Reforming the troubled Department of Veterans Affairs was a key campaign promise of candidate Donald Trump. So how have things changed since he took office? What are the key and unexpected issues facing veterans today? And what has Department of Veterans Affairs Secretary Robert Wilkie done to meet these challenges?
Wilkie recently sat down with Epoch Times senior editor Jan Jekielek to discuss a range of veterans’ issues, including the mental health crisis, opioid addiction, and homelessness, and how Wilkie is using the largest budget in VA history to address them.
Jan Jekielek: We’re just about a year into your tenure as the secretary of the VA. You’ve taken a very hands-on approach to things, it seems. You’ve been to, I think over 30 states to assess different centers and so forth. You’ve done some work, and you’ve let go of some medical directors; I’ve been following that a little bit. You’ve asked for a large VA budget, which you got—I think a record one—and presumably, it was needed. I’d like to know, one year in, how do you think things are going here?
Robert Wilkie: Well, the state of VA is good, and I will tell you why. It’s two reasons. One, we do have the most noble mission in the federal government. And I have been accused of being a historian, so I’m going to plead guilty to that and say that if you look at presidential campaigns, and if you look at administrations since the end of World War II, no president until Mr. Trump has made veterans the centerpiece of both the campaign and the administration. You can’t find it. And he—thankfully, and for me, a great honor—allowed me to help implement his vision of what VA should be.
And that means two things: world-class service, but also choice for veterans. Give them the ability to do what is best for their needs and not necessarily put the institution at the center of a veteran’s life. And I think that’s a sea change in the way we do things here. The budget that you mentioned is the largest in VA’s history, $220 billion. But we also have 370,000 employees and take care of 9.5 million Americans. So we are the second-largest federal department. I think—given everything that this president has done—we are on a much different trajectory from what VA has had in the last few years, and we’re very proud of the progress.
Mr. Jekielek: The big issue that a lot of people want to know about was the wait times, right?
Mr. Wilkie: Right.
Mr. Jekielek: How are we doing?
Mr. Wilkie: Well, I will rely on a source outside of this department—the American Medical Association, [which] in January in its journal said that our wait times are as good or better than any in the country, when it comes to the most important medical services, [whether it] be primary care, cardiology, things like that. So we have turned the corner. I think where people get confused is they conflate wait times for first-time patients with those for continuing patients. We’ve always had a very short wait period for those who have been in the system. The trick for us has been getting those wait times down for those who are entering the system. And what the president has done by giving me the authority to open the aperture on choice, he’s saying that if a veteran has a wait time that is not sustainable for him or for her, then we give that veteran the opportunity to go into the private sector. So we’re on the cutting edge for America when it comes to offering alternatives to the normal routine of care.
Mr. Jekielek: This is quite interesting, because there was a previous act that focused on some kind of veterans’ choice in the previous administration. I think, roughly, the Choice Act. And now we have the MISSION Act that’s replaced it … as of about a month ago. Tell us a little bit about the stark distinctions that you’re aware of.
Mr. Wilkie: Well, the stark distinctions, it’s very simple because you have to look at the cause for each. The Choice Act came about as a result of the tragedy that occurred in Phoenix: Wait times, and there were veterans who, in some cases, lost their lives because of those wait times. And that was Congress’s immediate reaction to that particular instance. So they passed legislation in the heat of passion and it required an organization the size of VA to reform itself in 90 days. And that is a near-impossibility for any organization of this size, be it in the government or be it in the private sector. And the system collapsed in on itself. What the president did when he came to office [was to] say, “We need a more systematic approach to the way we handle veterans and the way this department operates.” He worked with the Congress, the MISSION Act was signed, and the MISSION Act set parameters for us to get veterans not only better waiting times but provide them with choice.
Let me tell you quickly what it isn’t. The president wasn’t signing legislation that created a libertarian vision of VA. It’s not me giving you a car that says veteran and you go out and prosper in the private sector. What it does say is if our wait times are too long and we don’t have the care that that veteran needs, then that veteran now has the option of going into the private sector. The other thing that the president pushed that we are implementing now, at record pace, is that he has now allowed veterans to use urgent care. Something that most American citizens are familiar with, something our veterans did not have access to. Now, they can have the same kind of medical services that their neighbors have. And we keep them out of the emergency room by doing that.
Mr. Jekielek: So how many veterans are you expecting to take advantage of the private care option?
Mr. Wilkie: Well, we don’t know. That data will come to us as the days go by, since we’re only about a month into this. I can tell you that on the first day, we had 44,000 calls. We haven’t had as many per day as that, but we have several thousand calls a day. Now, they’re primarily asking about urgent care, but in terms of determining what the eventual number will be, I can tell you that our veterans’ satisfaction rates are at the highest level that we’ve ever had. They’re about 87.7 percent, which means veterans are happy once they get into the system and they tend to vote with their feet. I think last year, we had 58 million appointments across VA, which means veterans are generally happy because they can go someplace where people understand the culture and speak the language. But I do expect the steep rise in new services to be in urgent care.
Mr. Jekielek: And is there enough budget to basically handle the volume you’re seeing?
Mr. Wilkie: Yes. Absolutely. Of course, we were given great leeway with this last budget. We have about $94 billion in that budget, just for veterans’ health. And I think that is sufficient to sustain any changes in the patterns that veterans have shown when it comes to their own health care.
Mr. Jekielek: So that’s remarkable, the 87 percent. That’s your internal data?
Mr. Wilkie: Yes, that is based on surveys across VA. I put a great premium in not only trying to determine what our veterans want, but I also put a great premium on what our employees experience. I’ve preached customer service, but … not in the same way that many people understand it, in that I go to our people first. Because if they are not happy, if they’re not communicating with each other across compartments, then the chances of veterans getting top services is probably much diminished.
So we’ve seen employee satisfaction go up. But we’ve also seen as a corollary, we’ve seen our patient satisfaction rise dramatically in the last year.
Mr. Jekielek: I saw something about this: a nonpartisan group that sort of assesses the quality of the workplace.
Mr. Wilkie: Yes, so let me talk about that. Thank you for bringing it up. The Partnership for Public Service is a nonpartisan think tank. And they gauge the temper of the federal workforce. They gauge the efficiency of the federal workforce, and they determine through their studies if the federal workforce is actually performing for the citizens that it serves. And for most of my career, VA has either come in 16 out of 17 or 17 out of 17 in terms of best places in the government to work. It is now [at] 6. And I believe we will be higher when the next survey comes out. And that’s a testament to the changes that we’ve seen in the past two years with this administration.
Mr. Jekielek: That’s obviously a very significant change. What actually has happened that these ratings, do you have any sense of this?
Mr. Wilkie: A couple of things. One, we have a top-notch team here at VA. Most of the people who’ve been brought in in the past year speak the language. They have served at different levels, some at the general officer level, some at the enlisted level, some at the field-grade level. Others come from families with long military traditions, so they understand what families go through. And I think that has been part of it.
The other part of it has been we’ve let people go. Not “go” in terms of dismissing them, but letting them take the general direction from headquarters and perform to the best of their ability. And that’s a classic military way of running an organization. The leadership gives general directions, and you let people follow those directions and fulfill their duties. And once you give them that kind of power, I think you see morale rise across any organization.
Mr. Jekielek: So this actually makes me think of…you recently did a site visit, as I understand it, to Tomah, Wisconsin—
Mr. Wilkie: Yes, absolutely.
Mr. Jekielek: Which at one point was—
Mr. Wilkie: The epicenter.
Mr. Jekielek: I would say like a horror show, almost because of massive overprescription of opioids and so forth. And I know that that has turned around significantly. What did you see when you went there recently?
Mr. Wilkie: I saw a completely different picture of a VA hospital in the center of America’s great crisis, the crisis that began in Appalachia [and] southern Ohio, and spread quickly through the Midwest and now terrorizes the entire country. Change in leadership, change in direction, part of an overall VA overhaul of the way we address pain. Now, I’m going to take a step back for you and describe what a VA patient in most cases looks like. They’re sort of like professional athletes. They’ve spent—they’re people like my father—30 years jumping out of airplanes, suffering tremendous wounds in conflicts like Vietnam. They come to VA with chronic pain and pain that needs to be addressed. The traditional way of dealing with that is not talking about it and just giving people pills. That is a prescription for disaster and death, as we have found.
What VA has done is embarked on a dramatic program to reduce the prescription levels, which we’ve dropped by 51 percent in the past year or so, but we’ve begun to replace opioids with combinations of over-the-counter medicines that get at the pain source and not affect the brain. So instead of a Tylenol 3, we will give a patient a combination of aspirin and ibuprofen or aspirin and acetaminophen.
But the other part of this is whole health. If you had told my father, who was badly wounded in 1970 in Cambodia, that we would address his pain with Tai Chi or yoga or acupuncture, my nose would have been flat against my face. Because that was not part of the ethos; that was not part of the warrior ethic. But we’re finding with these alternative therapies that veterans are now accepting that we can make them not only feel better but function better. And we do that by not treating the brain.
Mr. Jekielek: That’s very interesting. And I understand Tomah has quite a robust facility for this realm.
Mr. Wilkie: Absolutely. It’s called whole health. And you can go to Tomah and you can get Tai Chi lessons, you can experience acupuncture. I even went through aromatherapy, which is designed to relax those in the room. And it’s all part of a very new and nuanced way of treating people who have the potential to do themselves great harm or are actually in the middle of doing themselves great harm.
Mr. Jekielek: So this also makes me think of another issue that you’re trying to address along with the White House: suicides.
Mr. Wilkie: Yes.
Mr. Jekielek: And big issue among veterans, obviously. And I think you’ve said it’s the single largest clinical issue, or something to that note. Well, tell me a little bit about PREVENTS and where we’re starting off and what you’re hoping to do.
Mr. Wilkie: So let me tell you where I’m starting off. We just talked about opioids. And I think that it’s part of a continuum that includes homelessness, includes mental health and, sadly, includes suicide, which is the end of that continuum.
And I think we need to start off in this country by having a very deep conversation about life and the value of life. The last day I testified in front of Congress, there was a story about three New York City policemen who had taken their lives. The month before that, when I testified in front of the Senate Appropriations Committee, NPR and The New York Times did lengthy pieces on the spike—the 30 percent spike in teenage suicides amongst those who’d watched a Netflix show called “13 Reasons Why.” We are experiencing this across the country.
For veterans, 20 veterans a day take their lives. One or two are on active duty. One or two are in the [National] Guard. Another 10, we have no contact with. So of the 20, 14 we never see. So the president has told the country that we are going to take a whole of government and a whole health approach to this.
My feeling is that if we just concentrate on the last tragic act of a veteran’s life, this will just be another report. We have to talk about mental health in this country; we have to talk about opioid addiction, and we have to talk about homelessness. Veterans are the most visible manifestation of this national problem because people tend to understand, at the base level, what it means to wear a uniform. And if we can change the trajectory on the debate, I think we will have performed a great public service.
The last thing I will say, it is for us to come up with new ways to reach those veterans who are not part of VA. [I’ll] give you an example. In the state of Alaska, which has more veterans per capita than any state, more than half of those veterans are not in the VA system. I actually asked the Alaska Federation of Natives to go out and double the number of tribal representatives that they have, to help us get into the wilderness and find those veterans. This task force should make it easier, by providing groups like that with financial and material resources to help them help us.
Mr. Jekielek: And how does the homelessness side, and perhaps, you can talk a little more about opioids later, but is this a very big problem among veterans?
Mr. Wilkie: Well, it is. It’s not as big a problem as it was seven, eight years ago. We’re down to about 40,000 veterans a day who are on the streets. But let’s just look at West Los Angeles. West Los Angeles is our largest VA hub. It is also the place where we have the highest number of veterans who are homeless. It’s also the place where we have the highest number of veterans who are addicted to opioids. And there is a convergence in terms of conditions that create the prospect of homelessness rising and staying as a permanent part of those veterans lives. So when I talk about suicide, I also talk about whole health and whole of government approach to these other areas.
And that’s a societal problem out there. It’s also a government problem because housing prices are sky high, and they’ve regulated themselves to the point where a veteran in many cases can’t afford to live. And I will tell you, one of the saddest sites that I’ve seen—and I was born in khaki diapers, I use that, that’s an honor Gen. Mattis bestowed on me and I take it as such. So I’ve seen this military life from many angles, through the eyes of classmates in kindergarten and elementary school whose parents didn’t come home from Vietnam, whose fathers didn’t come home. And I’ve seen wounds certainly in my own family. But one of the saddest sights I’ve seen is dusk in Los Angeles and cars coming into the VA center and the door is not opening, but veterans are in there coming back from work. They actually work. They do what we ask of any American citizen: to contribute to society, to build a tax base, and yet they’re homeless. And that is one of the saddest stories that I’ve ever come across. And we have to work on that to help those who are doing what we ask of them.
Mr. Jekielek: And so what are some of the things that the VA’s doing now to directly address this?
Mr. Wilkie: On that front, we need more transitional homeless housing. The other thing that we are doing—and this pertains across the board and not just [to the] homeless: same-day mental health services. We’re increasing our vocational rehabilitation training, our occupational training for those. We are working with non-governmental organizations to place veterans in the job market, in the workplace.
But homelessness, we can only do so much. But if the policies of the states and localities make it so difficult, we’re never going to get our arms completely around that problem. We’ve made a huge advance. I mean, several years ago, we were talking about hundreds of thousands of veterans on the street. Now we’re talking about 40,000. So many of our largest cities have already eliminated homelessness—places like New Orleans and Houston and Jacksonville. So it can be done, and it can be a model for partnership between the federal government, the states, localities, and charities.
In New Orleans, I’ve visited the city’s homeless shelter. There were no veterans there. Because the city and VA, working with Catholic Charities, worked to get veterans off the street. And now, there are communities of veterans—veterans who are formerly homeless—living with other veterans and in and around the city of New Orleans. And that’s happening across the country. I wish I could snap my fingers and make it happen in Southern California.
Mr. Jekielek: Right. But you’re encouraging these kinds of partnerships, these kinds of policies.
Mr. Wilkie: Yes.
Mr. Jekielek: Let’s jump to another issue. And this is kind of a big part of what I think your task is, and you can correct me if I’m wrong, but it’s basically dealing with the waste and dealing with what has been described as rampant corruption in the agency. There’s been this VA Accountability and Whistleblower Protection Act that was passed. How is this actually helping?
Mr. Wilkie: Well, it gives me authorities that my other cabinet colleagues are envious of. Most cabinet departments have a general counsel and an inspector general, and it’s their job to not only find those who are not doing their jobs, but also to begin the laborious process of removing those who are not living up to their oaths. I have another prong and that is the Office of Accountability and Whistleblower Protection. And that is an investigatory arm that we have to do two things. One, protect those who come forth with a legitimate concern that something wrong is happening. There’s protection for them. But it’s also an arm that looks at those who are not doing their jobs. And it does make it easier for us to remove those individuals.
Now, the president had actually signed an executive order, several months before the Whistleblower Act was passed and signed by him, that made it easier for the secretary to remove employees who were not doing their job. And the reason that’s important here, if, and I’ve been accused of dismissing custodial people. Well, we have more custodial people than we have hospital directors. We only have 170 of them, and we’ve removed some of them.
But let’s talk about what happens in a VA hospital. This is not the Department of Labor. If someone doesn’t sweep the floor in the Labor Department or the Commerce Department, what you have is a dirty floor. If someone doesn’t sweep the floor at a North Carolina VA hospital, you’ve got more than a dirty floor. You have the potential for human catastrophe. And that’s what makes our mission different from the mission of any other department in the federal government because the consequences of failure are so high, and we need that authority. And what I’ve found is 99 percent of the people want to do a good job. That’s why you see morale up. That’s why you see our leadership walking the post, as we say in the military, going across the country, talking to people.
We’ve also put in place something we call the Just Culture. Now, the Just Culture is familiar to anyone in the U.S. Air Force. It was put in place by Curtis LeMay, when he became the commander of Strategic Air Command. And what it is is a process. So let’s say you’re meeting on Wednesday. Wednesday morning—and this happens every morning, but let’s pick Wednesday—the squadron commander gets with his fuel man, his maintainers, his intel guys, his pilots, his flight surgeon, and they go over what happened on Tuesday. Not so much to look at what was successful on Tuesday, but what might’ve gone wrong on Tuesday so that they have lessons learned in place. So what does that do?
Mr. Jekielek: Kind of like a debrief, basically.
Mr. Wilkie: Yes. It gives people stock in the leadership process. It gives people a hand in the decision-making of a higher authority. And once people are involved in the day-to-day management of their workforce, problems tend to disappear.
The beauty of that system in the Air Force is that with the consequences of failure in Strategic Command being so great, we haven’t had those. And we’ve brought that now to VA, and I’ve participated in several of those meetings at the highest level, which is the network directors level. But I’ve also participated in those sessions and the sterile processing units and the custodial units, who are at the other end of the pyramid. And we found that not only has morale has gone up, but mistakes are fewer and fewer.
Mr. Jekielek: Well, that sounds like a very positive development. So speaking of the whistleblowers, are you protecting any whistleblowers, as we speak? I’m not asking for names of course.
Mr. Wilkie: We have hundreds of investigations going on as we talk, and people are protected under the law. And each circumstance is different. And I will say not every whistleblower is right. I mean, not everyone who claims status is also worthy of beatification. But we protect those. We do the investigations. And it’s an authority that I’m glad that I have.
Mr. Jekielek: There was a Washington Post article you’re probably aware of, a couple of weeks ago. People were being allegedly, improperly—fake appointments were being made to cut the waiting lists, so to speak. You’re aware of this?
Mr. Wilkie: I was aware of it. I will say that The Washington Post was right on top of things by reporting it. I think it was a 2015 story. But we’ve investigated that over and over again and found nothing to that story. I think what happened, and I obviously wasn’t around when this came about, people saw two lists. Well, one list is a medical list, and the other list is an administrative list. That’s a process list about checking off whether you have the right amount of paperwork. So they are two very different things, and they were conflated into one. And, yes, there was a longer wait time in that period for an administrative check as opposed to a medical check. But they were two very different things.
Mr. Jekielek: Interesting. Good to get that clarification. With respect to staffing cuts, and there have been considerable ones. And what impact have you seen so far?
Mr. Wilkie: I wouldn’t say staffing cuts. The budget that I just presented calls for 390,000 employees. We have 370,000 employees. So we’re on an upward trajectory when it comes to adding people, but we have to compete in the workplace, the marketplace, and we have the same problems that the private sector has. For instance, America has a severe shortage of mental health professionals. America has a severe shortage of primary care physicians. So, yes, we are short in many of those categories, but the rest of America is, as well.
Mr. Jekielek: Is there anything remaining that’s kind of stopping you from basically building up? Well, one, I suppose, letting go of some people that need to be let go of, and also getting the 20,000-odd people that you still need.
Mr. Wilkie: I have permission to be more creative than my cabinet colleagues do, for instance. There’s been a federal pay scale in place since the 1880s. The Civil Service Reform Act of, I think 1887, and that set the standard for how we pay those working in the federal government. Well, that really doesn’t work when you’re trying to recruit doctors and nurses, and you have to get Americans with those skills into the rural parts of this country, where half of our veterans live. So we have to be more fluid, we have to have more authority when it comes to relocation and reimbursement pay. We’re allowed to bust through most of the federal pay scales for our people. But we do have to be creative when it comes to getting them out where the veterans are.
Mr. Jekielek: So Secretary Wilkie, we’re going to have to wrap up in a moment. But I wanted to ask you, first of all, you published a statement, maybe it was a couple of months ago now that was trying to target some misrepresentations that you had seen in the media. Is there anything out there right now that you feel you would want to set the record straight on?
Mr. Wilkie: Well, I don’t know that, I’ll give you a particular. I’ll give you a generalization. VA went through some very hard times. But people still want to work here, and I can tell you that veterans are voting with their feet. And I asked the media to come look at us now. Look at us as we are, not as The Washington Post presented in that article—it may have been the USA Today as well—that was based on something that happened in 2015. I see a lot of anecdotes that float out there. They continue to have nine lives, and they bear no relation to the reality on the ground.
We just launched the most transformative project in the history of this department going back to the GI Bill, which was the transformative project of all transformative projects. And the media and some political pre-reaction was: They’ll never pull it off. They can’t do it. They’re privatizing the place. They’ll fail, just so they can open up the spigots on privatization.
Well, what you’re hearing now is crickets because it’s working. And I think as a service to veterans, we need to look at the here and now, and we need to acknowledge what is working. We will step up when things don’t go right. In an organization this large, things don’t go right sometimes. But it’s fascinated me, having come from the Pentagon, and also before that in the private sector, that some in the media tend to hold VA to a standard that is unattainable anywhere in the world.
But we do a pretty good job. When we’ve got an approval rating [for] veterans that is close to 90 percent, and both the annals of internal medicine say our care is good or better than any in the country. And AMA says that our wait times are the same, good, or better. And the Partnership for Public Service says we’re one of the best places in government to work, that’s a good story to tell. And one of my promises to all of those who have devoted their lives to veterans is to help tell that story.
This interview has been edited for brevity and clarity.