Veterans Health Care

Floor Speech

Mr. SANDERS. Madam President, as chairman of the Senate Veterans' Affairs Committee, I would hope that every American understands that the cost of war does not end when the last shots are fired or when the last missiles are launched. The cost of war continues until the last veteran receives the care and benefits he or she has earned on the battlefield.

War is an incredibly expensive proposition in terms of human life, human suffering, and in financial terms. In my very strong view, if we are not prepared to take care of those men and women who went to war, then we should not send them to war in the first place. Taking care of veterans is a cost of war, period.

In terms of Iraq and Afghanistan, the human cost of those wars is almost 7,000 dead. The cost of war is 530,000 veterans seeking care at the VA in 2013 for post-traumatic stress disorder, not to mention those struggling with traumatic brain injury.

The cost of war is too many servicemembers coming home with missing arms and legs, lost eyesight, or lost hearing. The cost of war includes veterans each day dying by suicide, high rates of divorce, wives trying to rebuild their lives after losing their husbands, kids growing up in one-parent homes, and a too high rate of unemployment for returning servicemembers. Those are some of the real costs of war that this Congress cannot ignore.

Several weeks ago, Senator McCain and I hammered out an agreement which I think goes a significant way to address many of the serious problems facing the VA. I am very proud that the Sanders-McCain bill passed the Senate with overwhelming bipartisan support, with a vote of 93 to 3. In terms of funding, very importantly, by a vote of 75 to 19, an overwhelming vote, the Senate made it crystal clear that the current crisis in the VA, the crisis facing veterans who are not getting health care in a timely manner, is an emergency and should be paid for through emergency funding. I am very proud that in a bipartisan way the Senate made that important vote.

In the last 4 years we have seen a significant increase in the number of veterans utilizing VA health care. In addition, many of our other veterans from World War II, Korea, and Vietnam require a greater amount of care as they age.

Further, a recent VA audit revealed that more than 57,000 veterans are on too-long waiting lists in order to be scheduled for medical appointments.

In addition to that, there are many other veterans who were never put on a list in the first place, which is what this whole scandal is largely about.

Clearly, these waiting lists and veterans not getting care in a timely manner are unacceptable and must be dealt with immediately, not 6 months from now, not a year from now, not in a great debate about national priorities. This is a crisis which must be dealt with now. I could not agree with Senator John McCain more when he said on the Senate floor during this debate:

If there is a definition of emergency, I would say that this legislation fits that. It is an emergency. It is an emergency what is happening to our veterans and the men and women who have served this country. We need to pass this legislation and get it to conference with the House as soon as possible.

Senator McCain is right. I concur with what he said. We need to get this legislation moving as soon as possible and get it to the President's desk. Veterans in this country must get quality care and they must get that health care in a timely manner. We need to provide the funding the VA needs to accomplish that goal and do it as quickly as we can.

The simple truth is that the VA needs more doctors, the VA needs more nurses, it needs more mental health providers, and in certain parts of this country more space for a growing patient population. That is the reality.

Does the Veterans' Administration need better management? You bet it does. Does it need to be more efficient, more accountable? Absolutely. But at the end of the day, if you do not have the doctors and the nurses and the medical staff you need, there will continue to be waiting lines unacceptably long and veterans will not get the care they need.

I received, as did the chairman of the House Veterans' Affairs Committee, a letter on June 17 which was signed by virtually every major veterans organization. That is the American Legion, the DAV, the VFW, the Paralyzed Veterans of America, the Vietnam Veterans of America, the Iraq and Afghanistan Veterans, and many other organizations. They made a number of very important points in their letter talking about the kind of legislation we need to pass. I want to quote from one section of their letter, which they entitled ``Protect and Preserve the VA Health Care System.''

Any legislative, regulatory or administrative changes designed to respond to the VA health access crisis, whether temporary or permanent, must protect, preserve and strengthen the VA health care system so that it remains capable of providing a full continuum of high-quality, timely health care to all enrolled veterans .....

Then the letter continues:

Unless the legislation simultaneously sets VA on a path to intelligently strengthen health care delivery, expand access and capacity, reallocate resources and ensure that overall VA funding matches its mission, the current problems confronting VA and veterans will inevitably recur.

In other words, what they are saying is that unless we strengthen the VA, give them the staffing and the space they need, this problem of waiting periods of time will continue. In order to address the long waiting periods, the Senate legislation says to veterans around the country that if you cannot get into a VA facility in a timely manner, you will be able to get the care you need outside of the VA. That means access to private doctors, community health centers, or Department of Defense or Indian Health Service facilities.

Furthermore, what the bill says is to veterans who live 40 miles or more from a VA facility, that if they choose, they also have the option of seeking care outside of the VA.

Just as the letter from the veterans service organizations articulated, it is critical to address the current waiting period crisis. But we also have to make sure that that crisis does not continue to occur. We do that by providing the VA the tools it needs to ensure sufficient capacity for veterans seeking care at VA medical facilities. Clearly, no medical program can work unless we have the necessary medical staff.

Today, the VA has thousands of vacancies for health care providers. These vacancies, along with an untold shortage of health care providers to meet the demands of veterans who want to get VA care, has a direct impact on the ability to get veterans in the door for appointments. To fill these positions, the Senate bill provides for the hiring of VA doctors and nurses, and it does so in an expedited fashion by ensuring VA's hiring efforts are not hamstrung by Federal bureaucracy.

During the discussion of VA health care, let us not forget that today alone some 230,000 veterans will walk in the doors of VA facilities for health care--230,000 veterans today, 6.5 million veterans in a year. While it is absolutely true that not every veteran is satisfied by the care he or she is getting, the overwhelming majority--well over 90 percent of them--believe they receive high quality care. Over and over, I hear from Vermont veterans and veterans across the country who say that once they get into the system the care is good.

That is just not my view, it is the view of virtually all of the major veterans organizations and a number of independent studies that have compared VA health care with that in the private sector. We owe it to these veterans, to our veterans, to fix the current problems and bolster the system to ensure that quality care is available in the VA for years and decades to come.

I have heard a lot of criticism of the VA. Much of that criticism is valid. But when we talk about VA health care, we must put it in the context of health care in the United States of America. Does anyone seriously believe the VA is the only health care institution in America that has problems? It is absolutely the case that not everybody outside of the VA gets timely, quality, affordable health care. That is just not the reality.

Today some 40 million Americans have no health insurance. According to a Harvard study of a few years ago, 45,000 Americans die each year because they do not get to the doctor when they should. That is outside of the VA.

But it is more than that. Let me read you a few headlines from the last couple of weeks. I make this point not to argue the whole health care debate again but to say that anyone who thinks it is only the VA that has health care problems does not understand what is happening with health care in America.

Here is a quote from a few weeks ago.

A report released Monday by a respected think tank--

That is the Commonwealth Fund.

--ranks the United States dead last in the quality of its health care system when compared with ten other Western industrialized nations.

Then the report further tells us that the United States has maintained this dubious distinction while spending far more per capita on health care than any other country. We are spending far more on health care than any other country.

Let me read you another headline published September 20, 2013 by FierceHealthCare. ``Hospital Medical Errors Now the Third Leading Cause of Death in US.''

Medical errors leading to patient death are much higher than previously thought and may be as high as 400,000 deaths a year, according to a new study in the Journal of Patient Safety.

I mention all of this to make clear that the VA, of course, has its problems. Our job is to strengthen the VA, to provide better accountability, to make sure that incompetent and dishonest people are not working in the VA. But we also have to make sure the VA has the doctors, the nurses, and the other health care providers it needs in order to provide the quality of care our veterans deserve.

The last point I want to make. I hope very much the House will agree with the Senate that we are in an emergency.

It is absolutely imperative that we move as quickly as possible to get the funding we need so that all veterans enrolled in the VA health care system get quality care in a timely manner.

I hope very much that we don't once again have a major debate about whether we are going to cut food stamps or education or roads and bridges in order to fund the Veterans' Administration. When this Congress voted to go to war in Iraq and Afghanistan, it said that it was an emergency. Some of us disagreed with that, and I don't want to debate the Iraq war again, but when Congress said it is an emergency that we go to war, well, if it is an emergency that we go to war, it is more of an emergency that we take care of the men and women who fought in those wars. If you don't believe that is the case, don't send Americans off to war. Taking care of veterans is a cost of war.

I hope very much that we don't go back to the same old, same old of having a debate where some people say: Well, if you want to fund VA health care, you are going to have to cut education or cut Medicaid or cut Medicare or cut some other program. That is not the issue. This is an emergency. Our veterans have put their lives on the line. Now is the time for us to defend them, and we have to get this legislation moving.

With that, I yield the floor.

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