The House is Making Headway in Veterans Affairs

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.

Transcript

Mark Takano: 0:02

People don't realize that the fourth mission exists. But the fourth mission basically is about the VA. The you know, it's the largest health care system in our country. And when there's a natural disaster in the local or regional healthcare system is stressed and begins to break down the VA through its system of volunteers from its own workforce can be deployed to provide a backstop. In its VA has done this time and time again in cases of hurricanes, earthquakes and fires and even in the mass shootings. It's it's provided community support. When our emergency rooms are just sort of filled with gunshot victims. The VA steps up.

Charlie Malone: 0:57

Welcome to Season Two of the policy vets podcast, engaging with leaders, scholars and strong voices to fill a void in support of Policy Development for America's veterans. With your host former Secretary of Veterans Affairs, Dr. David Shulkin. And the Executive Director of Policy beds, Louis Celli, today's guest Mark Takano, a US representative for the state of California, and the chairman of the House Committee on Veterans Affairs.

Louis Celli: 1:26

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 the House and Senate Veterans Affairs Committee?

Dr. David Shulkin: 1:37

You know, I thought those relationships are really important for VA to be able to get its work done and not to get distracted. When I entered as Undersecretary there was a little bit of adversarial relationship between the committee chairs and the and the current administration. But I came in really, as much more a expert on the health system. And so I was not able, I was able to avoid some of those political issues. And I establish very good relationships when I was appointed as secretary. I remember, when I went to my swearing in at the White House, both the chairs of the House and the Senate, and the ranking members of the House and Senate came to my swearing in, which was really unprecedented, but it signaled the fact that I was not going to deal with Congress in a political way or represent any party. I was going to have relationships with both sides of the aisles to get the work done. And of course, I was confirmed 100 to zero, which, again, was unprecedented, at least in the last in the last administration.

Louis Celli: 2:54

Did you find that they all generally worked well together? Or did you sometimes feel like you were caught in the middle of some political gamesmanship?

Dr. David Shulkin: 3:02

Now, I felt that these committees really worked well together that, that it was not a lot of political gamesmanship. It didn't mean that there was always agreement. And you sometimes had to do some back shuttle diplomacy. But I never felt like there were direct political games being played.

Louis Celli: 3:21

So I mean, really not to oversimplify congressional responsibilities, but the committee's who have jurisdiction over the different federal agencies, they have really two primary responsibilities, authorization and oversight, then, of course, the funding is, you know, managed by yet another committee. And these tasks are usually carried out with the help of the public by either working directly with their constituents, or their districts or through the large groups like VSOs. And by hearing from the departments who work directly with the veterans.

Dr. David Shulkin: 3:53

Yeah, I think that's right. It's, there's a lot of separate responsibilities of these different committees in Congress. And then of course, they're even members of Congress that are don't sit on the committee's butter veterans themselves or care deeply about these issues that you have to engage with. I think, for example, John McCain was a great example of that, where he was not on any of the Veterans Affairs Committees, yet he had a lot of say in what happened in these types of programs. So learning how to work the various aspects of the way that things are done in Washington is a big part of the job when you're in the Secretary's chair. But it's important to be able to do because if you don't pay attention, or understand that your work is going to be much slower and being able to get anything done.

Louis Celli: 4:52

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. You know, in addition to many Any years worth of backed up legislation that's being signed and flooded into the VA, the pandemic is also cast a fog over everything, I mean, really obscuring much of the transparency and slowing progress on almost everything.

Dr. David Shulkin: 5:15

Yeah, it is hard to know, since his new administration, a new Congress, and now when you layer in the pandemic, what responsibility for this sort of slowness and inability to see a lot being done, you know, should be allocated to those various parts of, of the bureaucracy. But certainly the pandemic has made it very, very difficult. And one of the things that is really challenging that's probably going to continue for the future, is the staffing challenges that are going to be present in the VA. You know, VA entered the pandemic with about 48,000 vacancies, and I suspect it's at a much higher level now. And of course, recruiting people in any part of the economy is challenging, but recruiting people in the government is certainly going to be have its own challenges moving forward.

Louis Celli: 6:13

And you really bring up an excellent point, to be fair, I mean, VA has been wrestling with nursing, mental health and other critical specialty shortages for years, as has the rest of the country.

Dr. David Shulkin: 6:26

Yeah, and this is where Congress can help. I know that we're gonna hear from Chairman Takano, in this episode, and you're going to hear how he's been working to give increased compensation authority to the VA, to be able to stay competitive with the private sector. And that's really important. If we don't give VA the tools and flexibilities to remain competitive. I think we can all see that we're headed for yet another crisis in the VA.

Louis Celli: 6:58

Chairman Takano wasn't the chairman when when you were secretary, but you've worked with him in the past, right? Yeah, he was

Dr. David Shulkin: 7:04

the ranking member. And I've worked with him all throughout my time I find him to be thoughtful and fair. I think that he's in a very challenging situation, in trying to get things done. And I think he wants to get things done, because he believes very strongly in this mission, and the importance of having a strong VA.

Louis Celli: 7:30

Chairman Takano has always been great to work with. As you know, he represents California's 41st district, just outside of West LA and Riverside, and he went to Harvard. So

Dr. David Shulkin: 7:41

yeah, yeah, he's a smart guy. And, and he knows the complexities of both the VA as well as getting things done between the House and the Senate. And you'll hear at times that he's frustrated by the lack of progress that's being made.

Louis Celli: 7:58

One of the things that I'm really hoping that we're able to cover today is the the burn pit legislation. I mean, there have been, you know, more than one legislative initiatives that have been introduced, and some of them are pretty controversial.

Dr. David Shulkin: 8:12

Yeah, and it's not clear how this is going to be worked out, you know, the house has submitted a bill that is much broader, you know, gives much greater presumptive of authority, which is going to translate into probably a more expensive bill than necessarily the Senate. And yet, you know, neither neither of these bills really is going to probably, on its own be successful. So there's going to need to be some ability to compromise, some ability to keep focused on what the veterans really need. And of course, in the burn pit, Lu, as you know, the presumptive leaves that have been granted are the ones that, frankly, in my view, are the least sensible, that is the very, you know, asthma and sinusitis, and very, very common procedures, or common diagnoses, were the ones that we really think about where people are having life threatening, and ultimately are dying from their exposure, such as brain tumors and lung tumors and severe restrictive lung diseases. Those aren't being covered right now. And so we've got to bring some common sense into this. And I think that's going to be a real challenge for the Senate and the House to stay focused on that issue.

Louis Celli: 9:44

I absolutely agree. And as we talked about earlier, they have more than just the responsibility of authorization. They have oversight, and now they're going to have their hands full between keeping the EHR transformation on track and figuring out you know, how to navigate the burn pits legend which has turned out to be really kind of the number one legislative priorities of most of the VSOs. And then, you know, dealing with their their life changing war injuries, and all, while battling the suicide epidemic, 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 pay attention to is the pandemic itself. Because, you know, I come at things often from a healthcare perspective. And there is no healthcare system in the country, maybe even in the world, that hasn't been fundamentally changed, probably for decades. Because the impact of this pandemic and the VA, being the largest health system in the country is no different. I think there needs to be some very strong retro spective analysis of how VA has performed during the pandemic, whether they have lived up to the commitment to taking care of our veterans, but also to that fourth mission, that we don't hear a lot about that during times of national emergency, whether they be, you know, related to war, or related to natural issues, like pandemics or hurricanes, the VA has the responsibility to be able to step up and help other Americans besides veterans. And so we need to take a hard look at that fourth mission and see whether VA has learned and can do even better, should this situation occur again, and also how VA comes out on the other side of this pandemic? And again, not necessarily from looking to criticize, but looking to learn, and looking how we can perform even better in the future.

Louis Celli: 11:50

Absolutely agree. I mean, those are excellent points. And I think what we're dealing with now is really just global exhaustion, from dealing with this and almost an apathy at this point, you know, to, you know, in looking forward and trying to get to the end of it. So I say we get them in here and get started. All right. Mr. Chairman, welcome to the policy. That's podcast. Hey, thank you so much for taking the time 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 you again. I think I saw you last that Arlington Cemetery on Veterans Day, which was a great day to be out there recognizing our veterans. And for our listeners of the policy beds podcast, which is a very large audience of people that care deeply about these issues. This is really your second term now as chairman of the House Committee on Veterans Affairs, and many of our listeners probably would benefit from having an understanding of what are some of the key issues that you've been working on in the committee? And what are some of the significant accomplishments that have happened over those last 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 that first year, we accomplish something very, very important, which was the passage of the Bluewater Navy Vietnam veterans act. That was a decade in the making. I can't come. I can't claim total credit for this. I mean, it began with my, my former colleague, Tim Walz, who's now the governor of whisk of Minnesota. In Tim worked on this bill, 10 years prior, and actually, you know, former chairman, Phil roe had actually passed a version of the bill in the previous Congress, but it was it was it was stuck in the Senate. Sad to say, sometimes we say in the house that the enemy is not the other party in the House. The enemy is the Senate. So I think Phil roe understands that I took up the bill in 2019. And it was this was a very significant it's a it was a 40 years in the coming. It was a bittersweet victory. Why was it bittersweet? Because if we had done something like Bluewater Navy, decades before we could have helped so many more veterans who passed away in that interim time period, and what that bill do it it accorded access to health care and disability benefits to those veterans who served on surface vessels in the territorial waters of Vietnam. They were not getting Third expose because they didn't serve on land, the bill hangs up on my wall with great pride. In 2019, we also took up the failure to really make a huge dent in death by suicide among our veterans, that number stayed persistently high. It, it was a bipartisan frustration that we had a spate of suicides that occurred on on veterans, VA campuses, I wanted to make sure those suicides weren't in some way a form of protest. And we found that they weren't really a systematic protest, it was really that, you know, many veterans who are experiencing great health complications, a number of things intersecting together, knew that the VA would take care of the remains. And in so many ways, the suicides on those campuses weren't really a protest. But but it called attention to the fact that the that the suicide rates were high, we had a White House initiative that the Trump administration at the time, but you know, in that Congress, we passed the veterans compact Act, and the Commander John Scott, Han and mental health improvement, yeah, it was had an array of bipartisan ideas, and both bills. One of the things that I'm very proud of the past that was originated from my office was the the Access Act, which permits any veteran regardless of their eligibility, to call the Veterans Crisis Line, and get access to emergency metal, emergent, medical, mental health care, life saving health care, without worrying about having to pay. Now, this part has been fully implemented, but the implementation is coming soon. And soon, communities, families, veterans across the country are going to be able to know that if they get a veteran to call that line, when they're having an emergent moment, they can get access to care and not have to worry about the bill. Another big area that we've been working on is making the VA a welcoming place to all veterans, regardless of their racial background, religious background, gender, you know, that's the in sexual orientation and gender identity. It's amazing to me that we have, it's not really amazing, but it's it's alarming. The numbers of women who feel that coming to the VA is a barrier because of the climate that exists in vas. And so one of the things is that my colleague, Julia Brownley, who chairs the health subcommittee who chaired the existing women veterans Task Force, they put together the Deborah Sampson act, and one of the things that that Act does is it requires VA to plan for retrofitting medical facilities to better serve women veterans, and that often means having a separate access way for women to come into the VA and not be subjected to looks or, you know, cat calls or, or disturbing interactions. In you know, VA has already made a downpayment of $20 million for this retrofitting. There's many more elements of that bill that were enacted. And so I'm very proud. You know, those are just three of the things that highlights of what we've accomplished in the last Congress and

Louis Celli: 18:50

great, Mr. Chairman, I mean, as you talk about, your job is fairly comprehensive, in addition to representing the, you know, your district in California, you're the chair of the House Veterans Affairs Committee. And, you know, you've talked about some of the laws that you've passed, but but also, you know, a large portion of your job is oversight oversight for the Department of Veterans Affairs, making sure that they're implementing and carrying out the laws that you're, you know, that your committee really helped turned into law. And, you know, a couple that come to mind that were 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 bit about how that might be going,

Mark Takano: 19:31

the caregivers is going far too slow for my liking. People may not understand that. It has a lot more to do with implementation of new programs at VA or the expansion of programs and the inability to kind of get these programs up and running quickly. relates to antiquated IT systems in the inability to broadly administer programs You know, a lot 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 a basically, it's a review of all of the facilities across the country, what facilities need to be upgraded and updated. And believe me, we've got some facilities that date before World War Two, in some cases be will we really old facilities that need to be updated and need to have the capacity to house the modern equipment and the kinds of medical teams that we have today in modern medicine, contemporary medicine, so the air commission was supposed to actually be constituted by now, we're held back by the fact that the some of the congressional leadership, and we just throw some of the Republican leadership under the bus, they haven't they haven't named they were slow in naming their commissioners sending their nominations to the President, that still has to go through a Senate confirmation. The Secretary of Veterans Affairs was supposed to make recommendations based on market assessment data that had been gathered in the last two or three years, he delayed the publication of those recommendations. Part of it was, you know, kind of reviewing the data in terms of accommodating, you know, concerns about how would you know, the pandemic and COVID-19. But really, I think the Secretary was more concerned about the timing of his recommendations, signaling to some of the workforce prematurely, he didn't want to an overly alarmed workforce out there and making drawing conclusions prematurely about these recommendations. And he didn't want to see an exodus. Because he's trying to protect the workforce. So So you know, there's been a sort of bipartisan, sort of looking the other way, about, about the implementation of the air commission. So I have no doubt that it's, it's going to get up and running. But my concern, once it does get up and running, I will be having hearings, I'll be conducting hearings and having the secretary period before us to explain his recommendations. But I'm particularly going to be interested in how the lessons of the pandemic are going to reshape the thinking that went into the commission, because I think many people who instituted and created the commission and created this whole process, we're seeing that as a way to kind of like, dramatically slim down the physical footprint of VA, and I don't know that, that really is that's going to hold up after this pandemic, that, you know, one question how who's going to who's going to have all of 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 kind of run, like kind of an adjust in time sort of mindset? So I mean, you know, that's a question that I that's example, the question that would come up as we go through their commission review.

Dr. David Shulkin: 23:27

Mr. Chairman, I really appreciate the way you're thinking about that. And you're sharing the way that you're going to approach this. I think you're right, the pandemic has changed so much for the country, and certainly for healthcare. And of course, you know, we always worry about what about the new conflict, and if we face people returning that are going to need our help that that raise their hands thinking we're going to be there for them. So So I think you're approaching this in the right way. I do want to go back to what you had talked about earlier in the podcast about the accomplishments that you achieved or or with others helped achieve in the, the Bluewater Navy act that you have hanging on your wall, because it has a lot of similarities, I believe, to what our veterans today are facing with burn pit exposures, in that the blue water Navy didn't have this actual data, to be able to scientifically confirm the associations between Agent Orange and so many of the health issues that we're seeing. And it's the same issue with the burn pit issue that the data is not necessarily there yet. Just today I was contacted by a mother who lost her 28 year old son who had been serving in Afghanistan, and he died of a glioblastoma and as you know, not many 28 year olds normally die of brain tumors like that. I know that you've worked very hard On the pact Act, which is very comprehensive in addressing this blue, this burn pit issue. Can you tell us a little bit about why you feel so strongly about burn pits and where you think the pact act is and if there's going to be a resolution to this coming forward?

Mark Takano: 25:21

Well, Mr. Secretary, let me just say that the Bluewater Navy Vietnam veterans act really deepen the my conviction that we cannot allow what happened to our Vietnam veterans to be repeated with, you know, the Iraq and Afghanistan generation of veterans. It's already been 20 years since we started that conflict. But Bluewater Navy was like the bill was four years after the fact right and and to think that we we saw just huge numbers of Vietnam veterans not be able to benefit from the Bluewater Vietnam veterans Act and the slow pace at which the VA could address these claims. And what is I think, really troublesome or even offensive is the idea that our veterans the burden of proof is put on our veterans. Our veterans who don't necessarily have connections to research institutes, and who aren't scientists themselves. It's veterans and their families who have to go through this as their suffering. So I believe a one of the principal ideas of the pact act is to shift from a system where the burden of proof for the service connection of your condition is put on you the veteran, we need to shift that to a system where the benefit of the doubt is extended to you. Because it may take decades for scientific evidence to actually link and we may never conclusive there, there may always be an alternative explanation for why you got that oil called geo blastoma or Gladstone, yes, glioblastoma, geo blastoma. There always may be an alternative explanation that's plausible in could be a reason for why the government denies you. And but what we do, though, are the facts. The facts are you stepped up, the nation made a promise to you to take care of you to have your back. And we know that millions of veterans were exposed to burn pits that could not exist in the United States. No community would have permitted the these huge burn pits to be burning 24/7 with the kinds of things we don't even we have they even keep track of what they put in these burn pits. But we know that they did put a lot of things that shouldn't been in those burn pits and would not have been permitted in the United States. So the military does not have to knuckle down under OSHA rules or other kinds of environmental restrictions that every state and every community or country would have done. So what is what is my pact, what is PAC act do? Well, it basically would provide health care for 3.5 Toxic exposed veterans, it would establish a new review process for establishing toxic exposure presumptions. You know, Mr. Secretary, when the the Academy of Sciences presents a secretary, even even when they present the secretary with compelling evidence that there is a reason to conduct a an illness to some sort of exposure, that secretaries are often not able to have the authority, but not really they have to kind of knuckle under whoever is in charge of OMB. And so your Secretary believes it's the right thing to do. You know, a secretary often is constrained by by other things. And so, you know, we've worked together with the VSOs to try and create a process which which puts the veterans first and that own before us, right. So we create a new process, we we concede exposure to airborne hazards and burn pits based on the location you served and the date you served. And that's where how we get to 3.5 million exposure. Now all those 3.5 million going to get disability benefits No. But you can bet if a rare cancer shows up At age 28, instead of waiting for the absolute scientific connection they have through an academy of science that may take 40 years to do. We're saying let's give the benefit of the doubt to that rare cancer and by definition, a rare cancer is not going to show up in all 3.5 million veterans, right? So what we do we, we actually look at 23 respiratory illnesses and cancers, and there probably were there were cancers related to burn pit and airborne hazard exposure. You know, three of those respiratory illnesses have already been sort of, in some way vetted by the National Academy of Sciences. And the Secretary is already moving on, on the regulations to establish those as presumptive illnesses. But roughs are really like rare cancers. And I think, you know, it's going to cost us some money, but it's not going to be we're not going to see all 3.5 million soldiers have those those cancers, but we need to take care of those who do get those cancers. We create a presumption of illness of exposure to radiation for veterans who participated in cleanup activities and Palomares, Spain and the you know, what, in a wet tech asshole in the Pacific, we expand Agent Orange exposure presumptions to veterans who served in Thailand, Laos, and Cambodia, we really look to improve the data collection between VA and the Department of Defense, what's called the Eiler system. And so they're there. So we can actually kind of track this and study it. And we require VA to provide standardized training to improve toxic exposure based disability claims, at adjudications. There's much more, but I've kind of just given you the kind of more important ones. But you know, we've got the nine, nine major veteran service organizations, advocates such as Jon Stewart and John feel, and over 70 co sponsors. We have the momentum in this Congress, and this house representatives, I think, to potentially have a strong bipartisan vote, I'm talking to my Republican colleagues, they want to do the right thing, as well. It does cost money. But you know what, it's, this is not about money. This is about keeping a moral compact, a pack that we had with our veterans, that when we send you in the harm's way, we take care of you. And this is this is what I would call a cost of war. I mean, it's, I really can't distinguish, paying for the effects of a toxic exposed veteran, in this case, to burn pits or radiation. It can't distinguish that from, you know, paying for body armor or a tank, or there are arms means the American people in the Congress would not hesitate to equip our soldiers with what they need in the heat of battle. And the truth is, when you've been exposed to toxic substance, and you're suffering, the ill effects of it, you're you're debilitated, you got a cancer in your head and your brain, you're still in the heat of battle, you're still in the heat of battle. So that's, that's, that's, that's what I have. That's what I how I feel about it. And I know, Mike, I know that a lot of members feel that way. Yeah,

Louis Celli: 33:27

Mr. Chairman, your your team has been very gracious and has been able to carve us out a few extra minutes. And we know you have, we know that you have a, you know, a pressing meeting that's backed up against this. So, you know, I want to make sure that, you know, first of all, I want to thank you for bringing up a couple of key and important issues. One, that, you know, OSHA regulations would absolutely prohibit that type of toxic behavior happening on American soil. And yet we did it, you know, within really, you know, within living and eating range, you know, of our of our American servicemembers. And the other thing is, we have no idea what was in those pits, we'll never know, DOD was never forced to keep any, any sort of inventory over what they burned, whether it was computers, or jet fuel, or whatever, that whatever was in there. The real question that I think is relevant that that our listeners are going to want to hear about is, as you know, you know, the Senate has introduced another bill. I think it's at least a second or third attempt at trying to address this, which is markedly different than then the House bill. And I'm just I'm curious, what you see, as you know, as reconciliation. We, you know, we've all been doing this a long time. We know that, you know, there are concessions that are always made on every bill, how do you see these negotiations playing out? Well,

Mark Takano: 34:55

I see them playing out based on how Strong we generate the kind of support we generate in the house, how, how the we gauge what the, the momentum we create with a strong House vote will shape these negotiations. And the American people can shape these or these negotiations, I would say the amazing unity of the veteran service organizations, in the advocates for a robust, strong and comprehensive bill is going to reverberate, they're going to be coming to town in the next six weeks or so. Right? It's so important that the conversation, not just be in Washington, that conversations happen all across this country. And veteran voices are really respected the desire of the American people to do right. by those who put themselves in the line of fire, and those who are suffering, the effects of their service, the American people really want to help them. So my view is that is that I'm doing what I can here personally, every day. And I've got an enthusiastic corps of members on a bipartisan basis who are interested in that in the same as well. And I know the VA, I know, the veterans service organizations, this is their number one priority, it is hard to say no, to what everybody knows is the right thing to do it really hard. And we've just got to make sure that people know, look, what they produced in the Senate is not bad policy. My intention is to include it. But it can't be It can't be it. It can't, it can't only be that it has to be significantly more. So I congratulate the Senate on what they accomplished. But we can do better. We can we can do better. And we will do better. This is the exact time that we need. When our country is so divided. We need a good pre tax to come together. And I'm so grateful that our veterans have offered us this opportunity to come together. And so once again, you know, the cause the cause of serving our veterans could bring us together and I hope mine I believe it will, I believe it will bring us together.

Dr. David Shulkin: 37:28

Yeah, Mr. Chairman, you've been very generous with your time, I just want to wrap up with one final thing you had mentioned earlier in some of your comments that the pandemic really has changed everything. And we're going to need to look at some of these issues through the context of a very different world going forward. And I just wonder if you would just share any thoughts you have about how VA has performed during the pandemic, they not only have had the responsibility of caring for the country's veterans, but also in their fourth statutory mission for emergency preparedness. And, you know, it's clear coming out of the pandemic, that the VA like everyone else in health care is going to be dealing with severe staffing shortages. And, you know, already significant amounts of vacancies that could be worse, just given what we're seeing throughout all of the economy. I just wonder your thoughts about about both how VA has performed and what it looks like going on the other side of the pandemic?

Mark Takano: 38:35

Well, there's a lot to your question. Just real quickly, we just passed the raise act I had hoped it would have. It got bipartisan support. 44 Republicans crossed over and voted for it. I was disappointed the ranking member didn't throw his support behind it. Vaccine politics Scott played, but But you know what, in spite of all that 44 Republicans in the House still voted with the Democrats to raise the pay of nurses in metropolitan areas. So there's a tremendous, you know, competition now for that talent. I'm hopeful that we'll get back to some form of a build back better. We included in Boback better, a lot of money for more training. But listen, we get to the performance of the VA during the pandemic. You mentioned the fourth mission, many people don't realize that the fourth mission that exists. The fourth mission, basically is about the VA. You know, it's the largest health care system in our country. And when there's a natural disaster in the local or regional healthcare system is stressed and begins to break down. The VA through its system of volunteers from its own workforce can be deployed to provide a backstop. In its VA has done this time and time again in cases of hurricanes and earthquakes and fires. And even in the mass shootings, it's it's provided community support. When our emergency rooms are just sort of filled with gunshot victims, the VA steps up, no less. So in a time of a pandemic, when nursing homes were overwhelmed, VA has tremendous infection control expertise. And when invited in VA performed magnificently when they were able to partner, but they have to be invited in. That's part of the I actually think that VA ought to be put positioned, so it can be more proactive. So it can actually lead and not have to sit back and wait for the governor of a state to request. Or it may make more sense for VA to kind of lead emergency response than that other agencies that are positioned to do that. VA performed magnificently, with its own community living centers of what our community considers the basic long term care facilities, we have very few infections, Dr. Stone made some very decisive decisions about closing the access down was hard on those families that had family members in those communal living centers. But it saved lives. Where we lost a lot of lives were in the veterans homes in the states, the state veterans homes, which are not administered by VA, they're administered by states, I believe there needs to be greater oversight authority of VA to make sure that they're up to standard, we did provide an American rescue plan, more money for states to upgrade their facilities, and we need oversight. Related to that. I'm worried that we're not doing enough to prepare for future pandemics we certainly didn't do as well as we could have with this current pandemic. But along with that, we have I think, the specter of climate change and more frequent extreme weather events across the country. And so if you have a pandemic, which is everywhere, and extreme weather events, also that maybe not just one, but maybe two or three in a year, we need to start looking at the fourth mission of the VA in a much more expansive way we haven't really looked at what my committee began to do is to take a look at extreme weather events. As part of the planning that VA needs to do. The VA in Puerto Rico clearly wasn't anticipating a prolonged prolonged shutdown of power. Although it has its own power, the VA has its own power sources and is self contained. What I'm getting at is the the prolonged need of veterans to who are remote and vulnerable, who didn't have access to power. So I mean, these are the kinds of things that the fourth mission as we as we look to update the fourth mission, responsibilities, pandemics, natural disasters more frequent. But VA, under the circumstances performed magnificently. We need to pay attention to the entire workforce needs of the country in terms of health care. So that VA is not competing for what little scraps there are with everybody else.

Louis Celli: 43:37

Mr. Chairman, I and I think you would get broad support on that. As a matter of fact, one of our most recent podcasts dealt with public private relationships. And, you know, and how successful those have been. Listen, I really want to thank you. You've been very generous with your time as the Secretary has said, we know that you're that you're very busy leading that committee and you know, really thank your team. You know, Jenny and Miguel and Lana for us. They really helped us pull this off. And this has been 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 miss this podcast because this is a follow up to a previous podcast that we had done on cannabis. And there have been some advancements in the industry. We're going to hear from Dr. Steven Groff, about how he became one of the first federally licensed growth facilities in the country. See you next week.

Charlie Malone: 44:42

Thanks for listening to the policy bets podcasts. For more information about projects and other podcasts go to policy vets.org