P‑R‑O‑C‑E‑E‑D‑I‑N‑G‑S

                                           9:35 a.m.

            REPRESENTATIVE EVANS:  Thank you all for

joining us today for what I hope will be an

informative and productive session regarding funding

options for the Department of Veterans Affairs medical

system.  Things are not well in the VA health care

system.  Most veterans agree that VA is a good

provider, but it simply lacks the resources to

adequately address the large number of veterans who

need its services.  There are also unreasonable waits

for care, unacceptable delays in services and some

veterans are being denied access altogether.

            At the peak of the waiting time problem we

put forth our first legislation to establish mandatory

funding for veterans' health care.  This was a

bipartisan bill.

            After the bill was introduced, the

President's Task Force to Improve Health Care Delivery

for Our Nation's Veterans recommended modifications to

the current budget and appropriations process by

using the mandatory funding mechanism or some other

changes in the process that could achieve this desired

goal. 

            Unfortunately, some in the House who

originally supported this concept have now

reconsidered.  As a result, I introduced H.R. 2318,

which is now pending in the House with 184

cosponsors from both parties.  It's a big step forward

and I want to thank the staff for getting that many

people on board.

            Senator Tim Johnson's bill, S. 50, and

Senate minority leader Tom Daschle's bill, S. 19, which contains a mandatory funding provision, are pending in the U.S. Senate.  As Members of the minority party in both chambers we have not been able to get the hearings scheduled to address these bills and the concerns that have arisen about the current funding process for veterans’ health care.  This forum is intended to remedy that.

            We want to have a candid discussion about

mandatory funding today.  The bottom line is this: the

status quo of late budgets which bear no relation to

the number of veterans who need VA health care and which

do not consider medical inflation, must not stand.  We

must find a better way to fund the VA's health care

system on behalf of the nation's veterans. 

            Thank you for coming today to discuss your

ideas and at this time I'd like to yield to Senator

Johnson for his opening statement.

            SENATOR JOHNSON:  Well, thank you,

Congressman Evans.  I want to thank you for organizing

today's forum and for your years of extraordinary

leadership on issues affecting our nation's veterans.

There is no one in the United States Congress who has

been a greater champion of veterans' issues than Lane

Evans and I'm pleased to be here with you and with

your House colleagues who have made veterans' issues

a high priority. 

            I served for a time on the House Veterans'

Affairs Committee and I know the frustrations and the

challenges that go with that service.  But so long as

we have the leadership that we have here today, I'm

convinced that we will accomplish more than some

people might think.

            I can think of no more appropriate topic

to discuss in the week following Memorial Day than

providing our nation's veterans with the health care

that they deserve and which we owe to them.  The very

moving dedication ceremony for the national World War

II Memorial served as a reminder that we owe our

veterans a debt of gratitude that can never be fully

repaid.  But what we can do is to live up to our

nation's commitments to the men and women who have

served in our Armed Forces and for me this includes

ensuring that they have access to quality health care.

            This need is brought home to me all the

more fully by the service of my oldest son, Staff

Sergeant Brooks Johnson, who most recently served in

Iraq with the 101st Airborne, but served in Bosnia,

Kosovo and Afghanistan prior to that.  He's now home

in the United States as a recruiter and one of the

things that he assures me is that not only is living

up to our obligations on health care to our veterans

a moral obligation and a right thing to do, it's also

the smart and the necessary thing to do.  We are not

going to be successful at attracting the best and

brightest of our young men and women into our nation's

uniform in the years to come in an all‑voluntary

military if these young people recognize that their

parents, that their older siblings have in fact been

treated shabbily by the United States Government in

failing to live up to health care and other

obligations to them, to those people who have served

our nation with great courage and great distinction,

and great professionalism and yet have too often been

forgotten when they've come home.

            Once again we face a budget that severely

underfunds VA medical care needs.  Under the budget

submitted to Congress, many veterans will not have

access to the VA health care system and will have

increased co‑payments and fees, and will face

continued delays in accessing the care they were

promised.  All too often tax relief for America's

wealthiest families has taken a priority over living

up to the financial needs and obligations that we have

to our veterans.

            Once again Congress will be forced to make

the difficult choices in finding additional funds for

the VA.   I'm

concerned that this yearly struggle to find just

enough funding for veterans' health care is simply

unsustainable.  It breaks the promises we've made to

our veterans and threatens the long term viability of

the entire VA health care system. 

            This is what makes legislation such as the

Veterans Health Care Funding Guarantee Act which I

introduced in January of 2003 particularly

interesting.  This bill would establish a baseline

funding year and calculate the average cost of a

veteran using the VA health care system.  It would

then provide funding for the total number of veterans

who participate in the VA health care system, which

would be indexed annually for inflation.  I'm pleased

that this approach has been endorsed by the

Partnership for Veterans Health Care Funding Reform

whose Representatives are participating in today's

forum.

            The President's Task Force to Improve

Health Care Deliver for our Nation's Veterans, a 15‑

member panel that was assembled to study the health

care needs of our nation's veterans, has also weighed

in on this issue.  The Presidential Task Force

released their recommendations in a report on May 28th

of 2003.  The report clearly that the most pressing

problem facing the VA health system is that funding is

not keeping pace with the need for care. 

            While the panel encouraged greater

cooperation between the VA and the Department of

Defense's health care system, they recognized that

this would not address the fundamental problem.

Instead, the panel recommended two solutions to the

VA's funding problems: create an independent board

which will set the level of VA health care spending

each year or establish a formula and provide a

mandatory amount of funding for VA medical care.  The

second recommendation is the concept contained in the

Veterans Health Care Funding Guarantee Act. 

            I look forward to hearing more about the

Task Force's recommendations from our upcoming

witnesses.  And that being said, making the VA medical

account a part of the mandatory budget may not be the

only, or even the best solution to the problem.  I

remain open to other suggestions.  What is clear is

that the status quo is unacceptable.  It's not

working.  And this is what makes today's forum

particularly important.  It allows us to hear from the

experts and to get their input on how we can best

address veterans’ health care funding needs. 

            I welcome the distinguished members of the

panels that are going to be testifying here today and

I thank our witnesses for their willingness to share

their ideas and their expertise.  I look forward to

working with each of you as we continue the effort to

improve veterans’ health care and I would share the

observation with you that I regret that I will not be

able to stay as long as I would like.  I will be here

later on this morning.  My

home state of South Dakota is going to be having our

new Congresswoman sworn into office on the House floor

and she, I believe, is going to be a star in the

United States House of Representatives and I want to

be there to escort her to the floor for that purpose.

            Thank you again, Representative Evans and

all the members of the panel for your participation in

this hearing.

            REPRESENTATIVE EVANS:  Thank you, Senator.

I'd like to yield now to Mr. Michaud for any comments

he'd like to make.

            REPRESENTATIVE MICHAUD:  Thank you, Mr.

Evans.  As we gathered here today, our young men and

women in uniform are selflessly risking their lives in

Iraq and Afghanistan.  The bravery that they show

demonstrates the great sacrifices made by our veterans

and their families.  America owes a great debt of

gratitude to its veterans.

            Veterans across America are all too well

aware of what the President's Task Force to Improve

Health Care Delivery for our Nation's Veterans

described as, and I quote, "a significant mismatch in VA between demand and available funding."  And as we

enter an election year, the sad truth is politics will

take priority over good policy.  And once again the VA

budget will likely be held to the end of the year,

causing veterans to wait to see what level of care

will be available through the VA.  To address the

growing mismatch, the Task Force recommends, and I

quote, "modification to the current budget and

appropriation process by using a mandatory funding

mechanism."  We definitely do need a system that

ensures that our veterans are not subject to partisan

appropriation process because caring for veterans

should not be a partisan issue.  It should be one of

the highest priorities of the Government and the

Assured Funding for Veterans Health Care Act of 2003

introduced by my good friend Mr. Lane Evans, would

create a guaranteed funding stream for veterans’

health care.

            Not too long ago passing legislation like

this might have seemed impossible. Because of the hard

work of the VSOs and the very dedicated members of

Congress,  I believe that this battle can be won if we

continue to fight it.  The veterans in this country

need to know that the Congress is serious about

caring for their needs and that this country must keep

its promise to the veterans.  So I want to thank you

very much, Mr. Chairman, for having this hearing this

morning.

            REPRESENTATIVE EVANS:  I thank the

gentleman from Maine.

            Ciro Rodriguez?

            REPRESENTATIVE RODRIGUEZ:  Yes, thank you,

Mr. Chairman.  I want to thank the Ranking Members,

Member Evans and Senator Johnson.  I’m also real

pleased with the new member from your state and real

pleased she is my neighbor in the Longworth building, so thank you very much for helping bringing

her up to us.

            I would also like to take this opportunity

to thank the entire leadership that's here and I would

also like to take this opportunity to thank especially

the Veterans Service Organizations that are here, the

veterans advocates that are present today and the ones

that continue to advocate on behalf of all our

veterans.  Never before in my seven years in Congress

have I witnessed such a united effort as we see now. 

Throughout this country and together I know that we

can really make something happen and achieve the

mandatory funding for veterans health care.  In no

other time than election time do we have an

opportunity to make something happen and be able to

leverage what needs to happen, especially at time when

we're in war. 

            It is with great honor that I inform you that the Congressional Hispanic Caucus has

unanimously expressed its support and endorsed HR‑

2318, 20 members of the Congressional Hispanic Caucus

have all endorsed the Assured Funding for Veterans

Health Care Act of 2003.  As chairman of the

Congressional Hispanic Caucus, I'm glad to see

that my colleagues understand and support the health

needs of America’s veterans.  This bill is not only

important, but it's necessary. 

            What message is America sending to our

troops in Iraq and Afghanistan when the administration

and the leadership and Congress continue to cut the

benefits that they will receive as veterans?  We need

to question that message.  What message does it send

to our veterans who were promised these benefits when

they put their lives on the line for our freedom?

What message does it send to our young people when

their grandfathers and their grandmothers sit and

worry about whether they will have the VA health care

benefits from one year to the next?  This is what we

need to do and I think it's only acceptable and it

should be something that we ought to make happen and

what is occurring right now is unacceptable and we need

to move forward.  All we ask is for the Veterans

Health Administration to receive the same funding

structure as we do for most of the other programs;

Medicare, Social Security and all the others.

            Our veterans served their country

honorably, were promised adequate access to health

care and deserve mandatory funding.  It is up to us to make that

happen and if we don't make it happen while we're in war,

we'll never make it.  So we've got to make this

happen, especially at a time when we know the

demographics.  We know that we're losing a large

number of our World War II veterans and we need to

make sure we reach out there.  We ought to be

embarrassed that we have some 25 million veterans out

there, but less than 4.7 receive any kind assistance

or services.  So we got to continue that effort.

            Carlos Martinez, a constitution of mine

and president of the American GI Forum National

Veterans Outreach Program in San Antonio said it best

in a recent committee hearing when he said, "Veterans

have a different perspective on benefits.  They see

them as entitlement while civilians see them as social

services."  Our veterans are entitled to the VA health

care.  It is the least that we can do for their

service and we need to be there for them. 

            I'm real pleased with this strong

effort.  More needs to be done and I'm glad that we're doing this together with the Senate.  Senator Johnson, thank

you very much for helping us in this effort and I

think we can make something happen nationally.  And we

could not make it happen without the ones that are

sitting in front of us and I want to thank you

personally for what you do for all of us and all our

veterans, and our country as a whole.  Thank you very

much.  Thank you.

            REPRESENTATIVE EVANS:  At this point I'd

like to yield to Ms. Davis.

            REPRESENTATIVE DAVIS:  Thank you.  Thank

you, Ranking Member Evans, and thank you, Senator

Johnson, as well for holding this forum today.  Thank

you to all for being here.

           Of course I'm a proud co-sponsor of HR‑2318,

your legislation, Mr. Evans, which would ensure VA

health care is funded according to the need.  What a

wonderful idea.  According to the need. 

            If I could just share my experience with

this issue.  In my district in San Diego we have one

of the highest rated VA medical facilities in the

nation and I'm really very proud of it.  But I have to

tell you that I still hear from many, many veterans in

my community who are forced to wait several months for

treatment, particularly when specialized care is

required.  We all hear the stories from veterans

nationwide who have waited six months or longer for

basic care at a VA facility.  It really is no secret,

certainly no secret to all of you here today.  The VA

does not possess the resources to give veterans

quality care in a timely manner because we are just

not providing enough funding. 

            Secretary Principi himself told the VA

Committee earlier this year that the President's

request for fiscal year 2005 is not adequate and that

he requested more.  Additionally, the Task Force to

Improve Health Care Delivery for Our Nation's Veterans

appointed by the President himself, reported that

funding is falling well short of the need.

Unfortunately, the budget resolution passed last month

by the House underfunds VA health care once again, not

even providing enough to cover for inflation and

payroll increases in 2005.  It will be our veterans

who pay the price when waiting lists become longer and

when the VA is forced to turn more of them away. 

            So I believe it is time to put an end to

these funding shortfalls and pass meaningful

legislation to guarantee the VA has the funding it

needs to provide for a America's veterans.  To all of

the veterans here today, you deserve better health care and all

veterans deserve it.  So thank you very much, Ranking

Member Evans, and Senator Johnson, for your work on

this issue and for giving me the opportunity to speak

on behalf of veterans’ health care here today.  Thank

you.

            REPRESENTATIVE EVANS:  Thank you very

much.  Mr. Strickland?

            REPRESENTATIVE STRICKLAND:  Thank you, Mr.

Chairman, and I will be very brief because I do want

to hear from your witnesses.

            I just think the recently discovered memo

from the OMB indicating the potential of a $900

million cut in VA funding for the next fiscal year is

adequate reason for us to pursue mandatory funding and

say once again, talk is cheap.  What we say matters

nothing to a veteran who is in need of adequate health

care.  It's only what we do here that counts.  And so

I thank you for this time and look forward to hearing

from our witnesses.

            REPRESENTATIVE EVANS:  Ms. Brown?

            REPRESENTATIVE BROWN:  Thank you.  I will

also be brief.  Let me just say that many politicians

talk the talk, but they don't walk the walk.  We just

finished Memorial Day events and we have others coming

up and, you know, every member of Congress indicates

that they love the veterans.  But, you know, show me

your love.  That's how you spend your money and it's

very clear that veterans are not a priority of this

administration.  You know, when we go into conference,

everybody says, "Well, you know, we love you."  But

when we go into conference and we come out and major

cuts have taken place, that's an indication that

veterans are not a priority. 

            Now we need you in the time of war and

you're doing all you can to help America, but when you

need us, we're not there.  And I think it's the

obligation of the Congress to put forth proposals that

will remedy this problem and put it on the desk of the

President and see what happens then.  Thank you, Mr.

Chairman.

            REPRESENTATIVE EVANS:  Thank you.  Thank

you, all.  I appreciate everyone giving us their time

today so we can discuss these issues. 

            Right now, I'm going to call on our

counsel to introduce our first witness for his

statement, after which members will have an

opportunity to comment and ask questions.

            MR. HOLLEY:  We're pleased to have Mr.

Robert W. Spanogle join us today.  Mr. Spanogle served

as a member of the President's Task Force to Improve

Health Care Delivery for Our Nation's Veterans.  He's

been the national adjutant for the American Legion

since 1981 and he's held numerous leadership positions

within that organization.  He's an Army veteran who has shared his expertise and guidance on veterans’ issues

with presidents and with many other Government and

private sector officials and bodies over the years.

            Thank you for being here today, Mr.

Spanogle.  Your full written statement will be made

part of the record.  Begin when you're ready.

            MR. SPANOGLE:  Thank you very much, Jim,

and to Representative Evans and Senator Johnson, and

the Members of Congress, and other concerned

Americans.  I appreciate being here. 

            And, Senator Johnson, I'd like to

associate myself with your remarks because I have a

son also in the 5th Group Special Forces and has been

to all those places like Bosnia, Afghanistan and Iraq.

            But I appreciate the opportunity to be

here to talk about this mismatch between annual

funding for the Department of Veterans Affairs, the

Veterans Health Administration and the demand for

services identified in the final report of the

President's Task Force to Improve Health Care Delivery

for Our Nation's Veterans.

            First, I want to reiterate my appreciation

for being asked by President Bush to serve as

Commissioner on the Task Force.  Second, I want to

thank my good friend, Representative Evans, for

bringing together veterans advocates to discuss

possible solutions to the funding dilemma.  Finally,

I have a great deal of confidence that a responsible

and equitable solution is achievable and to assure

that no veteran in need of timely access to quality

health care will ever be turned away from the VA door.

            As national adjutant of the American

Legion, nearly every day a veteran or a veterans’

family member contacts the American Legion seeking

assistance in getting into a VA medical facility.

            Whether the need is primary care,

inpatient care or long term care, all too often VA is

their health care provider of last resort.  For many,

VA health care is their preferred health care

provider.  For the rest, VA is a life support system

because of severely service‑connected medical

conditions that have left them in need of the VA's

specialized services.  For those very reasons I take

exception when I hear the term "core veterans" being

tossed around, unless they are just talking about

Marine Corp veterans. 

            I am from the old school that believes

that a veteran is a veteran is a veteran.  Veterans

are those individuals who commit themselves to the

unique form of national service that places them under

the Uniform Code of Military Justice where being

overweight, late for a meeting or not properly dressed

is punishable.  It also means following orders that

may send a veteran to heaven or hell.  Their fate is

absolutely out of their control for the term of their

enlistment.  In return, a grateful nation has granted

all veterans certain earned benefits and in some

cases, entitlement for those that returned with

service‑connected medical conditions.

            The only distinction I believe can be made

in veterans is clearly defined in Title 38 United

States Code.  "The term veteran means a person who

served in the active military, naval or air service

and who was discharged or released therefrom under

conditions other than dishonorable."  I find that

definition very straightforward and clear. 

            In June 2003, Dr. Wilensky testified as

the Task Force co‑chair.  Today I will focus on the

only portion of the Task Force report that failed to

muster consensus by all the Commissioners,

recommendation 5.3 addressing Priority 8 veterans.

Personally I believe that this is the most critical

issue in the entire report because it deals with the

greatest portion of the veterans’ population, the

average G.I. Joe and G.I. Jane. 

            I still disagree with this final

recommendation and stand by the dissenting

recommendations provided as a footnote in the full

report on page 80 and that offer tangible and

achievable solutions.  Although annual discretionary

funding of the VHA system was discussed throughout the

life of the commission, it was never the first topic

discussed.  On more than one occasion when

Commissioners asked about funding, they were reminded

that in the opinion of the chair the primary mission

was first and foremost to make recommendations on VA

and DoD collaboration. 

            And early Task Force meetings stakeholder

panels of Veterans Service Organizations and military

associates were invited to offer their views.  Their

views were consistent.  Funding of the VHA was the

first priority.  Clearly the veterans community

encouraged the commission to make funding its first

priority.  There are some organizations that would say

the Task Force majority of recommendation on full

funding for priorities 1 through 7 was a landmark

recommendation and you've reiterated that in your

opening remarks.      I still do not believe it is a

landmark recommendation because it fails to address

the funding needs of an entire class of eligible

veterans, Priority 8 veterans.

            After examining a Task Force

recommendation on Priority 8 veterans, I think you

will find it does not rise to the level of

recommendations, but merely is a statement that says

the status is unacceptable.  Individual veterans have

not known from year to year if they will be granted

access to VA health care.  The President and Congress

should work together to solve this problem.  Just a

statement. 

            That is the very reason that this forum is

necessary, working together to fix this problem.  Who

among us would like to suggest the repeal of Title 1

of the Veterans Health Care Eligibility Reform Act of

1996 as it amended Section 1710 of Title 38 United

States Code establishing the eligibility of Priority

8 veterans for health care?  Who is prepared to tell

all of the Priority 8 veterans that their honorable

service to America was not worthy of recognition as a

patient in the Veterans Health Administration? 

            Just who are among these Priority 8

veterans?  First, there are service‑connected disabled

veterans that make too much too money to be in

Priority groups 5 through 7.  They can ask to be seen

for their service‑connected medical condition, but

nothing else.  They can use the VA pharmacy for

service‑connect medical medications, but then it's out

the door.  Others may be veterans of the greatest

generation of the Unforgotten War. 

            Why not have a "pay as you go" system for

Priority 8?  Medicare subvention is under act of

consideration by VA and HHS.  And what we basically

say in our recommendations is basically in our

dissenting opinion is the fact that all enrolled

Priority 8 veterans would be required to identify

their public and private insurance.  VA would be

authorized as a Medicare provider for Priority 8

veterans.  Would be permitted to bill, collect and

retain all or some defined portion of third party

reimbursements from CMS for the treatment of a non‑

service‑connected veterans.  VA should be authorized

to offer a premium health care based insurance policy

to any enrolled Priority 8 veterans with no public or

private health insurance.  All Priority 8 veterans

would be required to make co‑payments for treatment of

non‑service‑connected medical conditions.  And

finally, all enrolled Priority 8 veterans with no

public or private insurance would agree to make co‑

payments or pay reasonable charges for treatment of

non‑service medical conditions.

            So needless to say, we support mandatory

health care for all our nation's veterans and we are

convinced that it will work. 

            Thank you, Mr. Chairman.

            REPRESENTATIVE EVANS:  Thank you.  Senator

Johnson, do you have any comments or concerns you'd

like to share right now?

            SENATOR JOHNSON:  Well mostly I just want

to thank Mr. Spanogle for his leadership and the work

of the American Legion, and your leadership on the

panel. 

            On the Medicare subvention issue, a lot of

my veterans think this is common sense and can't

understand why we haven't made greater progress than

we have on this.  Do you believe that we could

actually deliver health care services at a lower cost

by utilizing the VA and then charging the Medicare

than having Medicare pay for that service through the

existing Medicare program?

            MR. SPANOGLE:  I firmly ‑‑

            SENATOR JOHNSON:  Do you think it could be

a win‑win situation for both the VA and for Medicare?

            MR. SPANOGLE:  I firmly believe that,

Senator, and the assenting opinion when we talk about

Priority 8 veterans and those that paid for their

Medicare, either their employer or themselves ‑‑ and

they can use that Medicare, as you well know, in the

proprietary health system.  I think if they were

allowed to use it in the VA and VA has third party

collection authority, and actually it's prepaid health

care plan.  Mr. Scully disagrees with me, but that's

his right.  I think you can deliver Medicare through

the VA at a cost‑effective rate and I think it would

be great because you can do it in the Indian Health

Service, which is another federal health provider.

Why not the VA? 

            My attitude is, I'm just from the

cornfields of Indiana, but you know, there's a little

county down there, but quite frankly the VA is

subsidizing Medicare and that's why we don't want it.

            SENATOR JOHNSON:  When people talk about

the higher income veterans who are not eligible, and

the rich veterans that were not getting service to,

what's the income cut off that we're looking at?

            MR. SPANOGLE:  I think Jim could help me

out here.  I think it's $27,500.  Is it not, Jim?  I'm

not totally sure of that.

            MR. HOLLEY:  It's not quite that

high, and it's determined geographically.

            MR. SPANOGLE:  Oh, the HUD, yes.  I'm not

familiar with the HUD.

            MR. HOLLEY:  It's closer to

$25,000. 

            MR. SPANOGLE:  You know, when you talk

about priority of veterans, you may be talking about

one of those that were at the dedication of the World

War II Memorial that flew 130 combat missions. 

            SENATOR JOHNSON:  Well, it seems to me

that you're exactly right, that no one means tested

these people when they went into our nation's service

and put their lives on the line and then the

additional insult to suggest to people that if they

make an income that is modest by any standard, that

they're then too affluent to deserve the care that was

promised them.  That's just unacceptable. 

            So, thank you again for your work on the

panel.  I know that Bill Dodson made some ‑‑ well, did

make some valuable contributions.  It also, I'm sure,

was a source of some frustration for you as well.  But

again, thank you for joining us here today.

            MR. SPANOGLE:  Thank you, sir.

            REPRESENTATIVE EVANS:  Mr. Michaud?

            REPRESENTATIVE MICHAUD:  Thank you, Mr.

Chairman.  The Task Force report with your mandatory

funding recommendation was submitted to the President

almost exactly a year ago today.  Can you tell us what

has happened to the report, if any of its

recommendations have been acted upon by the

administration, or if the Task Force members ever

received an official response to your recommendation

from the administration?

            MR. SPANOGLE:  Well, let's see if I can

remember.  That's a $64,000 question.  I'm not sure it

was delivered to the President.  I think that question

the panel may wish to ask Dr. Wilensky as the co‑chair

of the Task Force and John Paul Hammerschmidt who

followed Jerry Solomon, Jerry, his untimely death,

because quite frankly I wasn't there.  So, I don't

know whether it was delivered or not.

            REPRESENTATIVE EVANS:  Mr. Rodriguez?

            REPRESENTATIVE RODRIGUEZ:  Let me first of

all thank you for your service and your commitment.

I agree totally with you in terms of

indications on the Priority 8 veterans.  Because what

happens later on is that you're going to start, you

know, cutting off veterans and when you see a veteran,

they all ought to be treated as equally as possible.  

            And so I wanted to ask you more in terms

of where we're at now and where we need to go and I

guess that goes to the rest of the future panels as to

what we need to do to make this happen, if there's any

strategic plan that needs to come up to put pressure

on the system to make it deliver.

            MR. SPANOGLE:  Well, Congressman, of

course being a non‑profit professional, and quite

frankly I think for the first time all the Veteran

Service Organizations, the majors, and they're all

major, so I'm not talking about the ‑‑ I suppose the

big three have together in a partnership seeking

mandatory funding and I think in my 30‑some‑odd years

of both being a volunteer and a staff member of the

American Legion, this is the first time that I've seen

that and you have those panel members that are

appearing today.  And that's a milestone when you have

11 Veteran Service Organizations coming together as a

group seeking mandatory health care for the VA.  And

I would agree with you.  If you can cut off 8s, you

can cut off 7s, you can cut off 6s, you can cut off

5s.  And I'm a Priority 8 veteran and Category 8,

Priority 8, whichever they call it now, and I'm

willing to put down my Great West insurance card and

let the VA bill my insurance company.  You know, the

VA can do it.  The Indian Health Service can do it.

So I think it's a milestone to have our Veteran

Service Organizations come together and quite frankly

I think America would agree with that.  We do it for

Medicare.  We do it for other things. 

            And when you talk about service to our

country, I'm not trying to say veterans are more

patriotic than anybody else, but basically they did

serve two, three or four or five years during war time

and sometimes 20 years to retire and I think they

ought to get a bite of the apple, so it's really about

priorities.  And you hear that all the time, I'm sure,

from other people.  Thank you.

            REPRESENTATIVE EVANS:  Ms. Davis?

            REPRESENTATIVE DAVIS:  Thank you.  No

questions right now, Mr. Chairman.  I hope to come

back after the vote and really appreciate your being

here.

            MR. SPANOGLE:  Well, thank you very much.

            REPRESENTATIVE EVANS:  She's doing that

because my brother is one of her constituents.

            MR. SPANOGLE:  I see.  Okay.

            REPRESENTATIVE EVANS:  We have a pending

vote and I'll turn it over to Jim Holley, our counsel,

to continue this forum.  We will return shortly.

            MR. HOLLEY:  Mr. Strickland, before you retire for a vote, do you have comments or questions?

            REPRESENTATIVE STRICKLAND:  Thank you.  I

just want to say to you, sir, [SPANOGLE] that listening to you,

and I'm sure the others who follow you, you have great

credibility because you have experience, you know the

system probably better than many of us who sit at this

table and the thing that gives me courage is the fact

that you are so united on this effort and with that

united front, I think comes great power and the one

thing that I've been trying to encourage you and

others to do is to use the power that you have because

I think especially at this time in our history the

American public is perhaps more aware of and more

sensitive to what veterans have done for this country

than maybe for a few decades.  And so I hope that this

zeitgeist, this spirit of our time, as reflected in

the most recent celebration we had here in Washington

will be used to pursue this very worthy goal of

mandatory funding.    If we don't do it now, will we

ever do it?  I doubt if we will ever have a moment

like this in the near future.  And so, I just want to

thank you for your testimony and all those who agree

with you and support you because you have great

credibility.  Thank you.

            MR. SPANOGLE:  Thank you, sir.

            MR. HOLLEY:  I did have one remaining

question and we'll excuse this panel.

            Mr. Spanogle, your statement discusses VA

offering a premium‑based insurance policy to Priority

8 veterans.  Does that envision VA financing the care

of these veterans and possibly their dependents in the

private sector?  And given its experience with third

party collections, do you believe the VA has the right

type of experience and expertise to put that type of

program together?

            MR. SPANOGLE:  Well, Jim, I'm like a lot

of people in this room.  I'm a great believer in the

VA health care delivery system.  I've seen it in

operation, like Congressman Strickland said.  So I'm

going to answer the question as I few it.

            One, the VA's had third party collection

authority since 1986.  They had problems, as you know,

and you well know, in your position because they never

had to do that.  So they developed the system

internally.  You know, looking back, hindsight's

always 20/20.  Maybe they should have contracted it

out and then brought it back in.  I think they've had

experience at it.

            Now when I talk about a premium‑based

health care plan, I'm talking about that Priority 8

veteran who basically may be back in my hometown, a

little town in Ohio, Scobee the barber, you know, one‑

chair barber shop who wasn't covered by Medicare, who

wasn't service‑connected, but wanted to utilize the

system.  Maybe that veteran that just got out of the

service.  And it seems to me as a federal agency of

this size that with a little innovation and

entrepreneurial spirit, and with a little forethought,

that the VA could offer that veteran who's not

Medicare‑eligible, not service‑connected, not

indigent, but would like to use the VA, be able to

offer that veteran a health care plan that he would

pay into and a good, better, best kind of thing.

Basic health care and then if he wanted to put the

bells and whistles on it.

            You also have, as you know, dependents in

the system under certain conditions.  I don't know

about the dependents, but I do know about the veteran.

It seems to me the veteran health care system doesn't

operate in a vacuum.  I know I'm already familiar with

Roudebush and their affiliation with IU Medical Center

and the affiliation system.  There's no doubt in my

mind that the dependents might be able to go to the

affiliate hospitals and other hospitals within a

hospital system, a consortium of hospitals.  I think

too often veterans look at the VA like it's just, you

know, maybe people that don't know it, just like a 100

and some plus hospitals that operate in a vacuum,

which they don't through the affiliation process.

            So I think I'm one of those people that

think that all things are possible with leadership and

all of those things.

            MR. HOLLEY:  Thank you.  Susan [EDGERTON, HEALTH CARE COUNSEL], did you

have anything?  Thank you very much.

            MR. SPANOGLE:  Thank you, Jim.  Appreciate

it.

            MR. HOLLEY:  Thank you for coming all the

way from Indiana.

            MR. SPANOGLE:  That's all right.

            MR. HOLLEY:  I’ll call our second panel forward.

It consists of groups who represent a variety of

perspectives. 

            Our first witness is Richard Kogan from

the Center on Budget and Policy Priorities.  Mr. Kogan

has had a great deal of experience with Congress

having served on the House Budget Committee for more

than 20 years and also with the Congressional Research

Service prior to his current position.  He's going to

give us the Center's perspective on the budget outlook

for fiscal year 2005 and beyond.

            Pat Eddington has had a wide ranging

career.  He came to know the Veterans Affairs

Committee as a CIA analyst and author of "Gassed in

the Gulf," but he's here today representing the

American Academy of Ophthalmology, part of a coalition

of medical groups including the American Medical

Association, which has supported improved funding

processes for veterans’ health care.

            And Linda Bennett has served as

legislative representative for the American Federation

of Government Employees and specifically for veterans’

care providers for the past seven years.  She received

her law degree with honors from the University of

Wisconsin in 1989, as an aside I should say that

your father uses VA health care, so you certainly have

firsthand experience with the system.

            Mr. Kogan, would you like to begin?

            MR. KOGAN:  Thank you very much for

inviting me.  I am not an expert on veterans’

programs, but I am an expert on the federal budget

because of decades of inundation.

            Let me tell you that the federal budget is

always a depressing area to work in. 

            I would like to start by painting a fairly

broad picture.  Right now the United States is faced

with a large deficit.  By a large deficit, I mean a

deficit that causes the national debt to rise even

faster than the nation's economy.  That

means that each year we have a large deficit, we

go further into debt.  The ratio of debt to gross

domestic product keeps rising.  By definition, CBO,

OMB, GAO, all budgetary experts agree this is

unsustainable over the long term.  It's what causes

third world countries to go bankrupt.

            The problem is that projections that our

organization has made, in conjunction with the Concord

Coalition, the Committee for a Responsible Federal

Budget, and the Committee on Economic Development are

that we will continue to have large deficits every

year of this decade.  The deficit will never drop back

to being a small deficit or to being a surplus.  Rather, it

will remain large and the debt will continue to outpace the

growth of the economy forever through this decade.

And then the baby boomers retire and things will get

worse.

            Okay.  Why do we have large deficits?

There are many reasons, but one fundamental reason is

that over the last three years Congress has enacted

very large tax cuts.  If it had not enacted those tax

cuts, if everything else had been the same as it was,

the spending increases that were a result of 9/11, a

result of the wars in Afghanistan and Iraq,

increases in education that the President requested,

if all of those had taken place but the tax cuts had

not, the deficit would be going from large to small

this coming year and would remain small for the rest

of the decade.  We would see debt dropping as a share

of GDP from 32 percent in 2001 to 29 percent instead

of rising from 32 percent to 45 percent by the end of

the decade.  So the problem, or one of the problems,

is the tax cuts.

            I say this because if we have unsustainable

deficits, something has to be done about it and the

only two choices ultimately are to increase taxes--

reverse the tax cuts--or to cut federal programs. 

            And this brings us directly to the

question we now face:  would veterans’ medical care

be better off if it remained on the discretionary side

on the ledger so that it's funded through the annual

appropriations process, or would it be better off, as

many people think, if it were on the entitlement side

of the ledger so that it had its own formula and the

formula was more related to need, perhaps not

completely related to need, but more related to the

health care needs of the veterans’ population. 

            The answer to that question is

unfortunately not as clear to me as it might seem.  I

say this because I'm looking ahead.  If we look

backwards, there's a chart in my testimony that shows the growth of Medicare, Medicaid, and

veterans’ medical care over the past 30‑some years and

it shows that in real dollar terms Medicare and

Medicaid have grown vastly faster than veterans’

medical care.  There's a divergence and this

divergence has occurred in almost every single year,

in all but two of those 37 years the veterans’

benefits grew more slowly than Medicare or Medicaid or

both.

            So it would seem on first blush that

looking backwards if veterans’ medical care had been

an entitlement, perhaps like Medicare or Medicaid, it

would have done better in the past.  But that's the

past.  Is it necessarily a foretaste of the future?

            To think about that, I would like to turn

your attention to two bills that have been introduced

recently in this Congress: H.R. 3800 and H.R. 3925.

These are both comprehensive budget reform bills and

within them, as a major title of each of these bills,

are identical entitlement caps, statutory caps on the

total level of entitlement spending.

            The statutory caps are very tight.  An

analysis we at the Center on Budget did showed that

the caps would force $1.8 trillion in cuts in

entitlement programs over the course of the next 10

years.  Now of course this is an immediate threat to

veterans’ compensation, veterans’ pensions, burial

benefits and so on.  My point is relatively simple,

which is that if veterans’ medical care is moved into

the entitlement category at the same time that an

entitlement cap is being instituted by Congress, then

veterans’ medical care will also be subject to the

same cuts.  The promises made in the legislation that

makes it an entitlement might be simultaneously

repealed or undercut by legislation capping

entitlements.

            To put it in a different light, right now

veterans’ medical care has to compete against assisted

housing, against the EPA, against NASA and more

broadly, against other discretionary programs such as

education and the Defense Department.  If it were an

entitlement, however, it would be competing in a

different pool.  It would be competing against

Medicare and Medicaid.  And so the rapid growth that

we see in Medicare and Medicaid looking backwards

would be a threat to squeeze out resources for

veterans’ medical care looking forward and veterans’

medical care as an entitlement. 

            Therefore, unlike other witnesses, I'm not

able to say whether in the future veterans’ medical

care would be better off remaining discretionary or

being made an entitlement.  I am able to say that

an entitlement cap is a threat to existing

veterans’ entitlement and could be a threat to

veterans’ medical care and that more fundamentally

permanent, large deficits caused by permanent

tax cuts are a threat to all Government programs,

including veterans’ programs, including veterans’

medical care. 

            Ultimately, if we want to fund the

services that we think that the country needs, that we

think that veterans deserve, we need the resources to

do so.  So to me, the ultimate question is what level

of revenues we are willing to raise, rather than what

side of the ledger we put a specific program on.

Thank you.

            MR. HOLLEY:  We'll come back to this.  Mr.

Eddington?

            MR. EDDINGTON:  Jim, thank you very much

and my thanks to Ranking Member Evans and Senator

Johnson and the other Members who were here earlier

this morning for inviting the American Academy of

Ophthalmology to participate in this particular forum.

            I want to just reiterate that the medical

community only this year has really begun to actually

grapple with this issue, and as I think we've included

in our formal presentation to this particular forum,

we sent a letter to every Member of the House and the

Senate on April the 29th.  It's a letter signed by the

American Medical Association, my organization and I

believe seven others, in which the medical community

stated categorically that we are standing shoulder‑to‑

shoulder with our colleagues in the veterans’

community in essentially demanding that the problem be

fixed. 

            Now, what we don't have is a consensus in

the medical community right now on how you fix

that?  I'm very grateful to Mr. Kogan for getting me

off the hook by mentioning the potential competition

with Medicare.  I don't think there's any question

right now that that is probably the central concern

that our colleagues at the AMA have with regard to

creating a mandatory funding mechanism. 

            Bottom line, and I think everybody in this

room knows it, we have to have a bigger pot of money.

We have to have a larger pool of resources if we are

going to meet existing and emergent needs for health

care, both within the regular civilian population and

also within the veterans’ community.  And just by way

of anecdote, I am a fourth‑generation citizen soldier

as well.  My grandfather fought with the Big Red One

in the First World War, my dad was a Pacific Theater

veteran, my brother's a Vietnam Veteran and I was

Cold Warrior, so this is very personal to me as

well.

            But as I have studied this problem over

the course of the last several years--and I went to

most all the Presidential Task Force meetings during

their deliberations--the thing that has continued to

strike me is the idea that at some level mandatory

funding is going to completely solve the core problem

that we have in the VA.  I think that it will go a

long way toward solving the problem and I think the

medical community as a whole feels that it will

certainly help.  We also have to fundamentally have

accountability and I know that House Veterans’

Affairs, the Senate counterpart and others are well

aware of a number of the problems that have cropped up

in the VA certainly over the last decade with regard

to mis‑allocation of funding, to put not too fine a

point on it.

            But we have hundreds of millions of

dollars dedicated to the Hepatitis C program that

cannot be accounted for.  That's a problem.  When we

have other information technology systems such as the

one down in VISN 8 that turned out to not be too

great an idea and hundreds of millions expended there

for no real results, that's a problem.  And I think at

the end of the day any solution to the resource

problem in the VA has got to have both a funding

component and an accountability component.  I'm sure

that we're going to hear more about this from my

friend Rick Weidman on the third panel, but I think

the medical community is definitely in the same place

with regards to some measure of accountability,

mechanisms of accountability to insure that funds that

have already been appropriated are expended correctly.

We can't simply have a circumstance, to be completely

blunt about it, where senior executive service, either

VISN directors or others, mismanage resources to

the tune of millions or hundreds of millions of

dollars and are then simply shuffled off to another

VISN or elsewhere and are simply protected by the

SES club.  That has to end.  There has to be

accountability.  At the end of the day I don't think

we can generate the kind of truly bipartisan political

momentum for changing this unless we have

accountability measures built in the process.

            Having said all of that, from a resource

standpoint it is very, very clear from the scientific

literature that there is a correlation between

availability of resources and quality of care.  And I

just want to read a very brief portion of my testimony

on page 1.

            Given the aging veteran population, the

need for a stable, reliable funding mechanism is

urgent, as the published, peer‑reviewed literature

shows a clear link between access to care and

outcomes.  A Military Medicine study published in 2002

showed that at once VA facility, in this case I

believe it was the Memphis VA, the primary factor

adversely affecting diabetic eye examination rates was

a delayed access to care, complicated by an increased

demand for eye care services.  And as we go on to

note, this issue merits the highest level of attention

from the Congress and the administration.  At‑risk

veterans with diabetes cannot be forced to wait for

critical exams that can mean the difference between

keeping their sight or losing it. 

            And I think that's one of the most

striking things that I found when I did my literature

review prior to participating in this forum is that

there is a clear link between the funding issue and

access to care, and potentially outcomes. 

            So there's no question that there is an

adequate scientific basis to support the notion that

we need to have more resources in the system and I'm

sure that my colleague Linda Bennett is going to talk

about this in her testimony as well.  You know, we

represent the providers.  We represent the folks,

whether it's the doctors or the nurses or the techs or

whoever, who actually help folks like those sitting

behind me in the audience get the care that they need.

And we have a crisis.  Many of you of course are well

versed in this.  We have a major nursing crisis in

this country, a nursing availability crisis.  It's

only going to get worse.  VA is more impacted by this

crisis than even the private sector so far as I'm

aware.  We're going to have a lot of doctors who are

going to be retiring from the Federal Government to

include the VA over the next five to seven years.  So

we have a number of issues here that are going to have

to be addressed as we go forward.

            And to just sum up, I don't think there's

any question that the medical community as a whole

supports the idea of providing adequate resources for

the system.  The central question that we have to

answer is, how do we do that without disenfranchising

Medicare beneficiaries, Medicaid beneficiaries and

others in our society that we've made those same

promises to?  That is the true challenge before us.

Thank you very much.

            MS. BENNETT:  Thank you.  I wanted to

thank you for inviting AFGE, the American Federation

of Government Employees, to participate in this forum.

            We represent roughly 150,000 VA employees.

Our members are the folks who do the direct work of

healing, bathing, feeding veterans, maintaining VA

facilities; they are physicians, pharmacists,

med techs, janitors, infection control

staff, food service, anyone at the hospital we

represent the frontline staff.

            These are the workers that stand ready to

care for the brave men and women who are fighting now

in Afghanistan and Iraq and around the world and who

will be tomorrow's veterans.  It is the dedication and

professionalism and compassion of these workers that

gives meaning to our nation's commitment to veterans

every day. 

            This past weekend across the nation,  Americans gathered here in D.C. and

in small towns and in cities to honor veterans and

remember our fallen heroes.  And our nation once again

showed a sincere and genuine support for our troops

who are in harm's way by honoring and recognizing the

sacrifices we ask of soldiers.

            This weekend was also a time for patriotic

speeches, about the debt we owe veterans and the

promise to repay that moral debt.  Our nation has

promised in essence to leave no veteran who suffers

from the psychological or physical wounds of war

behind without medical care.  Many of AFGE’s members are

very frustrated because they wonder where is that

patriotic promise?  What does that rhetoric come down

to when it comes to VA's

budget?  And their frustration is very deep and my

phone rings off the hook because our members see first

hand how an inadequate budget delivers a broken

promise of health care. 

            Our members are very troubled

that the administration's budget continues to lock

VA's doors to Priority 8 veterans.  Our members also

see a veteran as a veteran as a veteran.  We are also

deeply worried by news reports that this White House

plans for deep cuts in staffing and resources to care

for veterans in the next four years. 

            While Congress has indeed increased

funding for veterans’ health care in the past, VA has

suffered from chronic underfunding.  This underfunding

coupled with the legitimate increase in demand for

veterans’ health care has led the VA to ration care,

erode mental health services and place an increasing

number of veterans on waiting lists for appointments.

Our members regularly say that they are struggling to

do more and more with less and less to the point that

they are doing less.

            VA's budget, as it's been noted, has not

kept pace with medical inflation, but it also has not

kept pace with large government purchasers of health

care like FEHBP or CALPERS, the California state plan,

which have had larger increases in their premiums than

VA's budget reflects.  The current budget is an

untenable situation.  It does not reflect our nation's

genuine commitment to provide veterans with access to

care. 

            Our members have told us many examples and

I wanted to give you some concrete examples of what it

really means when you have an inadequate budget.  When

a homeless veteran who wants to enter a substance

abuse program that's in Arizona is told, "You're going

to be put on a pretreatment waiting list.  We don't

have a waiting list.  It's pretreatment."  Then that

promise to that veteran for care is being broken. 

            When a family of a veteran with

Alzheimer's in Walla Walla, Washington is told that

the VA has no adult daycare program, then that promise

is being broken. 

            When VA hospitals regularly divert

ambulances because the VA beds are full to capacity,

the beds they've cut, the beds they have been

understaffed are full, then that promise is being

broken to veterans.

            When veterans are denied access to

preventive cancer care, and this has happened in

Togus, Maine, under the guise of

management efficiencies.  Medical equipment was broken

and VA's budget couldn't afford the needed maintenance

or to buy the new equipment so veterans in need of a

preventive cancer care were told, "I'm

sorry, we have to reschedule you in several months".  That means a promise to care is

being broken.

            We cannot let patriotic rhetoric that

we've heard this weekend that many people talk about,

about how much we honor veterans to obfuscated the

disgrace of these broken promises.

            We believe that changing veterans’ health

care budget process demands political courage and

patriotism.  The current funding must change.  It must

be a mandatory funding stream that's based on a solid

formula that makes sure VA's funding keeps pace with

medical costs, inflation and with the demand for care.

And when we say the demand for care, we mean including

Priority 8 veterans in that demand. 

            AFGE stands ready to fight with you in

this struggle to figure out what does make sense in

terms of if we are facing cuts in mandatory funding,

if we have to fight to repeal permanent tax cuts, if

we have to fight to stop tax cuts to keep the current

hemorrhaging of veterans’ health care Fund from growing.  We stand ready to fight

with you to rebuild VA's capacity to care for

veterans.

            MR. HOLLEY:  Thank you very much.  Before

we go on to questions, I want to introduce the

distinguished gentleman from Texas, the Honorable Chet

Edwards.  Be kind, he's on Appropriations.

            REPRESENTATIVE EDWARDS:  Well, hopefully

if we do our work here, Appropriations won't be quite

as important to veterans in the years ahead because it

seems to me that veterans have already earned the

right for health care.  They shouldn't have to beg for

it every year and politic for it every year, and twist

arms every year in the Appropriations Committee and I

salute those of you that are pushing for health care

for veterans to be an entitlement.

            Let me first thank all of you for being

here and I want to express an apology that I'm late.

True story, the reason I'm about an hour late today is

there was a World War II veteran whose son brought his

father today to Washington for the first time in the

father's life.  This veteran fought in France in World

War II, had never seen the White House and they were

about 45 minutes late getting to the White House and

I wasn't about to leave before I got them on a White

House tour. 

            But you know, seeing that veteran and his

love of this country just enhances my emotional

commitment to doing the right thing for those you're

speaking out for today.  How we can on one hand have

the rhetoric of patriotism and supporting our troops

and veterans and on the other hand turn right around

and vote to underfund VA health care, I don't know.

            And those of you that didn't watch last

week, this was an example of the frustration we felt

on veterans’ issues, when the Armed Services Bill

passed last weekend, it was a one‑year freeze on the

most important effective military‑housed improvement

program in American history, the Joint Public Private

Partnership.  Within three hours of that same vote

that we're telling military families during a time of

war, "We don't have enough money to continue your

improved housing programs, we got to put that on hold

for a year," at the same time we voted to give Members

of Congress a tax break.  I didn't vote that way, but

specifically a $69 billion new tax cut for extending

the child tax credit coincidentally just above the

salary range that benefits Members of Congress.  They

wanted to give me a $2,000 tax break because I got two

kids while telling veterans we can't afford to fully

fund VA health care and telling our military families

we can't afford to continue their housing improvement

programs even during a time of war.  It is that kind

of hypocrisy that I hope leaders such as yourselves

will root out in either party.  I don't care where it

exists.

            Let me ask you, since I missed your

original testimony, do all three of you support

entitlement funding for VA health care, or not?

            MR. KOGAN:  I'm sorry, Mr. Edwards.  I

couldn't put myself in that position.  Very briefly,

to recap, I noted that H.R. 3800 and H.R. 3925, the

Hensarling bill and the Kirk bill, which might be

before the House of Representatives as early as next

week, had entitlement caps in them, entitlement caps

that are so tight that they would require $1.8

trillion in cuts in entitlement programs over the

course of the next decade.  Entitlement caps that

would limit the growth rate of entitlement to 3.3

percent per year on average in nominal terms.

            REPRESENTATIVE EDWARDS:  Right.

            MR. KOGAN:  Whereas veterans’ medical care

historically has grown at 5.7 percent per year and in the last five

years has grown at 8 percent per year.  If

veterans’ medical care went to entitlement status at

the same time that Congress imposed these Draconian

entitlement caps, it could be a lose/lose situation.

            REPRESENTATIVE EDWARDS:  True.

            MR. KOGAN:  And I further said, as other

witnesses have said, that the reason that these entitlement

caps have such currency these days is that the nation

is faced with large and growing deficits, deficits

that it cannot afford over the long term, deficits

that are not manageable and not sustainable because of

the sorts of tax cuts that you're talking about. 

            One point that's in my written testimony

that I didn't make in my oral presentation is that the size of the already enacted

tax cuts just for the wealthiest one percent of the

population, households making $310,000 per year or

more, is larger than the entire annual VA budget. 

            REPRESENTATIVE EDWARDS:  Wow.  That's

amazing.  Now, I think your point is well taken.  I

still support entitlement.  Hopefully the Hensarling

bill won't pass, but many in this room will remember

on March 21st of last year, you weren't there

physically I hope, at 2:54 in the morning we voted to

‑‑ I opposed the budget resolution, but it had $28

billion in veterans’ cuts over the next decade,

including entitlement cuts.  I think $14 billion of

that was entitlement cuts.  Eight minutes later at

3:02 a.m., during the first week or so of the Iraqi

war, we voted to salute our future veterans, those

troops over there risking their lives in Iraq.  So

clearly, making VA health care an entitlement isn't a

guarantee that there wouldn't be challenges to vet

funding, but perhaps many of us think it would be

harder for people to go after an entitlement than it

would be, you know, for us to fight that annual budget

fight.  But thank you for your very important point.

            MR. HOLLEY:  Let me just say while this

gentleman's sitting here, veterans have a

good friend in Congress in Chet Edwards.  He

really helps carry your water and he's there for every

fight.  He is outspoken, spirited and passionate on

the floor on veterans’ issues.  So we're very

fortunate to have him on the veterans’ team.

            REPRESENTATIVE EDWARDS:  Thank you, Jim.

I'll talk to Lane about a salary increase.

            MR. HOLLEY:  Then I was successful.  Susan

Edgerton is our health care counsel.

            MS. EDGERTON:  Thank you.  Thanks for your

testimony today.  I guess my question is for Mr.

Kogan.

            As conscientious veterans’ advocates

you've provided us documentation in the past that

shows the President's budget would drop the VA medical

care budget by 17 percent by FY 2009.  You know, I think it’s that

situation that compels us

to look to entitlement funding as an option and I

guess I just wanted to make that as a general

observation. 

            If we're in this assuming that we will

have these tax cuts and that we may be able to keep

the entitlement caps at bay, do you want to just

comment on that scenario?  I mean, I guess we see this

as the best hope of getting veterans’ health care

funding at a level that's adequate to support the

growing needs of veterans.

            MR. KOGAN:  You've asked me to speculate

on a situation that I find distasteful--that is to

say, a permanent extension of the tax cuts thereby

denying the Government as a whole of revenues that

would be adequate to support the sorts of programs

that we're currently supporting, much less any increased

benefits and programs.  Because it's the strong opinion

of the Center on Budget and I think many objective

people in the middle of the political spectrum that we

cannot use large-scale deficit financing forever to

take care of the mismatch between the revenues we want

to pay and the benefits that we feel are necessary.

            Okay.  Nonetheless you've said "assume"

that the tax cuts are made permanent.  What then?

Well, there is no doubt that if the tax cuts are made

permanent, then the pressure on programs that had been

largely lacking for the first few years, for the past

couple of years, will increase year after year and that

discretionary appropriations will be squeezed tighter

and tighter and tighter. 

            My point in bringing up these entitlement

caps is that entitlement programs also will be

squeezed tighter and tighter and tighter and it is, as

I said in my testimony, basically a guess as to which

side of the ledger will fare worse and under which

circumstances.  I just wanted to repeat the point that

I made earlier, which is that under current

circumstances veterans’ medical care has to compete

against popular programs such as education and

environmental concerns, and programs of that nature.

But if it were made an entitlement, it would have to

compete against the 800‑pound gorillas of Medicare and

Medicaid.  It's not at all clear what the most

successful course is.

            MR. HOLLEY:  We

go back and forth using the terms "entitlement" and

"mandatory."  And I'm just wondering if there's a real

difference here.  Does it matter that the bills, Mr.

Evans' bill, or Senator Johnson's or Senator Daschle's--that

call for assured funding or mandatory funding do not

create an individual entitlement to health care as

Medicare and Medicaid do?  Is it rather a system

entitlement, if you will?  I mean, is there a

difference in that regard?

            MR. KOGAN:  There are differences that are

important with regard to the actual operation of the

program.  Individual entitlements, almost by

definition, are open‑ended entitlement, Social

Security for example or compensation and pensions, where

the cost of the program depends entirely on the number

of people who are eligible and the formula that

determines how much they are eligible for.  Whereas

system entitlements, as you put it, or capped

entitlements, capped by a dollar amount or by a

formula, are somewhat different.  Examples of a capped

entitlement would be the Title XX grants to states for

social services.  This is mandatory funding.  It is

not determined by the annual appropriations process.

This funding has been frozen for more than 20 years so

that it is not necessarily the case that capped

entitlements, which the Center on Budget tends to view

as a contradiction in terms, is in any way the best

way to go.  It might be that if you're going to create

an entitlement, creating an individual entitlement

would at least have the advantages of being more

responsive to fluctuations in need, fluctuations in

health care conditions, as for example if there's an

epidemic, and so. 

            I'm not recommending an individual

entitlement relative to a capped entitlement relative

to discretionary spending.  I am saying that they are

all different in the context of global entitlement

caps or mandatory caps that are being proposed in the

bills that we were talking about and by others who are

talking about the subject in the popular press.  They [advocates of entitlement caps]

do not draw distinctions between individual

entitlements and system entitlements.  For them, all

those programs would be in the same pot.  They would all be

subject to the same type of cap.  They would all compete

against each other.  I hope that helps.

            MR. HOLLEY:  Let me just throw

it open to any members who might have comments or

questions.  Mr. Strickland?

            REPRESENTATIVE STRICKLAND:  Yes, if I

could just follow up on that because I'm trying to

understand.  If a mandatory funding program can be

frozen for, you say 20 years, then it seems to me that

the important element, if you have such a program in

place, is the beginning point and then if you could ‑‑

I mean, could you build into such a program an

inflationary aspect so that that mandatory funding

cannot be frozen, but increases at least according to

some formula each year?  It seems to me that that

would be important if you're going to have, instead of

an individual entitlement program, a system mandatory

funding program, it would be important to start out at

an adequate level and then have some mechanism as a

part of that program that increases funding so that it

isn't frozen for a significant period.  Otherwise, you

know, what have we accomplished? 

            MR. KOGAN:  Indeed, and your question is

certainly on point.  H.R. 2318, as I understand it,

attempts to do exactly that, attempts to start at an

adequate level and it attempts to adjust itself for

the medical price component of the consumer price

index.  The overall global entitlement caps in the

legislation that I'm talking about, the Hensarling

bill, and the Kirk bill, set global caps that

start at existing levels, 2005 levels, before the

prescription drug benefit takes effect.  The bills adjust total entitlement spending only for

changes in case load and the general price index, the

CPI, and only for indexed programs. 

            If, within that tight cap, you have a

program that has been promised faster growth, either

because it's an individual program or because it's

been designed rationally in the way that you spoke of,

then that program is contributing towards the overall

caps being breached and that program would be under

tremendous political pressure as Congress decides each

year what cuts to make in order to make the global

caps effective.

            This then is the threat.  The threat is a

global entitlement cap.  No matter how well designed

an entitlement is within the global entitlement cap,

it is still subject to the cap and it's still

competing against all other programs within, relatively speaking,

a shrinking pie. 

            REPRESENTATIVE STRICKLAND:  Thank you.

            MR. HOLLEY:  Mr. Rodriguez?

            REPRESENTATIVE RODRIGUEZ:  I apologize.

I didn't hear the testimony, but I was wondering if ‑‑

because I know how this administration has been

operating and they've brought in some people from

Texas.  In terms of how they did things down there and

one of the things was that we know that we operated

under the entitlement programs.  We knew that those

were dollars that we could not touch as much except if

we want to come back in and cut across the board or

cut three percent or ask the agencies to go back and

cut 10 percent, that kind of thing.  And then the non‑

entitlement ones were the ones that, they went after.

            Has anybody been following what

they did back in Texas in terms of the cuts.

            Secondly, I would think that one of the

advantages of funding this way is that, number one,

administratively you would have an assured amount of

resources already coming in.  Then we can look at the

four missions that the VA has and look in terms of what we're not doing as well and

seeing what we could do in those areas.  For example, monies for

facilities and other things that were proposed through

the CARES and other studies, or other recommendations

that come out.  But at least you have some degree of

resources that you know that are already flowing and

yes, they might come back and say, "Look, we're going

to go across the board and cut six percent from all

agencies."

            And then the other caveat I would throw

out is that we would also look at demographics and

patterns with certain programs and others.  And in

this area, you know, the demographics show that our

veterans have reached that age where they need us and

that will also supposedly come up and

down.  And so I just wanted to throw that out and get

some feedback from you.

            MR. KOGAN:  I can't answer the question

about budgeting in Texas.  I'm sorry.  Perhaps some of

my colleagues can, but I wanted to say very briefly

that the gist of my testimony is that the Assured

Funding for Veterans Health Care Act would be a

misnomer.  The word "assured" would have to be crossed

off if Congress passes the entitlement caps that may

be on the floor next week in the House of

Representatives proposed by Congressman Hensarling and

Congressman Kirk.  And beyond that, even if those

bills do not pass next week, or if they pass the House

and the Senate kills them, ultimately the word

"assured" still is a misnomer if we're not willing to

raise the revenues necessary to support Government

programs.

            MR. EDDINGTON:  Mr. Rodriguez, like Mr.

Kogan, I'm afraid I have to plead ignorance when it

comes to how the Bush administration and its

successors down in Texas handled this. 

            But speaking for the medical community, I

just want to echo what Mr. Kogan has said with regards

to this idea of competing for different pools of

money.  I think that's the core concern that the

medical community has, is that if we go to mandatory

funding does that then mean we're having head‑to‑head

competition between what I personally believe are the

most deserving group of human beings in our society:

veterans and senior citizens, and the poor and the

indigent who depend so much on Medicaid. 

            I think if we allow that to happen, from

my perspective, that's social cannibalism.  And I

think the medical community would basically agree with

that, perhaps not using quite those words, but that,

I think, is the precipice that we have to be concerned

about and that's why Mr. Kogan's observations with

regard to increasing the size of the pie I think are

really important. 

            A dedicated funding stream, I think, is

important, but at the same time, as we indicated

previously, also having proper management

accountability controls in place to make sure that

existing funds are expended properly is absolutely

vital.  We can't have $500 million for the Hepatitis

C program just disappear into thin air.  I mean, that

just cannot happen.  We cannot have those kinds of

problems because at the end of the day that undermines

support for the very thing that we're trying to do,

which is get dedicated funding.  If it's not being

spent properly, if the stewardship is not there, then

that undermines, I think, our basic argument to try to

actually get mandatory funding.  But I fully associate

myself with Mr. Kogan's concerns about the entire idea

of mandatory funding if a cap is looming out there at

some point in time.

            MS. BENNETT:  I just want to add to what Mr. Kogan has

pointed out so eloquently about the problems of tax

cuts.  AFGE, the AFL‑CIO and many groups, fought very

hard against the tax cuts and when I spoke about

mandatory funding requiring political courage and

patriotism, it may mean that in order to have a

successful effort at mandatory funding that is

meaningful and is not influenced by caps or the social

cannibalism that Mr. Eddington describes, it may mean

that groups who support and want mandatory funding

that we collectively must start to translate to our

members what those tax cuts meant to veterans’ health

care. 

            MR. HOLLEY:  Any other questions?  If not,

thank you very much.  We Call our third panel forward.

            Our final panel is comprised of

representatives of the Partnership for Veterans Health

Care Budget Reform.  This group of nine major Veteran

Service Organizations, which also includes AMVETS,

Blinded Veterans Association, Jewish War Veterans,

Military Order of the Purple Heart, Paralyzed Veterans

of America and the Veterans of Foreign Wars, has made

changes in the funding process for VA health care a

top legislative priority. 

            National Commander Alan Bowers of Disabled

American Veterans is an Air Force veteran of the

Vietnam War.  As a member of DAV since immediately

following his injury, he's had numerous leadership

positions within DAV and in local, fraternal and

community organizations in Massachusetts.  Welcome,

Commander Bowers.

            Richard Weidman is the Director of

Government Relations for Vietnam Veterans of America.

Rick was an Army medical corpsman in the Vietnam War.

He's been active in veterans’ issues in New York and

here in Washington since that time.

            Steve Robertson is the Legislative

Director for the American Legion.  An Army National

Guardsman during our first deployment to the Gulf,

Steve was retired as a captain of the U.S. Air Force

after 20 years of military service in 1996. 

            Welcome, gentlemen.  Let's begin with

Commander Bowers.

            COMMANDER BOWERS:  Thank you, Jim,

Representative Evans, members of the distinguished

panel.  Thank you for holding this forum and providing

the Disabled American Veterans the opportunity to

discuss alternate methods of funding for veterans’

health care. 

            The veterans’ panel sitting before you

represents nine major Veteran Service Organizations

that have come together to form the Partnership for

Veterans Health Care Budget Reform.  The partnership

includes the American Legion, AMVETS, Blinded Veterans

Association, Disabled American Veterans, Jewish War

Veterans of the USA, Military Order of the Purple

Heart of the USA, Paralyzed Veterans of the United

States, Veterans of Foreign Wars of the United States

and the Vietnam Veterans of America.

            The benefits of the VA health care system

are well known to you and to your colleagues.  Access

to comprehensive health care and the specialized

services that the VA provides is essential to the care

and well being of the many service‑connected disabled

veterans and other veterans with special needs. 

            Unfortunately, VA's ability to fulfill

America's promise to our nation's veterans is not

well‑served by the annual federal appropriation

process.  Simply put, the method of discretionary

funding for VA health care is broken.  This puts

veterans at risk and the time to make the change is

now.  The goal of the partnership is to shift the VA

medical care funding from discretionary to mandatory

in the federal budget. 

            As a result of the chronic underfunding,

VA has been forced to ration health care.  They do

that by creating long waits for appointments.  That

drives veterans away from the system.  Thousands of

veterans are waiting, some more than six months, for

basic health care appointments and the Priority 8

veterans has been noted, continue to be turned away

from the system.  For them, the VA health care door is

shut.

            The problem is the way that the VA health

care funding is provided.  As a discretionary program

it is put into direct competition with other federal

departments, agencies and programs.  To make matters

worse, over the last several years varying political

pressures have delayed the enactment of the funding

bill.  Last year's bill, the funding did not pass

Congress until January, almost four months late.  So

not only does the system fail to provide adequate

funding, but it can't even get it done on time.  This

severely impairs the VA's ability to plan adequately

to care for the millions of veterans it is required to

care for. 

            Moving VA health care from discretionary

to mandatory funding would insure that VA receives

sufficient resources to care for veterans who use the

health care system.  Very important point, it would

not change VA's current mission, nor would it create

an individual entitlement to health care.  What it

would do is eliminate the year‑to‑year uncertainty.

Under mandatory funding, the VA would be able to

adequately plan for and meet the growing needs of

veterans who seek medical care. 

            Congress retains its critical oversight of

the VA programs and health care services.  The VA

would still be held accountable for how it spends its

money.  Those mechanisms are in place now.  They would

be challenged to continue to run a health care system

with quality.  An essential element of our funding

proposal is that the Congress retains its oversight

abilities. 

            We believe that funding, with proper

checks and balances, will insure accountability.  It

will provide a predictable funding system that allows

the VA to meet the health care needs of our nation's

veterans.  As has been noted, the President's on Task

Force to improve health care delivery to our nation's

veterans concluded in its final report that there is

a significant mismatch between VA demand and the

available funding.  That's an imbalance that they

believe not only impedes the collaboration efforts

with DoD, which was one of their goals, but if left

unresolved will delay veterans’ access to care and

threaten the quality of VA health care.

            The Task Force recommended that the

Federal Government provide "full funding" to insure

that enrolled veterans in Priority Groups 1 through 7

are provided current comprehensive benefits in

accordance with VA's established access standards.  By

using a mandatory funding mechanism or some other

change in the budget and appropriation process that

meets those goals, those goals can be achieved.  The

Task Force also suggested access issues for Priority

Group 8 must be addressed.  Unfortunately, the

Presidential Task Force recommendations to resolve VA

health care funding have been virtually ignored. 

            So as I conclude my remarks, I want to

emphasize that there is widespread agreement that the

funding mechanism, the funding mechanism, not the VA

health care system, is what needs fundamental reform.

The DAV, as part of the Partnership for Health Care

Budget Reform, fully supports a mandatory funding

mechanism as a long term solution to the problem.  And

the American people support this solution. 

            In a recent nationwide survey, nearly all

of the respondents said that veterans should not have

to wait to receive care that they have earned.  The

Partnership calls on every member of Congress to make

mandatory funding for veterans’ health care a top

priority to insure that sick or disabled veterans have

prompt access to quality care, quality care they need

now and will need in the future.

            So, Representative Evans, members of the

panel, that concludes my statement and if there are

any questions, I'd be happy to address them after the

panel finishes.

            MR. WEIDMAN:  Mr. Chairman and

distinguished members of this panel, I am pleased to

be able to represent Thomas H. Cory, our national

president and our officers and board before you today

discussing alternatives processes for funding

veterans’ health care. 

            I'd like to associate myself with the

remarks of Commander Bowers and also state that

Vietnam Veterans of America is very pleased and proud

to be part of the partnership of standing together

with the other eight organizations on this issue,

which is central to the quality of care at VA, namely

adequate funding of the care at VA.  It is the first

time, I believe, that all the major organizations are

literally on the same sheet of paper when it comes to

health care issues.  We've gotten together on other

things, but for health care issues this is the first

time and it feels good to have achieved that unity

with the help and assistance of some of you at that

front table at the very beginning of that effort.

            We believe that unless the funding

mechanism is fixed for VA, VA will cease to exist and

that even now it's already affecting the quality of

care across the nation.  There was a book published by

Ralph Nader some 40 years ago now that was entitled,

"Unsafe at Any Speed."  Many of our VA facilities are

so over funded and robbing to Peter to pay Paul and

taking from the neuro clinic to give to the Hepatitis

C clinic, to give to whatever clinic, that there's

only so many little peas under those walnut shells you

can move around and it's becoming that kind of a shell

game for our medical administrators, even the very

best of them.

            We do support moving to mandatory funding,

although like Senator Johnson and others have said

here this morning, what we have said back when people

say, "I don't believe in moving to mandatory funding,"

some quite genuinely, I believe and we believe at VVA,

and Members of Congress, that they're philosophically

opposed to it because they believe that it abrogates

their Constitutional authority to put money forth.

Well if that's true, and this is what we've come right

back and said to those folks who we believe are

genuine, "Show us the alternative.  How do we get to

where we need to get and stay there for funding for

the veterans’ health care system?"

            We will continue to push there because we

are in this fix, as I think you all know, because of

the rules of discretionary funding and it harkens back

to the Balanced Budget Amendment of 1996 where the

deal was made with the devil between Mr. Gingrich and

the administration to flat line the veterans’ health

care budget.  It took three years and tremendous

effort from Senator Johnson and others and we finally

broke it in the Senate with a united front.  But now

the base has been eroded from where it should be. 

            We pointed out last year in a white paper

that we published and shared widely with the veterans’

community and with the Congress that in comparison

with Medicare, veterans were getting 60 cents on the

dollar in the President's request for the FY 2004

budget.  The request for 2005 is 58 cents on the

dollar.  The gap is widening every year.  You saw a

graph when you walked in the room that showed that

VA's health care funding had risen at a much slower

rate than VA health care funding.  But that's assuming

you have the same size.  We believe the only way to

compare veterans’ health care funding with Medicare

is, because Medicare is a per capita, per capita that

has to be on per capita users at the VA system and

based on that comparison of methodology, using Center

for Medicare and Medicare Services and the VA's

figures.  The President has asked for 58 cents on the

dollar.  Even with the additional funds that have been

added under the budget, assuming it's in the

appropriation, it will still be short.

            So, what is the problem?  We believe that

if we don't go to mandatory funding and we're once

again pleased to be part of this broad coalition, that

it will be end any semblance of meeting our

obligation, our obligation to the men and women who

have served in the military our country so well.

            There are three things that we believe

have to be done in this regard.  The first is that the

nation needs, and it's the nation's health care

system, not the VA's and certainly not Office of

Management and Budgets, it is one, the nation needs

the dough to make it go.  I mean, you could just put

it quite simply.  In other words, we need the adequate

and predictable, as pointed out by Commander Bowers,

funding.  You can't plan for the adequate maximization

of bang for the buck of taxpayer dollars if you don't

know until four or five months into the fiscal year

and you can't really plan to get the best out of that.

            Secondly, we need much greater

accountability of senior management for best use of

taxpayer dollars and for the outcomes of clinical care

for each veteran.  We believe that frankly much of

senior management at the VA is not held properly

accountable, yet the average bonus is the highest in

the Federal Government of over $11,000 a year and that

does not count awards and other kinds of monetary

incentives that are handed out like popcorn and

spoils.  We have a hard time with that.  We have a

very hard time with that.

            And thirdly, we believe that we need a

system that is systematically and determinedly a

veterans’ health care system.  We've talked about the

need for military history and that to begin at the

front door of VA time and time and time again and that

is the third thing that we believe that if it must

become a veterans’ health care system adequately

funded with proper accountability for getting taxpayer

bang for the buck for taxpayer dollars and for

clinical outcomes of the veterans who use that system

and otherwise the system will end and not fulfill the

obligation of the American people toward those men and

women who have been harmed by virtue of military

service.  Thank you very much for this opportunity.

            MR. ROBERTSON:  Thank you for holding this

very important forum.  I think the average American

citizen would be appalled to know that you were having

to have this discussion.  I think the average person

that's not affiliated with the VA or have has a family

member in the VA system doesn't realize that this

problem even exists. 

            I want to make it clear that there are

many other organizations besides the Partnership that

endorse the idea of mandatory funding.  Clearly the

current VA appropriations process is broken.

Repeatedly inadequate appropriations, continuing

resolutions, srecisions, offsets and delayed

appropriations plague and adversely effect nearly every

aspect of VA.  For many years, VA has robbed Peter to

pay Paul forcing VA administrators to shuffle funds

from one account to another to meet payrolls, often at

the expense of non‑recurring maintenance repairs,

purchase of state‑of‑the‑art equipment and purchase of

needed supplies.  This situation has a ripple effect

on other aspects of VA to include recruitment and

retention of quality health care providers.  VA should

be the employer of choice in the health care industry,

not the job of last resort.

            For over 7 million veterans, VA is their

health care provider of choice and there are hundreds

of thousands of other veterans that would like to

enroll, but currently are prohibited from enrolling

due to inadequate funding.  VA is recognized as a

leader in so many areas of expertise, especially

specialized care.  In addition, VA clearly provides

the most cost‑efficient testimony throughout the

health care industry, both public and private.  VA

remains the nation's most clinically‑focused setting

for medical and prosthetics research and continues to

contribute to medical achievements. 

            It is important to understand why the

current process is not properly funding VA as

advertised.  The first step in the process is the

Secretary of Veterans Affairs' budget request to the

Office of Management and Budget.  This is a

recommendation that is not known publicly.  After

analysis by OMB, the Secretary is told, "This is your

new budget."  The Secretary of course can appeal to

the President.  But whatever the final decision is

made, that is what we're going to live with.

            Frequently, the President's budget request

is inadequate to fully fund and sustain current

services within VA.  On several occasions in recent

history VA has requested supplemental or emergency

appropriations later in the fiscal year.

            Another problem has been the failure of

Congress to pass an annual appropriations for VA in a

timely manner.  In this situation, VA is forced to

operate under the previous year's appropriation, even

if it's clearly inadequate.  In the last two fiscal

years, the final passage did not come until well into

the second quarter of the new fiscal year.

            The non‑binding budget resolution is

another excellent example of the frustration caused by

the current budget process.  Many programs funded with

mandatory appropriations such as Medicare, Social

Security or VA comp and pen reflect a stable multi‑

year projection, whether it be a five or 10‑year

projection.  Programs funded by discretionary

appropriations are extremely volatile with noticeable

peaks and valleys.  This creates uncertainty and

further complicates the short and long range planning,

staffing decisions and availability of services. 

            Finally, budgetary scorekeeping blurs the

fiscal lines of responsibility.  The best examples is

the MCCF, the Medical Care Collection Fund, being

scored as an offset against discretionary

appropriations, especially when third party

reimbursements from the largest federal health insurer

is exempt from collections.  If VA fails to meet its

collection goals, then it faces budgetary shortfalls

that will adversely impact its patient population

either through rationed health care or lengthy delays

for access to care.  Over half of VA's enrolled

patient population is Medicare‑eligible.  Congress on

one hand expects VA to act like a private health care

provider, but then prohibits from billing the majority

of its patients' health care insurer.  This is an

extremely hard concept to explain to most veterans,

especially those that are Medicare beneficiaries and

have chosen VA as their primary health care provider.

            Clearly, there are alternatives for

funding veterans’ health care if veterans’ health care

is to be indeed a national priority.  Historically

every time Congress has been faced with a problem that

is deemed a national priority, laws are enacted and

funding is made available.  The American Legion

believes the nation's top priority is maintaining a

strong national defense.  A strong national defense

enables the rights guaranteed by United States

Constitution.  Men and women that wear the uniform of

the Armed Forces sustain that strong national defense.

VA exists only because of the men and women that have

worn that uniform with honor and dignity.  To short

change veterans of their earned benefits constitutes

a failure on the nation's part to properly recognize

their sacrifice.  That concludes my remarks.

            REPRESENTATIVE EVANS:  Thank you, Steve.

We appreciate your testimony today. 

            At this point I'd like to go to Mr.

Rodriguez.

            REPRESENTATIVE RODRIGUEZ:  Thank you very

much.  Let me first of all thank all of you for the

testimony and for the work that you do for all of us.

We can never thank you as much as we should for what you

do for our veterans out there.

            I was just looking at the Washington Post

Parade and one of the basic questions that they ask,

and I'm going to throw it out to you as to how you

would define that.  It says, "What do we owe our

veterans?"  I want to ask you to respond to that.

            MR. ROBERTSON:  As being a veteran, father

of a veteran and having a wife that's an active duty

lieutenant colonel, we really don't ask for much, just

respect. 

            The health care system was established to

take care of those that had borne the battle and

clearly that's our national commitment.  I do not

understand for the life of me why we're in competition

with anything because without the service, the

commitment, the continued dedication of the young men

and women stepping forward today, you wouldn't have a

government to be arguing with. 

            COMMANDER BOWERS:  Certainly at the very

minimum the Government owes the individuals who have

served in uniform and have suffered physical, mental

or other disabilities certainly at a very, very

minimum the Government owes timely quality care.

That's a given. 

            I think I'd like to emphasize the point,

VA health care is really a cost of national defense.

The day that that veteran takes off the uniform and

crosses the street from Bethesda or Walter Reed and

goes into the VA hospital, that arm doesn't grow back

on, that vet doesn't regain his eyesight, that wound

doesn't automatically heal.  Veterans’ health care is

a continuing cost of national defense.  The war is not

over when the last bullet flies or the last bomb

falls.  There are men and women out there today who

are still fighting World War II and they're fighting

it every single day, and they are paying every single

day and they're paying with pain.  I think your

colleagues need to understand that and if they do,

there should not be any fight about how VA health care

is funded. 

            MR. WEIDMAN:  Vietnam Veterans of America,

we believe that when people take that step forward

pledging life and limb in defense of the Constitution

of the United States, not a particular government, not

a particular president, but the Constitution of the

United States which begins of course with the words,

"We, the people," that that forms a covenant, it's

deeper than a contract, it's a covenant in the

Biblical sense, between the people of the United

States and that individual American citizen who

willingly gives up his or her liberty and potential of

losing both life and/or limb in defense of the country

and the Constitution, against all enemies foreign and

domestic.  And we believe the commensurate flip side

of that is that the American people, where that

individual has been lessened physiologically,

neuropsychiatrically, economically or, we might add,

spiritually, it is the obligation and duty of the

American people and every American to see that they

are restored to as whole person again as is humanly

possible to where they would have been had they not

performed that service.

            Now, the fourth one of those, spiritually

changing, is not the province of Government, nor

should it be, but it's not just the province of our

clergy either.  It is the province of every American

to understand, particularly combat vets, everybody is

changed by that experience in their relationship with

God as they know it.  Sometimes it's strengthens;

sometimes it's weakened. 

            The first three of those obligations,

however, physiologically, economically and

neuropsychiatrically, that is what the people owe

through our Government mechanisms to restore that

person as much as possible.  But if you don't fund it

properly, then you're shirking that obligation and

therefore breaking the covenant between that

individual citizen who served in harm's way and the

American people.  That will, as Mr. Robertson so

eloquently pointed out, affect the future of people

serving our country.  "If they're not going to keep

faith with me, why should I keep faith with them?"

            REPRESENTATIVE RODRIGUEZ:  Thank you very

much.

            REPRESENTATIVE EVANS:  Mr. Strickland?

            REPRESENTATIVE STRICKLAND:  Thank you very

much.  I think it's impossible to have a forum such as

this and talk about policies without being aware that

we are involved in a political process and the answer

to the policy problems will be determined within the

context of political considerations.  We cannot escape

that.  That's our method of governance in this

country. 

            I've just been struck by some of the

phrases used here today; "social cannibalism,"

"rationing health care for veterans."  You know, I

think the American people would just be appalled if

they knew we were doing that, but we are in fact doing

that.  The fact that you can be a combat decorated

veteran and be told, "You're out of here," when it

comes to VA health care.  I just don't think the

American people understand that that's our situation.

VA health care as a continuing cost of national

defense, I mean, when you hear it expressed as you

did, so easily understood that it is.  And the

difference between per capita funding for Medicare and

per capita funding for ‑‑ I mean, I've learned a lot

today.  I just wish there were more of us here, quite

frankly.  And the only answer to the problems that

have been discussed today are political answers.  And,

you know, that's a given, I guess. 

            But quite frankly, even when we use high‑

sounding words, myself, you know, I do that

occasionally, you know, we love the veterans and, you

know, after awhile it almost makes me feel sick

because they are words and although words are

important, without actions they are absolutely empty

and meaningless and I'm just getting to the point

where I don't even want to hear the words anymore

because I see such a disconnection between the words

and what we as a governmental body does.  And I just

yearn for the day when the veterans of this country,

and there is power among you and within you, finally

say, "We've had enough and we are going to demand what

is rightfully needed by" ‑‑ I mean, you're not

speaking for yourselves.  You're speaking for those

who depend upon you to be their voice and the same is

true of us.  And, you know, I feel frustration and I

can only imagine what you must feel and I can only

imagine what the veteran who has served the country,

perhaps been in combat, and then goes to a VA facility

and is told, "You're ineligible," you know. 

            And because it's a HUD formula, my

understanding is in parts of my district you can make

as little as $24,000 a year and you're considered

higher income.  We make over $150,000 a year as

Members of the House of Representatives.  And to

consider someone who makes $24,000 a year, has served

the country, may be facing incredible financial

obligations to be told, "You can't participate in this

system," I mean, that is shameful and I really believe

if the American people understood it, really

understood it, that they would be appalled at what is

being done to veterans in spite of all of the lofty

phrases and beautiful rhetoric and all of that.

            So, I just want to thank you.  I've

learned a lot today and I want to thank you for

educating me.  Thank you.

            MR. ROBERTSON:  Mr. Strickland, may I ask

a question?  How would you feel if you knew your zip

code determined whether or not you had access to the

system?  That's what the HUD formula is based on, is

where you live.  The guy across the street could make

as much money as you, but because he's in a different

zip code, qualifies for access.  It's that kind of

idiotic decision making that really is disrespectful

to the folks in the uniform. 

            I listen to the comments about caps,

worried about caps on mandatory formulas.  I wish they

would think about caps on the number of people that

could get killed in combat.  I wish they would think

about caps on the number of people they're going to

deploy.  I think there needs to be a reality check

here.  This whole process is completely out of whack.

Most of the veterans find out that they have a problem

when they discover that their private health care

insurance company has gone bankrupt and all of a

sudden they are in need of care.  They turn to the

people that they understood they could turn to in time

of need and are being turned away.  To me that's the

greatest injustice of all, is that you make your life

plans based upon promises from your Government and

then watch them unravel.  For a veteran to have to

become financially indigent to get something that he's

earned, I think is a disgrace.

            REPRESENTATIVE STRICKLAND:  Thank you,

sir, and I agree.

            REPRESENTATIVE EVANS:  I recognize Chet

Edwards from Texas.

            REPRESENTATIVE EDWARDS:  Thank you for all

your testimony and for your respective organizations'

tremendous work for veterans over the years and most

recently your fight on this disabled Americans

Veterans Tax, Disabled Veterans Tax and the Survivor

Benefit Plan.  I know we still have work ahead in both

arenas, but because of your leadership, at least we're

making some progress.  I salute you for that and most

importantly for your service in uniform to our

country.

            I want to ask you about the leaked memo

that came out, a memo sent from OMB to the various

agencies of the Federal Government about the fiscal

year '06 budget request, basically the directive that

they should begin planning based on certain levels of

funding.

            As I understand it, in that memo it would

fund the Veterans Administration programs,

discretionary programs, at $500 million below fiscal

year '04, actually enacted, before you even take into

account the increased number of veterans needing care,

health care inflation.  It would be $900 million less

than the President's own request for '05 and it would

be $2.2 billion in a cut compared to the FY '05 budget

resolution for VA discretionary spending.  And to me,

that's the real number.  It's what we end up at the

end of the day with that counts as to whether we're

making progress or moving backwards.

            So, my question to you would be if your

respective organizations or each of you personally had

an opportunity to look at what the potential

implications might be of a $2.2 billion cut for fiscal

year '06 compared to funding for fiscal year '05.

Commander Bowers?

            COMMANDER BOWERS:  I personally have not

had an opportunity to look at that, but the fact is

those kinds of numbers are so Draconian, I'm not sure

that any of us are going to consider that a

possibility and I sure as hell hope not.

            The independent budget, which you're all

aware of, has been generated to try to put a number on

what the VA actually needs to provide quality care,

ready access and timely appointments.  That ought to

be the standard that we're looking at.  Making cuts to

a system that is already not functioning well is just

incomprehensible to me.  I can't understand how

anybody can consider it and I certainly hope you will

not.

            REPRESENTATIVE EDWARDS:  Thank you,

Commander.

            MR. WEIDMAN:  The Post article that came

out, I believe it was a week ago Monday, quoted an OMB

official about this who said, "You have to understand

we're in a war and we must have shared sacrifice."

            Now personally, I wonder where the hell

was he when we were giving the first tax break ever in

the history of our country during war time.  The first

ever.  Where was that attitude when we needed it?  And

only semi‑facetiously in fact have I suggested to some

members that you introduce a modification that people

can keep the tax breaks if in fact they have a family

member, such as Senator Johnson, have a family member

who's serving on active duty in the United States

military.  You pay one way or another.  You have a

family member serving, you can keep that extra money

for your extra string of polo ponies, Mr. Ultra‑

millionaire.  But if you don't have somebody serving,

then you don't get to keep it.  And that then gets

towards shared sacrifice.  Shared sacrifice now has

become an empty phrases when people use it in that

manner. 

            I would also just point out one other

thing.  Office of Management Budget, we check the last

year's stats.  Four‑hundred‑and‑ninety‑eight permanent

employees, 12 veterans, not veterans preference

eligibles, because we think only five of them were

veterans preference eligible and not a single disabled

veteran on the permanent staff of Office of Management

and Budget.  No one will ever convince us that that is

by accident.  This is a result of consistent

discrimination and what we call "vetism," of

discriminating against people because they're disabled

vets in particular, but because they served their

country in the military.  And so this agency, frankly,

needs to be dismantled and rebuilt from the bottom up

because the corporate culture is nothing other than

sick.  We've talked to the deputy, Mr. Robin

Cleveland, about that, who incidently all the promises

she made to the big six back in 2001 have gone by the

boards in terms of regular contact, but the point

about it is, is we told her also, "We'll work with you

on greater management controls as well as on the

budget side," and she told us flat out, "We're not

interested."  And I said, "Well, why don't you drop

the management out of the title of this agency so that

you still have the spectacle of 162 medical centers

across the country and 162 accounting systems?"  This

is nuts.  The only reason why you do that is to

preserve deniability at the top and to hide brother‑

in‑law contracts and other mismanagement and/or

possibly illegal activities.  And I would hope ‑‑ I

talked to Mr. Walsh about this, Mr. Edwards, and I

hope that you will push, and we'll get you the

language if you like, to push that through as part of

the appropriations bill requiring VA to take that and

other significant steps toward greater accountability.

Thank you.

            REPRESENTATIVE EDWARDS:  I appreciate

that.

            MR. ROBERTSON:  Needless to say, I receive

quite a few phone calls from folks as they began to

read the article, mostly Legionnaires and auxiliary

members complaining about the article.  And I've only

been working on the Hill now for 16 years and I was

trying to remember of a President's budget that the

veterans’ community embraced and I can't seem to

remember one. 

            Secondly, I think that a lot of people

that were questioning whether our decision to push for

mandatory funding as the right idea.  I think we got

a lot of converts thanks to that article. 

            And I think finally that's exactly the

reason we're here.  It is that kind of uncertainty and

instability that we are very, very concerned about and

we really need to get a handle on.  Whether it's this

Congress or the next Congress, it really has to take

place.

            REPRESENTATIVE EDWARDS:  If I could

respond briefly, Mr. Chairman.

            Steve, I would agree.  I respect veterans’

organizations for standing up to Democratic and

Republican Presidents when they don't ask for adequate

funding for VA health care.  I do think one of the

lessons of the last couple of years when the budget

committee voted on a partisan basis to cut veterans’

spending by $28 billion over 10 years is that when

people come out with these Draconian proposals,

whomever it might be, we have got to shoot that

balloon down with 50‑caliber verbal bullets so that

the next time some cockamamie green eye shade

bureaucrat in OMB comes up with one of these ideas

such as cutting impact aid education funding to

military kids at Fort Hood last year while their moms

and dads were getting on the plane to fly to Iraq, as

well as their veterans’ proposals, that somebody says,

"Geeze, we don't want to make that mistake again."

            So, you know, I hope people realize that

while this is Draconian, there's some folks pushing

very seriously for Draconian cuts and thanks to you

and your organizations and other veterans’ groups, we

haven't had to face those.  But, I hope nobody takes

that for granted out there and I hope the response to

this memo isn't silence.  I think some on the other

side of this fight would interpret that as meaning,

"Hey, maybe we can get a ways down the road."

            Just for the record, I will say that the

Democratic staff on the Veterans Affairs Committee put

together some analysis that suggested that this kind

of a cut of $900 million below the President's request

for fiscal year 2005, if it were to be enacted, could

require the VA to dis‑enroll about 140,000 veterans.

It could require a forced layoff of 10,750 full time

employees for medical care, notwithstanding the fact

we've already been cutting back over the last decade

the number of VA employees, could have huge

implications for the CARES process.  I know as they

recommend closing down some hospitals, they're saying,

"Well, we'll spend $5 billion creating new hospitals."

I hope you as our leaders in the veterans’ community

will point out that what we could end up with is the

worst end of that deal.  We end up with closed

hospitals and not have the money to duplicate or

improve those services somewhere else.

            And just for the record, and I'll finish

with this, that $900 million accounts for about 40

percent of the VA's estimated payroll for physicians,

20 percent of the VA's estimated payroll for nurses,

25 percent of the VA's estimated costs for all drugs

and medicines and about 70 percent of the entire

budget for the VA estimated for psychiatric care.  So,

I just hope that while we hope these Draconian

measures aren't taken seriously by some, obviously

somebody at the OMB took it seriously enough to send

out that memo to every federal agency.  Thank you

again for your service and leadership on behalf of the

veterans.

            REPRESENTATIVE EVANS:  Any questions or

comments?

            Okay.  Ms. Davis?

            REPRESENTATIVE DAVIS:  Thank you, Mr.

Chairman.  Thank you all for being here.  You've been

terrific.  I feel like I want to clone you all and send you throughout the country.  I think it's very

important that people hear the statements coming

from you, frankly.  We project that to an extent, but

not nearly as well as you can.  So I really appreciate

that.

            I wanted to turn just for a second to

mental health services.  I think one of the things

that we don't do very well is talk about the cost if

we don't provide the services.  And I know in the San

Diego area, we were one of the first cities, I believe,

to have something called stand‑down.  Once a year the

vets come together, particularly Vietnam vets, but

veterans in the community who have been homeless, who

have been without work and certainly have mental

health issues that they've had for some time and, you

know, every time we get up there and I just feel like

saying, "You know, let's put this thing out of

business."  And every year there are more and more

people who are there and yes, they're doing a great

job that weekend. 

            And so I wanted to just ask a few

questions in your estimation in terms of the mental

health needs that are not being met and if we're going

to be cutting in the future seven percent, 70 percent,

of the cost?  Which is it?

            MS. EDGERTON:  Seventy percent ‑‑

            REPRESENTATIVE DAVIS:  Seventy?

            MS. EDGERTON:  ‑‑ of the cost of

psychiatric care.

            REPRESENTATIVE DAVIS:  Yes.  That's an

amazing figure.  We're not even beginning to address

the need today and I know the young men and women that

will be coming from Iraq and Afghanistan, we know

well, I visited the psychiatric wards here now and we

know that there are great issues that they're bringing

back.  Can you help me with that a little bit?  Do you

think that this is even being talked about at the

level that's appropriate, or are we just putting it

under the table?  Do you see some things that should

be done that even aren't that costly?  You know, one

of them is having people followed up when they return

and I think one problem is that we may have that in

cities.  There may be, you know, an advantage in doing

that.  We may have more personnel on hand.  I think

about it and I watch the kids, you know, who've been

killed over there.  They're all from small towns, you

know, the bulk of them.  And so, are those services

going to be there for them?  What's going to happen?

What impact will this have on their family?

            MR. ROBERTSON:  When CARES, the Capital

Assets Realignment Commission ‑‑ for Enhanced

Services.  I keep forgetting about the enhanced

services because I don't see them.  But when they were

putting together that process, one of the concerns

that the American Legion and other organizations had

was they basically took the whole mental health issue

out of the formulas, out of the debate and said,

"We're' going to come back and address it later."

Well, it seems to me that that's not exactly the best

way to run a train.  It seems that that should be in

your forefront because that, quite honestly, is a very

serious problem within the veterans’ community.  And

I think you're exactly right.  I think that a lot of

veterans that came back from World War II were not

properly treated and were told, "Just suck it up and

live with it."  I think that the same message was

passed around during the Korean conflict and I think

that there was probably a lot of harm that was done to

those veterans and a grave disservice.  Fortunately,

a lot of the Vietnam veterans, it turned around a

little bit more and we began to aggressively address

the problems of mental illness. 

            Obviously this has to be a major portion

of any health care package that we come forward with

in the Veterans Affairs arena and I agree with you

1,000 percent that it's not being adequately

addressed.

            COMMANDER BOWERS:  Like you, I've attended

more than a few stand‑downs across the country and

have seen what you just indicated you've seen in San

Diego.

            I think the real problem here may be the

fact that those veterans are the least able to

annunciate their needs.  They're the least able to

stand up and defend themselves and the Disabled

American Veterans obviously, along with the other

Veteran Service Organizations that are here today,

feel that obligation to stand up for them so mental

health is an issue that needs to be included in the

package of services, absolutely. 

            And again, to consider cuts when we're not

doing the job at an adequate level right now is just

incomprehensible to me.

            MR. WEIDMAN:  Steve Robertson correctly

pointed out in the CARES process that they said they

will come back around the horn on long term care and

on mental health.  And then they turned around and the

six hospitals that were targeted were primarily

neuropsychiatric facilities.  "We're going to leave

them out of the formula, but we're going to close them

anyway."  This makes no sense.  We have repeatedly

discussed this, is a good way to say it, with the

Secretary whom we have a good relationship with, but

we believe he's dead wrong on this.  And at one point

he, in seeking our opposition to Mrs. Clinton's

amendment on the other side of the Hill that would

slow up or stop closings of neuropsychiatric

facilities and others before there was more hearing,

I said that we wouldn't do because they were going to

close Highland Drive in Pittsburgh and move all the

patients to University Drive, but there were no

facilities there.  And those people are going to be

out in the street and so he stared at me and said,

"Rick, why in the world would you think that I would

close a facility and throw very ill older veterans out

on the street?  Where did you get such a crazy

notion?"  And I said, "Under Secretary Roswell's reply

to Chairman Specter in answer to a direct question

about that facility, that they were going to close

this hospital immediately and then start to make plans

to make plans to enlarge the space at the other

hospital."  Well, greased lightening is five years for

construction at VA, so what happens in the interim to

those very ill veterans, many of them very old

veterans?            

            I think that the whole issue of

neuropsychiatry within the VA is a sorry, sorry

history and don't have time to get into it here, but

I will point out this; at the end of World War II,

'46‑'47, by the time most of the physiological cases

had passed through the VA as inpatients, the majority

of inpatients at VA facilities were neuropsychiatric.

People forget that and they turn to us and Vietnam

vets and say, "How come you boys can't get over that

war?  We didn't have" ‑‑ you didn't have any problem?

Then how was that so?  And how was it that people were

self‑medicating, bellying up to the bar down at the

Legion or the VFW, or wherever?  So, it's a

significant problem. 

            It's been pointed out and I would point

out that if you don't have a copy, Congresswoman,  I

would be glad to get you a copy of the Special

Committee on PTSD, the last three issues done by that

distinguished group of psychiatrists.  I think two out

of 17 of the recommendations have been addressed.  The

rest of them have been blown off.  The serious chronic

and mentally ill working group, which I attend along

with representatives from the other major

organizations, they've also not taken any of the

recommendations of the SMI group, which is both VA And

outside distinguished neuropsychiatric or mental

health providers, inclinations of one sort or another.

So the real key here is we need the strong support on

the inside. 

            Last, but by no means least, they need to

ask somebody, "How do you feel about the nightmares?"

World War II vets, I was making a presentation at my

old Jewish War Vets Post in Albany a number of years

ago, and talked about discussing with the Stratton VA

Medical Center people the issue of taking military

histories and we were making some progress, but had a

long way to go and after the meeting three different

veterans all of whom I knew well, all of whom had gone

out and led fully successful lives, all of them World

War II; one was a Marine and made several landings in

the Pacific, one was with Patton and the other was at

D‑Day and then fought all the way across France.  Each

one of the approached me privately and when I had made

a comment about the nightmares, "You know, nobody ever

asked me about the nightmares, so I never told them,"

and pulled me aside and wanted to talk about it.  So

it's not being addressed properly and then it

manifests itself physiologically in acute care which

runs up the cost on the other end.  It's just a crazy

system that we're not doing rationally and veterans

organizations from the VAV to Paralyzed Veterans to

the Legion to the VFW to VVA to Military Officers,

many have looked at this problem, and it has to be

approached in a comprehensive way on both sides of the

aisle, both more money and smarter, better care, well

as minding your Ps and Qs for getting bang for the

taxpayer dollars just in contracts and goods and

services.  It can be done, but it takes real

bipartisan leadership going after it in all of its

facets and it takes significant support directly out

of the White House and out of the Secretary's office

that we're going to remake this corporate culture.

            MR. ROBERTSON:  Whenever you have tight

budgets, one of the first victims are specialized

services because they're so costly and they're saying,

"If I can get rid of this, that gives me extra money

to spend on delivery of direct health care."  And

that's s a shame because VA's reputation in the world of

specialized care is unprecedented in the industry.

            REPRESENTATIVE DAVIS:  Thank you.  Thank

you, Mr. Chairman.  And I pledge that I would like

very much to continue to work on that issue.  I think

it's terribly important.  Thank you.

            REPRESENTATIVE EVANS:  Sergeant Reyes?

            REPRESENTATIVE REYES:  Thank you, General.

And I apologize for not having been here for the

previous two panels, but we just finished up

intelligence committee hearings on the Chalabi issue.

And so that's why I wasn't here, although I will tell

you there isn't any issue that's more important for

me.  I've got over 80,000 veterans in my district.

Last weekend when we dedicated the memorial to World

War II, I had 51 veterans and their families that

actually made the trip from El Paso here, which was

quite an undertaking, given their age and economic

situation and it was a tremendously moving experience

and very patriotic on their part to make that trip.

            But I also am reminded that we deal with

a number of cases where these World War II veterans do

not have even the money to do the co‑payments and it's

not unusual for us to see a veteran come in with a

bill from the VA for $1,100, $1,400, $1,500, which for

some is not a big deal, but for them that are on very

little income and mostly living with one of their

children or in situations that really are not in

keeping with what we ought to be doing for our

veterans, it's important for all of you to advocate.

And we have a such a long list of things that we need

to be changing in terms of the way the VA provides

services for our veterans.

            Just three short years ago when we had the

surpluses, I and a number of other Members of Congress

were advocating, "Hey, let's put the veterans at the

front of the line.  With the surpluses, let's take

care of them fully and then we won't have this nagging

issue that really is always coming back to budget."

Well, now that we've got historic deficits and we've

got these plans to make further cutbacks, it seems to

me that as veterans, and I'm proud to be a veteran,

and as veterans’ organizations, this is the time to

draw the line in the sand and say, "Look, no more."

Statistics are fine, but we see the people.  I see the

51 veterans that made that trip here last weekend and

that were so proud to have a memorial, a monument to

their service and it's a travesty to not have the kind

of support for them. 

            We talk, and I get incensed because we

talk about the War on Terrorism, we talk about the

sacrifices that are being made by our soldiers, men

and women in uniform in places like Afghanistan and

Iraq, other parts of the world, 120 different

countries in the world, and we talk about those men

and women and their patriotism and yet we fail to

realize that as a country we're not measuring up when

we fail to take care of yesterday's heros.  These were

individuals that during their prime stood up and

fought for this country and in a lot of cases, let me

tell you, in a lot of cases, even today, those that

are in their 80s are embarrassed to have to come and

seek help.  The most vulnerable in that population are

certainly the ones that are homeless, that have the

need for the kind of service that Ms. Davis is talking

about and is a champion for.

            So, I think these kinds of hearings, these

kinds of opportunities that we have to shine the light

of day on I think one of the biggest travesties that

we should all be ashamed to be a part of has to happen

and has to continue and I applaud you gentlemen for

standing up and saying, you know, "We've bled them

enough.  We've allowed them to suffer and while we can

build monuments, let's spend the money."

            I say if we can find $67 billion and

another $25 billion and tack that thing onto the

deficit, why in the hell can't we do the same thing

for veterans’ programs because this is not building

power grids and roads, and buying dump trucks in Iraq.

It's taking care of people that took care of us and we

wouldn't be here if they hadn't done that.  So, Mr.

Chairman, I think we ought to say, you know, "If money

is an issue, if money is a problem, let's handle it

the same damn way that we handle this war against

terrorism and the continuing drain on our resources in

Iraq and Afghanistan and every place else.  If it's

good enough for our enemies, it damn sure is good

enough for our patriots, I think. 

            And thank you, gentlemen for continuing to

work and again, I applaud everyone's efforts and we

just have to refuse to give up on this issue.  Thank

you.

            REPRESENTATIVE EVANS:  Thank you.  I think

we've had a good session today.  I think we've opened

up new dialogue that should have been started before

with the VA's most important constituents, veterans

and their care providers, about the priority they

ascribe to funding reform.

            We all understand the challenges ahead,

but it seems very clear that something must change to

allow VA to deliver high‑quality accessible care to

our nation's veterans.

            Understanding some of the likely budget

forecasts that Mr. Kogan has shared with us should

convince all of us that the tax cuts and other

priorities will make discretionary funding

increasingly scarce, at least in the next few years.

That means much less funding for VA health care.

            In the absence of significant reform, I'm

convinced that each year Congress will be rearranging

the deck chairs on the Titanic.

            I look forward to working with your

organizations and with my colleagues on this issue

and at this point, we'll adjourn the meeting.  Thank

you.

            (Whereupon, the forum was adjourned at

11:57 a.m.)