weightless, unrealistic wait times. the v.a. is trying to work with that. i was with the secretary for breakfast and they have great ideas they are tried to roll out and moving in a direction that is more 21st century. i would say that they are making some strides there. as bad as he wants me to move away from what has happened in the past, we still have to try

to root out some of the culture is in the v.a. that is more about taking care of the bureaucrat than it is the veteran. until that is done, i do not think the v.a. will be operating on all eight cylinders. president obama: michael: thank you. cars and walls. -- congressman walz. rep. walz: in our commitment, there is not an inch of daylight between us. and you ask them, there is no issue that unifies us more than caring for our veterans. if you posted a survey, nothing would pull higher. only 7% of the mac in public our veterans. on the public is there an want to get it right, very few have a deep understanding of how the system works. i've often said that i am the v.a. staunchest supporter and their harshest critic because it may be unfair, and i think the chairman is right, where we get

accused of focusing on the negative, but the fact of the matter is this is a zero-sum game. if one veteran waits too long, that is a failure. i think it is unrealistic tissue for 100%, but in any organization, that has to be the goal. you heard some of the things that i think they do well. i'm a product of that system in terms of the g.i. bill. that is how i got a college education. and middle-class kit from nebraska, that is one of the v.a.ns that you took of a home wanted those things are managed well and doing well. as jeff said, it is a large organization. i have a unique perspective on this and that i represent the most accounts, outside folks think it's one of the best health care systems in the country if not the world. -- thehe temp largest temp largest with the v.a. being around 42 billion in the mail around 6 billion. they get 80 million visits per --r from when the problem

per you could one of the problems is that we have to look at what goes on could you cannot have abuses and mismanagement in the system. and wenot have cronyism need to continue to read those things out. this is a distraction from the big picture fits. the v.a. does many things right. and i asked the mayo clinic, if you want to get the best health care in the world, it's the minneapolis public trauma center. they are doing work on the extremity injuries not done anywhere else. 80% of our physicians are trained at v.a. hospitals. this is an intragroup part and this is what we miss in this country -- it's an integral part of our health care system in general. you cannot talk about the v.a. and health care reform in a vacuum outside of the larger issue. think chairman miller has done a good job of this, asking the v.a. to focus on their core competencies. for me, you see a lot of folks who do not understand the issue ary well could this becomes

department versus privatization versus non-privatization. they are intertwined closely anyway. i think when the v.a. focuses on their core competencies, they can get better if they are willing to look at that term of 21st century. reformt think it is much as it is disruptive innovation. health care innovation is changing rapidly. i see it at mayo clinic and i think the v.a. can do that. if we get bogged down again and try to build hospitals, they are not good at it. they are not good at the construction of hospitals. that is not a proxy fight for government versus non-government. it's a reality. we as citizens want the best health care for veterans and we want it delivered in a timely manner because they have earned it and we want it to be cost effective. whatever model that is is the one that we should go for. i think now is a golden opportunity to do some that. there are many things going well and many people going to work at v.a. facilities that are giving of themselves. they are delivering the highest

quality of care. all you have to do is turn on the tv and see that is not the case elsewhere. i think we are holding onto a system that is no longer keeping up with modern challenges. that is our opportunity. before i get to the question of privatization and other options on the table, let me ask to break down a little bit the distinction between core competencies. this physical health care in the , to the injury to lambs body and general versus mental health care, ptsd, trammell brain injury -- traumatic brain injury. is the v.a. better at one or the other was that the right framework to break it down? rep. miller: i do not know if that is the right framework and you have to look at the way that they can treat tbi, the signature injury of the past two wars. posttraumatic stress is becoming an issue that is affecting all generations.

you are seeing it really manifest itself with the vietnam veterans now. , lot of them as they get older certain triggers are being hit. obviously mental health care is something that is important to all of us in to make sure that we do everything we can to stop the scourge of 22 veterans a day committing suicide. the vast majority of those are older veterans and they are vietnam era veterans. i learned this morning at a breakfast with the secretary that the vast majority of those who do commit suicide are not even in the v.a. system. i think they said seven out of 10. it is a huge number. so that the v.a. has no way of that these folks are actually in need of help, and of course, the veterans themselves are not willing to step forward.

there's a stadium that needs to be overwritten. michael: they are not actively part of a hospital treatment program at this time. rep. miller: correct. there is a category one through eight and you have to apply to be put into a category. most of these individuals are not getting any type of health care benefit from the department. michael: they may be getting some kind of ava benefit through a g.i. bill or something else, but they are not in the health-care system of the v.a., which is half the overall budget. the number is about 57% on that. i would fall into that category where i do not use the health care hospital for services. rep. walz: your question about what they do well is that in many cases, you do have some of the highest quality care being delivered. i've often said that you can have the best position in the world, but if there is an inept administrator, they are not going to get the patient to them to care for them. as far as the mental health piece on this, i do think -- and

again, i want to keep coming back to this. as a country in general, mental health parity is something we are struggling with you the problems in the military are also manifesting themselves in the private sector. the v.a. is moving forward on this. thathairman and i together the clay hut suicide act that bested to take some of the practices. if you're going to get to the presentation piece, one of the best practices shows that if you can get. counseling and peer work as early as possible with some of thee folks, you can reduce possibility of attempted suicide. that is smart to get them back to the community. if they had to minneapolis and they live in southern minnesota, they are disrupted from their community and their disjointed from that and it's better off to get at home. overall, they are starting to lead on many of these things that the v.a. has always done. again, they are not going to do it alone. barriers are those

that make it very difficult for some of the practitioners to deliver that. i think trying to compare them -- we know it is an overused cliche, but if you have been to one va hospital, you have been to one va hospital. there's truth in that. some are better than others. i think in that lie some solutions on how some of them are doing it right and some of them are quite honestly failing. compared toall patient care in the private pretty they stack up well. i think the chairman would say this as he always has -- if you can get in and get by the barriers, which is a fairport. surveys are good for those who can get physical treatment could the level of happiness and satisfaction is comparable to what we have seen elsewhere. i've two more questions and we will go to all of you. is -- and i'm tried to anticipate the question of what are the policy initiatives or reforms that we have not yet a

accomplished? that's my last question. what have we gotten better at in the last 15 years? i would put this in both the bush and obama administrations. we will spend our time talking about what we have not yet fixed. you're both keyed up a lot of the issues. for the sake of understanding the contents, are there any points where we can say we are better now than we were in the 1990's? rep. miller: we adjusted for the use of our ground forces that were preponderantly coming out of the national guard. rep. walz: we did it much better job of integrating those folks into the system, both on the benefit side and on other things as well is getting them into the v.a.. i think that is something we do much better now and the show this and that our dual veterans are enrolling in joining the v.a.. i remember when i first got to

congress. at that time, the v.a. was saying that they did not feel like they can advertise to get people in there. we had to have this debate and they started putting up placards on the side of buses. if you can advertise for a few good men and women, and we will take those men and women to the v.a. system. we have done a better job of letting them know what is available to them. the downside is that there was very little preparation to prepare for that. i would say to keep this in mind -- the bulk, and the chairman again pointed this out, the bulk of those suicides and the bulk of the care contrary to what might be popular belief are the veterans of these recent conflicts. it is like the rabbit through the boa constrictor. years afteromes 50 the conflict starts. we are seeing the vietnam veterans now. the real push of the v.a. from the current conflict will come in 2050. that is why i say there is no excuse for not being prepared for 2050 if we let that slip.

that is why i think now is the time. we are getting people in better and integrating our forces better. we are getting them to know their benefits and are entreating them and many of them can be prevented the medicine. the problems that start to rise on what times, i do not believe gotten significantly better. rep. miller: i would also say that one of the things that the committee mandated several years ago was mandatory transition assistance, the tap program. it used to be that most branches of the military did not require the folks to go through tap. even what was required, i think it was the marines and they only required five hours. you cannot teach everything that somebody needs to know about reintegrating into the system and civilian life and a five hour period. it's a longer process and more involved in most folks when they are exiting the service are not focused on the things they may need 20 years down the road.

i focused on getting back to their branded pickup truck or their boyfriend or girlfriend or whatever it may be. still, making sure that they know that the benefits are available and where they need to go. i will tell you one of the things that the v.a. is doing very quickly and from an i.t. standpoint. they have websites that were all over the map that provided information for veterans, but you had to figure out where to go. now they're bringing, i think i heard the number 70, they are bringing back down into one where a veteran can actually go to one singular website and navigate their way through that , making it easier for them to know what is available. michael: by the way, just a framing or factual point -- congressman walz, you mention that it is only 7% of the population today that is veterans. that is a very important statistic. it is worth reversing and look at the other wicked 7% of 320

million people is still almost 45 million veterans. when you think of families, we are talking about perhaps a third of the country that is closely linked to a veterans issue. the g.i. bill, you alluded to it. that is one of those things that even though it is not in the health care domain, it is proper health care and that is more accessible to family members can let me now turn to what you both said earlier has to be our main concern, which is where are we still falling short. you both alluded to wait times, culture of bureaucracy. in addition to maybe delving into any of those issues in greater detail, i wondered if you could also offer for all of us the one or two most important policy initiatives that you would advocate or propose. what is the fix for the worst of the problems that we still face today? we really started

changing the way the v.a. does business last august when we passed the choice act. a feea. has always had for services, but it was not used in a way that i think the veterans would expect it to be used. what we are trying to do is not compare a smallerr: it's number and they are struggling to fill that number. there are trying to be all think all people. veteransard the new health administration secretary say, we need to start focusing on what we do well and nobody else can do, which is the trauma centers. the thinks that are most critical that the a does better than anyone in the world and done ininks that can be

the community allows the veteran -- it makes no sense that a veteran would be required to go to a clinic to get a flu shot. eyeglasses,nk with oress there is an eye injury a standpoint of optometry. i understand that. there are many, many thinkgs from basic health care that can be done. we don't have to go and spend hundreds of millions of dollars the vaastructure that owns and have to take care of. we can leverage of what we already have. organizations, we are very thankful they were involved we were doing the choice act trying to help the best.o it they do

rep. o'hanlon: before i go to z, you aren wal advocating a much more private option. the choice act says you have to wait a month or be in a role area. choicese, you have no but to use the veterans system. sounds like you are saying you really need to give the veteran the choice? rep. miller: i would like to see that as reality. the fact is, it probably won't be reality anytime soon. and we did the choice act, we appropriated $10 billion. billionn't -- that $10 was supposed to cover people outside of the 40 mile parameter. measuring 14 days for certain distances may not be realistic. that number may need to be

adjusted outwardly. i would like to see the veteran have the choice of where they go. continuity cares, that is something the va says a lot. they are talking about going outside and taking care of things they do well and let others do the things that they do. thank you. host: congressman. rep. walz: jeff is right. one of the issues, again, i want to keep coming back talking about the health care in general. whether it is cultural or economic, a large percentage of our veterans to come from rural 20%s even though we make up -20 5% of the veterans in that area. if you give that card to someone -- you area, you do

back to trying to make it work. there is a reality. we should not be duplicating services. should not forget that we have a special responsibility. what do congressmen do when the local hospital does not get them in on time? do we hold hearings on why we can't get them a quick enough? what kind of authority do we have over that? jeff has done a good time -- a good job of that in the committee. realization that the country's population and changing demographics are taking to the point where we have to be open to the idea that you cannot drive down the street to a big va hospital. if there are open bets in louisville, who should be figuring out how to do it. host: or a dod facility.

rep. walz: i think we have figured it out. smartest carehe for veterans and it should be the most cost effective. one of the think we can figure out, this issue of continuity of care, would be greatly enhanced and dod should be placed we should start. weis absolutely unacceptable don't have electronic medical records they can be used. i learned from mayo clinic, and electronic medical record is a diagnostic tool and can put things in the forefront. it would make sense and track continuity and make a bigger impact. i am convinced you will see a blended system. you are hearing it from jeff, those court issues and research,

although things that need to be there. we need to be smart about how we do things. we have a responsibility. they are also citizens seeking health care in the local community. rep. o'hanlon: i do have one final questioned because it comes out of this discussion. last week, there was a political debate saying that you were involved a little bit. i am trying to understand exactly if there is a fair amount of consensus, not just between you two, and with the veterans affairs system about what is the plan. where is the current disagreement we need to focus in on to resolve -- this agreement gets a bad name, right? theocuses the issues and

issues we have to confront. not achievingstem right now that it could do better in the remaining weeks of this congress' session to get us to the next step, even if we are not going to get to the final goal anytime soon? rep. miller: if i were to pick one saying, accountability is the think that will change thinks -- things the quickest. blumenthal richard this morning. is, the number one person in the health the benefitsn, or administration, it is too difficult to fire people at the department of veterans affairs. you have to be able to hold people accountable.

it's probably not a huge number as it relates to 330,000 people. it still has to be done. accountability and transparency are the two biggest thanks. in make it easier to disappoint people who can't or won't do their jobs. gs. are doinge at the va their job and doing it very well. but, there are people out there causing that they are grief at the v right now. rep. walz: i always heard you cannot fire public school teachers. one think, the principles don't come out of their offices to see if teachers are underperforming. i think -- the only strength they have is to go and collectively argue if something

is wrong. we don't disagree. i think the chairman has been a champion on accountability. i couldn't agree more. , i understand, these are highly qualified people. they can take it at the va hospital, but not the abuse that was there. i do agree that the quickest hing you can do is have the accountability piece. i think there are ways, and they haven't if they would move on it and do their job and get rid of them. now, a big right mistake is going to be made that is going to have long-lasting applications that will hurt our ability to do this. dod, they are on the path of purchasing a new electronic metal -- medical records and they do not care what va says.

the taxpayers will buy a system that will not be able to communicate with the va. that is irresponsible. are doing what is wrong accountable as quickest as possible. the big systemic change in the world today is being able to manage data towards an outcome that leads to better health care. rep. miller: to piggyback on what tim says, we spent $10 billion. it was supposed to be an integrated system. dod finally just said, forget it, we are not going to do it. now they are using this word interoperable. in the 21st century, it doesn't make any sense at all. even though they are both doing different thinks with that system, the system can be made to work like this, not like

this, which is what i'm afraid is what they are doing. dod makes the argument that our system has to work in a summer rain. submarine. app,er can come up with an you should able to do this. this is more complex than an app. i do believe we can overcome this. i would make the argument that would best put their effort there while simultaneously making sure that the culture is broken down. thosetwo thinks with -- two things what have a radical impact. i think they have the ability to do it and is not enforce it. say it's to make sure

the veterans get the best care possible. i have seen this being in a profession where i often times heard you couldn't get rid of a bad teacher, many times you could. i can tell you, nothing bothers a bad teacher or bad anything more than the person down the hall not doing their job. they want to get rid of this. we differ there. rep. miller: what i told the secretary is that they me need -- there is a lot of risk analysis that is done in what .hey do is it less expensive to just read a settlement with this individual that it would be to take them all the way through and let them appeal to the protection board, and then the va.epth back at thee we need to take one of the most egregious cases and go all the way to the top.

even if it gets reversed. i think the american people would be able to understand how difficult it appears to be able to do this. if you go back to the phoenix waitlist issue with sharon hellmann, she ended up being the manipulation of the wait times. with the infant of doing was finding out she had been taking i on the side.de --gifts fts only three people have been fired for the wait times. there are a couple of people in the process. there was one last week. , i chief medical officer think they have taken action for overprescribing opiates. again, when there is a problem,

it takes way too long. we still have people on paid administrative leave a year and paid fromer getting phoenix. rep. o'hanlon: thank you. pleas wait for a microphone and identify yourself. and pose one questioned. will he thinks that right there in the back. >> arthur allen from politico. about electronic health records, the department of defense has --eady signed an agreement vare was recently a report look into getting a commercial system as well. ownays they have their program for developing called "evolve."

this is been going on for so long, this whole process. what do you take it needs to be done to just make a decision since it seems key that dod and va bm the same track? is that happening now, or do you feel like somebody needs to step in, in the white house, or something to clarify what is going on? --ler: i do believe that rep. walz: i do believe that. i understand, i was frustrated when i bought a computer and then i had to upgrade. this is a culture that started with the business system and the mayo clinic told me, they were pioneers in this. at one point, it was one of the best records. , but it isery good inexcusable that we aren't

working together. it is inexcusable that we aren't using the clouds of these two systems to force the change into the private sector because most people understood and most people involved with health care reform know this electronic medical system was at the heart of real reform. this, i would welcome white house intervention to drop the hammer on this one and forces them to do this. to. miller: it really needs be done. the secretary will talk openly about a lot of this -- the code that is being written. this to and others that are based on our older languages. congress mandated and appropriate the money for va and dod to do that. thatva -- it seems that wants to write their own.

leader that has jurisdiction over both of them is the president and the white house and their involvement would be very important, because this is a critical piece that will take decades down the road for the young person who is enlisting today to be able to have that truly electronic health record that follows them from induction to death. somebodying to me that who did not wear the uniform, when i first got elected in 2001, i talked that a veteran was a veteran. no, there is a better read and then there are retirees and there are two different classes there. dod is done when with you, you get your dd 214 and you are not involved with dod anymore. you are now va's problem.

these are americans and the government should be taking care of them from the beginning to the end. the middle is still very mushy. rep. o'hanlon: the woman in the purple shirt right there. hi i'm emily and i have a question for the congressman. how can the congress work va?ether to expand the th and help the caregivers bring va -- the caregiver program is one of the best things that is going.

especially if it is a family member that is taking care of that veteran, being able to make the thingsdo that they need to do. when it was rolled out, they tried, i guess, to go as far out as they could, but not very deep. you talk about going back to vietnam and korea and world war ii. it's a focus. -- if they focus of the committee, but it's just one of the things that is in the mix right now. rep. walz: i would agree. i know that former senator dole is working heavily on this and helping us. -- thing inness va could becomeh

a bipartisan snapping back and front -- back and forth. i don't think any of us are happy with the way it's going. public cares deeply, but they don't see it every day. you have spouses and parents who have given up careers, and we .re not paying anything it is being burdened by that family. this is the case again were i do va.believe the this alone. it is going to be collectively together to figure it out. think -- i think having senator dole involved is elevating the discussion. i agree. she has brought to the discussion, credibility, and

certainly, she is being able to do things outside of the system and bringing it to us and really being a resource to try to resolve some of the issues that remain out there for the caregivers. rep. o'hanlon: let's keep moving up. right there, on your left. >> hi, tom porter. vank you for your accountability bill. we do need you to work on the other side. we appreciate you working together. , a top question priority, suicide mental health for our 400 -- 4000 plus members. see vongly would like to va is comingg -- along.

will he thanked schedule one. that is easy enough. we'll be able to do it by the end of the year. we pass individual bills. critical andeck is you have my pledge that you will have a hearing early next year. i would say on this issue of suicide and working on bills. i am glad you brought this up. because people don't care, but they move on to the next issue. people, on the day that we passed that, in my local newspaper, it was passed by congress, the bottom half of the newspaper was a bout a young

veteran walked into a library and shot himself. the idea that we passed a bill the situation is going to get better, we better be very, very careful. the chairman has always responded to it. look for to that hearing. rep. o'hanlon: yes sir, here, on the other side. you, i am days with lrp publications. representative miller, if the provisions of hr 1994 becomes that as au look at pilot in which the same type of provisions could be spread to other federal agencies as a way to improve performance and address some of the problems -- in the v in thea a. rep. miller: i do.

don't jump. [laughter] there are issues out there. you always need to keep things moving around the don't become static. a part of what that has been happening at the va. it's the way they have always done it. when you are trained, you are trained in the wrong way to do something. from an accountability standpoint, things have gotten tougher and tougher and tougher as it relates to holding people accountable. that it isi contend still difficult to do it. came, when danny pommel before us the other night for a hearing on monday night, he said, it is virtually impossible .

that is not me saying it. , andis somebody at the va not just somebody down here, but someone at the very top. va, i would like to see if is the test case, i would like to see it expanded. i will make the same offer to my friend, 10. blumenthal, let's find a way to find a middle ground to get the bill passed. that is what is important. i don't think there is a change of evidence year requirements. -- i don't think there is a change and requirements. i come from, when you are fired, you are fired. .ou walk out the door that day va isat you hear from

that somebody is going to be fired. firingthat is not somebody. we have different ways we look at it. i think we will find a solution that we can all agree to. but i amty stubborn, not stubborn enough to hold a good accountability keys even if it's not 100% of what i wanted. rep. walz: and i agree with the chairman. these are healthy debates going on. it starts with the premise, i don't question him one inch. the premise is to hold people to provide better quality care to our veterans. i think it's fair to try to find a middle ground. attemptthink this is an of a right to work. not an 800 pound gorilla in

the room. it is a realistic conversation with absolute understanding that there are problems with accountability. i would make the case that mr. pommel could have done his job better and not give bonuses to and under performing employee. find a that we have to place where that happens. i think that's why the va committee is the best place for it to happen. rep. o'hanlon: the third row. , i ran the bemith a medical research program for three years. i now am directing a new forming georgetown center for veteran studies. ask --va ba has

va -- i think choice has been good. point where the best resources of the think that would be great. however, there are about 7 million or 8 million veterans who are not use veteran care. 34%hose who use it, 84% -- use the health care. it is going to cost 1.4%. as you expand choice, it will be expensive. i wonder how you would respond? i can tell you how

much it costs to see a doctor in a particular community. can'til just recently, i they will tell you what the dr.'s salary is, but you have to factor in the hard costs. there was a study that came out and i have yet to have an opportunity to read it. $250 per hour for a visit. that was opposed to the private sector of $50 per hour. there should be a correlation as you expand the choice that there is a savings within the va system. you are right. system has used the public sector for many years.

thee will take you live to national press club my by the secretary of veterans affairs. he took office at the end of july last year after reports that dozens today, he is expected to talk about the current state of the v.a. system and continuing efforts to improve the situation. the press club president, making the introduction. >> i am editor for word and first president of the national press club. our speaker today is robert secretarythe eighth of veterans affairs. he will update us on the status of federal programs for the people who have served in the

military. but first, i want to introduce our distinguished head table. this table includes both national press club members and guests of the speaker. e'sm the audienc shaft, argeant veterans affairs correspondent. , a do lucky -- ken commander of the american legion post. , a veteransrnke advocate and host of the next word. , past president of elks ofvolent order of

the united states of america. john donnelly, a senior defense roll call and chairman of the press freedom committee. , a militarys veteran, and deputy director of das office of client relations. . chairman of the national press 's speaker committee, and former press club president. skipping over our president, a captain of the u.s. a be clubed, andy pres the press member who arranged this luncheon. , the chief officer of ymca of the usa. max letter, an army veteran, and

publisher of stars & stripes. angel, president of the d.c. connection, and mc of the at georgeck rally washington university, this coming veterans day. a navy veteran, and former publisher of the washington examiner. [applause] in addition to our audience here in the packed hall room of the national press club, i want to welcome our c-span audience, as well as our audiences listening on public radio. you can also follow the action on twitter. pclive. #n

confirmed asld was secretary of veterans affairs in july of last year. eased not have time to into the job. he came aboard to fix problems at the department with 312,000 employees. the agency, at the time, was facing criminal investigations, congressional outrage, and construction cost overruns. you can remember the media reports from that time, as well v.a. audit.al it was discovered that more than 120,000 veterans were either waiting for care, or had not yet received it, or never received it. schedulers were pressured to use unofficial lists or engage in other practices to make waiting times appear more favorable. mr. mcdonnell made it his

mission to restore trust with the nations nearly 9 million veterans, and their families. he drew upon his past experience to try to set things right. as the former ceo of procter & gamble, he was no stranger to overseeing large, complex operations. he also had an understanding of military service. he served five years in the u.s. airborne the 82nd division. he graduated from the military academy at west point. he finished in the top 2% of his class. 15 months it has been since he took the job. how are things going at the v.a.? congress has provided $60 billion in additional funding for the v.a. to pay for some veterans to get medical treatment from other doctors and

hospitals, and to increase the number of v.a. staff. lawmakers also gave the v.a. secretary more latitude to fire managers. sees much to be positive about at the department. he was quoted telling a house committee recently, "maybe you could hold a hearing on his progress, i would welcome that." giving alcome me and warm, national press club welcome to veterans affairs secretary, robert mcdonald. [applause] sec. mcdonald: thank you. inc. you sthank you so much. you know, since the civil war, the y has been a friend of

the fractions. today, i am pleased to announce that the v.a. and the ymca have legacyto continue the by further expanding our partnership. this enhanced agreement makes it easier for local v.a. facilities transitioningelp service members to connect to the resources and opportunities that they need. neil, thanks to you and the entire organization for your and during devotion to veterans, the benevolent protective order of elks have been friends of veterans for a long time too. the reconstruction hospital that they built in boston in 1918 thed gave it to government, is a forerunner of today's v.a. centers. last month, the elks committed $4 million over four years to help and veterans homelessness.

further, they are deploying 800,000 members across the country to help and veterans homelessness in their own communities. paul, thank you and the elks across this country for your generosity and loyalty to our nation. [applause] the ymca, the elks, these are the kinds of strategic partnerships that we are establishing as part of our "my ," which isormation making profound differences in the lives of veterans, and their families. let me also welcome a great veteran nba employee, patty andrews. than is representing more 100,000 v.a. employs the rva's va'selves -- that are

themselves. think you for your example and continued service to the nation and the v.a.. [applause] like john, i would like to recognize all of the veterans here today, and wish you all an early happy veterans day. for your services and sacrifices, and those of your family as well. several days ago, i was in kansas city. i had lunch with the vietnam veteran named larry parrish. larry agreed to let me share his v.a. experiences with you. larry is a very active man. over the last two years, his health has deteriorated over a hip problem. he said, i was 278 pounds, walking with a cane, in pain, and only 61, i was suicidal because of the pain, and because no one seemed to care.

on the advice of a trusted friend, larry turned to the v.a.. here is what larry said about the v.a.'s physical therapy -- they gave me my life back, they turned around and 24 hours, they were the most cordial of any therapist i ever worked with, public or private. v.a. doctor recommended a hip replacement, larry chose th v.a. his private health insurance the aboute -- deductible was $5,000, more than he could afford. more important to him was this, i wanted to go to the same place good.e they were so damn every time someone saw me, they would hug me, that mia on the back, and say, thank you for your service, welcome home, brother. right. b v.a. doing it

living theyees values of integrity, commitment, advocacy, respect, and excellence. those stories are out there in abundance. they are too rarely reported. i want to begin by telling you access to improving health care, and meeting demand. we focused on four pillars. ,he first pillar is staffing space, productivity, and v.a. community care. we have more people serving veterans, the veterans health administration staff is up over 15,000. we have activated over 1.7 million square feet and increase the number of primary care examiners and fiscal year 2014, so providers can care for more

veterans everything all day. we have added 2.2 million more square feet and fiscal year 2015 . in the wake of and access crisis, we increased access to care. and the 12 months following the crisis, june 2014-june 2015, we completed 7 million more appointments than during the the previous year. 2.5 million of these were within v.a. in thelion of these were community. this fiscal year, we completed 6.5 million appointments, 3.1 million more than the last fiscal year. or than 2 million more at the facilities. one million more at the community level. altogether, 2.6 million veterans were authorized care in the community, a 9% increase in authorizations over the year before. right now, 97% of appointment are within 30 days.

92% are within 14 days. 87% are within seven days. 23% are the same day. specialty care average wait time is six days. primary care is four days. mental health care is three days . those averages are excellent for most, but, if you are the one in the tale of the curve like a veteran living in the city seeing dramatic veteran growth, they are not acceptable. we will take advantage of the scale of the v.a., its affiliates, and partners to have own today access stand make sure every veteran gets their care. we have made progress in adjusting veteran homelessness.

altogether, across the country, there has been a 33% decline in homeless veterans. backlog claims are down 88% to 76,000 from a historic peak of .11,000 in march 2013 we completed 1.4 million claims and fiscal year 2015, the highest in our history, and year0 more than mus last . today's veterans weigh about 93 days for claims decisions, six months fewer than in march 2013, and the lowest in the century. veterans are noticing. i met a veteran last week at the .ashington, d.c. medical center his father served in vietnam, with the first infantry division, and the 101st division, and his grandfather

fought rommel in world war ii. .e brought up a great point he said, my spirit with v.a. has positive, but some people are not experiencing the same quality of the work that i got. he advised, what we need to work on is consistency across the board. he pinpointed the reason that the transformation is shaping a seamless, unified customer experience across the entire enterprise, and across the entire country. ey v.a., the transp transformation that we are in now will put the indians, interest of veterans of beneficiaries first. it is focused on five main objectives. first, we must improve the veteran experience. second, we must improve the

employee experience. third, we must achieve service support excellence. fourth, we need to establish a culture of continuous improvement, and faith, we need to enhance strategic partnerships. two of them are great examples here. i have suggested, as john pointed out, to the chairman and ranking members of our house veterans affair's committee that we hold a hearing on the my v.a. transformation hearing, rather occurredings on what two years ago. in the meantime, here are updates on our progress, transforming v.a. -- we are from nine organizational boundaries and structures to a single framework . this means downsizing from 21 , 18 that arerks

aligned in five districts, by state rounders. the realignment means opportunities for local level integration, and promotes the consistently effective customer service that was described. veterans from syracuse to seattle will see one ba our veterans experience office is fielding customer service experts who will help us get this vision -- every veteran everywhere getting the same focus. they will be focused on delivering consistent quality and the highest standards of integrity.lism and the north atlantic office opened at the end of this year. we are following up with the southeast office in february, the midwest office and april, and we are working on details of the continental and pacific offices. this is about making it easier for veterans and their families to be v.a. customers.

we have launched the my v.a. community model across the country. this brings together local veteran service providers, advocates, and others, to improve outcomes for veterans and her families in that community. their community driven network local by -- chaired by leaders. i was in connecticut when we established the first board in august. 37 other communities have adopted the model. in 25 cities last may, we kicked off the initiative. the veterans economic communities promote local collaboration and partnership amongst organizations serving transitioning service members, veterans, and their families. we are doubling down on economic communities early next year. we are investing in v.a. employees. the last federal employee

viewpoint survey results show that employee experiences are improving, trending slightly higher than last year. the best customer experience organizations in the world, nothing wisely, are also the best places to work. leaders.aining great customer service companies use human centered design to understand what customers want and need, and design customer experiences to meet those needs. we started training leaders last month. by december 2016, we intend to have 60% of our trainers trained. we started in october, and are

looking to train 5000 employees over the next year. improving employees experience is inextricably linked to improving veterans' expense. there is not a good customer service company that has unhappy untrained or employees. we kicked off a cascade training model with 300 field leaders last month. i was told it was the first time that the top leaders of v.a. had ever gone together on that scale. we are equipping leaders to dramatically improve the quality and delivery of service to veterans, and create a better work environment for employees. this month, we will complete initial training for all leaders so employees are better informed understand so they all of the egg, not just a little peas. we are giving them training that we call v.a. 101. 6000 employees over 60 sites have received the a one-to-one

training so far. we will have 100 70,000 trained -- 170,000 trained by next december. it also helps employees better appreciate the value they bring to the a. some notable progress on health care delivery, the claims that backlog, vengeance homelessness, and he might be a transformation. all that is to say we have made undeniable progress. every health care system has challenges, and the v.a. has its fair chair, but some are unique v.a.e the you have read about the stark experiences from facility to facility, about the bureaucratic leadership and staffing challenges, failures and access and quality, cultural employees andt leaders experience.

when i testified in october, the assessment has given us new ideas and a great deal of information on some known problems. it also confirms our own , and indicates we are headed in the right direction for some time now. as long as one veteran does not have the larry parrish experience, we have more work to do. let me address some challenges before we open things up to questions. ask us to care has improved. here is the inevitability. improved access means more demand. completed 7 million more appointments in the year following the crisis that we did the year before. that should have satisfied the demand twice over. still, the number of appointments not completed in 30 days has grown from 300,000 to 500,000, or nearly 500,000. why? more veterans come to us for care.

the more veterans that come to us for care, the harder it is to balance supply and demand. that kind of imbalance predicts failure in any business, public or private. the health-care industry is no different. the 2014 access crisis. the axis crisis was predominantly a matter of a mismatch of supply and demand. crisis was exacerbated by a greater number of veterans receiving services. you see, more veterans like .a., andrrish choose v with good reason. for people like larry, it is about quality and cost. the average medicare reimbursement for a knee replacement is $25,000 with a co-pay of 20%. v.a. saves veterans $25,000 per replacement. we cover all hearing loss.

veterans for thousand dollars for hearing aids. veterans notice this. sector health care turnover is about 30%. our turnover is about 9%, pretty favorable. physicians, 4000 and 10,000 more nurses. we need to fill 41 senior-level vacancies in the field. the shortage is a national problem. for our own part, we are working closely with the deans of medical schools. we are working with congress, asking for more residencies. we are asking for scholarship reimbursements from congress. we are working with universities and state governments to create even more medical schools. one of our most dressing challenges is the appeals process -- delivering timely decisions in the manner that

veterans deserve. in 2015, the board of veterans appeals served over 55,007 hundred veterans, more than we have in recent memory. they held over 12,000 hearings. that is a lot. .t is not enough suddenly put, our capacity to serve veterans with timely, final appeals decisions has been encumbered by cumbersome laws. they do not well served veterans today with a modern system. we work with veteran service organizations to reengineer the process, and now we are working with congress to pass the laws necessary to bring the process into the 21st century. we still have challenges and veterans experiences in benefit delivery. last month, i received an urgent hughes.rom mike

calls to his regional office word on productive and frustrating. the call center agent could not access the information necessary to answer his questions, and correct the problem on the spot. even though that is one veteran and one and counter it is not the kind of customer service we aim to provide. we owe veterans more. we owe our employees, who serve veterans, more, to empower them to give every veteran a world-class experience. are strengthening our customer service model so it is more veteran-centric. as of the september, we are processing dependency claims at the point of the call so agents can, for instance, at a minor

child or spouse to a claim. as we continue to strengthen our service model, call center agents will begin taking more and more action while veterans are directly on the phone. other issues i have described -- other initiatives i have described will, over time, help us achieve our customer service goals for veterans. challenges. we are working hard to do our part, aggressively tackling issues within our control. in the relatively short period for an enterprise of the sizing complicity, we have demonstrated the capacity for meaningful change. an independent assessment reported that the v.a. can perform amongst the best health care systems of the world. we will.

the ymca, the elks, they are just to members of hundreds v.a.rtners helping the .et me be clear while these partnerships are important, our most essential partnership is with congress. congress holds the keys to many of these doors. congress legislates the benefits. we provide the veterans. it is congress that has to legislates.efits it recommendations require congressional action. we literally cannot do it alone, not without the right congressional support. here are five specific requirements that will make a significant difference to veterans. i have repeated them during testimony, and it every other opportunity.

i do not mind reciting them again. first, we need congress to fully fund the president's 2000 60 budget request. second, we need congress to give the flexibility to align resources with veterans demand for care. third, we need congress to act on the proposal we submitted may 1 to end the uncertainty on aspects of purchase care that are outside of the veterans choice program care andicate other community programs. fourth, we need congress to address many of the statutory .a. withurdening the thv red tape like the appeals process. to streamlineed all programs into one program. the independent assessment reiterated this requirement of veterans. for years, a variety of authorities and programs that provide care in the

community to veterans gearing it is difficult to understand. veterans do not get it, our employees do not get it, medical providers do not get it, so we last fridayhe hill -- the vision for a long term quality care. withweek, i had breakfast the chairmen and ranking members of our senate and house committees. there is tremendous unanimity to pass these measures, work together to transform the v.a., and provide a more delightful experience for veterans. remember my cues -- that veterans who could not get answers about his claims. a week after he wrote me, he wrote me again. toweek after might you melt you, i received a call from the regional office, assuring me that my claim had been heard,

and was one that would be handled properly. go that is the response that mike should have gotten to be in with. we will get there. we are well on our way. i look forward to your questions. thank you. [applause] >> thank you, mr. secretary. you mentioned the progress that you have made. however, looking back of the problems of two years ago, have you now held everyone accountable at the department that needs to be held accountable, and if not, do you need any additional authorities so that you can hold them accountable? sec. mcdonald: let's talk about accountability. jim collins,d, talks about the need to get the right people on the bus, and in the right seats on the bus. of my leadership team, 10 of the 16 our new since i was confirmed

. 10 of 16. also, over 90% of the medical centers have either new directors or new leadership teams. and calendar year 2014, 1100 people were terminated from the v.a. and calendar year 2015, 1500 people were terminated from the v.a. since july 29, when i was 2800rmed, last year, people have been terminated from the v.a. we have imposed disciplinary action over individuals for manipulating scheduling. the worst of those, you may have already seen. an individual in a gust that, augusta, georgia has been indicted. the charges bring with them a $250,000 fine and potential for five years in jail. we are working with the ig, the

office of special counsel, the fbi on other investigations that are ongoing. over the last year, we have had a total of 62 criminal convictions that have been discovered by our inspector general. i have to say, accountability is a lot more than firing people. it is also about giving people the responsibility, the training , and working with them, and training them to perform at a high level. one of the things we have done over the last year, we have built into people's review plan, all of the things i have talked about -- improving customer service, the transformation, improving our call centers. this is being built into people's performance plans. we have made progress. there is a lot more to do. there are investigations currently underway. as time goes on, you will see

the results of the investigation. a question about cost control. what mechanisms have you put in place to control costs, how are you ensuring that payments are proper and in line with fair market values? sec. mcdonald: cost control is really important. one of the things that i believed in in the procter & gamble company, there were two things i believed in. one was innovation. the v.a. is a great innovator for this country. we spent one point $8 billion on innovation, research. that research is not only critical to american medicine, but also to the american people. secondly, productivity. productivity is critically important to us. we measure value units, which is a common measurement in the medical industry. it is a measure of productivity. 18% overctivity is up the last year, versus a budget increase of 2.8%.

ways to improve our productivity every day. there is no question that demand is increasing for our services. goingot feel capable of to congress and asking for more money, unless i can show them that we are trying to save money. if you look at my testimony over the last year, what you see is i told congress that we had 10 million square feet of unused space. unfortunate, it is all in someone's congressional district. if we could close that space, that would save the v.a. and the american taxpayer $25,000 per year. please look at my testimony. million per year. we are eager to work with members of congress to close that space. and, we will have more space because we have digitized the claims process. by digitizing the process, we

eliminate 5000 tons of paper. 5000 tons of paper. >> standardizing care. how will the be a standardized on seas nationally so that the veterans will have the same access to care, no matter what v.a. they attend? the example they give is the various and limitations and qualifying criteria of caregivers, post 9/11 veterans to receive a stipend. sec. mcdonald: great question. i think i adjusted in my remarks, but the under secretary for health, one of the new leaders at the v.a., this is how to identify the current best practice, and bring all the v.a. up to the current best practice approach, well, at the same time, trying to innovate to improve the best .ctres practice

let me give you an example. if you are a vegan, and have to change your address, you have to change your address nine different times in the v.a. with is not one backbone information. we will go to one data backbone with one list of address, which keeps track of every interaction with each of our customers. that is one example. that will cost money and will take time, but now is the time to do it. we have a new assistant secretary for the office of information technology. her name is laverne counsel. i recruited her. she was the i.t. leader at johnson & johnson and dell. she knows how to do this. now is the time to get it done. >> how have the changes that you initiated with might be

v.a. helped to address cultural challenges and more out? sec. mcdonald: again, i think i addressed that. the all employee ceremony was taken this year before we did the leaders developing leaders program. i think our leaders developing leaders program has been a breakthrough. we are working with nolteel ge.hi, from his daughter works for the v.a. design a training program that has been outstanding. interestingly, the leaders do the training. i do the training. gibson, he does the training. our leaders do the training. we do not hire consultants to do the training, we trade

them ourselves. we have done 300. those 300 will go back and train their own organizations. we put together a packet, a training packet, and they will go train their subordinates. i attended one last week in kansas city. i was thrilled with what we were accomplishing their. while i can talk about my vision for the v.a., where i need everything with employee to do is talk about how their vision for their organization cascades from my vision or the organizational vision. the test for any high-performing organization is, can you walk into a medical center, and ask the person in housekeeping how what they are doing that day contributes to the overall organization.

if the answer, i'm putting a man on the moon. somellary clinton got attention recently when she said the v.a. scandal has not been as widespread as it has been made out to be. do you agree with her? sec. mcdonald: i told you, we have made progress, and have more work to do. [laughter] [applause] >> cnn reported that long waits continue for many v.a. patients seeking medical services. in august, more than 8000 timests for care had wait longer than 90 days. why do these delays continue, and what can be done to cut down on the way time? -- wait time? sec. mcdonald: 70% of veterans have a choice. before. that choice 70% of veterans have medicare, medicaid, their own private

health insurance. 78% of veterans have a choice. the exercise that choice. today, on average, the average veteran, and of course there is no average veteran, but the average veteran uses v.a. for 34% of their medical care. only 34%. that 34% maybe the hearing aids $4000, or the knee replacement that saves $5,000. only 34%. as we have improved our care, as we have improved our culture, as people have learned about the great things that the v.a. does, as we open up more facilities, as we hire more providers, more people are coming. more people are coming, and those already in the system are looking for more of their care from the v.a. if the 31st percent becomes 35%, a $1.4crease, i need

billion budget increase from congress. $1.4 billion for one single percentage point. as many of you know, the budget problems we got into last year, because of a miracle hepatitis c drug that was invented in 2014-2015 -- that budget was talked about two years before that. we will have to do something with our committees to create the kind of processes that exist in business for how you have budget flexibility and agility to meet customer demands. otherwise, what will happen is as more people come into the system, if we do not get that budget flexibility, then the appointments may not be within 30 days. maybe the average mental health appointment -- not mental health, that would be about example, but primary care appointment has to go from four days to five days, or six days because the budget is given to us by congress and the benefits

are defined by congress. >> a question about the v.a. complex in los angeles. admiral mike mullen is investigating there. how extensive are the problems, and will people be held accountable? dearmcdonald: mike is a friend, and is there on my behalf. i do not quite understand the question. no, we have problems in west l.a. a lawsuited there was in los angeles. there were 10 plaintiffs suing the past secretary. the lawsuit has been going on for four years. i discovered that that lawsuit was getting in the way up a solving problems in los angeles. i went to los angeles. we have changed the leadership in los angeles. we have hired more providers. we have strengthened our

relationships with medical school affiliates, like ucla, and with new partners like you uc. we have created a master plan for the facility. it is on the internet, you are welcome to comment. we need to use the land properly for the care of veterans, rather use it as a car lot, and other things that were done in the past. we are moving in the right direction in los angeles. again, we have a lot of work to do. progress, but work to do. at least we got the lawsuit, which i was able to settle, out of of the way. we have stronger partnerships, and we are moving in the right direction. >> mike is being very helpful. it was reported that 30 v.a. systems black permanent directors. why is it so difficult to fill

these jobs? is pay an issue? do facilities without a director suffered? sec. mcdonald: i said job one is getting the right people on the bus, and the right people in the right seat. the process does take some time. as i said, 90% of our medical centers have either new leaders or new leadership teams. i can personally about freight for eachally vouch person in place. if it takes longer to do that, i'm ok with that. there is no substitute for leadership, and leadership does matter. this is a question about legislation that has been introduced to help world war ii veterans exposed to mustard gas, and help them receive compensation for their injuries if the v.a. does not help them. will it take legislation for the v.a. to compensate these

veterans and their families, or is there something the v.a. can do now? sec. mcdonald: we have been collecting names, and we have a short list. i was lucky to meet, i think she here?- issu from npr? yeah. i'm trying to get her list, and it with our lives. that is step one. i'm not sure if legislation will be required. we will do everything without legislation. plan presented to congress to consolidate community care states explicitly that needs congressional support in funding. how likely are we to see that plant realized, and when? sec. mcdonald: as i said, great .nanimity with our committees

ranking members and the chairman said they understand the plan. the reason there are some a different ways of getting care and the community is that over the years, congress has passed so many laws that layered on top of each other. each one had a different reimbursement rate, a different selection criteria, and as a result of that, you had the seven different programs that were very difficult for veterans to understand, and very difficult for our employees to understand. similarly, you had dysfunctional or skewed incentives. i went to montana with senator jon tester, a great guy, and he providers,a room of medical professionals, and they all told me how much they loved one of the seven plans. and said,d to john the reason they love that plan is because the reimbursement rates in montana are the highest for that plan.

we have to get one plan, easy for the veterans to understand it. we are in the customer service business, but these laws have been layered over the years. we will get this done, and get it done quickly. veteransntal health of suffering for post-traumatic stress is one of the biggest challenges that the v.a. faces. what alternative methods are being used for veterans -- our music, art alternatives? sec. mcdonald: when i was going through my confirmation progress, there was a very small number of senators, one or two, who said, why don't we blow up the v.a., and give up vouchers. the v.a. is not only essential for veterans, it is essential for american medicine because we

are on the cutting edge of so many treatments. therefore, it is essential for the american public. billion on.8 research. we did the first liver transplant. it was a v.a. nurse that had the idea to connect patients with barcodes to records. v.a. was the one that came up with the idea of taking an aspirin a day. when you have the largest integrative medical system, you can be on the cutting edge. right now, we are leading the effort imprecision medicine. we had 1000 -- we have a project projecthe million vets with blood samples of veterans connected to 40 years of medical records, and we are doing the genome mapping of all of those blood samples.

imagine the research that can be done to go back to the genome to understand the causality of that genome and cancer. more work will be coming. without the v.a., who is going to do that? trains 70% the v.a. of doctors in the country. without the v.a., who will train those doctors juggle it is a primary source of residency for .edical schools we need more medical schools. we are working to create a medical school at the mercy of the about a las vegas -- the university of nevada at las vegas. we need more residencies. is the largest employer of nurses, the largest trainer of nurses. to deal with the help, because

we are who we are, and because we are on the cutting edge of mental health, we will try anything, any treatment that may .ork we found that acupuncture is effective with some people. we are the largest user of acupuncture in the country. we found that equine their feet is effective with some users. we have equine centers around the country. i could go on and on. there are many different techniques that are effective that a for-profit system will never figure out. it is up to us to figure it out, write the reports, write the research, do the literature, and create new standards of care. one of the things we will do coming up this spring is hold a mental health summit here in d.c. we have already done one of these, this will be the second.

we will share knowledge and make sure that we are all working synergistically to figure these things out, rather than in a redundant way. womens question says veterans are often invisible to the v.a., and also the fastest growing population of the homeless. what is your plan to outreach to women vets nationwide and informing them of benefits? sec. mcdonald: the question is correct. women veterans often do not identify themselves as veterans. all veterans feel inadequate because they feel there is someone who has done more than they have. we find some veterans think the word "veteran" means only if you served in combat, or that you are male. we are hiring more providers for female veterans, more obstetricians, gynecologist. we are also setting up women's

clinics in most of our major facilities. if, who ever asked that question c., take a look at our new women's clinic. i'm quite proud of it, and think some good work is going on there for women. the same thing in atlanta, georgia. we got some space from the department of defense and set up a women's clinic. we have women's clinics going in all over the country. are 11% of veterans today, and in the not-too-distant future, 20%. of time, almost out but for a get to the last question or two, i have some housekeeping. the national press club is the leading organization for journalists, and we fight for a free press worldwide. to go to ou find out more, go tr g.bsite, press.or

to donate to our institute, go rg/institue. comingpresentation this tuesday at 6:00 p.m. book clubill hold its and others night on november 17 at 5:30 p.m. we have more than 100 authors that will be here in the club, and there are so many of them that are noteworthy, i will not even begin mentioning a few of them. debra lee james, the 23rd secretary of the u.s. air force will speak at a club luncheon on december 2. i would now like to present our guest with additional national press club mug, the greatest keepsake of the national press club. [applause]

you were here one year ago, so you now have your collection started. we hope you come back in a year for your third. you really have to get the larger set to get the full experience of the press club mug. mr. secretary, you have been at the v.a. more than a year now. compare the challenges of running a large government .gency with a corporation how are they like, how are they different? how di do the challenges differ? sec. mcdonald: how they are alike is the burden of big numbers. we have 9 million veterans in the health care system regularly . if you make a mistake, .5% of the time, that is still a very big number. i talked about the more completed appointments, by also talked about the tail.

if you are in a place where the veteran's population is growing rapidly, you do not care what is happening elsewhere. big numbers is really a big deal . how do you be perfect across that system? that is why design thinking is so critical to training the organization. secondly, one of the differences -- at procter & gamble, what we had health care business, it was things like over-the-counter remedies. here, we are in the health care business where people have catastrophic injuries. also makes for a difficult -- that also makes for a difficult situation where there is no room for errors. a big difference for me is i spent 33 years with the company, and had lived and worked all over the world, 16 of those years outside of the united states. i lived in japan, brussels, it

philippines. here, i have just been on the .ob a little over a year how do you compress those 33 years of knowledge of the people in such a short period of time. when i got the question of why does it take you so long to fill it wasrship vacancy, easy when i do someone for 33 years, it is a little more difficult today. those are some of the differences. more veterans are running for elected office. has this been helpful to you and the v.a.? also, it is a campaign system. -- campaign season. what do you think in terms of the veterans issues? are you hearing and a discussion of veterans issues out there, or not? sec. mcdonald: i'm always glad when veterans issues are raised. i wish there would be more checking on the

numbers used. there are a lot of myths out there. what i have tried to do today is give you both the good and bad. leave it ative at that. >> as far as more candidates there are veterans being elected, is that helpful? sec. mcdonald: i think it is helpful when you have more seople with veteran experience writing laws. there is no question that we will keep moving in the direction where very few of our elected leaders, or at least, not as many as in the past, where veterans. that is why i think it is critically important that, rather than having veterans at the center of a political issue,

and using veterans as a political pawn for one party or the other, to play gotcha with the president, the administration, or the department, it is better that we work together, and have hearings on what we want to do in the future, rather than what happened to-three years ago. about differences, coming from the business world, i'm just not used to this, where someone behaves one way privately to you, and different way on camera, and they work hard to write a question that you may answer incorrectly. let's work together, all work together, all of us, including people in this room, strategic partners, members of congress. do's work together to what is right for veterans, and forget this gamesmanship. it is not make sense. -- it does not make sense. [applause]

to be clear, i think we have two minutes unanimity today. i will tell you, i'm not running for political office. i'm in this for only one reason. i came out of retirement for one reason, and that is to do this job. i will do my job to the best of my ability, and it will did the changes that lead to the right thing. announcer: robert mcdonald in washington, d.c. as we take you to the white house for the daily press briefing in progress, taking questions regarding the white house rejecting the keystone xl pipeline project. mr. earnest: the comment of senator hat