Secretary of Veterans Affairs Dr. David Shulkin appeared on Tuesday’s Breitbart News Daily to discuss reforms made at the V.A. on his watch, the challenges that still remain, the state of health care reform for the private sector, and the emotional Medal of Honor ceremony for Vietnam War Army medic James McCloughan.
SiriusXM host Alex Marlow began the conversation by relating his wife’s highly positive experiences working in the V.A. system.
“What most people don’t realize is, 70 percent of all doctors trained in the United States will rotate through a V.A.,” Shulkin pointed out. “If it wasn’t for the V.A. health care system, we wouldn’t be training the types of doctors that we are in the country. They go out and they work, and they’re taking care of everyday Americans, but it’s really the V.A. health care system that was part of their professional training.”
Shulkin said his department was “moving forward with modernizing the system – a system that’s been neglected, really, for decades.”
“We’ve announced that we’re putting in a new electronic records system that is the same system that the Department of Defense uses, which just is good common sense, since we know all of our customers are coming from the Department of Defense in the future. You might as well have one system that stores records,” he said.
“We’re making updates on our facilities, getting rid of all our vacant and underutilized facilities. We have over 1,100 of them – 500 of them that are from the Civil War and the Revolutionary War – and making sure that we reinvest those resources back in the V.A.,” he reported.
“Right now before the Senate, we have a bill that’s waiting to be passed,” said Shulkin. “We hope this week that it will authorize 28 new leases around the country. They’ve been stuck in Congress for over three years. These are desperately needed new facilities to provide our veterans the most modern type of care that we can provide them.”
“Little by little, we’re working our way through this system and modernizing everything for our veterans,” he said.
Shulkin said the process of upgrading old V.A. facilities is complex, as each facility presents different challenges.
“Often we will get out of a facility and we’ll turn it back over to the GSA, which is the Government Services Administration that runs our facilities. They then go and they dispose of the facility, or they sell it,” he explained.
“I was just this week in New Orleans, and our old hospital that had been destroyed by Katrina, which we had been maintaining ever since Katrina, we just have turned over to GSA, who gave it to the City of New Orleans, who is using it to house homeless people,” he said. “We often will look either to monetize the site or to make sure that it’s being used for good purposes to help people.”
Marlow asked for an update on the V.A.’s efforts to fill its many open positions.
“When the president signed the Whistleblower and Accountability Act a few months ago, he also included in that something called direct hire,” Shulkin replied. “That’s for some of our critical positions like those people that run our medical centers, that we now have a streamlined process in which we can bring people on.”
“We are seeking additional changes to the hiring and to the workforce requirements because it’s just been too complex to get through the maze of paperwork and hoops that it takes to get into the federal government. That is one of our key issues: getting the right people on board and having people like your wife who understand that working in the V.A. is actually a pretty good experience,” he told Marlow.
Shulkin said the V.A. is fulfilling a pledge to post information such as wait times at clinics and disciplinary actions against its employees online, offering a unique level of transparency for a federal agency – in fact, above and beyond what even many private institutions offer.
“We’re the only health care system in the country that is posting wait times,” he noted. “We are posting our information as accurately as we possibly can, and we take great lengths to make sure it’s accurate. But these are average wait times, so if you look online and you see that it takes four days to get an appointment, that’s the average experience. There are going to be some people that are longer, some people are shorter. But it’s franky the most effective way that we can be honest about where we are right now in terms of our wait times, to post this information.”
Marlow brought up the issue of suicide prevention, a vitally important form of care for veterans returning from conflicts in the Middle East.
“It’s our top clinical priority in the V.A.,” Shulkin responded. “There are 20 veterans a day who are taking their life, and that’s just far too many. It’s a statistic that’s really hard to get your head around. Of the 20 veterans a day, 14 are not getting any help within the V.A. system.”
“We know that if we can get people to come into the V.A. to get connected with our mental health professionals that we can help and save lives. We show that people do better when they’re getting care,” he said.
“We are working and reaching out to community partners. We’re working with family members, friends, churches in the community to make sure that if they see a veteran who could use some help, that they get connected with help. We have a 24-hour veteran’s crisis line. All of our facilities have same-day services for urgent mental health care needs,” he said.
“The real message we’re trying to get out there is, reach out to veterans that you know, make sure that if they need help that they know we’re there for them,” said Shulkin.
Marlow turned to Medal of Honor recipient James McCloughan, whose astonishing acts of valor were undertaken on the battlefields of Vietnam almost 50 years ago.
Shulkin, who attended the ceremony, said it was “quite an emotional event.”
“It was meaningful not only to Mr. McCloughan and his family, but when those ten fellow soldiers stood up at the White House, you could see how moved they were. That was an event that happened in 1969, so when you have your brothers in arms all together, and you know that they wouldn’t be there if it wasn’t for the support of each other and how they made sure that they looked out for each other, you just don’t see things like that on a regular basis, which made it such a special day yesterday,” he said.
Marlow asked for Shulkin’s thoughts on the state of the health care debate.
“I don’t think it’s over,” Shulkin replied. “I think that this is too important an issue to the American people for it to stop here. Our current system is not sustainable.”
“This seems like an issue that unfortunately has been polarized,” he reflected. “I think that we’re going to need to continue to work at it until we find solutions, and I do believe that the best solutions will probably include support from both parties – because ultimately everybody understands that the cost of care needs to come down, that Americans need access to care, and the trends towards just more and more complex, expensive care are going to make the situation get worse unless we find these new solutions.”
“I do believe that there are many people in Congress, and I know the president, they’re committed to finding a solution, to coming up with something that works for the American people,” he said.
Another health care issue urgently in need of resolution is the epidemic of opioid abuse, which involves both prescription drug abuse and illegal drug smuggling. Noting that many veterans are vulnerable to the opioid epidemic, Marlow asked for Shulkin’s perspective on the problem as V.A. Secretary.
“This is an issue that V.A. has been working on well before it became an issue that was being talked about in the general American public,” Shulkin recalled. “Back in 2010, we launched the largest opioid reduction initiative that has probably ever been done, and we’ve seen a 34 percent decrease in the use of opioids among veterans since 2010.”
“We still have a long way to go,” he conceded. “But let’s remember, the real issue here is that people start on prescription opioids because of pain, so what we also need to focus on is doing a much better job on pain management.”
“Research that we’re working on, that the NIH is working on, is looking at finding non-addictive medications for pain management,” he said. “We’re looking at alternative approaches towards pain management using complementary therapy and giving veterans more control of their lives, and also looking when opioids are necessary, when it is the best therapy approach towards the management of pain, how we can appropriately prescribe and monitor the use of opioids. One of the things we do in the V.A. is, we have patients actually sign their own informed consent forms, so that they’re part of the process of how to manage their pain, and to work with our clinicians in doing that.”
“It’s a complicated issue, but one of the most important issues that we’re working on. Of course, Governor Christie is now chairing a commission for the president that I’m part of, that we’re working on for the whole country,” Shulkin said, referring to the presidential commission headed by New Jersey Governor Chris Christie that began meeting in March.
Shulkin said it was not surprising that government officials seemed slow to recognize and respond to the opioid epidemic, because the issue is so complex, and that means it doesn’t make for a “great political issue.” He added there was a great deal of money involved in the very big business of prescription drugs, further clouding the issue.
“The most important thing is, we now know the number of deaths that are happening: 120 a day from overdosing on prescription medications and heroin,” he observed. “There aren’t that many types of public health issues that are having that large an impact on the American public. Each of these are tragedies. They not only ruin people’s lives, but they ruin family lives.”
“This is an issue that has not been very politically attractive, but ultimately as you say, you can’t ignore these things. Now it’s facing us head on, and we just have to do something about it,” he told Marlow.
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