Office of Public and Intergovernmental Affairs
Remarks by Secretary Robert Wilkie
The National Association of State Directors of Veterans Affairs (NASDVA)
February 25, 2019
Hello everybody. She said something about the Air Force and the Navy. I couldn’t make up my mind? But it’s worse. As your executive director knows, I am the first Wilkie since 1845 who was not an artillery officer. So I am definitely the heretic in the family.
It’s good to see you all. It’s very good to see you. So I apologize for this [referring to his foot in cast]. This is the product of decades of athletic mediocrity. You know, I was just profiled by my college magazine, Wake Forest [Magazine]. Now, Wake Forest is a place where the football dorm is named after Arnold Palmer, which ought to tell you something. So instead of chronicling my glories on the athletic fields against the hated enemy—well it’s not a college, the University of North Carolina Chapel Hill—they detailed the number of broken bones that I had: noses and everything else. So that’s the byproduct of all that. But, it’s good to see you all.
This is an important time. It’s an important time for the future of our department . . . . I’m going be appearing in front of two committees this week. And I will be proudly discussing that we are no longer on the cusp of transformation. This is the most radical transformation since Omar Bradley ran the Department of the Veterans Administration right after World War II. We’re actually in the middle of [transformation].
Last week, we announced the implementation of our Veterans appeals modernization plan. That is now up and running. As a result—in the lead up to that—we adjudicated more cases than the department has ever adjudicated. We are now in the middle of making the timelines for the implementation of the MISSION Act, which opens the aperture on Choice. And I’ll talk a little bit more about that in the questions and answers as to what Choice is and what it isn’t. Because of the MISSION Act, we have finally, finally closed the benefits circle of those who served in Southeast Asia because we recognize—and we will support financially and with resources—the families who take care of those who served in Vietnam.
And you probably know that is a very special part of my life, having grown up at Ft. Sill and Ft. Bragg. I can count the number of classmates from preschool, kindergarten, and elementary school whose fathers did not come back from Southeast Asia. And the MISSION Act finally, finally closes that circle.
But we have been the recipient of a lot of good news in the last few weeks. And I’ve been saying for a while now that the state of your VA is good. The turmoil of the first half of last year is behind us. And that’s been validated by several independent studies. The first one is from the Annals of Internal Medicine, Dartmouth. It says that our VA healthcare is [as] good, or better, than any in the country, in any region. The second is from the Journal of the American Medical Association, which says that our wait times across the country, in primary care and specialty care, are [as] good or better than any in the country. And, finally, the Partnership for Public Service—which has been for decades taking account of the best places in the federal workforce to work . . . I will say that in every one of those surveys prior to this last one VA was sixteen or seventeen on the list . . . there were only seventeen institutions—we are now in the top third, and getting stronger.
And that ties into what we’ve seen in our Veterans’ customer surveys, wherefore our VHA facilities were sitting in the high 80s [percentile] when it comes to customer satisfaction. And that is really the key. It’s the key for me, and it’s the key for each of you. And that is customer service. Not necessarily what we have come to think of customer service as the outward appearance that we maintain for those we serve, but first customer service in and amongst ourselves—breaking down compartmentalized barriers within the institution, talking with—as opposed to at—each other. Because if we can’t do that, we’re not going to be able to provide service to our Veterans.
So I cannot speak of the specifics of the budget. It was delayed because of the government shutdown. It will be out, I believe, on the 11th of March. But I can tell you, generally, that when the President does present his budget to the Congress, you will see rather large increases in money for not only benefits but also for our Veterans’ health. And in terms of the breakdown in the budget, what you will see is—even though the numbers are rising—you will continue to see the same breakdown in Veterans’ health services that have really existed since General Bradley was in the scene. About 30 to 35 percent of all of our Veterans get their care outside of VA. The budget reflects that—the high 60 billion [dollars] for Veterans’ health inside our institution, about 15 billion for community care.
And on that community care note. We have let the contracts out for the regions in the country where we will have new companies taking care of our bills and paying our bills. We can’t have choice if we don’t take care of our small-town doctors, our community hospitals, our emergency rooms. So that is in train as well.
We have all been saddened by the stories of suicides. We continue to see Veteran suicides at about twenty per day. Three of those twenty are on the active side. Two are from the guard and reserve. Fourteen of those that we see we have not [had] contact with. I was just up in Alaska at the end of last year. And in Alaska, 50 percent of the Veterans in that state are not part of our system. I asked the Alaskan Federation of Natives to actually double the number of tribal representatives that they have who specialize in Veterans’ care, to get out and help us find those Veterans.
In my testimony last year, at the end of the last Congress, I was asked to give a metric as to what the goal is for Veteran suicide. And I refused to do that. I think it would be foolish for us to set a goal on something as complex as Veteran suicide. For those of you . . . who served in Vietnam, I can tell you that what we know of our population, the vast majority of those who take their lives are from the Vietnam era, which means in some cases their problems have been brewing since Lyndon Johnson was president. And I would be lying to somebody if I told them that we, us, could get our arms around that problem completely.
But it does require a change, not only in the level of cooperation that we have with you all, but a change in the way that we treat suicide. And that is to treat mental health holistically. There is a continuum—suicide, opioid abuse, homelessness. All of those contribute to a condition that sometimes we see manifest itself in our own parking lots. Although I think less than .03 percent of Veterans who take their lives do so on our grounds. But treating a Veteran holistically . . . everything from occupational therapy to the reverse in terms of our opioid prescription protocols, to enhancing our Veterans’ health crisis line. We get about 2,000 calls a day.
I was in Los Angeles at the end of the year and had a great meeting with the mayor, a Navy Veteran, Mayor Garcetti. And we are working with the City of Los Angeles on mental health intervention. We’re working with them on transitional homeless housing for Veterans. It’s something that I intend to talk with your governors about, with you all about, in the days ahead.
I just had the privilege of sitting down with some of your bosses, both last night and tonight. And when I talk about suicide, I talk about further cooperation between you, who are on the ground, and VA. We can’t be everywhere. But you all are closer, in many cases, to the folks we need to reach than we are.
So as the budget moves forward, my goal in the next year or two is to increase the amount of money that you all have available in terms of grants and support toward everything that you do. Again, this is a symbiotic relationship. And it does begin from the ground up.
Again, I will close before we talk about the event here [that is, signing the new Memorandum of Agreement between NASDVA and VA that follows the Secretary’s remarks] to say that we’re on a good trajectory. We all, I believe, have the most noble mission in the federal government. Most of us in this room have put on a uniform and understand the culture of service. We understand the language. And, before I conclude, I’ll use that. I’ll take it aside and talk about privatization. Because I think what I just said about culture is important.
First of all, if this were about privatization, I would simply go to all of our Veterans, give a Veteran a card, and say, “Go to it.” It’s not about that. It’s not about total choice. What it is about—and I say this with my friends from North Carolina, my home state, in front of me—if the Fayetteville VA cannot provide one of our Veterans who needs rheumatology services with that service, we give that Veteran the option to go into Fayetteville, or go up to Durham, or Charlotte to get that medical service. The rest of his needs are taken care of by us. But that is a choice for that Veteran to make.
Again, it is not unfettered choice. It is a choice that is given when we can’t provide that service. If you look at our customer surveys, if you look at the number of appointments that we increased last year—we increased the number of appointments by 680,000. So we’re up above 58 million individual appointments in the VA. That tells me that people are going where people speak their language. And I don’t expect that to change. But I take Section 104 of the MISSION Act seriously when it says that the interest of the Veteran is at the center of all of our decisions. It can’t be any different. It’s not the institution of the VA. It’s not the states’. It is the interest of that Veteran. And that’s where I believe the aperture of choice will open for the betterment of those that we serve. And in so doing I also predict that 30 to 35 percent of Veterans who chose care or get care outside of the VA—which has been steady since 1946—will probably stay about the same, particularly as we enhance the capabilities of our institution, which I see going all across the country.
So where does that leave us? It leaves us with getting a more cooperative stance. The door is open. As I said, I will be pushing for more funds to be available to you from the federal government because we can’t do this without each and every one of you. So it’s a good news story.
I will—before I recognize some of the folks who have been honored by you—I will conclude where I’ve stopped with many of my presentations when it comes to describing what we do. And I fall back on General Eisenhower and General Eisenhower addressing 40 Korean War Veterans, many of them without limbs, missing limbs, all the rest horribly disfigured. And he gave them a charge. And he said, “You never put your uniform away. You are here to remind your fellow citizens why they sleep soundly at night.” And I can’t think of a more sublime sense of what we are about than to say that the people we serve remind their fellow citizens why they sleep soundly at night. And if we keep that in mind, as we all do, then we will continue to improve the lives of those Americans who have worn the uniform.