It’s rare when a member of the President’s cabinet reaches out to a media outlet as small as Montana Public Radio. So when the office of Veterans Administration Secretary Robert Wilkie did, and offered an interview, we said yes.
Secretary Wilkie said he’s reaching out to as many media outlets as he can.
"To me, the the population of veterans in Montana reflects what I want to achieve, and the groups that I want to reach, and also present issues for reform that I think are very important for this department to act on," Wilkie said.
The big one is the Mission Act, set to roll out in June. Montana’s Democratic Senator Jon Tester co-wrote it with his Republican co-chair on the Senate Veterans Affairs committee, Georgia Republican Johnny Isakson. Also worth noting, both of Montana’s Senators sit on the Senate Appropriations Committee, at a time when the VA is asking for a nearly 10-percent budget increase, to a record $220 billion.
Wilkie says the Mission Act will make a big difference in Montana.
"In many cases in Montana we are requiring veterans and families to travel hundreds and hundreds of miles around trip to get to a V.A. facility," Wilkie said.
It seems to make sense that vets should be able to use their benefits to pay a local doctor or clinic, and the VA has allowed some of that through its history.
In 2014, Congress told the VA to expand that with the Choice Act. To make it vastly easier to get healthcare outside the VA. But only gave the agency 90 days to do it, and it didn’t go very well. The Mission Act is supposed to do it right.
But, Wilkie says, "This is not libertarian V.A. It is not the department giving a veteran a card that says veteran, and you can go out and get anything that you want."
Some people want that kind of card, including the Koch brothers funded group Concerned Veterans for America. They want to privatize health care for veterans as much as possible.
That has some VA fans worried at a fundamental level, says Quil Lawrence, veterans correspondent for NPR, "(They're) saying this is all a plot to bankrupt the VA, by sort of driving so much of its resources into the private sector that it’ll become a self-fulfilling prophecy that VA care isn’t as good as the private sector because the VA will have been starved of resources."
Secretary Wilkie points to evidence that the VA, the largest single healthcare system in America, can and does compete with the private sector.
"The Annals of Internal Medicine have said that our VA health care is as good or better than any health care in any region in the country," Wilkie said. "The American Medical Association has said as recently as January that our wait times are as good or better than any in any region of the country and unlike private healthcare we actually publish our wait times. "
Wilkie acknowledges there are significant gaps, especially in rural states like Montana. But it’s also true that in rural Montana private sector health care can be hard to find, too, especially specialists.
"So it is not always greener in the private sector," Wilkie says, "and we’re proof of that."
That’s certainly true when it comes to standing up electronic records systems for their patients. Private hospitals have sunk billions into an expensive disruption with lots of remaining problems.
But that doesn’t mean things are great with VA’s electronic patient records, says NPR’s Quil Lawrence.
"By law the VA and the Pentagon were supposed to have a seamlessly integrated electronic health record," Lawrence said. "For the last decade Congress has been telling them to do this. Congress spent a billion - with a B - dollars, trying to make (Department of Defense) and VA’s computers to talk to each other."
Senator Tester is so skeptical of VA’s ability to stand up its new electronic health records that he’s proposed creating a special independent oversight committee. Secretary Wilkie says, no thanks.
"I disagree with the thrust of this legislation" Wilkie said. "It just adds another layer of bureaucracy to this process. We don't need another commission looking at a process that we are regularly having congressional hearings on."
Tester, who has a Republican co-sponsor for his bill, seems inclined to press the issue.
"I like the secretary," Tester said, "I get along with him very well , but he’s wrong. We need to have oversight, and that’s what this bill is about."
Tester says Congress needs technical help assessing how the VA is doing on digital health records.
"Look, if was Wilkie I wouldn’t want oversight either," Tester said. "That’s not the way it works around here. These are taxpayer dollars. There needs to be oversight."
Oversight committee or not, Secretary Wilkie is confident that, bottom line, veterans aren’t going to abandon VA healthcare once the Mission Act gives them increased access to the private sector.
"We've seen veterans participation in private sector go down," Wilkie said. "I expect as the quality of our care increases that that will continue to be the case."
Wilkie is actually on a recruiting tour, trying to get more vets enrolled in VA healthcare. In part because of the suicide epidemic that takes veterans lives at a rate of 17 every day.
On a recent trip to Alaska Wilkie reached out to Native communities for help finding vets to enroll. Native Americans have among the highest per capita participation in the military.
"The same paradigm applies to a place like Montana" Wilkie said, adding he wants to visit more Native communities. "I will probably finish in Montana sometime this summer to also ask for their help in getting us to those veterans that we can't see yet."
So, Secretary Wilkie is on a push to recruit more vets to VA care in rural states at the same time that both the VA and private healthcare systems have huge shortages of doctors, for both mental and physical health. Wilkie says the VA has hired 3,900 mental healthcare staff in the last year. But NPR’s Quil Lawrence points out that overall the VA is losing medical staff faster than they’re hiring them, with 49,000 vacancies at the end of last year.
"If you he’s giving you the raw number of people he’s hired, you'd have to subtract the number of people who've left or retired," Lawrence said, "and I'm afraid you'd still come out with a huge crisis, that, you know, as he said, they're trying to address. But the numbers can be presented to paint whatever story you want there."
VA Secretary Robert Wilkie is preparing to roll out a transformation of veterans health care of historic proportions, on June 6, the D-Day anniversary. As he looks toward the future, he says he gets frustrated constantly being reminded of VA’s historic baggage.
"I think it's too easy for people to take shots at a very wonderful federal workforce and not that we should be above scrutiny," Wilkie said. "We should be the most scrutinized department in the federal government along with the Department of Defense. And it is it is tough when you're having to answer backward looking documents documents that have no relevance to what's going on in the department at this time."
Robert Wilkie is the Secretary of Veterans Affairs. He’s responsible for the healthcare of more than 9 million Americans, delivered by the largest integrated healthcare system in the county, with more than 1,200 facilities nationwide.
