VA Secretary Robert Wilkie On Allowing More Veterans To Seek Private Health Care

NPR's Ari Shapiro talks to Robert Wilkie, secretary of the Department of Veterans Affairs, about a new program that launches June 6 that would allow more veterans to seek private health care.

ARI SHAPIRO, HOST:

We're going to spend the next few minutes talking about something that we don't often see in Washington these days, a bill that passed Congress with overwhelming bipartisan support. It's called the MISSION Act. And starting this week, it will bring big changes to the Department of Veterans Affairs, particularly when it comes to health care. The law expands the number of veterans who qualify for private care that is reimbursed by the VA.

Today I spoke with the Secretary of Veterans Affairs Robert Wilkie, and he told me the number of veterans seeking health care outside the VA has actually gone down recently. So I asked the secretary - if that's the case, how many people does he expect to take advantage of this expansion?

ROBERT WILKIE: I don't see that large a rise. The way the system is set up is that the veteran will come to us, we will tell him that we cannot provide a service. And because he lives outside a certain number of minutes from a VA facility and we're telling him that the wait time is greater than 20 days, then he has the option of going into the private sector.

SHAPIRO: As you know, critics are afraid that this is a move towards privatizing...

WILKIE: Right.

SHAPIRO: ...VA health care. Explain why you disagree with that view.

WILKIE: Well, I just presented a $220 billion budget, a budget that also calls for an employee base of 390,000. Ten years ago, the budget was 98 billion, and we had 280,000 employees. So if we're going about privatizing this, we're going about it in a very strange way.

SHAPIRO: But on its surface, doesn't expanding eligibility for private care constitute a shift away from government-provided health care, whether or not this is part of, as critics would accuse, some kind of Trojan horse larger project of privatization?

WILKIE: Well, no, not if you read the MISSION Act. My goal is to provide the best possible health care because it's not only the right thing to do, but the Congress said it right there in the legislation. And because of the nature of our patient base - people like my father, who suffered terrible combat wounds in Cambodia - there's nothing in the private sector that is going to understand or take care of someone who has suffered that kind of trauma in battle. There's just no other place like it.

SHAPIRO: I'd like to talk about another important topic, which is expanding efforts to prevent veteran suicide.

WILKIE: Yes.

SHAPIRO: The VA has said this is the highest clinical priority.

WILKIE: Right.

SHAPIRO: Something like 20 veterans die each day by suicide. And this number has, for the most part, been pretty consistent.

WILKIE: Yes.

SHAPIRO: Why, after years of making this a priority, hasn't the VA been able to make a real improvement in this area?

WILKIE: Well, I don't think the country has made it a priority. I've said that we need a national conversation on mental health, homelessness and addiction.

SHAPIRO: But you're in charge of the VA...

WILKIE: Yeah.

SHAPIRO: ...So let's talk about what the VA is doing.

WILKIE: Yeah. Well, the VA has got very specific programs. Every veteran who comes to us gets a mental health screening. Every veteran who comes to us has same-day mental health services.

SHAPIRO: So why haven't the numbers improved?

WILKIE: Here's just the problem. All of these cases are not related. Give you an example - 14 of the 20 who take their lives are veterans that we have no contact with; a couple are on active duty; several are on guard and reserve duty and never deployed. And the bulk are from the Vietnam era. Lyndon Johnson left Washington, D.C., 50 years ago in January, and many of these problems have been brewing ever since that time.

So we're not going to be able to get these numbers erased. But we have to change the culture that we start training troops, from the time they get into boot camp to the time they leave, not only on their own mental health but to see signs in their buddies. And I will also say, you know, our Veterans Crisis Line gets 1,700 calls a day. Of those 1,700, we act on 200 to 300 calls, where we send people out and we get those veterans help.

SHAPIRO: Does the VA have enough mental health providers right now?

WILKIE: Well, we are in the same position the United States is in. We were able to hire 3,900 mental health professionals last year. I think NPR has covered the fact that most of our medical schools are sending their students into the most expensive specialties out there, and VA suffers just as the rest of America suffers.

SHAPIRO: Secretary Wilkie, the last thing I would like to ask you about is a surprising moment that happened on the campaign trail recently...

WILKIE: Yeah.

SHAPIRO: ...Where Congressman Seth Moulton of Massachusetts...

WILKIE: Yes.

SHAPIRO: ...He's a veteran running for the Democratic...

WILKIE: Right.

SHAPIRO: ...Nomination. He did four combat tours in Iraq.

WILKIE: Yeah.

SHAPIRO: And at a campaign event last week, he spoke very frankly and openly about his experience with...

WILKIE: Yes.

SHAPIRO: ...PTSD. This is what he told NPR about that moment.

(SOUNDBITE OF ARCHIVED BROADCAST)

SETH MOULTON: Now I'm applying to lead the country, and I think it would be disingenuous not to lead by example and share my own story about my own struggles with these issues.

SHAPIRO: What's your reaction to seeing this kind of an honest conversation happening in a forum as prominent as a presidential campaign?

WILKIE: Well, it is about time. It is about time. We are seeing a generational shift in the armed forces of the United States, where we finally talk about these things; we don't hide them. The military is a conservative institutions for many reasons, and one of them is it takes it a long time to change. But the more we hear voices like this - the more we talk about it, I think, we'll be in a much better place.

SHAPIRO: Robert Wilkie is secretary of the Department of Veterans Affairs. Thank you for joining us today.

WILKIE: Ari, thank you for having me.

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