S t r i c t l yS p e a k i n g |
March 1998 Office of Public Affairs |
| Contents |
TOGO D. WEST, JR. |
(Before the Senate Committee on Veterans' Affairs, February 24, 1998) |
TOGO D. WEST, JR. |
(Excerpts from presentation to the House Committee on Veterans' Affairs, February 4, 1998) |
| Looking Back to the Future -- Where We Have Been And Where We Are Going | KENNETH W. KIZER, M.D., M.P.H.
Under Secretary For Health |
(Excerpted from a presentation to the VHA Executive Leadership Summit -- "Journey of Change: Exploring And Discovering VHA's Future," Baltimore, December 9, 1997) |
| Responding to Gulf War Illnesses | KENNETH W. KIZER, M.D., M.P.H. Under Secretary for Health |
(For the House Committee on Veterans' Affairs
hearing on Gulf War veterans programs, February 5, 1998) |
| Build on Our History | GERALD HINCH Deputy Assistant Secretary for Equal Employment Opportunity |
(At Black History Month Dept. of Army employee program, Fort Riley, Kansas, February 11, 1998) |
Statement for Confirmation
Hearing
TOGO D. WEST, JR.
Acting Secretary
(Before the Senate Committee on Veterans'
Affairs, February 24, 1998)
Chairman Specter, Ranking Democratic member Rockefeller, members of the
Committee, I am pleased to appear before you today.
During my years of service to this country, I learned firsthand of the extraordinary
contributions made by America's men and women in uniform.
As the President's nominee for Secretary of Veterans Affairs, I am grateful
for the opportunity to work on behalf of veterans who have earned the nation's
gratitude and respect. Few privileges compare with the opportunity to have
daily contact with America's sons and daughters in uniform and, through
them, their families and the civilians who share a commitment to our nation's
security.
This young nation has survived and matured at great cost to its citizens.
The freedoms we hold so dear were won on battlefields by ordinary people
who held freedom more dearly than their own lives.
They believed that self-determination and self-governance should be a birthright
to all. In the course of our 222 years of independence more than 41 million
of our citizens have served the cause of freedom. More than a million have
died in the name of freedom. A million and a half have been wounded. Today
there are almost 27 million citizens who are veterans.
Around the world, young men and women and seasoned service members stand
up for freedom and stand against tyranny. They do so as volunteers. They
do so as patriots. They do so as the sons and daughters, husbands and wives,
mothers and fathers of the future of the world. It is to all of these gallant
and brave citizens, past and present, that America owes her freedom. It
is to them that America has made a promise. It is the Department of Veterans
Affairs that has been given the responsibility of keeping America's promise.
As we move toward the next millennium, I look forward to working with you
on behalf of veterans and their families.
I will expect, and am prepared to demand, of the department that we:
improve the quality and timeliness of the delivery of benefits;
continue improving our health-care system, emphasizing quality, compassion
and effectiveness;
assure our employees a work environment that is conducive to their best
efforts in behalf of veterans;
master the challenges of information technology, including the looming issues
of the year 2000; and
more fully integrate the department's organizational elements.
I will expect and demand of myself and our employees that we accomplish
these things because they are important in keeping America's promise to
our veterans.
Since I became Acting Secretary at VA I have been immersed in the learning
process. I am pleased by what I have learned.
During the five years of this administration, VA and Congress have worked
to make significant progress in changing and improving the way we provide
services to veterans and their families. As we move into the next millennium,
we must improve that process so that at VA we work as true partners with
the Congress, in collaboration with the veterans service organizations,
to build together as we deliver on America's promise to her veterans.
Our top priority is to treat our veterans with dignity and improve their
quality of life. That includes intensifying our efforts to ensure improvement
of the quality, timeliness and veteran satisfaction with the delivery of
compensation and pension benefits and services.
VA has been successful in removing many barriers between veterans and their
health care and compensation benefits.
Work is continuing on many fronts, such as:
exploring several new approaches to improve our claims processes;
negotiating agreements with the Department of Defense to streamline our
records transfer process;
collaborating with the Federal Express Center for Cycle Time Research to
study and refine our business flows; and,
· undertaking a system-wide "business process reengineering"
review to improve our service delivery.
These initiatives and others have provided short-term processing improvements,
but more significantly they have reminded us of the importance of viewing
our program delivery from a balanced perspective. Our efforts will focus
on service improvements from the veteran's point of view. Dramatic service
improvements require dramatic change in the way we view our business, the
way we train our employees, and the way we engineer our systems.
Mr. Chairman, our health care must be the standard against which others
are measured. I am committed to VA becoming a world-class health-care provider.
We will accelerate the improvement of our health-care system. We want to
bring health care closer to where veterans live. I am pleased that we are
providing more and better outpatient care. VA is establishing more outpatient
clinics and closing costly, unused and unneeded hospital beds. The result
is that we are treating more veterans in the most appropriate setting.
Through the combined efforts of many service organizations, individual veterans,
VA and the enlightened action by this Committee and Congress, the eligibility
rules for health care have been revised and updated to make sure that veterans
who need care are not prohibited from receiving it.
I am committed to all these improvements and changes. I say again: We cannot
lose sight of our prime purpose. We must continue to focus on the highest
quality of care. We must focus on not just treating more veterans, but treating
them with all the compassion, expertise and respect they deserve.
We must be sure we are also meeting the special needs of veterans for whom
priority care is critical and specialized:
-- veterans suffering from the hazards of past service in the Persian Gulf;
-- veterans with spinal cord injuries;
-- aging veterans from World Wars I and II and the Korean War;
-- veterans who are Ex-POWs;
-- veterans exposed to Agent Orange;
-- women veterans;
-- atomic veterans; and
-- homeless veterans.
VA must be the medical safety net for veterans at the lower end of the socio-economic
spectrum. We must keep our promise to all our veterans. We must continue
to expand our research into all the health areas which affect the quality
of life for our veterans. Finally, when life for them is no more, we must
be prepared to provide a fitting and final resting place of honor.
Key to accomplishing our mission is assuring that we have a workforce we
can be proud of and one that is proud of what it does. I want to be sure
we have a working environment that fosters a sense of the importance and
worth of what our employees do for veterans. I want our employees to come
to work confident that their very best efforts are not hampered by inappropriate
behavior by any other employee. I want VA employees to leave the workplace
each day with a strong feeling of self worth, knowing that their work has
made the quality of life for some veteran better.
Success in serving veterans is dependent upon having a highly effective
workforce comprised of the best clinical providers, the best adjudicators,
the best qualified people with the right skills and training to meet our
promise to veterans. Part of that success is making sure that VA employees
have the right information technology and the proper training to use that
technology. It is essential that we be able to transfer information accurately
and quickly between the various elements of VA if we are to make progress
in the quality and timeliness of the services we provide.
I am committed to the five-year strategic plan as we continue moving to
a more customer-focused organization, functioning as "One-VA."
Veterans seeking benefits do not see us as several separate entities. They
see only the VA. We want our service and our response to veterans to be
seamless and coordinated.
These are the priorities and goals I have set for myself and for the department.
They are simple to state; but achieving them will not be easy. I assure
you that I believe they are attainable. Progress in meeting them is underway.
Mr. Chairman, in this time of looming crisis in the Gulf, I want to address
the issue of health problems of Gulf War veterans from Operations Desert
Shield and Desert Storm and some lessons we have learned. Nearly 700,000
U.S. troops were deployed to the Gulf area during those operations. Many
veterans returned home with a variety of symptoms and illnesses and came
to VA for help.
More than 221,000 Gulf War veterans have utilized VA medical facilities;
22,000 Gulf War veterans have been hospitalized at VA medical facilities;
and more than 80,000 have been counseled at VA's Vet Centers. More than
140,000 have been determined as service connected. We will continue doing
all within our power to provide dedicated, compassionate care for our veterans.
We are vigorously searching for answers to the causes of their suffering
and examining a growing list of risk factors through more than 120 research
protocols funded by federal agencies representing an investment of more
than $100 million.
President Clinton has made it clear that no effort should be spared in this
search for an answer. I intend to meet that mandate.
We have learned some important lessons in addressing the health-care problems
associated with modern-day injuries and illnesses sustained in the battle
area. Today, war is different than those we fought in Europe and Asia in
the 40s and 50s. The battlefield may contain environmental hazards with
which we have not previously been confronted. In many ways those environmental
hazards pose as much of a challenge as the traditional wounds inflicted
on our service members.
We have learned that maintaining accurate and detailed medical records of
troops in the field is critical to timely and accurate health care once
the individual comes to VA for health care. The records must clearly include
any inoculations given, what they were and who received them when.
There must be better risk management and risk communication. That simply
means there is a responsibility to keep track of who is at risk and what
kinds of risk they face on the battlefield from chemical, biological or
environmental hazards. Those risks must be communicated clearly to the service
members who have the potential of exposure. The U.S. men and women in uniform
must understand why there is risk and how to deal with it. That is a command
responsibility.
We must know who was where at what time if we are to accurately assess their
exposure to harmful agents. During my tenure as Secretary of the Army, the
Army had the lead in developing the Gulf War unit location database which
has greatly expanded the ability to track individual service members who
may have been exposed to chemical or environmental threats. That is a technique
that we must continue to improve.
I cannot overstate the importance of coordination and communication between
federal agencies with overlapping responsibilities for active, Guard and
Reserve members and veterans. The Persian Gulf Veterans Coordinating Board
is the mechanism we currently use to further this coordination and communication
process primarily between the Departments of Defense, Health and Human Services
and Veterans Affairs.
In summary, we have learned a great deal. We are putting that knowledge
into practice at VA. Our counterparts in other federal agencies are working
on solutions to identified problems to make sure that information important
to providing good health care for veterans is available to VA when needed.
It is my responsibility to see that the efforts move forward in this very
important element of our national commitment to care for veterans.
I conclude with this thought: For the most part, we are a country of citizens
who never faced the specter of invasion. No other country in the world can
lay claim to it. And it is so because of one group -- one group of dedicated
men and women. When they wear their uniforms, we call them soldiers and
sailors and marines and airmen and coast guardsmen and when they take off
their uniforms they still call themselves that. And we call them veterans.
America's heroes.
I am here to serve them. I promise you and, more importantly, I promise
our veterans that I will do my very best to keep America's promise.
***
VA's 1999 Budget Request
TOGO D. WEST, JR.
Acting Secretary of Veterans Affairs
(Excerpts from presentation to the House Committee on Veterans' Affairs, February 4, 1998)
Mr. Chairman, members of this committee, I am pleased to present the President's FY 1999 budget request for the Department of Veterans Affairs (VA). We are requesting $42.8 billion in new budget authority for veterans' programs.
...Working with Congress over the past five years,
VA has torn down bureaucratic barriers between veterans and their health
care and compensation benefits, has reorganized its health-care system,
and has revised eligibility rules to best meet the needs of our veterans.
VA right-sized, cut back, did more with less, and reallocated resources
to accommodate the changing needs of those we serve. VA is making good on
our promise to the nation's veterans in the 21st century.
My goal will be to keep VA on this aggressive course. As we approach the
new millenium, we will work to ensure the improved delivery and accuracy
of compensation and pension benefits, continue the transformation of our
health-care system, and fully integrate organizational elements into "One
VA." ... To ensure success, we must provide a workplace free of discrimination
and harassment. Employees must be recognized for their innovation and be
provided the appropriate tools for their work. Our request builds on our
previous accomplishments and positions us for the future. Highlights by
major component are:
· Medical Care. The budget provides $17.7 billion (includes
$700 million in medical collections) to provide medical care. By continuing
to improve the delivery and access of outpatient care, the department will
open 71 new outpatient clinics and treat 134,000 more veterans in 1999 than
in 1998, a four percent increase. The Medicare demonstration program is
again recommended by the administration.
· Montgomery GI Bill and Readjustment Benefits. The budget
proposes to increase mandatory Montgomery GI Bill education benefits by
20 percent, or $191 million, in 1999 the most significant increase in benefits
since the program's inception. The budget also proposes an increase of $100
million ($500 million over five years) in VA's readjustment benefits account
to reimburse Department of Labor (DOL) programs to train, retrain, and assist
veterans to find employment (Vietnam era). Since almost 30 percent of adult
males are veterans, this would be aimed at helping older, displaced workers.
· Medical Research. The $300 million request includes
a ten percent increase over the 1998 enacted level.... This program is included
in "The Research Fund for America."
· Veterans Benefits Administration. The budget provides $806
million, $52 million over the 1998 enacted level, a seven percent increase....
· National Cemetery System. The budget requests $92 million,
$8 million above the 1998 enacted level.... The department will open four
new cemeteries during the next two years a number unprecedented since the
end of the Civil War.
· Smoking Cessation. The budget proposes to establish a $87
million smoking cessation program for veterans who began to smoke during
military service.
Further details on our FY 1999 request are as follows:
... Emphasize a Business-like Approach to Health Care
... Retention of all medical collections and user fees will add tangible
incentives for our employees to enhance customer service. The opportunity
for additional patients to choose VA has the potential to improve the return
on the VA infrastructure investment made by the taxpayer and to maintain
the health of the VA health-care system. We will continue to distribute
medical care resources under the Veterans Equitable Resource Allocation
(VERA) system. The financing of additional workload in 1999 reflects our
ability to serve more veterans with their care financed by a system-wide
unit cost reduction achieved by increased emphasis on primary care services.
VA will expand and improve health-care delivery without any increase in
appropriated funds above the current 1998 enacted level for medical care.
Resources include the Medical Care account's annual appropriation ($17 billion),
sharing and other reimbursements ($147 million), and the Medical Care Collections
Fund ($677 million). We expect to provide quality health care to more than
3.4 million unique patients, including 3 million veterans, an increase of
approximately 134,500 unique patients. The new funding level should support
almost 695,000 inpatient episodes and 37 million outpatient visits.
Starting in 1998, VA committed to the goals of reducing per-patient cost
for health care by 30 percent, serving 20 percent more veterans, and increasing
alternative revenue sources to 10 percent of all medical care funding by
2002. This five-year projection assumes FY 1998 authorization of Medicare
subvention, successful pilot testing and expansion nationwide. It is important
to emphasize that the per unique-patient price reduction of 30 percent is
dependent upon the workload increase of 20 percent. This dynamic allows
VA to spread its fixed cost across an expanded workload base.
Improving Benefits Delivery
We have made a strong commitment to improving compensation
and pension claims processing through better management and development
of a Balanced Scorecard for measuring progress. Using five core measures
-- customer satisfaction, speed, accuracy, unit cost, and employee development
and satisfaction --the Veterans Benefit Administration (VBA) will upgrade
the delivery of benefits and services to veterans and their families. VBA
will establish new management information systems and revise existing ones.
... Some current performance measures and targets will change as new systems
are implemented with new data consistent with the Balanced Scorecard. Eventually,
VBA will use a data-driven Balanced Scorecard to link strategic planning
and performance management with annual budget requests....
This budget requests $22.6 million to continue VBA's Business Process Reengineering
(BPR) initiatives aimed at producing significant improvements in processing
compensation and pension claims over the next few years. We are also requesting
additional funds to fully automate our education assistance payments for
veterans and their dependents, making it much more convenient for them and
less costly to the taxpayer. ...
Ensure a Lasting Tribute for Veterans and Family Members
We project that annual veteran deaths in the U.S. will increase over 14
percent, from 525,000 in 1996 to 601,200 in 2003. Annual veteran deaths
are expected to peak at 620,000 in 2008. As the number of deaths increases,
the National Cemetery System (NCS) projects increases in the number of annual
interments from 71,786 in 1996 to 104,900 in 2008. Our request for the NCS
continues to position VA to meet these future requirements. ...
State veterans cemeteries are a complement to VA's system of national cemeteries
and have an important role in meeting future burial demand. To foster an
enhanced partnership with the states, as proposed last year, legislation
is under consideration to amend 38 U.S.C. 2408 to encourage the establishment,
expansion and improvement of state veterans cemeteries by increasing the
maximum federal share of the costs of construction from 50 percent to 100
percent. The legislation would also permit federal funding for up to 100
percent of the cost of initial equipment for cemetery operations. States
would be responsible for providing the land and paying all costs related
to the operation of the state cemeteries and for subsequent equipment purchases.
... I will now briefly summarize our 1999 budget request by program.
MEDICAL CARE
... The administration supports enactment of a
demonstration program in 1998 to test the feasibility of "Medicare
subvention," i.e., collecting from Medicare for health-care services
provided to Medicare-eligible, higher income veterans without compensable
disabilities. The advantages of this initiative are that: veterans will
have more options in selecting a quality health-care provider closer to
where they reside; Medicare will be billed at costs which will be lower
than the private sector; and VA will be able to use underutilized capacity
to provide health care to Medicare-eligible veterans. The administration
will work with Congress to ensure passage of the Medicare subvention pilots
this year.
To promote more efficient management of resources, VA proposes a change
in the appropriation language that provides for a two-year spending availability
for up to 8.3 percent of resources made available. This percentage is equivalent
to approximately one month of spending authority. This proposal promotes
more rational spending aligned with business-type decisions, recognizes
the need for management flexibility during this period of significant change,
and reflects the GPRA concept of integrating budget decisions with planning.
SMOKING CESSATION
The administration is requesting authorization
of a five-year smoking cessation program for any honorably discharged veteran
who began smoking in the military. Private providers, on a per capita basis,
will deliver the program to the extent that resources are available. Once
this program is authorized, the administration will submit a budget amendment
requesting an appropriation of $87 million for this new activity. A legislative
proposal to authorize this program will be transmitted in the near future
by the administration. It is estimated that between 1.3 million and 2.6
million veterans would avail themselves of this valuable program over the
next five years.
MEDICAL AND PROSTHETIC RESEARCH
Funding for medical and prosthetic research is
proposed as part of the Research Fund for America. This proposal highlights
the administration's priority to support needed and sustained investments
in important federal research programs on a deficit neutral basis. A total
of $300 million will support over 1,795 high-priority projects and VA research's
general goal to meet the needs of the veteran population and contribute
to the nation's knowledge about disease and disability. VA research will
continue to focus on designated research areas that are of particular importance
to our veteran patient population, including: Gulf War illnesses, aging,
chronic disease, mental illness, substance abuse and sensory loss.
The additional $28 million requested will allow continuation of ongoing
programs and the start of major research initiatives.... The first of the
initiatives will establish a new Quality Enhancement Research Initiative
to accomplish unprecedented collaboration between research, policy and performance,
patient care and informatics. Target areas for this initiative include prevalent
conditions, such as cancer, prostate disease, depression and consequences
of chronic spinal cord injury. Other initiatives will focus on medical therapy
and surgical treatments of Parkinson's Disease; rehabilitative research
in the areas of vision and hearing, aging with a disability and prosthetics;
and prevention of complications of Type II Diabetes Mellitus. ...
MEDICAL CARE COLLECTIONS FUND
The enactment of Public Law 105-33 established
the Medical Care Collections Fund (MCCF) and enabled VA to retain third-party
recoveries and other copayments from the provision of health-care services
and to use those resources to provide additional care to veterans. In an
era of government efficiency, where fewer federal dollars are being spent
to provide more services effectively, MCCF will allow VA to have the necessary
flexibility to produce more funding through user fees while maintaining
no increase in appropriated funds.
In 1999, VA expects to increase collections by 13 percent from the previous
year to a total of $677 million. To improve recoveries, MCCF is focusing
on consistent utilization of existing billing and collection software; better
documentation of detailed clinical and cost data on insurance bills; implementation
of billing rates based on reasonable charges; and continued development
of automated recovery processes.
Benefits Programs
... The administration is requesting $21.9 billion to support FY 1999 compensation
payments to 2.4 million veterans, 305,000 survivors and 2,000 children of
Vietnam veterans who were born with spina bifida, and to support pension
payments to 390,000 veterans and 283,000 survivors. The mandatory appropriation
request includes the estimated cost of providing compensation for disabilities
and deaths attributable to tobacco usage during military service estimated
at about $17 billion over five years. VA's General Counsel has determined
that under current law service connection of a disability or death may be
established if injury or disease resulted from tobacco use in the active
military service. ... The budget proposes legislation to disallow benefits
for these disabilities or deaths attributable to diseases which began after
military service and after any applicable presumptive period, and based
solely on tobacco use during military service. Discretionary resources in
the budget assume enactment of this legislation.
We are also proposing in this budget a 2.2 percent cost-of-living adjustment
(COLA), based on the projected change in the Consumer Price Index, to be
paid to compensation beneficiaries ... at an estimated cost of $287 million
in FY 1999. Proposed legislation is included to pay full disability compensation
benefits to Filipino veterans and DIC to their survivors residing in the
U.S., currently receiving these benefits at half the level that U.S. veteran
counterparts receive. The cost will be approximately $5 million a year,
for a total of $25 million over five years.
This budget request also reflects a need for an additional $550 million
for the FY 1998 compensation programs. The COLA that took effect December
1, 1997, is responsible for $303.4 million of this increase. The remainder
is primarily attributable to higher than expected increases in average benefits,
with an increase of veteran cases as well as the inception of compensation
benefits and vocational training for children of Vietnam veterans who were
born with spina bifida. Several factors contribute to the increase in the
average benefit payments. Among them are: (1) the processing of older cases
as emphasis on reducing backlogs continues, which generates significant
retroactive benefit payments; (2) increases in the number of service-connected
disabilities claimed and granted to veterans; and (3) higher than expected
average benefit payments to Vietnam and Gulf War veterans. These changes,
along with estimated tobacco-related claims, result in the increase over
the original budget estimate.
... This budget proposes legislation to eliminate authority to finance the
sale of acquired properties (establish vendee loans) to the public. VA acquires
properties incident to the foreclosure of guaranteed loans. Properties can
be sold for cash, but in 80 percent of the cases VA finances the sale by
establishing a mortgage loan receivable. The establishment of vendee loans
and their subsequent sale extends VA's liability for many years. By selling
all properties on a cash basis, future expenses due to foreclosure of pooled
vendee loans will be eliminated. If enacted, this proposal is estimated
to save a total of $42.2 million over five years.
VA is also proposing legislation to charge lenders a fee of $25 for each
VA loan that is guaranteed. The fees would be earmarked for use in developing,
maintaining and enhancing a VA Loan Information System that would interact
with the information systems used by lenders to make and service VA-guaranteed
loans. Amounts collected will be deposited in the Supply Fund. VA may charge
this fee for four years, not to exceed a total of $15 million. ...
GENERAL OPERATING EXPENSES
... Veterans Benefits Administration
The 1999 budget request for the Veterans
Benefits Administration (VBA) of $651 million will support an average employment
level of 11,221, which is 125 FTEs below the 1998 level. Much of the FTE
decrease relates to moving 80 FTE to the Franchise Fund for the Debt Collection
Activity and to reductions in the overhead, administrative support areas.
Employment for direct processing of compensation and pensions claims increases
by 140 FTE over 1998. This request, combined with $155.5 million associated
with credit reform funding, will result in an increase of $52.5 million
in discretionary appropriated funding over the 1998 level.
... There are several initiatives which, taken as a whole, comprise our
new vision for processing compensation and pension (C&P) claims. Among
those included in this request are the conversion to service centers, or
the organizational and physical combination of Adjudication and Veterans
Services Divisions at each of the 57 regional offices. Once completed, enhanced
customer satisfaction as well as improved processing will follow. Also requested
are funds for the pre-discharge exam initiative that provides an outreach
effort prior to separation from the service at major sites. This is a critical
element of the reengineered C&P vision....
This budget also reflects funding for finalization of the ongoing geographical
consolidation of loan processing and loan service and claims functions from
45 offices to nine Regional Loan Centers (RLCs). Consolidation will result
in improved services to veterans at reduced costs through greater efficiency
and economies of scale. Service to lenders will improve through greater
consistency and responsiveness. This consolidation is expected to generate
nearly $43 million in savings through 2003. Funds are also included to deploy
a new Property Management Local Area Network (PLAN) System. Real property
acquired by VA as a result of guaranteed loans requires management and disposal.
Automated information support will ... promote the rapid acquisition and
sale of properties....
Other funds are also included to continue information technology initiatives....
Education processing will benefit from completing installation of imaging
technology into the VBA environment, reducing the dependency on paper documents
and improving timeliness and accuracy of claims processing. ... VBA will
also replace the current system of manual processing with an expert system
and replace the current system of delivering monthly benefit checks to veterans
by mail with either a voucher to be drawn through electronic benefits transfer
or electronic transfer of funds directly into their bank accounts.
Another initiative will improve timeliness and quality of service while
reducing costs for the insurance program. Paperless processing in this business
line will require an imaging system be installed to provide electronic storage
of insurance records and on-line access. Creation of a large database of
imaged beneficiary forms will allow the retirement of almost 2.5 million
insurance folders.
National Cemetery System
The National Cemetery System (NCS) proposes a budget
of $92 million. This represents an increase of $7.8 million over the 1998
level. The funding increase over last year's level is for: 1) workload increases
at the Tahoma National Cemetery in the Seattle, Washington, area; 2) the
continued activation of three new national cemeteries in Chicago, Illinois;
Dallas, Texas; and Saratoga, New York; 3) the partial activation of a new
national cemetery in the Cleveland, Ohio area; 4) the increased cost of
the Integrated Data Communication Utility (IDCU) system conversion; and
5) inflation and employee payroll costs.
... Equal Employment Opportunity
During 1998, VA has restructured its Equal Employment
Opportunity (EEO) complaint process. The 1999 budget reflects the creation
of two new offices to handle EEO complaint intake, processing and adjudication.
... For 1999, funding for the new offices will be handled entirely on a
reimbursable basis except for that portion of their operations performed
for staff offices within the General Administration activity of the GOE
appropriation (where ORM and OEDCA are housed). General Administration funds
that supported the previous EEO process for VHA, VBA, NCS and the Office
of the Inspector General have been moved to their respective budgets for
1999. Reimbursements are calculated on a per case basis.
Shared Service Center
The 1999 budget reflects the phased expansion of
the Shared Service Center (SSC) to encompass additional VA employees and
sites. The SSC will centralize payroll processing and personnel information.
For 1999, the SSC is requesting $26.6 million in reimbursement authority
from other VA organizations.
... Capital Planning
... VA has initiated a process to ensure that major
capital investments are based on good business decisions, tied to departmental
strategies and goals.... Representatives from top management, in the form
of the Capital Investment Board (CIB), make strategic decisions about capital
expenditures. This is an evolving process that also fosters a "One-VA"
approach to the use of capital funds....
CONSTRUCTION, MAJOR PROJECTS
A total of $97 million is requested for the Major
Construction program. The Major Construction request would fund a clinical
consolidation/seismic project at Long Beach, California, a seismic corrections
project at San Juan, PR, and columbarium projects at Ft. Rosecrans (California)
and Florida National Cemeteries. Additional funds are requested to remove
asbestos from VA-owned buildings and to support advanced planning and design
activities. ...
***
Looking Back to the Future
--
Where We Have Been And Where We Are Going
KENNETH W. KIZER, M.D., M.P.H.
Under Secretary For Health
(Excerpted from a presentation to the VHA Executive Leadership Summit -- "Journey of Change: Exploring And Discovering VHA's Future," Baltimore, December 9, 1997)
... VHA is an organization in major transition. There have been fundamental
changes in how we are organized and how we relate to each other; in how
we deliver service and provide care; in how we think about and judge ourselves;
and in how we are funded and will support ourselves in the future.
These many changes have involved a lot of hard work. I know that it has
not been easy, and I want to take this opportunity to publicly thank all
of you for your energy and enthusiasm, for your diligence and dedication,
and for your patience and perseverance in the face of the uncertainty, anxiety
and discomfort that inevitably accompanies changing what has been to what
will be.
... In the documents Vision for Change and Prescription for Change I outlined
many general and specific changes that VHA needed to pursue to help ensure
its future. I am pleased to report to you that much has been accomplished
in a very short period of time. Indeed, as a result of your efforts, so
much has been accomplished that even our most ardent critics of the past
are having to rethink their historical views.
Since the press of everyday business in an organization as busy, as large
and as far flung as the veterans healthcare system makes it impossible to
keep track, at the local level, of what the overall system is doing, I would
like to take a few minutes to recount for you some selected highlights of
VHA's reengineering -- results that underscore the profound changes that
you have accomplished.
Since late 1995, our approximately 1,100 sites of care delivery have been successfully reorganized into 22 veterans integrated service networks. Simply reorganizing an organization as large and diverse as VHA in less than two years is an accomplishment in itself, but during this time you have also substantially improved access to care, the quality of care, service satisfaction and cost-effectiveness.
These changes have been especially evident in the transition from an organization that historically offered an inpatient-focused, specialty driven, fragmented portfolio of services to one which is increasingly providing a truly coordinated continuum of care that is grounded in ambulatory and primary care.
Illustrative of the transition is the fact that since September 1994, 42 percent of all VHA acute care hospital beds -- some 22,000 beds -- have been closed. Minimal net decreases have occurred in the overall number of long-term care and domiciliary beds. And several new treatment settings, like psychiatric residential care and assisted living quarters, have become increasingly available.
Similarly, compared to FY 1994, annual inpatient admissions have decreased by 250,000, and bed days of care per 1,000 patients have decreased by 50 percent. VHA's bed days of care are now lower than Medicare, despite our older, sicker and more socioeconomically disadvantaged population, and our quality of care is better.
In this same vein, 59 percent of substance abuse treatment programs (112 of 190) have shifted, or are in the process of shifting, from inpatient to outpatient; and 22 percent (27 of 121) of PTSD treatment programs have shifted, or are in the process of shifting, from inpatient to outpatient status.
Ambulatory surgeries increased from 35 percent of all surgeries performed in FY 1995 to 69 percent in FY 1997. Associated with this has been increased surgical productivity and reduced mortality and other complications.
The management and operations of 42 hospitals have been, or are being, merged into 20 locally integrated facilities that are providing more responsive and more comprehensive care.
These and other changes have not been easy -- indeed, they were largely unimaginable only a short while ago -- but they have in fact occurred. In fact, no other healthcare system in the country can match the nature, extent and rapidity of change that has occurred in VHA.
These changes have not only been necessary to help
ensure our future but have also allowed us to provide more and better care
than ever before. For example, in the fiscal year just completed, VHA treated
over 3.1 million patients, more than ever in the history of the system.
And this has been done with now 23,000 fewer staff than three years ago.
There is a reason why you may be feeling like you are working harder!
In addition, and particularly relevant, we treated 19 percent more homeless
veterans and 8 percent more psychiatric and substance abuse patients in
FY 1997 than in FY 1995. Similarly, last year VHA recorded 32.6 million
ambulatory care visits, an increase in the annual number of ambulatory care
visits of 6.6 million, or 26 percent, compared to just three years ago.
One hundred forty-four new community-based outpatient clinics (CBOCs) have been sited, or are in the process of being sited, with savings achieved from our new approaches to care, and before the end of this month I expect to send a package of 21 more CBOCs to Congress for their approval.
Likewise, we have recently launched a new telemedicine
primary care initiative at 30 Vet Centers with savings achieved from other
programs.
We have also launched new initiatives to increase care management, home
care, use of clinical guidelines and end of life care, to name some of our
new efforts.
The pharmacy benefits management program initiated in 1995 is now
producing over $100 million in savings per year, while tens of millions
of dollars are being saved by using more business-like approaches to procuring
medical and surgical supplies, prosthetics, equipment, renal dialysis and
other support services.
Hoptels, VERA, MIRECCS, ACCESS, telephone-linked care and numerous other
terms label other new and innovative programs that have been
launched in the last three years. Unfortunately, time does not allow
me to detail these many other important changes that have been initiated
in how we provide medical care, in our education and research programs,
and in our contingency support function. But there certainly has been change
in all these areas. ...
While the journey of change has resulted in much to be proud of, there is
still much to be done. Indeed, the remaining years of the 20th century present
unparalleled challenge and unprecedented opportunity. The next two years
will be a time of peril and promise, for we are privileged to be in a position
to both make history and determine our destiny.
During this time when we strive to find more and better ways to enhance
quality, increase access, reduce costs and otherwise improve performance,
we must maintain a clear sense of purpose and a clear understanding of our
core values. During these times of turmoil and uncertainty it is more important
than ever that everyone in the organization understand what we stand for
and what we are about.
It is in this vein that we initiated efforts last summer to clearly
identify and articulate systemwide VA core values. We did this by collecting
nearly 100 individual facility and program value statements, by encouraging
widespread discussion of the subject through use of a strawman list and
motto last August, and by surveying a random sample of nearly 24,000 VHA
employees.
Based on these various inputs, it is clear that a number of core values
are held by the majority of VHA staff, although the specific values are
sometimes described in different words. These core values have not been
previously recognized at the national level, and our organizational behavior
has not always adequately reflected these values. I believe it is essential
that we now clearly articulate the core values which constitute the compass
that gives direction to our further journey of change and which will serve
as a critical barometer for aligning our mission, strategy, operations and
structure in the future.
Based on the wide-ranging discussion on this subject over the past several months, I am now identifying five VHA core values that, at a minimum, shall be reflected in the value statements of all VHA facilities and networks. These five values are: trust, respect, commitment, compassion and excellence. To promote a common understanding of these terms, they shall be understood to have the following meanings.
"Trust" is taken to mean having a high degree of confidence in the honesty, integrity, reliability and sincere good intent of those with whom we work, the services that we provide and the system that we are a part of. Trust is the foundation for any caregiver-patient relationship and is fundamental to all that we do in healthcare.
"Respect" is taken to mean honoring and holding in high regard the dignity and worth of our patients and their families, our CO-workers and the system we are a part of. It means relating to each other and providing services in a manner that demonstrates an understanding of and a sensitivity and concern for each person's individuality and importance.
"Commitment" means dedication and a promise to work hard to do all that we can to provide service to our CO-workers and our patients that is in accordance with the highest principles and ethics governing the conduct of the healthcare professions and public service. It is a pledge to assume personal responsibility for our individual and collective actions.
"Compassion" is taken to mean demonstrating empathy and caring in all that we say and do. It means sharing in the emotions and feelings of our co-workers, our patients and their families and all others with whom we are involved.
And, finally, "excellence" is taken to mean being exceptionally good and of the highest quality. It means being the most competent and the finest in everything that we do. It also means continually improving all that we do.
In espousing these core values, they are meant to apply to our actions and interactions internally and externally and to all of our multiple missions and all of the myriad settings and circumstances in which VHA operates.
Let me turn now and direct my remaining comments to the core value of excellence and some new scenery that you will be seeing along the multi-lane highway of our journey of change.
As one of our key strategic objectives, VHA is committed to the enhancement and systemwide standardization of quality. We are committed to improving healthcare quality in VA treatment facilities and in the healthcare industry overall. Indeed, I believe VHA should set the healthcare industry's standard for quality. VHA's performance should be the benchmark by which the quality of healthcare in this country is judged.
To assist us in improving our processes and outcomes, and to objectively demonstrate the quality of our facilities, programs and personnel, VHA participates in a broad array of external accrediting programs. Illustrative of these are the accreditation programs of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities, the American Colleges of Surgery and Radiology, the American Association of Blood Banks, the College of American Pathologists and several other such organizations.
As one example of how we do compare to the rest of the healthcare industry, in 1993 no VA hospital received JCAHO accreditation with commendation. However, for the last two years, 20 percent of VA hospitals have been accredited with commendation. This compares to 11 percent of private-sector hospitals.
In addition to facility and program accreditation, last June, as a further way of enhancing the quality of care we provide, I directed that all physicians appointed to practice in clinical settings should be board certified in the specialty area in which they will practice. We adhere to exacting educational requirements for allied health professional staff, and we are currently reviewing the qualification standards for registered nurses.
It is essential that individuals who are selected to serve in VHA executive leadership positions be subject to the same type of educational and on-going professional development requirements that we expect of our clinical care personnel. Therefore, I am asking that the VHA executive resources board, the network directors and all other executive leadership councils or search committees carefully consider the possession of an appropriate professional certification as one of the distinguishing factors for selection into one of VHA's key managerial roles. This participation and certification will also be considered by my office in recommending appointment of nominees by the secretary.
In evaluating the relevance of the professional certification or affiliation, greater emphasis will be given to those bodies which admit or advance candidates based on a structured process of education, experience, examination and continuing professional development, such as the programs administered by the American College of Healthcare Executives and the American College of Physician Executives.
... In addition to bolstering the professional training and credentials requirements for VA clinical care personnel and managers, we have launched a number of other initiatives in the past two years to assist our efforts to provide world-class quality healthcare. These efforts have included establishment of performance contracts for management; creation of new performance awards for innovation and collaboration; delineation of a comprehensive framework for quality of care; establishment of a clinical programs of excellence program; and initiation of a new patient safety program. I view our efforts to improve patient safety as especially important.
Notwithstanding the fact that various indicators suggest that the veterans healthcare system has a better record on patient safety than the healthcare industry overall, adverse events resulting from medical treatment occur too frequently in the veterans healthcare system -- as they do everywhere in healthcare. To improve this situation, we launched a patient safety initiative a few months ago.
This patient safety initiative has included, among
other things, promulgation of a new patient safety improvement directive
(VHA directive 1051); establishment of the forensic medicine strategic healthcare
group; creation of the national patient safety partnership; provision of
funding and other support for industrywide conferences; expert working groups
and new research on patient safety; and establishment of a new health system
management fellowship... Clearly, one of the major challenges facing
healthcare today is to become a "high reliability" industry. As
a further way of identifying the root causes of adverse outcomes and developing
improved processes and procedures to minimize potential patient safety risks,
I am now establishing the VHA Patient Safety Improvement Awards Program.
This program is designed to increase the emphasis on patient safety in clinical
practice by financially rewarding front-line caregivers and other health-care
practitioners who identify adverse events or potential patient safety problems
and improved processes that minimize or eliminate the risk. ... The amount
of the patient safety improvement award will range from $500 to $5,000,
depending on the extent to which the improved process can be adapted to
other patient-care settings and the severity of the potential hazard it
reduces or eliminates. ...
Further ... I am pleased to announce the establishment of the VHA Quality
Achievement Recognition Grant Program. This program is intended to recognize
VISNs that provide world-class healthcare quality. It is designed to recognize
the sustained success of those VISNs that achieve truly outstanding performance
by engaging the entire workforce in a results-oriented improvement process
that leads to exceptional outcomes and that demonstrates exemplary processes
of assessment, learning and improvement. The VHA quality achievement recognition
grant will be awarded in the amount of $1 million and shall be used, as
determined by the VISN, to further enhance the quality of patient care in
the network and to help disseminate its best practices throughout the veterans
healthcare system. ...
... I would challenge you to think creatively as we explore and seek to
discover VHA's future and as we continue the journey of change in the years
ahead.
***
Responding to Gulf War Illnesses
KENNETH W. KIZER, M.D., M.P.H.
Under Secretary for Health
(For the House Committee on Veterans'
Affairs hearing on
Gulf War veterans programs, February 5, 1998)
... My formal statement provides a more complete review of VHA's efforts
to provide health services to Gulf War veterans and of our research efforts
to find answers to the complex medical and scientific questions related
to Gulf War service.
Before mentioning a few specific things, I think it is useful to note the
context in which VA's response to the problems experienced by Gulf War veterans
has developed.
No two wars in American history have been alike. The geography, where the
conflicts have occurred; the military tactics and weapons used; the ambient
political, social and cultural climate in which they occurred; the prevailing
health technology at the time; and many other factors have been significantly
different for each war in our history. Just as the Vietnam War differed
from World War II, which was unlike World War I, the environment of the
Gulf War was unique. Indeed, while it may be pointing out the obvious, it
is often overlooked that much of what we are dealing with in Gulf War veteran
problems is a medical frontier.
There is no model or standard formula about how to best respond to post-war
health effects in general, or Gulf War effects in particular. There simply
is no textbook or standard reference on what the best practice should be
in these situations. In fact, when you consider the environmental, technological,
psychological and other factors that collectively impact the soldiers who
have fought in these wars, the countless ways that the human body can respond
to war-related stimuli, and the state of medical science, it should be clear
how complex it is to determine cause and effect and the most effective medical
interventions for post-war problems.
Because of these things, from the beginning of its response to the aftermath
of the Gulf War, VA has sought broad scientific and other input to help
inform us about the best course of action. As we have gained knowledge and
information, we have continued to consult the best scientists available
to help us focus and refocus our efforts. Various groups, including the
General Accounting Office, the Congressional committees, the Presidential
Advisory Committee and several others have reviewed our strategy and course
of action and have provided their opinions and advice. We welcome these
opinions and we have incorporated many changes to our health care and research
programs based on these inputs.
Regarding VA's health programs, almost 65,000 Gulf War veterans have completed
Registry examinations to date; more than 2.5 million ambulatory care visits
have been provided to over 220,000 veterans; more than 22,000 Gulf War veterans
have been hospitalized at VA medical centers for service-connected and non-service-connected
conditions; and more than 83,000 Gulf War veterans have been counseled at
VA's Vet Centers.
As we have discussed before, Gulf War veterans participating in the Registry
examination program have commonly reported that they suffer from a diverse
array of symptoms, including fatigue, skin rash, headache, muscle and joint
pain, memory problems, shortness of breath, sleep disturbances, gastrointestinal
symptoms and chest pain.
The diagnoses of Registry participants do not cluster in one organ system
or disease category, but instead span a wide range of illnesses and diagnostic
categories. A large majority of veterans suffering from these symptoms or
illnesses have been diagnosed and successfully treated. However, depending
on the particular medical nomenclature used, between 10 and 25 percent of
veterans from the Registry who have been examined have unexplained illnesses.
This frequency of unexplained symptoms among Gulf War veterans appears to
be about the same as in the general medical practice (i.e., a non-VA or
non-military general medical practice).
Important to note with regard to these unexplained illnesses is that medical
scientists are far from completing their studies of these conditions, and
there continues to be much uncertainty about the character, natural history
and potential causes of these conditions. VA is working hard to better understand
these health issues and develop effective treatments for these symptomatic
veterans.
For example, VA has initiated clinical demonstration projects for case management
and multidisciplinary clinical care for Gulf War veterans. Case management
as a routine clinical strategy for Gulf War veterans has already been implemented
at nearly 20 VA medical centers. In addition, FY 1998 performance measures
for VA's network directors have been established in this regard.
The Veterans Health Administration and the Veterans Benefits Administration
are working to improve the quality of compensation and pension examinations,
and particularly examinations of Gulf War veterans with undiagnosed illnesses.
We have worked cooperatively with VBA to develop clearer guidelines for
the physicians performing these examinations, and we are preparing a focused
training program for regional office and medical center staff who are involved
in working Gulf War veterans' compensation cases.
We are also expanding our educational efforts to all direct healthcare providers.
Our goal is that all direct care personnel have a working understanding
of Gulf War exposures and health issues and be able to discuss with their
Gulf War patients how these issues could impact on their current or future
health status. As one step toward meeting this challenge, we are publishing
this year a self-study Gulf War Continuing Medical Education program for
every VA physician. We will make this educational tool available to non-VA
physicians, at cost, as well.
In the interest of time, I am not going to discuss the research programs,
other than to mention that there are 120 federally sponsored research projects
currently underway or already completed. My formal statement discusses progress
on several of the especially significant studies among these.
My formal statement also discusses the Presidential Advisory Committee's
Special Report. Many of the recommendations of the report have already been
implemented or are underway. The previous panel at this afternoon's hearing
commented on the contract with the National Academy of Sciences (NAS) that
we recently effected. In brief, we have asked the Institute of Medicine
at NAS to complete periodic reviews of the available scientific evidence
regarding associations between illnesses and Gulf War service for purposes
of informing the decision-making process for benefits and future research.
The object of such an analysis would be to determine statistical association
between service in the Gulf War and morbidity and mortality, while also
considering whether a plausible biological mechanism exists for the association
and whether research results are capable of replication, are of clinical
significance and are likely to withstand peer review. VA believes that this
review by the Institute of Medicine would ensure that the best scientific
thinking will be brought to bear on the complex array of Gulf War veterans'
health problems.
My formal statement also discusses the June 1997 GAO report that recommends
improved monitoring of clinical progress and reexamination of research emphasis.
VA provided a detailed response to the GAO report, which is contained in
the report's appendix.
In speaking of the GAO report, I should also add that this is a good example
of well-intentioned, but difficult to complete advice. We are working with
the IOM to find a way to operationalize the GAO's recommendations, and in
the interest in time, I will not go into detail on the many difficulties
inherent in actually completing those recommendations.
In closing, Mr. Chairman, let me just say that there are many scientific
and policy conundrums which need to be worked out in addressing the problems
of Gulf War veterans. We are working with the National Academy of Sciences
and others in this regard. I believe that VA has made good progress in furthering
the understanding of Gulf War health issues and providing care for persons
having Gulf War-related health problems. Further, as I have previously testified,
while we believe that our programs have been well designed based on the
best available information, we also know that they are neither uniformly
delivered nor perfect. We also recognize that some veterans have not always
received the kind of reception or care at VA medical facilities that as
a system we strive to deliver. And as we have discussed before, we are working
diligently to improve the consistency and predictability of care provided
everywhere in this enormous healthcare system.
***
Build on Our History
GERALD HINCH
Deputy Assistant Secretary
for Equal Employment Opportunity
(At Black History Month Dept. of Army employee
program,
Fort Riley, Kansas, February 11, 1998)
As I thought about my remarks, I wondered what could I really say about
black history, what should I say and, even more importantly, why do we devote
a month to black history? Is black history just another once a year celebration,
your usual "feel good" kind of talk? Of course it is important
to remember the achievements of a people, to remember the great leaders,
the struggles.
... Frankly, you and I have a hell of a job to do. I do not see our young
folks, black or white, having even a knowledge of recent events. To most
of them, even the 1960s are only vague events. Some do not even know Martin
Luther King, Jr. and his contributions. Black history, the stories of Frederick
Douglass, Vessy Demark, P.S.B. Pinchback, Nat Turner, Sojourner Truth, Ida
B. Wells, are blank spaces in most of our history books. Even though my
family came from Vicksburg, Mississippi, my own children do not know what
segregation was really like -- the schools, stores, buses and all the meanness
and humiliation of segregation.
The movie "Glory," which came out a few years ago, was the story
of the 54th Massachusetts Regiment. It was the first film I have seen about
these gallant men who fought so valiantly for their freedom and the preservation
of this nation during the Civil War. Most of us never have heard of the
54th Regiment. Even now, few folks are aware of the blacks who fought in
the French-Indian wars; the colored regiment that George Washington agonized
over and then allowed to fight in the Revolutionary War; the black troops
who charged up San Juan Hill with Teddy Roosevelt during the Spanish-American
War; the Buffalo Soldiers that helped settle the West; the 369th Regiment
attached to the French army in WWI; and finally, the Tuskegee Airmen of
WWII.
Let us be honest: For most of us, black history is almost a total void.
My message today is that if we are not to relive the past, we must learn
and know the past. This is important, because all of us, blacks and whites,
have already invested so much to get America where it is today, so we must
not allow it to slip back. We all must remember and pass on our history.
Black history is America's history, not something separate or apart. Blacks
fought for this country, helped explore and settle this country, dug its
canals, laid its rails, picked its cotton, farmed its crops and worked in
its factories. We are very much a vital part of this country and its history.
We must build on that history to pass on to all our children the true story
of America and the story of blacks in America. Unless our children, all
our children, know the past, they cannot appreciate the present or seize
the opportunities to build a better future. If not us, then who can or should
tell them of the past? The schools? Will the movies? Will television do
it? Please don't hold your breath waiting. ...
We must do it ourselves. First, we must make the effort to learn it. In
today's world this is especially difficult. Past generations would pass
on their knowledge, wisdom, values at the dinner table. Now, however, the
dinner table is gone, replaced by a TV tray; many of us don't even eat together
at the same time. We get our values from TV. Think about it; how many hours
do we or our children spend viewing TV? What values do they learn? How are
blacks and other minorities portrayed? Pimps, hustlers, gangsters, slick,
stupid, etc. -- "Fresh Prince," "Martin," "Living
Single," "Hanging with Mr. Cooper," "Family Matters,"
"On Our Own," "Sister, Sister," "Moesha."
Somehow we have to turn off the tube and pass on to our children the values
and ideals they will need to survive. Then we must pass on the struggles
and humiliations of the past, the stories of blacks and whites who stood
together to change the system. Historically, the battle against racism was
fought by people of all colors -- the abolitionists, the freedom fighters
of the 1960s, etc.
The understanding of slavery being physical and also psychological, that
drugs enslave even more harshly than the whip; that knowledge is freedom
-- drop-outs doom themselves to a life of lessened opportunities; that today
there are more black men in jail than in college; in Harlem the death rate
is higher for black men then the death rate in Bangladesh; that murder is
the leading cause of death among black men under age 25 and it is blacks
killing blacks. Have we come so far, struggled so hard, to now slip back?
Yes, you and I have a tough job to do, but it is up to us to save the black
future, America's future. This country will never realize its true potential
if in its cities and towns its blacks, its Hispanics and any other groups
are allowed to be left out of the American dream.
Drugs, lack of jobs, crime, poor education are eroding the quality of life
for all of us. The problem, as I see it, is that all of us like to talk,
talk, talk, talk. We complain, we moan and, more importantly, we do nothing.
We keep looking for another great leader, a Martin Luther King, Jr., but
it is not going to happen. What we must do, if we really want to change
things, is to act -- to take it upon ourselves to do whatever, large or
small, can make a difference -- things such as: looking at others as we
would have them look at us; teaching our children to respect others; voting
for decent politicians who reflect the values we believe in; reaching out
to help wherever we can, and so on.
I like to think that the bottle is half full, not half empty. This is a
great country and we should be sure we truly appreciate how great it is
and how far we have come. I truly believe that we are a good people, not
a perfect people but a good people. We do believe in fair play, helping
the less fortunate, solving difficult social, economic and racial/ethnic
problems. Do you know a better country -- one that has made as much effort
to include all its citizens? Look at the ethnic and tribal strife in the
rest of the world. Remember where this country has come from in just 25
years. We are truly fortunate to live in a country where we can believe
that someday the dream will be real -- if we work to make it happen.
I ask that you and I, blacks and whites, Hispanics and all people of good
will renew our efforts and continue the struggle and make this more than
just a once a year celebration.
***