February 11, 2022 • 44 mins
Rep. Mark Takano, Chairman of the House Committee on Veterans Affairs, speaks about the progress the House is making in ensuring veterans needs are taken care of. He speaks about the relation to the Blue Water Navy Vietnam Veterans Act to Burn Pits, and how the 4th mission of the VA can serve to augment U.S. capabilities, even with non-veterans.
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Episode Transcript
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Mark Takano (00:02):
People don't realize that the fourth mission
exists. But the fourth missionbasically is about the VA. The
you know, it's the largesthealth care system in our
country. And when there's anatural disaster in the local or
regional healthcare system isstressed and begins to break
(00:22):
down the VA through its systemof volunteers from its own
workforce can be deployed toprovide a backstop. In its VA
has done this time and timeagain in cases of hurricanes,
earthquakes and fires and evenin the mass shootings. It's it's
(00:43):
provided community support. Whenour emergency rooms are just
sort of filled with gunshotvictims. The VA steps up.
Charlie Malone (00:57):
Welcome to Season Two of the policy vets
podcast, engaging with leaders,scholars and strong voices to
fill a void in support of PolicyDevelopment for America's
veterans. With your host formerSecretary of Veterans Affairs,
Dr. David Shulkin. And theExecutive Director of Policy
beds, Louis Celli, today's guestMark Takano, a US representative
(01:19):
for the state of California, andthe chairman of the House
Committee on Veterans Affairs.
Louis Celli (01:26):
Mr. Secretary, when you were at VT VA, both as
Undersecretary and as Secretary,How close were you with the
chair and ranking members of theHouse and Senate Veterans
Affairs Committee?
Dr. David Shulkin (01:37):
You know, I thought those relationships are
really important for VA to beable to get its work done and
not to get distracted. When Ientered as Undersecretary there
was a little bit of adversarialrelationship between the
committee chairs and the and thecurrent administration. But I
came in really, as much more aexpert on the health system. And
(02:03):
so I was not able, I was able toavoid some of those political
issues. And I establish verygood relationships when I was
appointed as secretary. Iremember, when I went to my
swearing in at the White House,both the chairs of the House and
the Senate, and the rankingmembers of the House and Senate
(02:25):
came to my swearing in, whichwas really unprecedented, but it
signaled the fact that I was notgoing to deal with Congress in a
political way or represent anyparty. I was going to have
relationships with both sides ofthe aisles to get the work done.
And of course, I was confirmed100 to zero, which, again, was
(02:50):
unprecedented, at least in thelast in the last administration.
Louis Celli (02:54):
Did you find that they all generally worked well
together? Or did you sometimesfeel like you were caught in the
middle of some politicalgamesmanship?
Dr. David Shulkin (03:02):
Now, I felt that these committees really
worked well together that, thatit was not a lot of political
gamesmanship. It didn't meanthat there was always agreement.
And you sometimes had to do someback shuttle diplomacy. But I
never felt like there weredirect political games being
played.
Louis Celli (03:21):
So I mean, really not to oversimplify
congressional responsibilities,but the committee's who have
jurisdiction over the differentfederal agencies, they have
really two primaryresponsibilities, authorization
and oversight, then, of course,the funding is, you know,
managed by yet anothercommittee. And these tasks are
usually carried out with thehelp of the public by either
(03:42):
working directly with theirconstituents, or their districts
or through the large groups likeVSOs. And by hearing from the
departments who work directlywith the veterans.
Dr. David Shulkin (03:53):
Yeah, I think that's right. It's, there's a
lot of separate responsibilitiesof these different committees in
Congress. And then of course,they're even members of Congress
that are don't sit on thecommittee's butter veterans
themselves or care deeply aboutthese issues that you have to
(04:13):
engage with. I think, forexample, John McCain was a great
example of that, where he wasnot on any of the Veterans
Affairs Committees, yet he had alot of say in what happened in
these types of programs. Solearning how to work the various
(04:34):
aspects of the way that thingsare done in Washington is a big
part of the job when you're inthe Secretary's chair. But it's
important to be able to dobecause if you don't pay
attention, or understand thatyour work is going to be much
slower and being able to getanything done.
Louis Celli (04:52):
Talk about slower we are in such a different
environment right now. I mean,so much has happened over the
past three years or so. Youknow, in addition to many Any
years worth of backed uplegislation that's being signed
and flooded into the VA, thepandemic is also cast a fog over
everything, I mean, reallyobscuring much of the
transparency and slowingprogress on almost everything.
Dr. David Shulkin (05:15):
Yeah, it is hard to know, since his new
administration, a new Congress,and now when you layer in the
pandemic, what responsibilityfor this sort of slowness and
inability to see a lot beingdone, you know, should be
allocated to those various partsof, of the bureaucracy. But
(05:38):
certainly the pandemic has madeit very, very difficult. And one
of the things that is reallychallenging that's probably
going to continue for thefuture, is the staffing
challenges that are going to bepresent in the VA. You know, VA
entered the pandemic with about48,000 vacancies, and I suspect
(06:00):
it's at a much higher level now.
And of course, recruiting peoplein any part of the economy is
challenging, but recruitingpeople in the government is
certainly going to be have itsown challenges moving forward.
Louis Celli (06:13):
And you really bring up an excellent point, to
be fair, I mean, VA has beenwrestling with nursing, mental
health and other criticalspecialty shortages for years,
as has the rest of the country.
Dr. David Shulkin (06:26):
Yeah, and this is where Congress can help.
I know that we're gonna hearfrom Chairman Takano, in this
episode, and you're going tohear how he's been working to
give increased compensationauthority to the VA, to be able
to stay competitive with theprivate sector. And that's
really important. If we don'tgive VA the tools and
(06:50):
flexibilities to remaincompetitive. I think we can all
see that we're headed for yetanother crisis in the VA.
Louis Celli (06:58):
Chairman Takano wasn't the chairman when when
you were secretary, but you'veworked with him in the past,
right? Yeah, he was
Dr. David Shulkin (07:04):
the ranking member. And I've worked with him
all throughout my time I findhim to be thoughtful and fair. I
think that he's in a verychallenging situation, in trying
to get things done. And I thinkhe wants to get things done,
because he believes verystrongly in this mission, and
(07:27):
the importance of having astrong VA.
Louis Celli (07:30):
Chairman Takano has always been great to work with.
As you know, he representsCalifornia's 41st district, just
outside of West LA andRiverside, and he went to
Harvard. So
Dr. David Shulkin (07:41):
yeah, yeah, he's a smart guy. And, and he
knows the complexities of boththe VA as well as getting things
done between the House and theSenate. And you'll hear at times
that he's frustrated by the lackof progress that's being made.
Louis Celli (07:58):
One of the things that I'm really hoping that
we're able to cover today is thethe burn pit legislation. I
mean, there have been, you know,more than one legislative
initiatives that have beenintroduced, and some of them are
pretty controversial.
Dr. David Shulkin (08:12):
Yeah, and it's not clear how this is going
to be worked out, you know, thehouse has submitted a bill that
is much broader, you know, givesmuch greater presumptive of
authority, which is going totranslate into probably a more
expensive bill than necessarilythe Senate. And yet, you know,
(08:35):
neither neither of these billsreally is going to probably, on
its own be successful. Sothere's going to need to be some
ability to compromise, someability to keep focused on what
the veterans really need. And ofcourse, in the burn pit, Lu, as
(08:55):
you know, the presumptive leavesthat have been granted are the
ones that, frankly, in my view,are the least sensible, that is
the very, you know, asthma andsinusitis, and very, very common
procedures, or common diagnoses,were the ones that we really
(09:16):
think about where people arehaving life threatening, and
ultimately are dying from theirexposure, such as brain tumors
and lung tumors and severerestrictive lung diseases. Those
aren't being covered right now.
And so we've got to bring somecommon sense into this. And I
think that's going to be a realchallenge for the Senate and the
(09:40):
House to stay focused on thatissue.
Louis Celli (09:44):
I absolutely agree.
And as we talked about earlier,they have more than just the
responsibility of authorization.
They have oversight, and nowthey're going to have their
hands full between keeping theEHR transformation on track and
figuring out you know, how tonavigate the burn pits legend
which has turned out to bereally kind of the number one
legislative priorities of mostof the VSOs. And then, you know,
(10:07):
dealing with their their lifechanging war injuries, and all,
while battling the suicideepidemic, it's gonna be an
important discussion today.
Dr. David Shulkin (10:15):
Yeah, the other issue, besides what you
mentioned, Lou, I think to payattention to is the pandemic
itself. Because, you know, Icome at things often from a
healthcare perspective. Andthere is no healthcare system in
the country, maybe even in theworld, that hasn't been
fundamentally changed, probablyfor decades. Because the impact
(10:38):
of this pandemic and the VA,being the largest health system
in the country is no different.
I think there needs to be somevery strong retro spective
analysis of how VA has performedduring the pandemic, whether
they have lived up to thecommitment to taking care of our
(10:59):
veterans, but also to thatfourth mission, that we don't
hear a lot about that duringtimes of national emergency,
whether they be, you know,related to war, or related to
natural issues, like pandemicsor hurricanes, the VA has the
responsibility to be able tostep up and help other Americans
(11:20):
besides veterans. And so we needto take a hard look at that
fourth mission and see whetherVA has learned and can do even
better, should this situationoccur again, and also how VA
comes out on the other side ofthis pandemic? And again, not
necessarily from looking tocriticize, but looking to learn,
(11:44):
and looking how we can performeven better in the future.
Louis Celli (11:50):
Absolutely agree. I mean, those are excellent
points. And I think what we'redealing with now is really just
global exhaustion, from dealingwith this and almost an apathy
at this point, you know, to, youknow, in looking forward and
trying to get to the end of it.
So I say we get them in here andget started. All right.
(12:17):
Mr. Chairman, welcome to thepolicy. That's podcast. Hey,
thank you so much for taking thetime to join us today.
Mark Takano (12:22):
Oh, my pleasure. My pleasure.
Dr. David Shulkin (12:24):
Great. Mr.
Chairman, it's great to see youagain. I think I saw you last
that Arlington Cemetery onVeterans Day, which was a great
day to be out there recognizingour veterans. And for our
listeners of the policy bedspodcast, which is a very large
audience of people that caredeeply about these issues. This
(12:44):
is really your second term nowas chairman of the House
Committee on Veterans Affairs,and many of our listeners
probably would benefit fromhaving an understanding of what
are some of the key issues thatyou've been working on in the
committee? And what are some ofthe significant accomplishments
(13:05):
that have happened over thoselast number of years that you've
been leading this committee?
Well,
Mark Takano (13:12):
I you know, I assumed the chairmanship in
January of 2019. And in thatfirst year, we accomplish
something very, very important,which was the passage of the
Bluewater Navy Vietnam veteransact. That was a decade in the
making. I can't come. I can'tclaim total credit for this. I
(13:36):
mean, it began with my, myformer colleague, Tim Walz,
who's now the governor of whiskof Minnesota. In Tim worked on
this bill, 10 years prior, andactually, you know, former
chairman, Phil roe had actuallypassed a version of the bill in
(13:59):
the previous Congress, but itwas it was it was stuck in the
Senate. Sad to say, sometimes wesay in the house that the enemy
is not the other party in theHouse. The enemy is the Senate.
So I think Phil roe understandsthat I took up the bill in 2019.
(14:21):
And it was this was a verysignificant it's a it was a 40
years in the coming. It was abittersweet victory. Why was it
bittersweet? Because if we haddone something like Bluewater
Navy, decades before we couldhave helped so many more
veterans who passed away in thatinterim time period, and what
(14:44):
that bill do it it accordedaccess to health care and
disability benefits to thoseveterans who served on surface
vessels in the territorialwaters of Vietnam. They were not
getting Third expose becausethey didn't serve on land, the
(15:04):
bill hangs up on my wall withgreat pride. In 2019, we also
took up the failure to reallymake a huge dent in death by
suicide among our veterans, thatnumber stayed persistently high.
It, it was a bipartisanfrustration that we had a spate
(15:25):
of suicides that occurred on onveterans, VA campuses, I wanted
to make sure those suicidesweren't in some way a form of
protest. And we found that theyweren't really a systematic
protest, it was really that, youknow, many veterans who are
(15:46):
experiencing great healthcomplications, a number of
things intersecting together,knew that the VA would take care
of the remains. And in so manyways, the suicides on those
campuses weren't really aprotest. But but it called
(16:07):
attention to the fact that thethat the suicide rates were
high, we had a White Houseinitiative that the Trump
administration at the time, butyou know, in that Congress, we
passed the veterans compact Act,and the Commander John Scott,
Han and mental healthimprovement, yeah, it was had an
(16:28):
array of bipartisan ideas, andboth bills. One of the things
that I'm very proud of the pastthat was originated from my
office was the the Access Act,which permits any veteran
regardless of their eligibility,to call the Veterans Crisis
(16:48):
Line, and get access toemergency metal, emergent,
medical, mental health care,life saving health care, without
worrying about having to pay.
Now, this part has been fullyimplemented, but the
implementation is coming soon.
And soon, communities, families,veterans across the country are
going to be able to know that ifthey get a veteran to call that
(17:10):
line, when they're having anemergent moment, they can get
access to care and not have toworry about the bill. Another
big area that we've been workingon is making the VA a welcoming
place to all veterans,regardless of their racial
background, religiousbackground, gender, you know,
(17:32):
that's the in sexual orientationand gender identity. It's
amazing to me that we have, it'snot really amazing, but it's
it's alarming. The numbers ofwomen who feel that coming to
the VA is a barrier because ofthe climate that exists in vas.
(17:52):
And so one of the things is thatmy colleague, Julia Brownley,
who chairs the healthsubcommittee who chaired the
existing women veterans TaskForce,
they put together the DeborahSampson act, and one of the
things that that Act does is itrequires VA to plan for
(18:14):
retrofitting medical facilitiesto better serve women veterans,
and that often means having aseparate access way for women to
come into the VA and not besubjected to looks or, you know,
cat calls or, or disturbinginteractions. In you know, VA
(18:35):
has already made a downpaymentof $20 million for this
retrofitting. There's many moreelements of that bill that were
enacted. And so I'm very proud.
You know, those are just threeof the things that highlights of
what we've accomplished in thelast Congress and
Louis Celli (18:50):
great, Mr.
Chairman, I mean, as you talkabout, your job is fairly
comprehensive, in addition torepresenting the, you know, your
district in California, you'rethe chair of the House Veterans
Affairs Committee. And, youknow, you've talked about some
of the laws that you've passed,but but also, you know, a large
portion of your job is oversightoversight for the Department of
Veterans Affairs, making surethat they're implementing and
(19:11):
carrying out the laws thatyou're, you know, that your
committee really helped turnedinto law. And, you know, a
couple that come to mind thatwere recently passed, you know,
as support for caregivers and,and the Air Act, you know, the
asset and infrastructure act.
Can you tell us a little bitabout how that might be going,
Mark Takano (19:31):
the caregivers is going far too slow for my
liking. People may notunderstand that. It has a lot
more to do with implementationof new programs at VA or the
expansion of programs and theinability to kind of get these
programs up and running quickly.
relates to antiquated IT systemsin the inability to broadly
(19:56):
administer programs You know, alot of the work we're doing is
trying to get it to up to speed,the air commission for the st.
Asset review, it's a it's abasically, it's a review of all
of the facilities across thecountry, what facilities need to
(20:16):
be upgraded and updated. Andbelieve me, we've got some
facilities that date beforeWorld War Two, in some cases be
will we really old facilitiesthat need to be updated and need
to have the capacity to housethe modern equipment and the
kinds of medical teams that wehave today in modern medicine,
(20:37):
contemporary medicine, so theair commission was supposed to
actually be constituted by now,we're held back by the fact that
the some of the congressionalleadership, and we just throw
some of the Republicanleadership under the bus, they
haven't they haven't named theywere slow in naming their
commissioners sending theirnominations to the President,
(20:59):
that still has to go through aSenate confirmation. The
Secretary of Veterans Affairswas supposed to make
recommendations based on marketassessment data that had been
gathered in the last two orthree years, he delayed the
publication of thoserecommendations. Part of it was,
you know, kind of reviewing thedata in terms of accommodating,
(21:25):
you know, concerns about howwould you know, the pandemic and
COVID-19. But really, I thinkthe Secretary was more concerned
about the timing of hisrecommendations, signaling to
some of the workforceprematurely, he didn't want to
an overly alarmed workforce outthere and making drawing
conclusions prematurely aboutthese recommendations. And he
(21:47):
didn't want to see an exodus.
Because he's trying to protectthe workforce. So So you know,
there's been a sort ofbipartisan, sort of looking the
other way, about, about theimplementation of the air
commission. So I have no doubtthat it's, it's going to get up
(22:11):
and running. But my concern,once it does get up and running,
I will be having hearings, I'llbe conducting hearings and
having the secretary periodbefore us to explain his
recommendations. But I'mparticularly going to be
interested in how the lessons ofthe pandemic are going to
(22:32):
reshape the thinking that wentinto the commission, because I
think many people who institutedand created the commission and
created this whole process,we're seeing that as a way to
kind of like, dramatically slimdown the physical footprint of
VA, and I don't know that, thatreally is that's going to hold
(22:54):
up after this pandemic, that,you know, one question how who's
going to who's going to have allof the kind of reserve ICU
units, when the private sector,this really have really been
driven by policies to kind of,you know, minimize them out of
bed space? You know, that kindof run, like kind of an adjust
(23:17):
in time sort of mindset? So Imean, you know, that's a
question that I that's example,the question that would come up
as we go through theircommission review.
Dr. David Shulkin (23:27):
Mr. Chairman, I really appreciate the way
you're thinking about that. Andyou're sharing the way that
you're going to approach this. Ithink you're right, the pandemic
has changed so much for thecountry, and certainly for
healthcare. And of course, youknow, we always worry about what
about the new conflict, and ifwe face people returning that
(23:48):
are going to need our help thatthat raise their hands thinking
we're going to be there forthem. So So I think you're
approaching this in the rightway. I do want to go back to
what you had talked aboutearlier in the podcast about the
accomplishments that youachieved or or with others
helped achieve in the, theBluewater Navy act that you have
(24:10):
hanging on your wall, because ithas a lot of similarities, I
believe, to what our veteranstoday are facing with burn pit
exposures, in that the bluewater Navy didn't have this
actual data, to be able toscientifically confirm the
associations between AgentOrange and so many of the health
(24:33):
issues that we're seeing. Andit's the same issue with the
burn pit issue that the data isnot necessarily there yet. Just
today I was contacted by amother who lost her 28 year old
son who had been serving inAfghanistan, and he died of a
glioblastoma and as you know,not many 28 year olds normally
(24:54):
die of brain tumors like that. Iknow that you've worked very
hard On the pact Act, which isvery comprehensive in addressing
this blue, this burn pit issue.
Can you tell us a little bitabout why you feel so strongly
about burn pits and where youthink the pact act is and if
(25:15):
there's going to be a resolutionto this coming forward?
Mark Takano (25:21):
Well, Mr.
Secretary, let me just say thatthe Bluewater Navy Vietnam
veterans act really deepen themy conviction that we cannot
allow what happened to ourVietnam veterans to be repeated
with, you know, the Iraq andAfghanistan generation of
veterans. It's already been 20years since we started that
(25:43):
conflict. But Bluewater Navy waslike the bill was four years
after the fact right and and tothink that we we saw just huge
numbers of Vietnam veterans notbe able to benefit from the
(26:05):
Bluewater Vietnam veterans Actand the slow pace at which the
VA could address these claims.
And what is I think, reallytroublesome or even offensive is
the idea that our veterans theburden of proof is put on our
(26:28):
veterans. Our veterans who don'tnecessarily have connections to
research institutes, and whoaren't scientists themselves.
It's veterans and their familieswho have to go through this as
their suffering. So I believe aone of the principal ideas of
the pact act is to shift from asystem where the burden of proof
(26:53):
for the service connection ofyour condition is put on you the
veteran, we need to shift thatto a system where the benefit of
the doubt is extended to you.
Because it may take decades forscientific evidence to actually
link and we may never conclusivethere, there may always be an
(27:16):
alternative explanation for whyyou got that oil called geo
blastoma or Gladstone, yes,glioblastoma, geo blastoma.
There always may be analternative explanation that's
plausible in could be a reasonfor why the government denies
you. And but what we do, though,are the facts. The facts are you
(27:38):
stepped up, the nation made apromise to you to take care of
you to have your back. And weknow that millions of veterans
were exposed to burn pits thatcould not exist in the United
States. No community would havepermitted the these huge burn
pits to be burning 24/7 with thekinds of things we don't even we
(28:04):
have they even keep track ofwhat they put in these burn
pits. But we know that they didput a lot of things that
shouldn't been in those burnpits and would not have been
permitted in the United States.
So the military does not have toknuckle down under OSHA rules or
(28:24):
other kinds of environmentalrestrictions that every state
and every community or countrywould have done. So what is what
is my pact, what is PAC act do?
Well, it basically would providehealth care for 3.5 Toxic
exposed veterans, it wouldestablish a new review process
for establishing toxic exposurepresumptions.
(28:52):
You know, Mr. Secretary, whenthe the Academy of Sciences
presents a secretary, even evenwhen they present the secretary
with compelling evidence thatthere is a reason to conduct a
an illness to some sort ofexposure, that secretaries are
often not able to have theauthority, but not really they
(29:15):
have to kind of knuckle underwhoever is in charge of OMB. And
so your Secretary believes it'sthe right thing to do. You know,
a secretary often is constrainedby by other things. And so, you
know, we've worked together withthe VSOs to try and create a
process which which puts theveterans first and that own
(29:37):
before us, right. So we create anew process, we we concede
exposure to airborne hazards andburn pits based on the location
you served and the date youserved. And that's where how we
get to 3.5 million exposure. Nowall those 3.5 million going to
get disability benefits No. Butyou can bet if a rare cancer
(29:59):
shows up At age 28, instead ofwaiting for the absolute
scientific connection they havethrough an academy of science
that may take 40 years to do.
We're saying let's give thebenefit of the doubt to that
rare cancer and by definition, arare cancer is not going to show
up in all 3.5 million veterans,right? So what we do we, we
actually look at 23 respiratoryillnesses and cancers, and there
(30:22):
probably were there were cancersrelated to burn pit and airborne
hazard exposure. You know, threeof those respiratory illnesses
have already been sort of, insome way vetted by the National
Academy of Sciences. And theSecretary is already moving on,
on the regulations to establishthose as presumptive illnesses.
(30:43):
But roughs are really like rarecancers. And I think, you know,
it's going to cost us somemoney, but it's not going to be
we're not going to see all 3.5million soldiers have those
those cancers, but we need totake care of those who do get
those cancers. We create apresumption of illness of
exposure to radiation forveterans who participated in
(31:04):
cleanup activities andPalomares, Spain and the you
know, what, in a wet techasshole in the Pacific, we
expand Agent Orange exposurepresumptions to veterans who
served in Thailand, Laos, andCambodia, we really look to
improve the data collectionbetween VA and the Department of
Defense, what's called the Eilersystem. And so they're there. So
(31:29):
we can actually kind of trackthis and study it. And we
require VA to providestandardized training to improve
toxic exposure based disabilityclaims, at adjudications.
There's much more, but I've kindof just given you the kind of
more important ones. But youknow, we've got the nine, nine
(31:50):
major veteran serviceorganizations, advocates such as
Jon Stewart and John feel, andover 70 co sponsors. We have the
momentum in this Congress, andthis house representatives, I
think, to potentially have astrong bipartisan vote, I'm
talking to my Republicancolleagues, they want to do the
(32:11):
right thing, as well. It doescost money. But you know what,
it's, this is not about money.
This is about keeping a moralcompact, a pack that we had with
our veterans, that when we sendyou in the harm's way, we take
care of you. And this is this iswhat I would call a cost of war.
(32:34):
I mean, it's, I really can'tdistinguish, paying for the
effects of a toxic exposedveteran, in this case, to burn
pits or radiation. It can'tdistinguish that from, you know,
paying for body armor or a tank,or there are arms means the
(32:55):
American people in the Congresswould not hesitate to equip our
soldiers with what they need inthe heat of battle. And the
truth is, when you've beenexposed to toxic substance, and
you're suffering, the illeffects of it, you're you're
debilitated, you got a cancer inyour head and your brain, you're
still in the heat of battle,you're still in the heat of
(33:18):
battle. So that's, that's,that's, that's what I have.
That's what I how I feel aboutit. And I know, Mike, I know
that a lot of members feel thatway. Yeah,
Louis Celli (33:27):
Mr. Chairman, your your team has been very gracious
and has been able to carve usout a few extra minutes. And we
know you have, we know that youhave a, you know, a pressing
meeting that's backed up againstthis. So, you know, I want to
make sure that, you know, firstof all, I want to thank you for
bringing up a couple of key andimportant issues. One, that, you
(33:47):
know, OSHA regulations wouldabsolutely prohibit that type of
toxic behavior happening onAmerican soil. And yet we did
it, you know, within really, youknow, within living and eating
range, you know, of our of ourAmerican servicemembers. And the
other thing is, we have no ideawhat was in those pits, we'll
(34:07):
never know, DOD was never forcedto keep any, any sort of
inventory over what they burned,whether it was computers, or jet
fuel, or whatever, that whateverwas in there. The real question
that I think is relevant thatthat our listeners are going to
want to hear about is, as youknow, you know, the Senate has
introduced another bill. I thinkit's at least a second or third
(34:31):
attempt at trying to addressthis, which is markedly
different than then the Housebill. And I'm just I'm curious,
what you see, as you know, asreconciliation. We, you know,
we've all been doing this a longtime. We know that, you know,
there are concessions that arealways made on every bill, how
(34:52):
do you see these negotiationsplaying out? Well,
Mark Takano (34:55):
I see them playing out based on how Strong we
generate the kind of support wegenerate in the house, how, how
the we gauge what the, themomentum we create with a strong
House vote will shape thesenegotiations. And the American
(35:18):
people can shape these or thesenegotiations, I would say the
amazing unity of the veteranservice organizations, in the
advocates for a robust, strongand comprehensive bill is going
to reverberate, they're going tobe coming to town in the next
(35:38):
six weeks or so. Right? It's soimportant that the conversation,
not just be in Washington, thatconversations happen all across
this country. And veteran voicesare really respected the desire
of the American people to doright. by those who put
themselves in the line of fire,and those who are suffering, the
(36:02):
effects of their service, theAmerican people really want to
help them. So my view is that isthat I'm doing what I can here
personally, every day. And I'vegot an enthusiastic corps of
members on a bipartisan basiswho are interested in that in
the same as well. And I know theVA, I know, the veterans service
(36:24):
organizations, this is theirnumber one priority, it is hard
to say no, to what everybodyknows is the right thing to do
it really hard. And we've justgot to make sure that people
know, look, what they producedin the Senate is not bad policy.
My intention is to include it.
But it can't be It can't be it.
(36:47):
It can't, it can't only be thatit has to be significantly more.
So I congratulate the Senate onwhat they accomplished. But we
can do better. We can we can dobetter. And we will do better.
This is the exact time that weneed. When our country is so
divided. We need a good pre taxto come together. And I'm so
(37:11):
grateful that our veterans haveoffered us this opportunity to
come together. And so onceagain, you know, the cause the
cause of serving our veteranscould bring us together and I
hope mine I believe it will, Ibelieve it will bring us
together.
Dr. David Shulkin (37:28):
Yeah, Mr.
Chairman, you've been verygenerous with your time, I just
want to wrap up with one finalthing you had mentioned earlier
in some of your comments thatthe pandemic really has changed
everything. And we're going toneed to look at some of these
issues through the context of avery different world going
forward. And I just wonder ifyou would just share any
(37:48):
thoughts you have about how VAhas performed during the
pandemic, they not only have hadthe responsibility of caring for
the country's veterans, but alsoin their fourth statutory
mission for emergencypreparedness. And, you know,
it's clear coming out of thepandemic, that the VA like
(38:09):
everyone else in health care isgoing to be dealing with severe
staffing shortages. And, youknow, already significant
amounts of vacancies that couldbe worse, just given what we're
seeing throughout all of theeconomy. I just wonder your
thoughts about about both how VAhas performed and what it looks
(38:31):
like going on the other side ofthe pandemic?
Mark Takano (38:35):
Well, there's a lot to your question. Just real
quickly, we just passed theraise act I had hoped it would
have. It got bipartisan support.
44 Republicans crossed over andvoted for it. I was disappointed
the ranking member didn't throwhis support behind it. Vaccine
politics Scott played, but Butyou know what, in spite of all
(38:55):
that 44 Republicans in the Housestill voted with the Democrats
to raise the pay of nurses inmetropolitan areas. So there's a
tremendous, you know,competition now for that talent.
I'm hopeful that we'll get backto some form of a build back
better. We included in Bobackbetter, a lot of money for more
(39:20):
training. But listen, we get tothe performance of the VA during
the pandemic. You mentioned thefourth mission, many people
don't realize that the fourthmission that exists. The fourth
mission, basically is about theVA. You know, it's the largest
health care system in ourcountry. And when there's a
natural disaster in the local orregional healthcare system is
(39:47):
stressed and begins to breakdown. The VA through its system
of volunteers from its ownworkforce can be deployed to
provide a backstop. In its VAhas done this time and time
again in cases of hurricanes andearthquakes and fires. And even
in the mass shootings, it's it'sprovided community support. When
(40:11):
our emergency rooms are justsort of filled with gunshot
victims, the VA steps up, noless. So in a time of a
pandemic, when nursing homeswere overwhelmed, VA has
tremendous infection controlexpertise. And when invited in
VA performed magnificently whenthey were able to partner, but
(40:36):
they have to be invited in.
That's part of the I actuallythink that VA ought to be put
positioned, so it can be moreproactive. So it can actually
lead and not have to sit backand wait for the governor of a
state to request. Or it may makemore sense for VA to kind of
lead emergency response thanthat other agencies that are
(41:00):
positioned to do that. VAperformed magnificently, with
its own community living centersof what our community considers
the basic long term carefacilities, we have very few
infections, Dr. Stone made somevery decisive decisions about
closing the access down was hardon those families that had
(41:22):
family members in those communalliving centers. But it saved
lives. Where we lost a lot oflives were in the veterans homes
in the states, the stateveterans homes, which are not
administered by VA, they'readministered by states, I
believe there needs to begreater oversight authority of
VA to make sure that they're upto standard, we did provide an
(41:45):
American rescue plan, more moneyfor states to upgrade their
facilities, and we needoversight. Related to that. I'm
worried that we're not doingenough to prepare for future
pandemics we certainly didn't doas well as we could have with
this current pandemic. But alongwith that, we have I think, the
(42:05):
specter of climate change andmore frequent extreme weather
events across the country. Andso if you have a pandemic, which
is everywhere, and extremeweather events, also that maybe
not just one, but maybe two orthree in a year, we need to
(42:27):
start looking at the fourthmission of the VA in a much more
expansive way we haven't reallylooked at what my committee
began to do is to take a look atextreme weather events. As part
of the planning that VA needs todo. The VA in Puerto Rico
clearly wasn't anticipating aprolonged prolonged shutdown of
(42:52):
power. Although it has its ownpower, the VA has its own power
sources and is self contained.
What I'm getting at is the theprolonged need of veterans to
who are remote and vulnerable,who didn't have access to power.
So I mean, these are the kindsof things that the fourth
mission as we as we look toupdate the fourth mission,
(43:15):
responsibilities, pandemics,natural disasters more frequent.
But VA, under the circumstancesperformed magnificently. We need
to pay attention to the entireworkforce needs of the country
in terms of health care. So thatVA is not competing for what
little scraps there are witheverybody else.
Louis Celli (43:37):
Mr. Chairman, I and I think you would get broad
support on that. As a matter offact, one of our most recent
podcasts dealt with publicprivate relationships. And, you
know, and how successful thosehave been. Listen, I really want
to thank you. You've been verygenerous with your time as the
Secretary has said, we know thatyou're that you're very busy
leading that committee and youknow, really thank your team.
You know, Jenny and Miguel andLana for us. They really helped
(44:01):
us pull this off. And this hasbeen a fantastic and very
informative podcast.
Mark Takano (44:05):
Well, thank you.
Thank you. My pleasure.
Dr. David Shulkin (44:07):
Thank you about seeing you again. Bye bye.
Louis Celli (44:13):
Really, is it that's all the time that we have
for today. So join us next week.
You are not gonna want to missthis podcast because this is a
follow up to a previous podcastthat we had done on cannabis.
And there have been someadvancements in the industry.
We're going to hear from Dr.
Steven Groff, about how hebecame one of the first
federally licensed growthfacilities in the country. See
(44:35):
you next week.
Charlie Malone (44:42):
Thanks for listening to the policy bets
podcasts. For more informationabout projects and other
podcasts go to policy vets.org
People don't realize that the fourth mission
exists. But the fourth missionbasically is about the VA. The
you know, it's the largesthealth care system in our
country. And when there's anatural disaster in the local or
regional healthcare system isstressed and begins to break
(00:22):
down the VA through its systemof volunteers from its own
workforce can be deployed toprovide a backstop. In its VA
has done this time and timeagain in cases of hurricanes,
earthquakes and fires and evenin the mass shootings. It's it's
(00:43):
provided community support. Whenour emergency rooms are just
sort of filled with gunshotvictims. The VA steps up.
Charlie Malone (00:57):
Welcome to Season Two of the policy vets
podcast, engaging with leaders,scholars and strong voices to
fill a void in support of PolicyDevelopment for America's
veterans. With your host formerSecretary of Veterans Affairs,
Dr. David Shulkin. And theExecutive Director of Policy
beds, Louis Celli, today's guestMark Takano, a US representative
(01:19):
for the state of California, andthe chairman of the House
Committee on Veterans Affairs.
Louis Celli (01:26):
Mr. Secretary, when you were at VT VA, both as
Undersecretary and as Secretary,How close were you with the
chair and ranking members of theHouse and Senate Veterans
Affairs Committee?
Dr. David Shulkin (01:37):
You know, I thought those relationships are
really important for VA to beable to get its work done and
not to get distracted. When Ientered as Undersecretary there
was a little bit of adversarialrelationship between the
committee chairs and the and thecurrent administration. But I
came in really, as much more aexpert on the health system. And
(02:03):
so I was not able, I was able toavoid some of those political
issues. And I establish verygood relationships when I was
appointed as secretary. Iremember, when I went to my
swearing in at the White House,both the chairs of the House and
the Senate, and the rankingmembers of the House and Senate
(02:25):
came to my swearing in, whichwas really unprecedented, but it
signaled the fact that I was notgoing to deal with Congress in a
political way or represent anyparty. I was going to have
relationships with both sides ofthe aisles to get the work done.
And of course, I was confirmed100 to zero, which, again, was
(02:50):
unprecedented, at least in thelast in the last administration.
Louis Celli (02:54):
Did you find that they all generally worked well
together? Or did you sometimesfeel like you were caught in the
middle of some politicalgamesmanship?
Dr. David Shulkin (03:02):
Now, I felt that these committees really
worked well together that, thatit was not a lot of political
gamesmanship. It didn't meanthat there was always agreement.
And you sometimes had to do someback shuttle diplomacy. But I
never felt like there weredirect political games being
played.
Louis Celli (03:21):
So I mean, really not to oversimplify
congressional responsibilities,but the committee's who have
jurisdiction over the differentfederal agencies, they have
really two primaryresponsibilities, authorization
and oversight, then, of course,the funding is, you know,
managed by yet anothercommittee. And these tasks are
usually carried out with thehelp of the public by either
(03:42):
working directly with theirconstituents, or their districts
or through the large groups likeVSOs. And by hearing from the
departments who work directlywith the veterans.
Dr. David Shulkin (03:53):
Yeah, I think that's right. It's, there's a
lot of separate responsibilitiesof these different committees in
Congress. And then of course,they're even members of Congress
that are don't sit on thecommittee's butter veterans
themselves or care deeply aboutthese issues that you have to
(04:13):
engage with. I think, forexample, John McCain was a great
example of that, where he wasnot on any of the Veterans
Affairs Committees, yet he had alot of say in what happened in
these types of programs. Solearning how to work the various
(04:34):
aspects of the way that thingsare done in Washington is a big
part of the job when you're inthe Secretary's chair. But it's
important to be able to dobecause if you don't pay
attention, or understand thatyour work is going to be much
slower and being able to getanything done.
Louis Celli (04:52):
Talk about slower we are in such a different
environment right now. I mean,so much has happened over the
past three years or so. Youknow, in addition to many Any
years worth of backed uplegislation that's being signed
and flooded into the VA, thepandemic is also cast a fog over
everything, I mean, reallyobscuring much of the
transparency and slowingprogress on almost everything.
Dr. David Shulkin (05:15):
Yeah, it is hard to know, since his new
administration, a new Congress,and now when you layer in the
pandemic, what responsibilityfor this sort of slowness and
inability to see a lot beingdone, you know, should be
allocated to those various partsof, of the bureaucracy. But
(05:38):
certainly the pandemic has madeit very, very difficult. And one
of the things that is reallychallenging that's probably
going to continue for thefuture, is the staffing
challenges that are going to bepresent in the VA. You know, VA
entered the pandemic with about48,000 vacancies, and I suspect
(06:00):
it's at a much higher level now.
And of course, recruiting peoplein any part of the economy is
challenging, but recruitingpeople in the government is
certainly going to be have itsown challenges moving forward.
Louis Celli (06:13):
And you really bring up an excellent point, to
be fair, I mean, VA has beenwrestling with nursing, mental
health and other criticalspecialty shortages for years,
as has the rest of the country.
Dr. David Shulkin (06:26):
Yeah, and this is where Congress can help.
I know that we're gonna hearfrom Chairman Takano, in this
episode, and you're going tohear how he's been working to
give increased compensationauthority to the VA, to be able
to stay competitive with theprivate sector. And that's
really important. If we don'tgive VA the tools and
(06:50):
flexibilities to remaincompetitive. I think we can all
see that we're headed for yetanother crisis in the VA.
Louis Celli (06:58):
Chairman Takano wasn't the chairman when when
you were secretary, but you'veworked with him in the past,
right? Yeah, he was
Dr. David Shulkin (07:04):
the ranking member. And I've worked with him
all throughout my time I findhim to be thoughtful and fair. I
think that he's in a verychallenging situation, in trying
to get things done. And I thinkhe wants to get things done,
because he believes verystrongly in this mission, and
(07:27):
the importance of having astrong VA.
Louis Celli (07:30):
Chairman Takano has always been great to work with.
As you know, he representsCalifornia's 41st district, just
outside of West LA andRiverside, and he went to
Harvard. So
Dr. David Shulkin (07:41):
yeah, yeah, he's a smart guy. And, and he
knows the complexities of boththe VA as well as getting things
done between the House and theSenate. And you'll hear at times
that he's frustrated by the lackof progress that's being made.
Louis Celli (07:58):
One of the things that I'm really hoping that
we're able to cover today is thethe burn pit legislation. I
mean, there have been, you know,more than one legislative
initiatives that have beenintroduced, and some of them are
pretty controversial.
Dr. David Shulkin (08:12):
Yeah, and it's not clear how this is going
to be worked out, you know, thehouse has submitted a bill that
is much broader, you know, givesmuch greater presumptive of
authority, which is going totranslate into probably a more
expensive bill than necessarilythe Senate. And yet, you know,
(08:35):
neither neither of these billsreally is going to probably, on
its own be successful. Sothere's going to need to be some
ability to compromise, someability to keep focused on what
the veterans really need. And ofcourse, in the burn pit, Lu, as
(08:55):
you know, the presumptive leavesthat have been granted are the
ones that, frankly, in my view,are the least sensible, that is
the very, you know, asthma andsinusitis, and very, very common
procedures, or common diagnoses,were the ones that we really
(09:16):
think about where people arehaving life threatening, and
ultimately are dying from theirexposure, such as brain tumors
and lung tumors and severerestrictive lung diseases. Those
aren't being covered right now.
And so we've got to bring somecommon sense into this. And I
think that's going to be a realchallenge for the Senate and the
(09:40):
House to stay focused on thatissue.
Louis Celli (09:44):
I absolutely agree.
And as we talked about earlier,they have more than just the
responsibility of authorization.
They have oversight, and nowthey're going to have their
hands full between keeping theEHR transformation on track and
figuring out you know, how tonavigate the burn pits legend
which has turned out to bereally kind of the number one
legislative priorities of mostof the VSOs. And then, you know,
(10:07):
dealing with their their lifechanging war injuries, and all,
while battling the suicideepidemic, it's gonna be an
important discussion today.
Dr. David Shulkin (10:15):
Yeah, the other issue, besides what you
mentioned, Lou, I think to payattention to is the pandemic
itself. Because, you know, Icome at things often from a
healthcare perspective. Andthere is no healthcare system in
the country, maybe even in theworld, that hasn't been
fundamentally changed, probablyfor decades. Because the impact
(10:38):
of this pandemic and the VA,being the largest health system
in the country is no different.
I think there needs to be somevery strong retro spective
analysis of how VA has performedduring the pandemic, whether
they have lived up to thecommitment to taking care of our
(10:59):
veterans, but also to thatfourth mission, that we don't
hear a lot about that duringtimes of national emergency,
whether they be, you know,related to war, or related to
natural issues, like pandemicsor hurricanes, the VA has the
responsibility to be able tostep up and help other Americans
(11:20):
besides veterans. And so we needto take a hard look at that
fourth mission and see whetherVA has learned and can do even
better, should this situationoccur again, and also how VA
comes out on the other side ofthis pandemic? And again, not
necessarily from looking tocriticize, but looking to learn,
(11:44):
and looking how we can performeven better in the future.
Louis Celli (11:50):
Absolutely agree. I mean, those are excellent
points. And I think what we'redealing with now is really just
global exhaustion, from dealingwith this and almost an apathy
at this point, you know, to, youknow, in looking forward and
trying to get to the end of it.
So I say we get them in here andget started. All right.
(12:17):
Mr. Chairman, welcome to thepolicy. That's podcast. Hey,
thank you so much for taking thetime to join us today.
Mark Takano (12:22):
Oh, my pleasure. My pleasure.
Dr. David Shulkin (12:24):
Great. Mr.
Chairman, it's great to see youagain. I think I saw you last
that Arlington Cemetery onVeterans Day, which was a great
day to be out there recognizingour veterans. And for our
listeners of the policy bedspodcast, which is a very large
audience of people that caredeeply about these issues. This
(12:44):
is really your second term nowas chairman of the House
Committee on Veterans Affairs,and many of our listeners
probably would benefit fromhaving an understanding of what
are some of the key issues thatyou've been working on in the
committee? And what are some ofthe significant accomplishments
(13:05):
that have happened over thoselast number of years that you've
been leading this committee?
Well,
Mark Takano (13:12):
I you know, I assumed the chairmanship in
January of 2019. And in thatfirst year, we accomplish
something very, very important,which was the passage of the
Bluewater Navy Vietnam veteransact. That was a decade in the
making. I can't come. I can'tclaim total credit for this. I
(13:36):
mean, it began with my, myformer colleague, Tim Walz,
who's now the governor of whiskof Minnesota. In Tim worked on
this bill, 10 years prior, andactually, you know, former
chairman, Phil roe had actuallypassed a version of the bill in
(13:59):
the previous Congress, but itwas it was it was stuck in the
Senate. Sad to say, sometimes wesay in the house that the enemy
is not the other party in theHouse. The enemy is the Senate.
So I think Phil roe understandsthat I took up the bill in 2019.
(14:21):
And it was this was a verysignificant it's a it was a 40
years in the coming. It was abittersweet victory. Why was it
bittersweet? Because if we haddone something like Bluewater
Navy, decades before we couldhave helped so many more
veterans who passed away in thatinterim time period, and what
(14:44):
that bill do it it accordedaccess to health care and
disability benefits to thoseveterans who served on surface
vessels in the territorialwaters of Vietnam. They were not
getting Third expose becausethey didn't serve on land, the
(15:04):
bill hangs up on my wall withgreat pride. In 2019, we also
took up the failure to reallymake a huge dent in death by
suicide among our veterans, thatnumber stayed persistently high.
It, it was a bipartisanfrustration that we had a spate
(15:25):
of suicides that occurred on onveterans, VA campuses, I wanted
to make sure those suicidesweren't in some way a form of
protest. And we found that theyweren't really a systematic
protest, it was really that, youknow, many veterans who are
(15:46):
experiencing great healthcomplications, a number of
things intersecting together,knew that the VA would take care
of the remains. And in so manyways, the suicides on those
campuses weren't really aprotest. But but it called
(16:07):
attention to the fact that thethat the suicide rates were
high, we had a White Houseinitiative that the Trump
administration at the time, butyou know, in that Congress, we
passed the veterans compact Act,and the Commander John Scott,
Han and mental healthimprovement, yeah, it was had an
(16:28):
array of bipartisan ideas, andboth bills. One of the things
that I'm very proud of the pastthat was originated from my
office was the the Access Act,which permits any veteran
regardless of their eligibility,to call the Veterans Crisis
(16:48):
Line, and get access toemergency metal, emergent,
medical, mental health care,life saving health care, without
worrying about having to pay.
Now, this part has been fullyimplemented, but the
implementation is coming soon.
And soon, communities, families,veterans across the country are
going to be able to know that ifthey get a veteran to call that
(17:10):
line, when they're having anemergent moment, they can get
access to care and not have toworry about the bill. Another
big area that we've been workingon is making the VA a welcoming
place to all veterans,regardless of their racial
background, religiousbackground, gender, you know,
(17:32):
that's the in sexual orientationand gender identity. It's
amazing to me that we have, it'snot really amazing, but it's
it's alarming. The numbers ofwomen who feel that coming to
the VA is a barrier because ofthe climate that exists in vas.
(17:52):
And so one of the things is thatmy colleague, Julia Brownley,
who chairs the healthsubcommittee who chaired the
existing women veterans TaskForce,
they put together the DeborahSampson act, and one of the
things that that Act does is itrequires VA to plan for
(18:14):
retrofitting medical facilitiesto better serve women veterans,
and that often means having aseparate access way for women to
come into the VA and not besubjected to looks or, you know,
cat calls or, or disturbinginteractions. In you know, VA
(18:35):
has already made a downpaymentof $20 million for this
retrofitting. There's many moreelements of that bill that were
enacted. And so I'm very proud.
You know, those are just threeof the things that highlights of
what we've accomplished in thelast Congress and
Louis Celli (18:50):
great, Mr.
Chairman, I mean, as you talkabout, your job is fairly
comprehensive, in addition torepresenting the, you know, your
district in California, you'rethe chair of the House Veterans
Affairs Committee. And, youknow, you've talked about some
of the laws that you've passed,but but also, you know, a large
portion of your job is oversightoversight for the Department of
Veterans Affairs, making surethat they're implementing and
(19:11):
carrying out the laws thatyou're, you know, that your
committee really helped turnedinto law. And, you know, a
couple that come to mind thatwere recently passed, you know,
as support for caregivers and,and the Air Act, you know, the
asset and infrastructure act.
Can you tell us a little bitabout how that might be going,
Mark Takano (19:31):
the caregivers is going far too slow for my
liking. People may notunderstand that. It has a lot
more to do with implementationof new programs at VA or the
expansion of programs and theinability to kind of get these
programs up and running quickly.
relates to antiquated IT systemsin the inability to broadly
(19:56):
administer programs You know, alot of the work we're doing is
trying to get it to up to speed,the air commission for the st.
Asset review, it's a it's abasically, it's a review of all
of the facilities across thecountry, what facilities need to
(20:16):
be upgraded and updated. Andbelieve me, we've got some
facilities that date beforeWorld War Two, in some cases be
will we really old facilitiesthat need to be updated and need
to have the capacity to housethe modern equipment and the
kinds of medical teams that wehave today in modern medicine,
(20:37):
contemporary medicine, so theair commission was supposed to
actually be constituted by now,we're held back by the fact that
the some of the congressionalleadership, and we just throw
some of the Republicanleadership under the bus, they
haven't they haven't named theywere slow in naming their
commissioners sending theirnominations to the President,
(20:59):
that still has to go through aSenate confirmation. The
Secretary of Veterans Affairswas supposed to make
recommendations based on marketassessment data that had been
gathered in the last two orthree years, he delayed the
publication of thoserecommendations. Part of it was,
you know, kind of reviewing thedata in terms of accommodating,
(21:25):
you know, concerns about howwould you know, the pandemic and
COVID-19. But really, I thinkthe Secretary was more concerned
about the timing of hisrecommendations, signaling to
some of the workforceprematurely, he didn't want to
an overly alarmed workforce outthere and making drawing
conclusions prematurely aboutthese recommendations. And he
(21:47):
didn't want to see an exodus.
Because he's trying to protectthe workforce. So So you know,
there's been a sort ofbipartisan, sort of looking the
other way, about, about theimplementation of the air
commission. So I have no doubtthat it's, it's going to get up
(22:11):
and running. But my concern,once it does get up and running,
I will be having hearings, I'llbe conducting hearings and
having the secretary periodbefore us to explain his
recommendations. But I'mparticularly going to be
interested in how the lessons ofthe pandemic are going to
(22:32):
reshape the thinking that wentinto the commission, because I
think many people who institutedand created the commission and
created this whole process,we're seeing that as a way to
kind of like, dramatically slimdown the physical footprint of
VA, and I don't know that, thatreally is that's going to hold
(22:54):
up after this pandemic, that,you know, one question how who's
going to who's going to have allof the kind of reserve ICU
units, when the private sector,this really have really been
driven by policies to kind of,you know, minimize them out of
bed space? You know, that kindof run, like kind of an adjust
(23:17):
in time sort of mindset? So Imean, you know, that's a
question that I that's example,the question that would come up
as we go through theircommission review.
Dr. David Shulkin (23:27):
Mr. Chairman, I really appreciate the way
you're thinking about that. Andyou're sharing the way that
you're going to approach this. Ithink you're right, the pandemic
has changed so much for thecountry, and certainly for
healthcare. And of course, youknow, we always worry about what
about the new conflict, and ifwe face people returning that
(23:48):
are going to need our help thatthat raise their hands thinking
we're going to be there forthem. So So I think you're
approaching this in the rightway. I do want to go back to
what you had talked aboutearlier in the podcast about the
accomplishments that youachieved or or with others
helped achieve in the, theBluewater Navy act that you have
(24:10):
hanging on your wall, because ithas a lot of similarities, I
believe, to what our veteranstoday are facing with burn pit
exposures, in that the bluewater Navy didn't have this
actual data, to be able toscientifically confirm the
associations between AgentOrange and so many of the health
(24:33):
issues that we're seeing. Andit's the same issue with the
burn pit issue that the data isnot necessarily there yet. Just
today I was contacted by amother who lost her 28 year old
son who had been serving inAfghanistan, and he died of a
glioblastoma and as you know,not many 28 year olds normally
(24:54):
die of brain tumors like that. Iknow that you've worked very
hard On the pact Act, which isvery comprehensive in addressing
this blue, this burn pit issue.
Can you tell us a little bitabout why you feel so strongly
about burn pits and where youthink the pact act is and if
(25:15):
there's going to be a resolutionto this coming forward?
Mark Takano (25:21):
Well, Mr.
Secretary, let me just say thatthe Bluewater Navy Vietnam
veterans act really deepen themy conviction that we cannot
allow what happened to ourVietnam veterans to be repeated
with, you know, the Iraq andAfghanistan generation of
veterans. It's already been 20years since we started that
(25:43):
conflict. But Bluewater Navy waslike the bill was four years
after the fact right and and tothink that we we saw just huge
numbers of Vietnam veterans notbe able to benefit from the
(26:05):
Bluewater Vietnam veterans Actand the slow pace at which the
VA could address these claims.
And what is I think, reallytroublesome or even offensive is
the idea that our veterans theburden of proof is put on our
(26:28):
veterans. Our veterans who don'tnecessarily have connections to
research institutes, and whoaren't scientists themselves.
It's veterans and their familieswho have to go through this as
their suffering. So I believe aone of the principal ideas of
the pact act is to shift from asystem where the burden of proof
(26:53):
for the service connection ofyour condition is put on you the
veteran, we need to shift thatto a system where the benefit of
the doubt is extended to you.
Because it may take decades forscientific evidence to actually
link and we may never conclusivethere, there may always be an
(27:16):
alternative explanation for whyyou got that oil called geo
blastoma or Gladstone, yes,glioblastoma, geo blastoma.
There always may be analternative explanation that's
plausible in could be a reasonfor why the government denies
you. And but what we do, though,are the facts. The facts are you
(27:38):
stepped up, the nation made apromise to you to take care of
you to have your back. And weknow that millions of veterans
were exposed to burn pits thatcould not exist in the United
States. No community would havepermitted the these huge burn
pits to be burning 24/7 with thekinds of things we don't even we
(28:04):
have they even keep track ofwhat they put in these burn
pits. But we know that they didput a lot of things that
shouldn't been in those burnpits and would not have been
permitted in the United States.
So the military does not have toknuckle down under OSHA rules or
(28:24):
other kinds of environmentalrestrictions that every state
and every community or countrywould have done. So what is what
is my pact, what is PAC act do?
Well, it basically would providehealth care for 3.5 Toxic
exposed veterans, it wouldestablish a new review process
for establishing toxic exposurepresumptions.
(28:52):
You know, Mr. Secretary, whenthe the Academy of Sciences
presents a secretary, even evenwhen they present the secretary
with compelling evidence thatthere is a reason to conduct a
an illness to some sort ofexposure, that secretaries are
often not able to have theauthority, but not really they
(29:15):
have to kind of knuckle underwhoever is in charge of OMB. And
so your Secretary believes it'sthe right thing to do. You know,
a secretary often is constrainedby by other things. And so, you
know, we've worked together withthe VSOs to try and create a
process which which puts theveterans first and that own
(29:37):
before us, right. So we create anew process, we we concede
exposure to airborne hazards andburn pits based on the location
you served and the date youserved. And that's where how we
get to 3.5 million exposure. Nowall those 3.5 million going to
get disability benefits No. Butyou can bet if a rare cancer
(29:59):
shows up At age 28, instead ofwaiting for the absolute
scientific connection they havethrough an academy of science
that may take 40 years to do.
We're saying let's give thebenefit of the doubt to that
rare cancer and by definition, arare cancer is not going to show
up in all 3.5 million veterans,right? So what we do we, we
actually look at 23 respiratoryillnesses and cancers, and there
(30:22):
probably were there were cancersrelated to burn pit and airborne
hazard exposure. You know, threeof those respiratory illnesses
have already been sort of, insome way vetted by the National
Academy of Sciences. And theSecretary is already moving on,
on the regulations to establishthose as presumptive illnesses.
(30:43):
But roughs are really like rarecancers. And I think, you know,
it's going to cost us somemoney, but it's not going to be
we're not going to see all 3.5million soldiers have those
those cancers, but we need totake care of those who do get
those cancers. We create apresumption of illness of
exposure to radiation forveterans who participated in
(31:04):
cleanup activities andPalomares, Spain and the you
know, what, in a wet techasshole in the Pacific, we
expand Agent Orange exposurepresumptions to veterans who
served in Thailand, Laos, andCambodia, we really look to
improve the data collectionbetween VA and the Department of
Defense, what's called the Eilersystem. And so they're there. So
(31:29):
we can actually kind of trackthis and study it. And we
require VA to providestandardized training to improve
toxic exposure based disabilityclaims, at adjudications.
There's much more, but I've kindof just given you the kind of
more important ones. But youknow, we've got the nine, nine
(31:50):
major veteran serviceorganizations, advocates such as
Jon Stewart and John feel, andover 70 co sponsors. We have the
momentum in this Congress, andthis house representatives, I
think, to potentially have astrong bipartisan vote, I'm
talking to my Republicancolleagues, they want to do the
(32:11):
right thing, as well. It doescost money. But you know what,
it's, this is not about money.
This is about keeping a moralcompact, a pack that we had with
our veterans, that when we sendyou in the harm's way, we take
care of you. And this is this iswhat I would call a cost of war.
(32:34):
I mean, it's, I really can'tdistinguish, paying for the
effects of a toxic exposedveteran, in this case, to burn
pits or radiation. It can'tdistinguish that from, you know,
paying for body armor or a tank,or there are arms means the
(32:55):
American people in the Congresswould not hesitate to equip our
soldiers with what they need inthe heat of battle. And the
truth is, when you've beenexposed to toxic substance, and
you're suffering, the illeffects of it, you're you're
debilitated, you got a cancer inyour head and your brain, you're
still in the heat of battle,you're still in the heat of
(33:18):
battle. So that's, that's,that's, that's what I have.
That's what I how I feel aboutit. And I know, Mike, I know
that a lot of members feel thatway. Yeah,
Louis Celli (33:27):
Mr. Chairman, your your team has been very gracious
and has been able to carve usout a few extra minutes. And we
know you have, we know that youhave a, you know, a pressing
meeting that's backed up againstthis. So, you know, I want to
make sure that, you know, firstof all, I want to thank you for
bringing up a couple of key andimportant issues. One, that, you
(33:47):
know, OSHA regulations wouldabsolutely prohibit that type of
toxic behavior happening onAmerican soil. And yet we did
it, you know, within really, youknow, within living and eating
range, you know, of our of ourAmerican servicemembers. And the
other thing is, we have no ideawhat was in those pits, we'll
(34:07):
never know, DOD was never forcedto keep any, any sort of
inventory over what they burned,whether it was computers, or jet
fuel, or whatever, that whateverwas in there. The real question
that I think is relevant thatthat our listeners are going to
want to hear about is, as youknow, you know, the Senate has
introduced another bill. I thinkit's at least a second or third
(34:31):
attempt at trying to addressthis, which is markedly
different than then the Housebill. And I'm just I'm curious,
what you see, as you know, asreconciliation. We, you know,
we've all been doing this a longtime. We know that, you know,
there are concessions that arealways made on every bill, how
(34:52):
do you see these negotiationsplaying out? Well,
Mark Takano (34:55):
I see them playing out based on how Strong we
generate the kind of support wegenerate in the house, how, how
the we gauge what the, themomentum we create with a strong
House vote will shape thesenegotiations. And the American
(35:18):
people can shape these or thesenegotiations, I would say the
amazing unity of the veteranservice organizations, in the
advocates for a robust, strongand comprehensive bill is going
to reverberate, they're going tobe coming to town in the next
(35:38):
six weeks or so. Right? It's soimportant that the conversation,
not just be in Washington, thatconversations happen all across
this country. And veteran voicesare really respected the desire
of the American people to doright. by those who put
themselves in the line of fire,and those who are suffering, the
(36:02):
effects of their service, theAmerican people really want to
help them. So my view is that isthat I'm doing what I can here
personally, every day. And I'vegot an enthusiastic corps of
members on a bipartisan basiswho are interested in that in
the same as well. And I know theVA, I know, the veterans service
(36:24):
organizations, this is theirnumber one priority, it is hard
to say no, to what everybodyknows is the right thing to do
it really hard. And we've justgot to make sure that people
know, look, what they producedin the Senate is not bad policy.
My intention is to include it.
But it can't be It can't be it.
(36:47):
It can't, it can't only be thatit has to be significantly more.
So I congratulate the Senate onwhat they accomplished. But we
can do better. We can we can dobetter. And we will do better.
This is the exact time that weneed. When our country is so
divided. We need a good pre taxto come together. And I'm so
(37:11):
grateful that our veterans haveoffered us this opportunity to
come together. And so onceagain, you know, the cause the
cause of serving our veteranscould bring us together and I
hope mine I believe it will, Ibelieve it will bring us
together.
Dr. David Shulkin (37:28):
Yeah, Mr.
Chairman, you've been verygenerous with your time, I just
want to wrap up with one finalthing you had mentioned earlier
in some of your comments thatthe pandemic really has changed
everything. And we're going toneed to look at some of these
issues through the context of avery different world going
forward. And I just wonder ifyou would just share any
(37:48):
thoughts you have about how VAhas performed during the
pandemic, they not only have hadthe responsibility of caring for
the country's veterans, but alsoin their fourth statutory
mission for emergencypreparedness. And, you know,
it's clear coming out of thepandemic, that the VA like
(38:09):
everyone else in health care isgoing to be dealing with severe
staffing shortages. And, youknow, already significant
amounts of vacancies that couldbe worse, just given what we're
seeing throughout all of theeconomy. I just wonder your
thoughts about about both how VAhas performed and what it looks
(38:31):
like going on the other side ofthe pandemic?
Mark Takano (38:35):
Well, there's a lot to your question. Just real
quickly, we just passed theraise act I had hoped it would
have. It got bipartisan support.
44 Republicans crossed over andvoted for it. I was disappointed
the ranking member didn't throwhis support behind it. Vaccine
politics Scott played, but Butyou know what, in spite of all
(38:55):
that 44 Republicans in the Housestill voted with the Democrats
to raise the pay of nurses inmetropolitan areas. So there's a
tremendous, you know,competition now for that talent.
I'm hopeful that we'll get backto some form of a build back
better. We included in Bobackbetter, a lot of money for more
(39:20):
training. But listen, we get tothe performance of the VA during
the pandemic. You mentioned thefourth mission, many people
don't realize that the fourthmission that exists. The fourth
mission, basically is about theVA. You know, it's the largest
health care system in ourcountry. And when there's a
natural disaster in the local orregional healthcare system is
(39:47):
stressed and begins to breakdown. The VA through its system
of volunteers from its ownworkforce can be deployed to
provide a backstop. In its VAhas done this time and time
again in cases of hurricanes andearthquakes and fires. And even
in the mass shootings, it's it'sprovided community support. When
(40:11):
our emergency rooms are justsort of filled with gunshot
victims, the VA steps up, noless. So in a time of a
pandemic, when nursing homeswere overwhelmed, VA has
tremendous infection controlexpertise. And when invited in
VA performed magnificently whenthey were able to partner, but
(40:36):
they have to be invited in.
That's part of the I actuallythink that VA ought to be put
positioned, so it can be moreproactive. So it can actually
lead and not have to sit backand wait for the governor of a
state to request. Or it may makemore sense for VA to kind of
lead emergency response thanthat other agencies that are
(41:00):
positioned to do that. VAperformed magnificently, with
its own community living centersof what our community considers
the basic long term carefacilities, we have very few
infections, Dr. Stone made somevery decisive decisions about
closing the access down was hardon those families that had
(41:22):
family members in those communalliving centers. But it saved
lives. Where we lost a lot oflives were in the veterans homes
in the states, the stateveterans homes, which are not
administered by VA, they'readministered by states, I
believe there needs to begreater oversight authority of
VA to make sure that they're upto standard, we did provide an
(41:45):
American rescue plan, more moneyfor states to upgrade their
facilities, and we needoversight. Related to that. I'm
worried that we're not doingenough to prepare for future
pandemics we certainly didn't doas well as we could have with
this current pandemic. But alongwith that, we have I think, the
(42:05):
specter of climate change andmore frequent extreme weather
events across the country. Andso if you have a pandemic, which
is everywhere, and extremeweather events, also that maybe
not just one, but maybe two orthree in a year, we need to
(42:27):
start looking at the fourthmission of the VA in a much more
expansive way we haven't reallylooked at what my committee
began to do is to take a look atextreme weather events. As part
of the planning that VA needs todo. The VA in Puerto Rico
clearly wasn't anticipating aprolonged prolonged shutdown of
(42:52):
power. Although it has its ownpower, the VA has its own power
sources and is self contained.
What I'm getting at is the theprolonged need of veterans to
who are remote and vulnerable,who didn't have access to power.
So I mean, these are the kindsof things that the fourth
mission as we as we look toupdate the fourth mission,
(43:15):
responsibilities, pandemics,natural disasters more frequent.
But VA, under the circumstancesperformed magnificently. We need
to pay attention to the entireworkforce needs of the country
in terms of health care. So thatVA is not competing for what
little scraps there are witheverybody else.
Louis Celli (43:37):
Mr. Chairman, I and I think you would get broad
support on that. As a matter offact, one of our most recent
podcasts dealt with publicprivate relationships. And, you
know, and how successful thosehave been. Listen, I really want
to thank you. You've been verygenerous with your time as the
Secretary has said, we know thatyou're that you're very busy
leading that committee and youknow, really thank your team.
You know, Jenny and Miguel andLana for us. They really helped
(44:01):
us pull this off. And this hasbeen a fantastic and very
informative podcast.
Mark Takano (44:05):
Well, thank you.
Thank you. My pleasure.
Dr. David Shulkin (44:07):
Thank you about seeing you again. Bye bye.
Louis Celli (44:13):
Really, is it that's all the time that we have
for today. So join us next week.
You are not gonna want to missthis podcast because this is a
follow up to a previous podcastthat we had done on cannabis.
And there have been someadvancements in the industry.
We're going to hear from Dr.
Steven Groff, about how hebecame one of the first
federally licensed growthfacilities in the country. See
(44:35):
you next week.
Charlie Malone (44:42):
Thanks for listening to the policy bets
podcasts. For more informationabout projects and other
podcasts go to policy vets.org
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