WEBVTT 00:00:05.160 --> 00:00:08.980 All across America and around the world, this 00:00:08.980 --> 00:00:15.140 is Veterans Radio. This is Veterans Radio. Good 00:00:15.140 --> 00:00:18.600 day. I'm Jim Fossone. I'm the Officer of the 00:00:18.600 --> 00:00:20.699 Deck today here on Veterans Radio and thanks 00:00:20.699 --> 00:00:23.460 for joining us. We've got some interesting stories 00:00:23.460 --> 00:00:25.640 for you. We always want to remind you, you can 00:00:25.640 --> 00:00:28.739 find more about Veterans Radio at its Facebook 00:00:28.739 --> 00:00:32.420 site or at the web, veteransradio .org, where 00:00:32.420 --> 00:00:35.259 we're on the web 24 -7. You can find a lot of 00:00:35.259 --> 00:00:38.299 our podcasts there as well. We post new ones 00:00:38.299 --> 00:00:42.479 every Tuesday, so you can get a new story, a 00:00:42.479 --> 00:00:45.219 new interview, something you didn't know before 00:00:45.219 --> 00:00:49.219 by going to veteransradio .org. And before we 00:00:49.219 --> 00:00:52.259 get started, we want to thank our sponsors. First 00:00:52.259 --> 00:00:55.259 up, we want to thank National Veteran Business 00:00:55.259 --> 00:01:01.039 Development Council, nvbdc .org. It was established 00:01:01.039 --> 00:01:04.379 to certify both service disabled and veteran 00:01:04.379 --> 00:01:06.659 owned businesses. You'll find out how they can 00:01:06.659 --> 00:01:12.319 help your business by going to nvbdc .org. We 00:01:12.319 --> 00:01:15.840 want to thank Legal Help for Veterans. Legal 00:01:15.840 --> 00:01:18.939 Help for Veterans fights for veterans disability 00:01:18.939 --> 00:01:22.040 rights all across the nation. You can reach them 00:01:22.040 --> 00:01:30.500 at 800 -693 -4800 or on the web at legalhelpforveterans 00:01:30.500 --> 00:01:36.180 .com. And finally, PuroClean. PuroClean is the 00:01:36.180 --> 00:01:38.760 paramedics of property damage. It provides water 00:01:38.760 --> 00:01:42.019 damage remediation, flood water removal, fire 00:01:42.019 --> 00:01:45.840 and smoke damage remediation, mold removal, biohazard 00:01:45.840 --> 00:01:50.879 cleanup. It also has a focus on veteran franchisees. 00:01:51.319 --> 00:01:54.340 You can learn more about them by going to PuroClean 00:01:54.340 --> 00:01:58.700 .com. We want to welcome to Veterans Radio today, 00:01:59.040 --> 00:02:01.939 Russell B. Lemley. Russell, welcome to Veterans 00:02:01.939 --> 00:02:05.659 Radio. Thanks so much for having me, Jen. Now, 00:02:05.659 --> 00:02:08.900 Russ is a senior policy analyst for the Veterans 00:02:08.900 --> 00:02:12.180 Health Care Policy Institute. Looks like 20, 00:02:12.180 --> 00:02:15.740 30 years. at the San Francisco VA healthcare 00:02:15.740 --> 00:02:19.419 system, and he was the chief psychologist there 00:02:19.419 --> 00:02:22.319 in that system for 25 years, so he knows what 00:02:22.319 --> 00:02:24.879 he's talking about. Dr. Lemley, why don't you 00:02:24.879 --> 00:02:26.580 give us a little bit more of your background. 00:02:27.419 --> 00:02:31.099 Yeah, and that's right. I did work for 38 years 00:02:31.099 --> 00:02:34.020 for the VA all at the San Francisco VA healthcare 00:02:34.020 --> 00:02:37.210 system. And as you mentioned, two thirds of that 00:02:37.210 --> 00:02:41.110 as the chief psychologist. I'm a clinical psychologist 00:02:41.110 --> 00:02:46.550 by background and I retired from the VA six years 00:02:46.550 --> 00:02:50.090 ago and worked full time in the nonprofit that 00:02:50.090 --> 00:02:52.509 we'll talk about in a moment in the interim. 00:02:53.080 --> 00:02:56.379 Well it certainly gave you a long career where 00:02:56.379 --> 00:02:58.759 you got exposed to a lot of things and there's 00:02:58.759 --> 00:03:02.400 a lot happening in the VA world, VA Medical Center 00:03:02.400 --> 00:03:05.740 world these days and we want to talk about that. 00:03:06.379 --> 00:03:10.379 But let's explain to our veteran radio listeners 00:03:10.379 --> 00:03:12.979 what the Veterans Healthcare Policy Institute 00:03:12.979 --> 00:03:16.819 is about. Happy to do so. So the Veterans Healthcare 00:03:16.819 --> 00:03:20.340 Policy Institute is a non -partisan, non -profit 00:03:20.340 --> 00:03:24.710 policy organization. focused exclusively on Veterans 00:03:24.710 --> 00:03:27.509 health care issues in the U .S. and we're led 00:03:27.509 --> 00:03:30.590 by Veterans health care policy experts and journalists. 00:03:31.090 --> 00:03:34.770 And we produce policy reports, analyses, education 00:03:34.770 --> 00:03:37.909 materials, all aimed at informing these issues. 00:03:38.490 --> 00:03:40.830 Well, it's kind of interesting that this think 00:03:40.830 --> 00:03:44.409 tank came about in 2016. So it's been around 00:03:44.409 --> 00:03:48.069 a while. And it was founded by veterans, health 00:03:48.069 --> 00:03:50.370 care providers, and journalists. Really kind 00:03:50.370 --> 00:03:53.069 of gives you a mix of professionals you're working 00:03:53.069 --> 00:03:57.550 with, with maybe a larger scope of how they look 00:03:57.550 --> 00:04:00.449 at issues. You've probably found that interesting 00:04:00.449 --> 00:04:04.250 since you've been there. Absolutely. And I hope 00:04:04.250 --> 00:04:07.610 we get more into that as we talk further. That's 00:04:07.610 --> 00:04:11.590 right. Absolutely. So one of the things that 00:04:11.590 --> 00:04:14.469 caught my eye recently was an article that you 00:04:14.469 --> 00:04:19.089 wrote in military .com in late February, talking 00:04:19.089 --> 00:04:22.410 about a, I guess a bill that's in Congress I 00:04:22.410 --> 00:04:24.850 really hadn't heard much about, which is called 00:04:24.850 --> 00:04:29.550 the Veterans Access Act. Can you explain to us, 00:04:29.709 --> 00:04:33.759 Doc, what that's about? I can let me just give 00:04:33.759 --> 00:04:36.220 a little bit of context and see if that works. 00:04:38.180 --> 00:04:43.399 You know what that opinion piece was about has 00:04:43.399 --> 00:04:46.899 to do with the impact that the legislation should 00:04:46.899 --> 00:04:50.930 have passed and at this point. it has been considered 00:04:50.930 --> 00:04:54.110 in both the Senate and the House Veterans Affairs 00:04:54.110 --> 00:04:58.329 Committees, but is on hold in part waiting for 00:04:58.329 --> 00:05:01.209 a Congressional Budget Office scoring of how 00:05:01.209 --> 00:05:05.329 expensive it will be. It's in a holding pattern 00:05:05.329 --> 00:05:07.870 at this point, but we can get more into that 00:05:07.870 --> 00:05:10.730 act in a moment. But the context of the whole 00:05:10.730 --> 00:05:16.930 opinion piece is to lay bare what the future 00:05:16.930 --> 00:05:19.389 of the VA would look like if this particular 00:05:19.389 --> 00:05:23.709 act passes other similar legislation on the future 00:05:23.709 --> 00:05:28.589 of the VA as a healthcare system. You know, since 00:05:28.589 --> 00:05:33.149 2014, when there were plenty of kind of media 00:05:33.149 --> 00:05:36.610 coverage of wait lists across many VAs, particularly 00:05:36.610 --> 00:05:40.949 at the Phoenix VA, there has been a very steady 00:05:40.949 --> 00:05:45.439 expansion of options for veterans. to receive 00:05:45.439 --> 00:05:49.319 their health care in the community. And the expansion, 00:05:49.560 --> 00:05:53.379 because it actually started back right after 00:05:53.379 --> 00:05:56.779 World War I, that veterans began getting options 00:05:56.779 --> 00:05:58.819 for care in the community. It started out at 00:05:58.819 --> 00:06:02.019 a much smaller scale, but we've had nearly 100 00:06:02.019 --> 00:06:06.439 years of community options for veterans when 00:06:06.439 --> 00:06:09.600 their local VA facilities at that point were 00:06:09.600 --> 00:06:13.459 just generally too far away from where they lived. 00:06:13.879 --> 00:06:23.040 Once the 2014 Phoenix crisis happened at the 00:06:23.040 --> 00:06:28.420 VA there with long wait lists, a choice act was 00:06:28.420 --> 00:06:33.480 passed and that was 2014 was implemented 15 and 00:06:33.480 --> 00:06:37.720 actually gave rise to my nonprofit. because it 00:06:37.720 --> 00:06:41.480 was beginning to change the nature of the balance 00:06:41.480 --> 00:06:45.560 between VA care and caring the community. And 00:06:45.560 --> 00:06:48.519 that balance has continued to shift, particularly 00:06:48.519 --> 00:06:52.019 with this one bill that, again, we'll get into 00:06:52.019 --> 00:06:55.759 in a moment. But the context has to do with the 00:06:55.759 --> 00:06:59.459 balance between these two systems and what could 00:06:59.459 --> 00:07:03.379 potentially happen in the future if that's not 00:07:03.379 --> 00:07:07.160 addressed. you know, ironically, at this point 00:07:07.160 --> 00:07:10.480 in time, community care is the one system that's 00:07:10.480 --> 00:07:13.639 never going to go away. But there's some danger 00:07:13.639 --> 00:07:16.800 in which the VA healthcare system internally 00:07:16.800 --> 00:07:20.620 could be reduced to a very small size and not 00:07:20.620 --> 00:07:24.680 look at all like what it is currently. And so 00:07:24.680 --> 00:07:27.459 that's the larger frame for talking about that 00:07:27.459 --> 00:07:29.579 particular legislation. Having this conversation 00:07:29.579 --> 00:07:32.899 in general is that you know, contrary to the 00:07:32.899 --> 00:07:34.819 way in which it's sometimes addressed in the 00:07:34.819 --> 00:07:37.560 media, community care is the one thing we know 00:07:37.560 --> 00:07:41.699 is never gonna go away. The danger is what could 00:07:41.699 --> 00:07:45.680 happen to the VHA. It's back to that old issue, 00:07:46.540 --> 00:07:50.439 right? Russell, like, does the exception eat 00:07:50.439 --> 00:07:54.639 the rule? The rule was, you know, if you're entitled 00:07:54.639 --> 00:07:56.660 to it, you should be able to go to a VA hospital 00:07:56.660 --> 00:07:58.939 or clinic and get your care. The government owes 00:07:58.939 --> 00:08:02.360 you that. Right. But when they couldn't, you 00:08:02.360 --> 00:08:06.040 know, out of the spotlight on the Phoenix crisis 00:08:06.040 --> 00:08:10.180 and wait lines in 2014, community care now has 00:08:10.180 --> 00:08:14.699 expanded and continues to expand. Does the exception 00:08:14.699 --> 00:08:16.899 eat the rule? Isn't that kind of a bit of the 00:08:16.899 --> 00:08:19.920 concern? Well, even before we talk about the 00:08:19.920 --> 00:08:26.139 Access Act, there was a independent review a 00:08:26.139 --> 00:08:30.600 year ago. known as a red team report, which was 00:08:30.600 --> 00:08:33.799 looking at just what you just said. And that 00:08:33.799 --> 00:08:36.860 is that community care referrals have been growing 00:08:36.860 --> 00:08:41.240 at 15 to 20 % a year since what was called the 00:08:41.240 --> 00:08:46.940 Mission Act in 2018. And at this point is approaching 00:08:46.940 --> 00:08:52.730 half of all the care that veterans receive. And 00:08:52.730 --> 00:08:56.909 the budget is over a third of the entire VA healthcare 00:08:56.909 --> 00:09:02.850 budget. And it's nonstop. So what you were saying 00:09:02.850 --> 00:09:09.230 about the exception overtaking the standard, 00:09:09.789 --> 00:09:14.289 that's exactly right, is that it's an unabated 00:09:14.289 --> 00:09:19.610 increase year by year by year, and it will overtake 00:09:19.500 --> 00:09:22.519 the VA and this red team report indicated exactly 00:09:22.519 --> 00:09:28.100 how that could happen to such an extent that 00:09:28.100 --> 00:09:33.379 within a kind of limited pie, with limited funds, 00:09:34.000 --> 00:09:36.360 the larger the slice of the pie that goes to 00:09:36.360 --> 00:09:39.179 community care, ultimately, the less it's going 00:09:39.179 --> 00:09:41.820 to go to the VA and it will overtake it. That's 00:09:41.820 --> 00:09:47.009 right. I don't think, don't get me wrong, don't 00:09:47.009 --> 00:09:48.710 get Russell wrong here. We're not saying that 00:09:48.710 --> 00:09:51.470 there isn't areas of community care that are 00:09:51.470 --> 00:09:53.570 necessary and appropriate, and a good one that 00:09:53.570 --> 00:09:56.070 he and I talked about before we got on air was, 00:09:56.070 --> 00:09:59.029 you know, women veterans can't always get the 00:09:59.029 --> 00:10:01.269 care they need in a VA and have to go into the 00:10:01.269 --> 00:10:04.529 community, even for such simple things as mammograms. 00:10:05.330 --> 00:10:09.490 So, but I always get worried when I come back 00:10:09.490 --> 00:10:12.539 to... These bills in Congress always have these 00:10:12.539 --> 00:10:15.779 names that are sort of developed somehow in some 00:10:15.779 --> 00:10:19.580 basement dungeon, I suppose. Let's find a cool 00:10:19.580 --> 00:10:22.519 name that will hide the real meaning. So when 00:10:22.519 --> 00:10:26.440 I read something like Veterans Access Act, well, 00:10:26.440 --> 00:10:29.600 that's got to be good. People like access for 00:10:29.600 --> 00:10:33.279 their health care. But I also know that that's 00:10:33.279 --> 00:10:36.139 part of the game. Let's name it something that 00:10:36.139 --> 00:10:39.940 everybody will get a little bit fooled by. What's 00:10:39.940 --> 00:10:44.279 really in this proposed act? Well, let me just 00:10:44.279 --> 00:10:46.080 say that I completely agree with what you just 00:10:46.080 --> 00:10:50.799 said, and I want to reiterate that having care 00:10:50.799 --> 00:10:53.779 options in the community is an important feature 00:10:53.779 --> 00:10:57.299 of the entire system. For some of the examples 00:10:57.299 --> 00:11:00.840 that you just gave, the conversation isn't whether 00:11:00.840 --> 00:11:04.679 it's a necessary ingredient, because it is. And 00:11:04.679 --> 00:11:07.860 that's especially true for rural veterans in 00:11:07.860 --> 00:11:11.700 which a VA facility and particularly a VA medical 00:11:11.700 --> 00:11:15.779 center itself is not conveniently located. So 00:11:15.779 --> 00:11:18.820 we do absolutely need the community to supplement 00:11:18.820 --> 00:11:24.240 VA care when it's at some distance. And then, 00:11:24.360 --> 00:11:27.700 of course, when the weights are way too long 00:11:27.700 --> 00:11:30.600 for the care, even if you may want care at a 00:11:30.600 --> 00:11:32.779 VA, but the weights are too long that you may 00:11:32.779 --> 00:11:36.480 then have the option of going to a community 00:11:36.480 --> 00:11:39.720 provider. So the first thing that you said, totally 00:11:39.720 --> 00:11:42.259 agree with. This is not a conversation about 00:11:42.259 --> 00:11:46.120 whether it's an important ingredient or whether 00:11:46.120 --> 00:11:49.379 it should be scaled back. the question is really 00:11:49.379 --> 00:11:52.580 the reverse. And as you're alluding to, there 00:11:52.580 --> 00:11:57.360 are various bills and they do come up with acronyms. 00:11:58.299 --> 00:12:01.500 It is the way that kind of bills are often named 00:12:01.500 --> 00:12:05.080 and it sometimes becomes easier to remember them 00:12:05.080 --> 00:12:09.500 because of that, or as you said, imply something. 00:12:11.059 --> 00:12:13.700 So if we pivot here and just talk about this 00:12:13.700 --> 00:12:17.980 one particular bill, in the Access Act, there 00:12:17.980 --> 00:12:24.840 is a component of it that creates a new way in 00:12:24.840 --> 00:12:27.899 which veterans would be able to access care in 00:12:27.899 --> 00:12:30.639 the community. Up until now, really, for the 00:12:30.639 --> 00:12:35.940 last hundred years, the way that the VA system, 00:12:37.620 --> 00:12:39.639 the health care that's provided by the VA is 00:12:39.639 --> 00:12:45.389 set up is that the VA will be the authorizer 00:12:45.389 --> 00:12:47.610 of caring community when the VA can't provide 00:12:47.610 --> 00:12:50.509 it in a very timely way or in a very kind of 00:12:50.509 --> 00:12:53.750 close in distance convenient way. And there are 00:12:53.750 --> 00:12:56.230 few other exceptions as well to that, but basically 00:12:56.230 --> 00:12:59.470 it's it's it's it's too long or it's too far. 00:12:59.750 --> 00:13:01.909 Then the VA says sure, if you want to go to the 00:13:01.909 --> 00:13:04.330 community, we will give you authorization to 00:13:04.330 --> 00:13:08.549 do so. And here's here's a list and there's over 00:13:08.549 --> 00:13:11.019 one and a half million providers. who are in 00:13:11.019 --> 00:13:14.779 the community who see veterans on the VA's dime 00:13:14.779 --> 00:13:18.980 if the veteran qualifies and then exercises the 00:13:18.980 --> 00:13:23.220 option to get care in the community. The Access 00:13:23.220 --> 00:13:25.799 Act actually would change that for the first 00:13:25.799 --> 00:13:29.259 time. And it basically says that the VA would 00:13:29.259 --> 00:13:31.659 no longer need to be the authorizer care. It 00:13:31.659 --> 00:13:34.820 is presumed that if you are enrolled veteran, 00:13:34.960 --> 00:13:37.559 you already are authorized so you can bypass 00:13:37.559 --> 00:13:41.179 and skip asking the VA for referral and just 00:13:41.179 --> 00:13:44.279 go get the care yourself and send the VA the 00:13:44.279 --> 00:13:47.539 bill. So it's a completely different system that 00:13:47.539 --> 00:13:54.360 is proposed in the Access Act. And if that passes, 00:13:54.879 --> 00:13:58.620 And as I said earlier, it's still in the pipeline 00:13:58.620 --> 00:14:04.100 that it might if that passes, there will be a 00:14:04.100 --> 00:14:08.299 further. kind of outsourcing of care, the funds 00:14:08.299 --> 00:14:13.259 follow the veterans care and under the way in 00:14:13.259 --> 00:14:16.399 which Congress is thinking about funding for 00:14:16.399 --> 00:14:20.039 veterans healthcare, the dollars will flow from 00:14:20.039 --> 00:14:24.519 VA facilities to the community and inevitably 00:14:24.519 --> 00:14:28.500 will have to reduce the scope of what they provide. 00:14:29.100 --> 00:14:32.059 Well, you know, just in that simple explanation, 00:14:32.080 --> 00:14:35.460 I think most of us would say, There's a there's 00:14:35.460 --> 00:14:38.659 a value in the gatekeeper role of saying yes, 00:14:38.700 --> 00:14:41.059 you can go to community care or no You can't 00:14:41.059 --> 00:14:42.940 hey, you know, we already have those services 00:14:42.940 --> 00:14:46.019 and yours appointment for next week Why would 00:14:46.019 --> 00:14:48.600 we send you off to the to the community for that 00:14:48.600 --> 00:14:52.840 thing? I? Can't imagine any kind of set of services 00:14:52.840 --> 00:14:55.220 where there was should be no gatekeeper and that 00:14:55.220 --> 00:14:57.860 that's kind of sounds like what they're doing 00:14:57.860 --> 00:15:02.519 here is Removing the gatekeeper on where referrals 00:15:02.519 --> 00:15:05.279 if you will should go You know, that's exactly 00:15:05.279 --> 00:15:09.919 right. And in removing the gatekeeper, the funds 00:15:09.919 --> 00:15:14.519 then become less easy to manage. If you qualify 00:15:14.519 --> 00:15:16.600 for healthcare, you're going to get the healthcare. 00:15:16.779 --> 00:15:20.860 And if more of that healthcare then is outsourced 00:15:20.860 --> 00:15:23.659 and the money follows it, as you said, without 00:15:23.659 --> 00:15:26.679 the kind of gatekeeping, there's just less available 00:15:26.679 --> 00:15:31.090 to maintain the services at the local. kind of 00:15:31.090 --> 00:15:33.909 VA facility. And really what we're talking about 00:15:33.909 --> 00:15:37.090 here is for those veterans who depend on the 00:15:37.090 --> 00:15:40.590 VA and the VA medical centers and facilities 00:15:40.590 --> 00:15:44.509 who prefer that, we're talking about those veterans 00:15:44.509 --> 00:15:49.909 will in time not have that option. Yeah, they'll 00:15:49.909 --> 00:15:53.090 get squeezed out monetarily. The budget will 00:15:53.090 --> 00:15:56.029 be eaten up and you'll see the thing you can 00:15:56.029 --> 00:15:58.750 control is your number of employees, your number 00:15:58.750 --> 00:16:02.759 of medical centers. But is this as currently 00:16:02.759 --> 00:16:05.220 envisioned by somebody in Congress, I don't know 00:16:05.220 --> 00:16:07.340 who's promoting this or what groups are promoting 00:16:07.340 --> 00:16:10.279 this, but is this envisioned as only to apply 00:16:10.279 --> 00:16:14.080 to one area of health care, like mental health 00:16:14.080 --> 00:16:17.440 and addiction, or does it apply elsewhere? Well, 00:16:17.539 --> 00:16:21.740 it's yes and yes. In this particular piece of 00:16:21.740 --> 00:16:25.240 legislation, it starts with mental health and 00:16:25.240 --> 00:16:28.799 substance use disorder care. So the first half 00:16:28.799 --> 00:16:30.659 of your question is that's how it's written, 00:16:31.019 --> 00:16:35.179 but it's also indicates that after a three year 00:16:35.179 --> 00:16:39.240 pilot period of time, it then is open to all 00:16:39.240 --> 00:16:43.639 areas and all medical conditions, all psychological 00:16:43.639 --> 00:16:47.120 and so forth. So although it starts in a more 00:16:47.120 --> 00:16:50.620 limited way in the legislation, it says that's 00:16:50.620 --> 00:16:53.559 just the way to get it started because the intention 00:16:53.559 --> 00:16:58.240 is for everything. That's where this caught me 00:16:58.240 --> 00:17:02.159 as a seismic change and yeah caught me as as 00:17:02.159 --> 00:17:05.319 you as you wrote It's transforming the VA's primary 00:17:05.319 --> 00:17:08.140 role from a health care provider to an insurance 00:17:08.140 --> 00:17:10.759 company writing checks And that really stopped 00:17:10.759 --> 00:17:14.759 me in my tracks Is that where you think this 00:17:14.759 --> 00:17:19.279 would head? Ultimately, I do think so it would 00:17:19.279 --> 00:17:23.259 happen incrementally because you know After the 00:17:23.259 --> 00:17:26.740 pilot's over and it expands to all medical conditions, 00:17:27.339 --> 00:17:29.579 there would just be more money that's flowing 00:17:29.579 --> 00:17:33.500 from the VA to the community. And once care is 00:17:33.500 --> 00:17:35.140 provided in the community, the VA has to pay 00:17:35.140 --> 00:17:37.900 for it. And where is it going to come from? It's 00:17:37.900 --> 00:17:40.119 just going to come out of local budgets. And 00:17:40.119 --> 00:17:45.099 so it would incrementally pull money out of VA 00:17:45.099 --> 00:17:48.970 facilities. I mean, you wouldn't get the upgrades 00:17:48.970 --> 00:17:51.430 that you need for infrastructure. You won't have 00:17:51.430 --> 00:17:53.369 as many staff. You won't have as many programs. 00:17:53.470 --> 00:17:57.150 You'll close units. And then, you know, facility 00:17:57.150 --> 00:18:00.819 by facility, there will be closures. Uh, so that 00:18:00.819 --> 00:18:03.579 ultimately, so this isn't going to happen in 00:18:03.579 --> 00:18:06.119 just a couple of years, but this could easily 00:18:06.119 --> 00:18:08.819 happen in a decade where you just see closures. 00:18:08.839 --> 00:18:12.099 And then the only care available is in the community 00:18:12.099 --> 00:18:17.500 for veterans. And, and the sad part is that there 00:18:17.500 --> 00:18:20.539 are many veterans who get all of their care at 00:18:20.539 --> 00:18:26.859 the VA and that's by choice. And they will no 00:18:26.859 --> 00:18:30.619 longer have the freedom to exercise that option 00:18:30.619 --> 00:18:33.740 because the option will be gone. If I think about 00:18:33.740 --> 00:18:37.059 this more, and obviously that's what your article 00:18:37.059 --> 00:18:39.779 op -ed piece did for me, made me think about 00:18:39.779 --> 00:18:41.880 it, you could see them saying, well, we don't 00:18:41.880 --> 00:18:46.700 need to buy the latest machine for MRIs or CAT 00:18:46.700 --> 00:18:50.400 scans or blood work or whatever, cancer diagnosis. 00:18:51.019 --> 00:18:53.200 We're not going to make that capital investment 00:18:53.200 --> 00:18:54.880 in the VA system because we're going to let you 00:18:54.880 --> 00:18:57.859 go to the community. And you can sort of see 00:18:57.859 --> 00:19:00.859 that kind of thinking if it creeps in, it will 00:19:00.859 --> 00:19:04.559 be ultimately the erosion of a VA healthcare 00:19:04.559 --> 00:19:07.940 system as we know it. And I think that's kind 00:19:07.940 --> 00:19:10.619 of what you're predicting, how this, over time, 00:19:11.680 --> 00:19:14.680 the exception could eat the rule. Yes, yeah. 00:19:15.059 --> 00:19:18.950 You know, for veterans who do not want to go 00:19:18.950 --> 00:19:21.130 to the VA for whatever their reason, and they 00:19:21.130 --> 00:19:24.990 qualify for care in the community, that option 00:19:24.990 --> 00:19:28.509 is just going to expand independent of this particular 00:19:28.509 --> 00:19:30.529 piece of legislation. That's just not going to 00:19:30.529 --> 00:19:34.849 be threatened. It is for the veterans who really 00:19:34.849 --> 00:19:39.670 do prefer the VA, that is what they exercise 00:19:39.670 --> 00:19:42.839 in terms of the options. of where they get their 00:19:42.839 --> 00:19:47.640 care, those are the veterans who should, and 00:19:47.640 --> 00:19:50.940 I said so in my article, make their voices known 00:19:50.940 --> 00:19:55.799 because if we wait too long, then they're gonna 00:19:55.799 --> 00:19:59.069 lose an option and it will not come back. And 00:19:59.069 --> 00:20:03.869 for those who want community care, most of what 00:20:03.869 --> 00:20:07.190 you and I are talking about is not that relevant, 00:20:07.369 --> 00:20:09.349 because that option is just going to be there 00:20:09.349 --> 00:20:11.809 for them always. We're really talking about the 00:20:11.809 --> 00:20:15.670 veterans who depend on the VA. Well, and you 00:20:15.670 --> 00:20:19.109 point out, I guess I didn't know this, that there's 00:20:19.109 --> 00:20:23.849 a huge shortage of primary care and psychiatrists. 00:20:24.119 --> 00:20:26.460 in the United States and in rural communities, 00:20:27.059 --> 00:20:29.720 kind of explain how the VA, because it's set 00:20:29.720 --> 00:20:33.000 up to deal with those kind of issues, fills that 00:20:33.000 --> 00:20:37.720 gap. That's correct in a couple ways that you're 00:20:37.720 --> 00:20:42.390 implying, which is when VA's shutdown units and 00:20:42.390 --> 00:20:46.049 shutdown services, there isn't necessarily something 00:20:46.049 --> 00:20:48.289 available in the community to pick up the slack. 00:20:48.990 --> 00:20:52.230 And so it's not inconceivable that there are 00:20:52.230 --> 00:20:56.569 just going to be much longer waits when the VA 00:20:56.569 --> 00:21:00.150 closes down different aspects of. what it now 00:21:00.150 --> 00:21:04.430 offers. There aren't enough primary care providers. 00:21:04.730 --> 00:21:06.430 There aren't enough psychiatrists. There aren't 00:21:06.430 --> 00:21:10.190 enough health care providers in general that 00:21:10.190 --> 00:21:13.069 are available in the community, especially in 00:21:13.069 --> 00:21:16.410 rural areas. And I talk a tiny bit about this 00:21:16.410 --> 00:21:19.529 in the article, including the fact that many 00:21:19.529 --> 00:21:24.089 of the rural hospitals are on the brink of financial 00:21:24.089 --> 00:21:29.019 collapse and closing. So the services aren't 00:21:29.019 --> 00:21:32.460 necessarily going to be there when the VA closes 00:21:32.460 --> 00:21:36.259 down. I don't think that is of major concern 00:21:36.259 --> 00:21:39.880 to those who are writing the legislation because 00:21:39.880 --> 00:21:45.720 the intention as it appears is to just keep expanding 00:21:45.720 --> 00:21:49.140 more options into the private sector. You know, 00:21:49.359 --> 00:21:53.519 it's philosophically based on other things that 00:21:53.519 --> 00:21:56.759 we're now seeing as well coming straight from 00:21:56.759 --> 00:21:59.500 the administration, which is that philosophically, 00:22:00.240 --> 00:22:02.799 the notion of government sponsored health care 00:22:02.799 --> 00:22:05.619 is something that is out of favor right now. 00:22:05.920 --> 00:22:07.460 And so whether the weights are longer, whether 00:22:07.460 --> 00:22:09.940 the quality is lower, which actually research 00:22:09.940 --> 00:22:16.339 shows that it is. that still is in favor at this 00:22:16.339 --> 00:22:20.619 point as a model of providing the healthcare 00:22:20.619 --> 00:22:23.700 for veterans. We're talking to Russell Lemley, 00:22:23.700 --> 00:22:28.900 PhD, who is with the, and this is what kind of 00:22:28.900 --> 00:22:32.759 caught my attention, he's with the Veterans Healthcare 00:22:32.759 --> 00:22:35.619 Policy Institute and has written on this issue, 00:22:36.839 --> 00:22:42.359 is the Veterans Access Act something, veterans 00:22:42.359 --> 00:22:45.099 should be writing their congress folks on, or 00:22:45.099 --> 00:22:49.500 is this so far not gonna, you know, so much stuff 00:22:49.500 --> 00:22:52.759 starts in Washington as an idea but dies in Washington 00:22:52.759 --> 00:22:56.559 because it's a bad idea. Where do you put this 00:22:56.559 --> 00:23:00.440 and what is your call to the veteran world based 00:23:00.440 --> 00:23:05.200 on your, you know, 40 years of being in the VA 00:23:05.200 --> 00:23:08.900 medical healthcare system? Right, I think if 00:23:08.900 --> 00:23:11.990 you're a veteran and you really would like the 00:23:11.990 --> 00:23:14.089 VA to go out of business, you could write to 00:23:14.089 --> 00:23:16.049 your member of Congress and say you're a big 00:23:16.049 --> 00:23:20.349 supporter of this because it will kind of increase 00:23:20.349 --> 00:23:24.869 the probability that the VA will downscale incrementally 00:23:24.869 --> 00:23:27.670 over time. So if you're somebody who has no interest 00:23:27.670 --> 00:23:31.089 in the VA, you could write and say you're in 00:23:31.089 --> 00:23:34.930 favor of this bill. If you're a veteran who really 00:23:34.930 --> 00:23:39.759 is generally pleased with the VA, Actually, the 00:23:39.759 --> 00:23:42.700 surveys indicate that the vast majority of veterans 00:23:42.700 --> 00:23:45.579 are generally pleased with their VA care and 00:23:45.579 --> 00:23:49.160 they would like the VA to remain the primary 00:23:49.160 --> 00:23:53.099 provider of healthcare systemically. Then you're 00:23:53.099 --> 00:23:56.599 a veteran who should think about writing your 00:23:56.599 --> 00:23:58.859 member of Congress and indicating that because 00:23:58.859 --> 00:24:03.619 the Access Act, unless it is significantly modified, 00:24:05.549 --> 00:24:10.650 is going to, I think, ultimately reduce an option 00:24:10.650 --> 00:24:14.109 that for those veterans you really want to see 00:24:14.109 --> 00:24:19.089 continued indefinitely. And this piece of legislation 00:24:19.089 --> 00:24:22.710 puts that in jeopardy. Well, it's a very interesting 00:24:22.710 --> 00:24:25.029 topic. I'm glad we're able to bring it to our 00:24:25.029 --> 00:24:28.009 veteran radio listeners early on before we wake 00:24:28.009 --> 00:24:30.490 up one day and go, well, this is now the law. 00:24:30.779 --> 00:24:33.500 I didn't even know what was going on and I wanted 00:24:33.500 --> 00:24:35.599 to give a chance to voice my opinion. Well, now 00:24:35.599 --> 00:24:37.700 you can. You know it's out there. You should 00:24:37.700 --> 00:24:40.079 voice your opinion, whichever way it is. And 00:24:40.079 --> 00:24:43.460 if you want to follow more about Russell's writing 00:24:43.460 --> 00:24:46.640 and what the Policy Institute is doing, the website 00:24:46.640 --> 00:24:52.559 is veteranspolicy .org. And this Military Times 00:24:52.559 --> 00:24:54.740 article and others that you've written on similar 00:24:54.740 --> 00:24:57.420 topics are there. Russell, I really appreciate 00:24:57.420 --> 00:24:59.259 the time that you've given to Veterans Radio 00:24:59.259 --> 00:25:03.799 today. Well, Jim, I appreciate the time to do 00:25:03.799 --> 00:25:07.059 this, because as you and I started, this is an 00:25:07.059 --> 00:25:09.420 opportunity to weigh in before it's too late, 00:25:09.420 --> 00:25:12.799 and I'm glad that you and I had a chance to talk 00:25:12.799 --> 00:25:32.829 about that. 693 -4800 or legalhelpforveterans 00:25:32.829 --> 00:25:36.029 .com on the web. You can follow Veterans Radio 00:25:36.029 --> 00:25:39.349 on Facebook and listen to its podcasts and internet 00:25:39.349 --> 00:25:43.950 radio shows by visiting us at veteransradio .org. 00:25:44.150 --> 00:25:47.890 That's veteransradio .org. 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