April 2001/May 2001
VA Secretary Anthony Principi Goes One On One With VVA
On March 26, VVA Government Relations Director Rick Weidman
and VVA Veteran staff met with the new Secretary for Veterans Affairs,
Anthony Principi. What follows is that conversation.
VVA: What are your top three objectives for the next
four years? How do you expect to achieve them?
Anthony Principi: The only reason I returned was to see
if I could make a difference. My top three priorities are: first, to reduce
the enormous backlog of claims that are currently pending before the
Veterans Benefits Administration--before the VA, I should say, because I
view this as a VA crisis, not just a VBA crisis. Clearly, reducing that
backlog to a point that at any given time we have no more than 200-250,000
claims in process is of utmost importance to me. That should allow us to
achieve a high quality rate and a timeliness of around 90 to 100 days. I
think that is a workable solution and my highest goal.
My second highest priority is to assure high-quality health
care for the largest number of veterans as possible. We need to maintain our
leadership role in specialized services: spinal cord injury, mental health,
homelessness, drug and alcohol abuse programs. But at the same time we need
to insure that we have a high-quality acute care and surgery system. We donít
have the advocates for those programs--other than the medical schools--like
we do in mental health and spinal cord injury. But clearly, making sure that
we have good programs in acute care and extended care is terribly important.
My third highest priority is putting in place the
infrastructure--the information technology systems--that will allow us to be
more effective, more efficient, and more productive.
How do I intend to achieve these objectives? Clearly in the
claims backlog, it's a very complex issue. Thereís no one easy answer. But
there are a number of things we can do immediately.
First, we need to hire more people and hire the right
people. Iíd like to see more people with military backgrounds and medical
experience: medics, corpsmen, RNs. Get them on board, get them certified in
the medicine so that we can dispense with that portion of the training, and
get them training immediately on the complexities of Title 38 and the
We need to take a good, hard look at some of the programs
that have been implemented over the past year or two. While I do not
question the motivation and the vision that has been brought to bear, it has
in some respects put a stranglehold on day-to-day rates. We have a lot of
people who have been taken away from rating claims to do other things. Iím
very, very concerned about that.
Iím very concerned about the software that has been
brought on line. Although theoretically an important tool, it has reduced
productivity significantly, rather than improving productivity. I intend to
take steps in the very near future to see that we get back to getting
ratings specialists doing what they do best, and that is rating claims.
In the area of health care, clearly budget, budget, budget.
Thatís first and foremost. You have to have an adequate baseline to start
with. Health care is expensive. We all know that. When we have a system the
size of the VA, it becomes terribly expensive. So you need to start with an
But some of the dramatic changes that have taken place over
the past eight years in VA health care-- transitioning from a very
traditional hospital-based system to a more contemporary veteran-focused
health-care system--came about in part because we didnít have all the
dollars we needed. We had to start changing the way we practiced health care
in the VA. The good old days werenít going to work anymore: long hospital
stays far in excess of what was done in the private sector, doing inpatient
surgery when it could be done outpatient. We needed more outpatient clinics.
We needed to go where health care was going in America.
Part of those changes came about not only because of the
dynamic leadership like Ken Kizer, but also because all the dollars werenít
there. We had to practice like they do in the private sector and bring a
business model approach to health care, as well as a compassionate medical
approach to health care. So sometimes you have to be more cost-effective in
the way you do things. We need to continue that trend.
So we need to get all the dollars we can get, but at the
same time we need to exercise more of a business mindset, if you will, in
some of the business operations we do. The Medical Care Costs Recovery Fund
is a good example. Clearly, if you look at the costs to collect, if you look
at the net collections, if you look at collections per FTE, you will see
that VA is way behind the private sector.
Recognize that there are differences between the private
sector and VA. We canít collect from Medicare or Medicaid, whereas the
private sector can. We have to collect from a host of smaller insurance
companies, which is much more difficult. But clearly we need to look at best
practices to insure that our programs are generating as much revenue as
possible. So you have to look at the different stages in MCCF--from intake
to utilization review to billing to collections--to make sure that weíre
doing this correctly.
Supervision of residents and interns. We need to insure that
we have adequate staffing to insure uniform access to health care, so that
at one VISN it doesnít take 180 days to get an appointment when at another
VISN it takes 30 days.
With the third priority, information technology, I have to
hire the best and brightest CIO. I have to find someone whoís willing to
come to work for the VA as an assistant secretary for information technology
who can bring the respect, leadership, and the management skills to tie
together this vast array of systems we have, both in computers and
telephony, and also link it to DOD, someone who has respect over at DOD. It
will be very, very difficult for me to attract someone from the private
sector, obviously. To find that kind of person with what we pay an assistant
secretary is very difficult. Our pay scales do not allow for that, unless
you can find someone who really wants to come into public service.
So I hope to find perhaps a retired military person who
commanded a large organization in the military, who has an engineering
background, who has the respect of DoD, because I believe we can do veterans
a great service if we can link our information systems together. Without the
information from DoD, we canít provide any health care, we canít
evaluate disability claims, we canít even bury a veteran. So I'm looking
very, very diligently for someone who recently retired from the military who
can bring that expertise.
VVA: Youíve stated that one of your key aims is to
ease or eliminate the backlog of claims in the Veterans Benefits
Administrationís Compensation and Pension Service. VVA has stated publicly
that the only way to do this is for the regional offices of VBA to get it
right the first time and to hold managers and supervisors accountable for
how accurately and fairly claims are developed and adjudicated that first
time. Do you agree, and how can this be accomplished in four years?
Anthony Principi: I certainly do agree that getting it
right the first time does cut back on your workload over the long period. We
should always have a zero defect policy and strive for quality. That should
always be our goal. I think it can be accomplished in four years. I think it
starts with hiring good people and training them appropriately.
I think we may have missed the mark a little bit. Iíve
only been here eight weeks and Iíve got a lot to learn, but it seems to me
that we now have implemented all these programs which are "designed to
give us high quality," and I donít think that's the case.
Itís become more of a defensive mechanism for cases that
are going to go up on appeal. Today, any rating decision can be about a
20-25-page legal brief thatís so thick you canít even put it in an
envelope. Itís gotten to the point where weíve just gone too far to one
side, given the fact that a very, very small percentage of cases are
appealed. This is further exacerbating an already difficult situation with
Quality starts at the very beginning. It starts at the
medical evaluation; it doesnít start in VBA. It starts with doing a good
medical exam and making sure you have the expert systems that can allow a
physician--whether an experienced C&P physician or a brand-new
resident--to insure that all of the issues required by the courts are
It starts at that point. I think that expert systems can
allow that medical evaluation to be converted into a medical report and into
a diagnostic code summary. That can aid the ratings specialist in doing the
I think it can be done. You do it through smart systems. And
you link VHA and VBA together. This is not a VBA problem; this is a VA
problem. The folks at VBA shouldnít be the only ones losing sleep over
this crisis. VHA senior leadership should be losing sleep, IT people should
be losing sleep, and the general consul should be losing sleep. I donít
think they are losing any sleep over this situation because it's never been
viewed as a VA crisis. I think thatís the real tragedy.
VVA: VVA and many of our good friends in the Congress
have advocated a much more rigorous application of the Government
Performance and Results Act. What steps do you intend to take to
systematically hold VA personnel accountable, especially those in key posts?
Anthony Principi: It starts with good measurements,
good metrics. People have to know what is expected of them, and we need to
have good measurement tools to be able to determine whether in fact theyíre
meeting those performance standards. Thatís the starting point.
Then it requires tough leadership to review those
measurement standards weekly, monthly, semiannually, and hold people
accountable for accomplishing those objectives. Senior leadership has to
determine our objectives and our goals and then make sure people are doing
their jobs. If theyíre not doing their jobs, then they have to be moved or
relocated. Because, again, we don't exist to serve ourselves; weíre here
to serve the customer. If the customerís needs are not being met, then
thereís got to be a reason for it.
People need to be held accountable. They need to be
supported, they need to be motivated, there needs to be high morale. We
shouldn't manage through intimidation or fear. But when we put people in
positions of authority, just like a captain of a ship, if something goes
wrong, then youíre held accountable for it. Strict accountability is very,
very important. We need to bring that sense of responsibility to the VA.
VVA: Some of our lay leaders have alleged that thereís
a problem within VA that the top leadership--VISN directors and hospital
directors--never get fired, they just get transferred. Will the task force
that you are forming on veterans benefits, be taking a look at these kinds
of accountability practices?
Anthony Principi: Sure. Theyíre going to be looking at
management, process, and organization. I would certainly encourage them to
look at that and performance standards and training. Youíre absolutely
right. You canít just hold the GS-7s and -9s and the -11s accountable. You
have to look at the top. I agree with that. And I will do so.
VVA: The Veterans Eligibility Reform Act of 1996
requires that the VA maintain a medical capacity for the specialized
services--PTSD, spinal cord injury treatment, blind and visual treatments,
substance abuse, recovery treatment--at least at the same level that existed
in FY96. Since the VA has not maintained capacity in this area, what is your
plan to document your efforts and to restore the organizational capacity so
that thereís no question that it's there in every sector of the nation?
Anthony Principi: Itís clear to me that in some areas
we have not maintained capacity at the threshold that we've been directed to
by legislation. In other areas weíve exceeded capacity. But clearly the
law is the law, and we need to abide by it.
The first thing we need to do is: How do we measure what our
current capacity is? Iím not sure we know. There are so many variables in
this very, very large health care system. But I intend to insure that if
Congress says that we have to have "X" number of beds in spinal
cord injury, that we have a model that shows us on any given day how many
beds weíre maintaining. It fluctuates sometimes. We may have a nursing
shortage in some parts of the country that causes us for good medical
reasons to lower the number of spinal-cord-injured beds. Itís a very
But by and large, I intend to insure that we have the
ability to monitor all the specialized programs to insure weíre meeting
capacity. If weíre not meeting capacity, I expect Dr. Garthwaite, the
undersecretary, to explain to me why. I assume there will be a good
explanation for it, and weíll communicate that to the Hill and to our
VVA: VVA is a strong proponent of the concept of
"in-country effect." Basically, this view of the veteran's
service-related disability maintains that the in-country Vietnam
experience--or in-country wartime experience during any war--including toxic
exposures, herbicidal agents, traumatic, stressful experiences, exposure to
endemic diseases, parasitic infections, et cetera, has an overall impact on
the personís physical and psychiatric health. Under this concept, the VA
would consider the total effect on the veteranís health as a whole and
compare that to a baseline of a nonveteran cohort group. The VVA would take
action where there are discrepancies or anomalies in the combat theater
group, rather than trying to treat disabilities one at a time.
Thatís a basic overall holistic view of veteranís
health, instead of us continuing to bicker over particular diseases and
causality, whether itís Agent Orange, PCBs, or whatever else people may
have been exposed to in the military.
Anthony Principi: Thatís an interesting question and
one that I would like to spend some time thinking about and getting briefed
by the experts on. From my first days on the Hill when I met with my first
group of veterans on ionizing radiation, I really saw the importance of
breaking out of the current mold we were in and looking at these
environmental hazards in a different way.
Iíve come to appreciate and understand how exposure to
environmental hazards is not very different, if at all, from a more
traditional bullet wound, cannon shell wound, or bayonet cut, and that we
have to be very, very proactive in this. On the other hand, I think the
science needs to be clear.
I'm not sure you ever have 100 percent of the science tell
you that this disease is associated with that exposure, whether it be Agent
Orange or ionizing radiation. Science can help show causality, but for every
scientist proposing one theory, you have someone proposing another theory.
So I think at some point itís a judgement call, and you have to give the
benefit of the doubt to the veteran. Because Iím not sure you'll ever have
100 percent of the science and the medicine tell you this is absolutely the
right thing to do or not to do. It just doesnít work that way.
The in-country effect is an interesting concept. I guess Iím
not sure how it would work. I would want to study this more carefully.
Certainly some lifestyle decisions I made were not the wisest decisions from
a health perspective. How would that impact on a disability rating I might
receive, vis-ŗ-vis my exposures and my traumas in Vietnam. But it's
something worth discussing, because weíre evolving in this area of
Weíve come a long way in the past twenty years. Weíre
still learning, and certainly the Persian Gulf syndrome is the latest in
that evolution. The VA has always, I believe, been very revolutionary in
some of the things that we have done since 1944 in benefits and service
delivery. I think the manner in which weíre dealing with environmental
hazards and chemical exposures has been a lesson for all America, not just
for the military.
VVA: The veterans health initiative, undertaken by Dr.
Garthwaite and his staff, to take complete militaries history of all
veterans who comes to the VA and test them for all the maladies and diseases
that veterans may have been exposed to due to duty station, branch of
service, dates of service, MOS, and what actually happened to them, thatís
one thrust. The other thrust is to reward VA clinicians who become
proficient in understanding those special health-care problems of each
generation of veterans, as well as particular things having to do with their
We want to know whether or not you are fully committed to
implementing this initiative.
Anthony Principi: Itís an area, again, I havenít
been able to focus on. But it certainly goes a long way toward what I hoped
to accomplish when I directed the establishment of a Persian Gulf registry,
so we would have a complete medical record on people who served in a given
area at a given time. We could build upon it and draw some conclusions.
Iíve always believed that we are a veterans health care
system, as opposed to a more generic health care system. One of our great
strengths is that we have a system thatís somewhat closed and provides us
the opportunity to build a wonderful database upon which to make decisions
in health care and peopleís lives.
The veterans health initiative--was that something that was
generated in-house by the VA or by the service organizations or by VVA in
VVA: We had recommended it to Dr. Garthwaite, and he
undertook it. There was a separate educational part having to do with
raising a base salary for three years if people passed proficiency
Anthony Principi: And are they doing it, to your knowledge?
VVA: It hasn't been implemented yet.
Anthony Principi: Oh. It hasn't been implemented at all.
VVA: The education part is done, but theyíre working
on the first test with radiation veterans. And then the others will be
Anthony Principi: It certainly sounds like something we
should pursue. But I would want to get more information.
VVA: One of the charges against the VA has to do with
quality of care across the system. One of the things thatís come to our
attention is that apparently it's up to the discretion of the VISN directors
whether to implement clinical best practices or protocols for any area of
medicine in their network. Many feel that this has resulted in a situation
where whether a veteran gets any treatment at all for a particular malady,
much less proper treatment, depends on where in the country he or she
happens to live.
Anthony Principi: Your observations are generally
correct. Weíre now in the process of putting borders on the amount of
discretion the field has. I think at one point when the VISNs were first
established it was complete delegation of responsibility. I believe now the
pendulum is beginning to swing back. Perhaps more needs to be done.
I believe in having decisions made close to the patient,
close to the veteran. At the same time, I believe it's very, very important
that there be uniform policies and procedures across the system to insure
that veterans, wherever they reside, have equal access to the system. Youíll
have some degree of difference across the nation. A system this large cannot
have absolute uniformity and consistency. But we can certainly have a lot
more than we do today.
We have a policy that says these programs have high
priority: spinal cord injury, mental health, homelessness, screening for hep
C, and things of that nature. I expect that those policies will be carried
out. I will hold people accountable for doing so.
VVA: As all health care--like all politics--is
ultimately local, VVA believes that requiring each hospital director to meet
with all the veterans service organizations at least every 4-6 weeks in a
formal manner would help very much in this regard. Do you agree and do you
plan to mandate this act at the local level?
Anthony Principi: I certainly believe that itís
absolutely critical to our success to meet with the stakeholders at all
levels. Clearly, one of the cornerstones and hallmarks of my tenure will be
close working relationships and partnerships with the veterans service
organizations. If itís good for me, it's good for the VISN director and
the medical center director to do so as well.
I will mandate this act of partnership at the local level as
well. Whether itís every four, six, or eight weeks, I'll leave that up to
the medical center directors. But it certainly shouldnít be once or twice
a year. But I would certainly think no more than quarterly. I would hope
that the vast majority of medical center directors and VISN directors have
quarterly meetings with the leadership of the veterans organizations.
Most of the folks I've met in the field reach out to a lot
of our stakeholders. But I intend to remind people how important that is. It
breaks down a lot of the cynicism and the distrust. The vast majority of
people donít expect that you can agree on every point. Thatís not the
way it works in any area. But you can certainly go a long way to achieving
that rapport, and itís just good for everybody to do so.
VVA: VVA is very concerned about the promulgation of
regulations affecting vital needs of veterans. These regulations include
declaring hepatitis C to be a presumptive disability and declaring Type II
diabetes to be a presumptive disability for veterans exposed to Agent Orange
anywhere in the world. Would you please give us your thoughts on these two
matters as well as pending regulations regarding veterans exposed to
radiation, payment for emergency care for veterans at non-VA facilities, and
the rewrite of the hepatitis C ratings schedule?
Anthony Principi: These--like the others--are very
important questions. There are a lot of components to your question.
Exposure to environmental hazards is very, very important to me. We need to
move out and provide presumptive service connection where it is warranted by
the science and the medicine and in areas where weíre having difficulty
finding answers to questions.
I defer to the committee; the committee on the Senate side
indicated a preference for doing the legislating on service connection for
ionizing radiation. I told them that I would like to move forward on
ionizing radiation and get the regulations over to OMB. They posed no
objection. Itís just a matter of getting my signature and getting them
over to OMB.
I hope to have the emergency care for veterans at non-VA
facilities done very, very quickly. I had some concerns there. I wanted to
make sure that this is something we should do, that was needed. My concern
is that I was told it would cost between four and five hundred million
dollars to go to basically community hospitals. Thatís an unfunded
mandate. The law is discretionary: It says I may go ahead and do
this, not that I shall do it.
But I intend to move forward with it. At the same time, itís
going to take four to five hundred million dollars out of our health care
system. Thatís a lot of money. I want to make sure the regulations protect
against abuse, that this is indeed emergency-care treatment; and that
lengths of stay in emergency rooms are reasonable and adequate.
A lot of private-sector hospitals are in difficult financial
situations, and I donít want this to be abused. This money is too
important to veterans. Before we just jump in and do things, letís keep in
mind that a half a billion dollars is a lot of money. Nobodyís throwing
another half a billion dollars at this health care system. And itís not
going into the VA health care system, itís being taken away and going to
So I want to make sure that those regulations protect the
VA, protect veterans who have no choice but to go to a community hospital,
and that if they have insurance, the insurance is going to pay for it. If
they have Medicare, Medicare is going to pay for it. If they have Medicaid,
Medicaid's going to pay for it. The VA is not going to be seen as the deep
pocket here to bail out hospitals that should be going somewhere else.
With regard to hepatitis C, that is a very difficult one. It
is difficult because I need to understand the science and the medicine a
little better. I read the report of an epidemiological study that was
conducted by the University of Florida, the Navy Medical Research Center,
and the VA, which had some interesting findings. I donít have the exact
percentages in front of me. But it was a small cohort of veterans who sought
treatment at the VA. This was a microcosm of the population that came to VA
for health care. So you can't draw conclusions about the entire VA
About 20 percent were Vietnam veterans. Most of the veterans
with hep C joined the service subsequent to 1974. So the vast majority of
veterans who were shown to have the hep C virus came on active duty after
1974. The majority of those found to have hep C were either Vietnam veterans
or came on active duty subsequent to 1974.
However, it also showed no correlation between hep C and
blood transfusions. The vast majority of those with hep C were self-reported
IV drug abusers. A quite high percentage were incarcerated, about 27 or 28
percent. So we see that those who served in Vietnam in combat--and do not
have any reported drug abuse or incarceration--have a very low incidence of
hep C compared to those who, regrettably, may have had an IV drug abuse
problem or something of that nature.
It concerned me, reading this epidemiological study, because
once you grant a presumption of service connection you cover the vast array.
Iíve asked for an analysis of this study. Is it scientifically valid?
Itís taking me a little bit longer to understand the
ramifications of hepatitis C and the various studies that have been done to
make sure Iím consistent with the science and the medicine, and also
taking into consideration the role of IV drug abuse and other behavioral
lifestyle decisions. We need to help men and women who served their nation
in uniform and because of that service are inflicted with this terrible,
terrible disease. Equally importantly, we need to make sure that we have the
programs in place--the screening programs, the centers of excellence in
hepatitis C. The VA can make a difference.
So itís not only an issue of disability compensation, itís
also equally important--and Iím sure for many, more important--that the
treatment and the research be there to take care of that. Weíre doing a
lot. We reimburse hospitals for men and women who are being treated for
hepatitis C. So there is an incentive to screen; there is an incentive to
treat. The reimbursement is a lot higher--about $42,000 per patient--than it
might be to actually treat that patient even with these expensive drugs.
If I thought there was a disincentive to treat then Iíd be
really concerned. But if a hospital knows that it will be reimbursed this
amount of money to make sure that this veteran gets the care he needs, then
I feel a lot better.
But again, in these eight weeks Iím just trying to get up
to speed and understand the various issues. With regard to emergency care
moving forward, and Iíll probably move forward hep C at some point,
hopefully not in the too distant future. Ionizing radiation I'm moving
VVA: Of deep concern to us is that 87 percent of the
folks whoíve tested positive for hepatitus C are not deemed good
candidates for treatment for one reason or another. Weíre deeply concerned
about the case management of that 87 percent. Weíre afraid of a train
wreck ten years down the line, with veterans needing liver transplants that
arenít available and the enormous strain in costs that that will bear on
the system, given that there's already 75,000 positive, that we've only
scratched the surface in terms of testing.
Anthony Principi: Thatís a difficult issue. We have
all of these special programs for treatment of hep C. Sometimes you don't
have all the resources you need. You do have these mandates, we do have
priorities, the secretaryís priorities in some of these areas and others.
Just balancing this entire workload and this breadth of workload is a tough
issue. But Iím optimistic we're going to get there.
VVA: VVA believes that the VA may not spend enough in
some areas, but it does spend billions to assist in the rehabilitation,
restoration, training and education of veterans, including homeless
veterans. Yet much of this effort will not make a long-range difference in
the lives for many of these veterans, particularly homeless veterans, unless
the veteran is assisted to obtain and sustain meaningful employment at a
living wage. Can you please comment on this whole-veteran concept?
Anthony Principi: Youíre absolutely right about
homeless veterans in need of sustained employment. Clearly, thatís the key
to success: allowing these veterans to reenter our society as productive
members whose respect, self-dignity, and self-worth are greatly increased.
How do we do that? Weíve got some wonderful homeless
programs out there. There are lots of great programs out there that strive
to get these homeless veterans into jobs. Compensated work therapy is a
As far as the Department of Labor goes, I certainly will be
talking to my counterpart, Elaine Chao, to determine how well DOL is doing
to find veterans jobs. Especially those who have serious employment
handicaps, like homeless vets. The others are pretty easy to find jobs, but
it's those with significant employment handicaps, such as the homeless
population, that more emphasis needs to be applied.
VVA: Do you think itís likely that the administration
will back efforts to significantly reform and hold the grantees under the
LVER program more accountable for performance and results?
Anthony Principi: I would certainly hope so. I intend at
some point to talk to my counterpart to see if that's something that she
would be willing to undertake. I can't really speak for the Department of
Labor or for the administration, but I would certainly urge them to do so,
and itís consistent with the President's initiatives to hold people
accountable in education for our youngsters. Letís work together on
mutually agreeable goals and objectives, and then let's measure our
performance at the end of the day and make sure we have the resources to get
the job done.
We really do spend a lot of money. A lot of money. Fifty-one
billion dollars is a lot of money. I like to think a lot of programs work
well. But some donít. We shouldnít be spending money on programs that
donít work. Thereís plenty of need in other programs that are
working--in homelessness for example.
There are some programs that are working wonderfully. They
should be funded more, because they have proven track records, and others do
not. Letís reward success.
VVA: You recently opened the Center for Veterans
Enterprise at the VA and spoke of the need to fully implement the Veterans
Entrepreneurship and Small Business Development Act of Ď99. What plans do
you have to market and expand the range of services available through this
Anthony Principi: I am utterly excited about the new
center. Iím going to work very, very closely with the director to
determine how we market and expand the range of services. Working with
employers, we will insure that veterans understand the services that are
offered by the center, educate employers on what we do, insure that we take
steps to make sure that the VA is complying with various directives and
procurement to insure that weíre given some type of preference allowed by
the federal acquisition regulations to veteran-owned small businesses. I
will be meeting with the director here this week to begin discussions on the
center and what we need to do to make it successful.
VVA: Congress strengthened veterans preference laws
in both í98 and í99, yet VVA believes there is much more that needs to
be done in the actual doing by the agencies. Do you plan to begin active
Anthony Principi: I believe military personnel make the
best employees. Bar none. I believe we need to do whatever we can to recruit
them into government service. They are skilled, they are dedicated, they are
motivated, they are disciplined and mature. They make wonderful, wonderful
employees. So we will be actively recruiting at transition assistance
programs and other places to get the military personnel to look at service
at VA as a viable career choice.
These are the kinds of people we should be going after. They
have a sense of mission, about who we are, what we do. Certainly veterans
preference is a way for us to get these people into the VA. I strongly
support hiring military personnel.
VVA: Currently, the only part of VA that is authorized
to treat the whole family is the VA Vet Center program, which is so
essential in regard to PTSD treatment and in regard to hepatitis C
treatment. Would you favor a change in law that authorizes VA to treat the
veteranís family when it is clinically indicated as a vital part of
treating the veteran, such as serious mental illness and hepatitis?
Anthony Principi: I certainly believe that such a change
is something we should seriously consider. Whether we should go beyond that
to open up our doors to dependents of military retirees or some segment of
the population we arenít currently seeing: I think there are long-term
strategic issues there that we need to consider. Theyíre an important part
of our beneficiary population, our patient population. Losing them and the
downturn in the World War II population and others, we need to maintain a
stable patient population base. The question becomes: Do we need to engage
in a discussion with the service organizations and with Congress as to
whether we should open our doors? Your question is more in the therapeutic
If itís part of the treatment process and important to the
veteran as well, bringing in the family for joint counseling, joint
treatment care, then itís something we should look at. I cannot think of
why we would not want to do that. But at the same time, we should look at
that carefully, and I should obviously talk to the undersecretary of health
and obtain his views.
VVA: Any last comment, Mr. Secretary?
Anthony Principi: I appreciate the opportunity to do
this, and I look forward to following up with you from time to time to see
how well we're doing in some of these areas. Itís important that the
American people and veterans understand how truly important we are in health
care in this country and build support for the system. Not that weíre
perfect; clearly we have lots of things that we have to do. But at the same
time, on any given day we're providing a lot of health care to people who
have no other option.
I think that's the point I want to make to OMB. I want to
educate some of the bureaucrats over there as to what we do and how we do
it, and urge them to get out and visit some of our medical centers and see
first hand the kind of care and the quality care we provide. I think they
have a somewhat skewed view of the VA and donít fully appreciate and
understand the magnitude of the work we do.