Civilian career and making that transition into the government world can be jarring. What wanted you to take up the world of government quick. During my twenties i didnt have a chance to serve the way that you did. I spent my time in medical institutions building my medical training. That was one of the real regrets that i had with this amazing country that i was not able to give back. Later in my career i was the ceo of a hospital and i had the opportunity to get a call from the white house for cho this was right at the time in 2014 when it was very public crisis in the v. A. That veterans were dying waiting for care. I was sitting there as a citizen to say i feel terrible about this. If anybody deserves the best care possible it is our veterans i wish there is something i could do to help. As sometimes happens i get a call from the white house to say would you consider coming to help lead the v. A. Healthcare system because were looking for somebody how they understand how healthcare works. I did but everybody tends to do. To make a list of pros and cons and con side was much larger but how could i say no . This is my duty as an american citizen to give back. So i really didnt think much and i said yes. Im prepared to come help teeseven that was during the Obama Administration initially and then to get into that but i would love to read a brief quot quote. Early on you right its important america understands what it is and how it works and why it exists. As mentioned a lot of people dont understand the scope and what they are responsible for. Maybe you had an elevator pitch because it goes well beyond health care. There so much more. I wrote the book im not sure the American Public understands why the v. A. Exist. But its a part of the National Security system. When we rely on the voluntary military that is less than 1 percent of americans serving but they raise their hand and are willing to sacrifice themselves, when they go there is a commitment that they will take care of them and there is no other organization that is focused on that. The v. A. Provides healthcare for 9 million a minute veterans. So it has a large effort directed toward education, g. I. Bill, benefits for those who require assistance if they are disabled, and through the time to make sure every veteran when the time comes is buried with dignity and respect was 114 v. A. Cemeteries so this is the second largest in Us Government with 370,000 people who are they are many veterans themselves to have that support and understanding of the american people. With the second largest budget and from civic standpoint. Thats right and also just about the healthcare aspect. And then with the private sector in the government i have never worked in government before. And reading these Horror Stories that i would go there and find this system is so broken and to say the best thing i can do for veterans is aluminate the v. A. Healthcare system and move everybody into private hospitals. And after i got to the v. A. To see what it does and then put on my white coat as a doctor to take care of veterans and visited hospitals across the country and went to see places like where we bring paralyzed veterans. And then i began to understand what the v. A. Does is very different than what the private sector does. And that the private sector doesnt do that the v. A. Healthcare does. For example the Behavioral Health care system it is expensive and large it is struggling to get access with these 9 million veterans that already is struggling we know the veterans do not come out on the right side of that so ive been a very strong advocate that this is a system that works well so it will be a sustainable system. I do want to come back to privatization which is a large part of your book. We will get to that but i want to continue with this setting because it reminded me of a common thing in the veteran community that if youve been to one youve been to them all the mention especially you have done a lot to visit different ones why do you think that is cracks even though talking about an agency that has oversight you get so many different stories . But you hear how the membership says they love the care that they get they would just like to have access faster but why is there such a variety of level of care . It is under public scrutiny that no other system in the country. So Little Things that happened in the v. A. Would never come to the attention turns out to be the subject of congressional hearings. So there are lots of things that are happening in v. A. Hospitals that dont happen in the Public Sector but using that comparison will what is the best hospital for me to go to . Interestingly there is no such thing and they may not be good of those other areas. To have the largest system in the country you will have some that are excellent and thats what you will find in healthcare but it has that complexity so therefore we have a large number of veterans that live in rural areas and especially the specialists its a challenge for the private sector as well. With a tremendous variation between what works from one place to another and of course i work very hard on to stander night one standardize these practices. And from your first confirmation hearing you need to come to alaska because they are circumstances here and you need to understand that sweat just to let people know about that journey many people dont understand the Senate Confirmation process. Actually in order to go quickly through a senate process and not require an entire floor vote you have to have unanimous consent and the white house that you have unanimous consent you will be confirmed in the next couple of minutes and write does that vote was happening senator sullivan said not so quick i need to have a conversation with the nominee. He said im standing on the senate floor and about to cast my vote. But i want you to commit to me in the first 30 days if confirmed that you will come to alaska with me. Because its very different than other states and i said senator we are going to alaska. I imagine that was your intention anyways because there is a lot of variability geographically speaking to those rural areas. Alaska is one of the few states New Hampshire and hawaii are the others that dont have their own hospital. Meeting the healthcare needs of those states is extraordinarily challenging. We actually partner with the air force. But i was delighted to travel with the senator as i was to other rural states like maine as well. Thats the way you really get to understand how to fix the problems that are out there like talking to veterans what they are experiencing. And you continue to see patients i wouldnt say you had the time to do it because you were working very hard seven days a week but that was something that you felt was necessary to your understanding. Every leader could do their job more effectively if they understood the impact of their decisions. If i would be making a decision on which electronic record how could i make that decision if i never use the electronic record cracks in working with patients and doctors and how they enter one interact so i would put on my white cut my white coat nobody knew i was secretary. But it helped me to understand what was working and how they experience the decisions and that made me a better and more effective leader. That there is a funny anecdote. In your doctor capacity. You god a startling response from the veterans. I would see patients to ways. I would see them in person in the exam room and then in telehealth from my office in washington from a rural part of the country so i got to experience both urban and rural. But i was in the new york manhattan v. A. When i saw a patient he said i need a physician to fill out this form and i said what is it more cracks he said i am suing the secretary. I asked him what that was about. He was a homeless veteran trying to get additional benefits to get himself out of the situation and back on track i needed a physician certification of his issues. I said first of all i will help you get you the form that you need but i dont think im the person to do it and he said why they said because im the secretary. But we got him on his way and another physician helped him. [laughter] you mentioned five priorities you had when you came in can you talk about those and how you arrived and to achieve those goals quick. When i first came to the v. A. I had never worked in government before Better Organization i was going to have to learn and it was so large that if i had waited until i truly understood everything we would be waiting a long time but veterans were literally waiting for care i felt like i didnt have the time so i came in and studied from the outside as best i could and said we will have priorities right now but single is to address the wait time crisis there were hundreds of thousands of veterans waiting more than 30 days for care. But most critical to me but there are 57000 waiting for urgent consultation. Waiting more than 30 days for urgent and that was totally unacceptable to me and that set the bounds of what i thought was reasonable so i immediately called for every Medical Center to be open the following weekend and we contacted the 50000 veterans and then we had that list down to less than a thousand by monday morning. So once we got that backlog taken care of i want to make sure we never got into that situation again. So i did a couple things. First it was to publicly post wait times today v. A. Is the only system ive aware of that publishes wait times so that people can see the second that i did was to establish Sameday Services throughout the entire country so by december 2016 i could tell secretary mcdonald president obama every v. A. Medical center had the capability to see everybody on the same day basis so that somebody with a urgent issue could not be taken care of. There was an article of the jama after he put all these things in place compared to the private sector for the wait time and the v. A. Is better now that we have made tremendous progress to address that issue with that commitment of employees and the staff that work there on establishing improving employee morale because there were 45000 vacancies in the v. A. And that is a significant challenge. Probably one of the most important priorities is to regain the trust of the veterans that we serve. We dont have a stock price if we are doing better with stock price but we can track regaining the trust that we lost in that began to climb is continuing today which is very good news. We had established another priority to create best practices learning from one to another. To decrease that variation that was successful thats how we established our priorities. And these things you brought from the pie private sector and does other things. Interestingly not only with the ways of government with the wait time issues but to start to think if i was a government employee. And with the private sector to government. And for many of those practices. And to modernize the way it is thinking. But the private sector could benefit from. This is a twoway learning between the private sector and government. Thats interesting there is an ongoing continued debate about the future of healthcare and i dont think that is the perspective that is brought into the conversation about what we can learn from the government side people say we can learn from the government. People dont understand looking at outcomes of care through the population which is very popular the v. A. Outperforms the most every other Major Health Care system. Not saying it is the best there are some great Healthcare Systems out there that this country provides Terrific Care but if you look on average the v. A. Performs better than most of the private sector so look at some of the things we did for example i made the declaration i wanted to eliminate hepatitis see from the entire veteran population of 163,000 veterans and now fortunately we have a federal drug that can eliminate the virus at 95 percent or higher cure rate. So now any veteran shouldnt have hepatitis so Congress Gave us one. 5 billion. We proactively contacted every veteran now we have treated over 100,000 of those veterans and are on the way to eliminating hepatitis c. We need to do that in the general population. Not Many Health Systems think that we proactively. But these are the lessons we can learn from the vat seven. Veterans show that our membership generally there is things they went for improvement but you didnt mention those priorities but you address in the book another area in which the v. A. Gets around military veteran suicide. As a complicated issue Mental Health is complicated but even we as a country are struggling to understand or figure out how to solve du have any insights how we can begin to address thi this . The highest clinical priority that i established was to reduce veteran suicide. Twenty veterans a day it is a staggering figure that i used to sit there and say if another day goes by then there goes another 140 veterans. There is still so much work to do but thats why im pleased secretary wilkie has continued to make veteran suicide a priority for the v. A. Taking a look at this of those 20 veterans a day, only six are getting care from the v. A. System. Fourteen are out in the community my biggest worry is they are getting help at all. So one of the first initiatives was to start outreach for Community PartnersCommunity Groups and churches and religious organizations and groups like the united way and local and state governments Work Together to identify veterans at risk. Every v. A. Medical center has a Suicide Prevention coordinator and their job is to be out there looking for veterans at risk in identifying ways to help them. That is one practice i think the v. A. Has that the private sector should have. This is an American Public health issue not just veterans. But we need to do a lot more for go the underlying reason why people take their lives as in because they wake up one day and say i feel like doing this but they are suffering. It could be depression, pts depression, ptsd, chronic pain, substance abuse, we have to look at the ways to get to the underlying reason to find that diagnosis and treatment and to make sure we are proactively identifying how we can help and theres so much more work to do. Lots of promising opportunities to do that with predicted analytics and therapies. But much work to be done. This is a number one priority as well. Especially that the situation is not improving from both military to show were not getting at the problem. And we shouldnt be looking at it as a an Emergency Response issue but chronic pain or homelessness, Financial Issues so much could be reaching into that. But clearly there has to be a whole government and whole Society Approach to this but the v. A. As the leader for the Veterans Community should be spearheading that. Yes. And im proud of the work the v. A. Is doing. But like many tough problems that americans face, we have to do more and push through some of those barriers that prevented us from making progress. You are right the recent Suicide Prevention report reports the data differently so it looks like a different one a smaller number. Actually went up a little bit but this is not about a scorecard. Its about making progress. Im not sure we are there yet. Im not sure we are there yet. To begin to change this culture throughout the country that doesnt recognize the service of Women Veterans as we do male veterans. The Fastest Growing demographic in the military is and then in the military. About 14 of our military service play extremely important roles and not to recognize and respect their service is simply wrong and something that cant be tolerated by the va or any other part of our society but i do think you are right this is a reflection of issues we see in the broader society. What theyve decided to do and something that ive supported a rather than waiting for the culture to change is to make sure we are providing the care everyone deserves so we have created Womens Centers that often have separate entrances but create a secure and comfortable environment where women get to go get their care and dont have to worry about any of the issues we talked about and in some ways it is a shame we have to create separate places for people that we were not willing to wait and say we are going to try to change attitudes that the same tim bute we are providing these centers we do need to begin to change the attitudes. There was a recent public issue at the washington, d. C. Va where a woman that her and was harassed just walking through the halls and had the courage to come out and talk about that experience, and i know that i certainly went out publicly and supported her as many of the organization stated to say this is unacceptable. We need people to this brave woman to be able to speak out on behalf of her fellow veterans, and we need to begin to start changing these attitudes. As you mentioned we need male veterans to speak up for them as well. Its not something the burden should be completely placed on the Women Veterans. One of the ways in which we are trying to begin this process and drive a topdown understanding that there really does need to be and should be a cultural change is to change the motto of many people dont know the motto of the va is an Abraham Lincoln quote for he who has borne that out over his widowed aunt for his orphan. Weve been pushing and there is legislation to change it to something that is more embracing of the changing nature of our military and our veteran community. Its something that frankly has received pushback in a lot of the quarters. Did this come up when you were within the va . Guest it was one of the disappointments i had. The military is the place in our society where differences and diversity have the opportunity to go away. This is the ultimate melting pot. Everybody shares the same goal. You rely upon each other in some cases just to survive doesnt matter if you are republican, democrat, black, white, women, male it is a common mission. For the va not to be inclusive and to embrace that i think is a mistake. While i understand peoples deep attraction to Abraham Lincolns motto, that was in a different time and we need to recognize that it needs to be leading in this type of inclusion and i think if there is a motto people feel excluded from it is time for us to recognize that, and i do not believe that Abraham Lincoln would be upset with that. He is a guy that stood for making sure we were one country together and he believed in strongly supporting the people who fought for the country as many of us do, but i think talking about the issues and the importance of women now a couple hundred years after lincoln its time for us to move towards a more modern motto. Host there is legislation to change it, but correct me if im wrong they have the ability to do it on it that on its own. It wouldnt need an act of congress to change that, correct . Guest know it would not and i do not think at least as a secretary i did not envision chiseling off the quote off the concrete of the building. There is a way of honoring history with respect and not changing the dignity of that Abraham Lincoln gave to us as a country with this commitment towards our veterans, but Abraham Lincolns original quote as you know talks about widows and orphans. This is not language that we traditionally used in 2019, and i think there is a way of honoring the original words by talking about the new va in a way that could be done with respect for history. Host i completely agree. We are kind of talking big picture about the va karyotype like to move into the time specifically in the administration specifically as secretary. Weve already touched on a couple of these issues, but i think its safe to say that if you look at especially the parts in your book about the va secretary under president trump, two of the underlining policy debates that drove so much of your time around privatization and the Electronic Health records that we discussed here, privatization is a word that comes up all the time. I dont think most people fully understand what is meant when we talk about that. Could you give the audience and understanding of what we mean when we talk about privatization in the va . Guest to its fullest extend toward the concept of shutting down the va Medical Centers and health care system, giving a voucher to a veteran and saying you go and find your own healthcare in a private setting and we will pay the bill. That would be the ultimate goal there is a strong belief that government shouldnt be involved in the delivery of services that the government is inherently inefficient. Weve talked about this earlier where i believe the case the governments involvement in the Va Health Care is the most effective way of honoring the nations commitment to our veterans. That doesnt mean veterans shouldnt have the ability to go into the private sector when its in their best interest, when the care is better or specialized care is available. I think we all believe that should be available, but my belief is the complete privatization of the va would be a disaster and we would look back when they are getting the care they deserve and say how do we create a system that cares for them. So i dont want to see us go in that direction. When i first came to the va, 19 were getting care in the community. When i left, it was 36 . So i was strongly in favor of not having veterans get inferior care or waiting for care if the va could do it, but we got into the private sector. I think that this is an issue of that there are policies being pursued by those who favor the dismantling of the va. Where they do not raise their hand and say they are in favor of privatization because that would be a politically unpopular but if you watch the impact it of the policies over the years to come i believe they will lead to a point where there is complete privatization of the va and what im trying to say and what i argue in the book is that we either need to come out and say whats going to happen if we follow these policies or the need to very closely monitor and make sure that there is not an unintended consequence of the policies before it is too late. And there is an appropriate role to have oversight of the va and there is a role in the press to make sure they are looking at whats happening and i am trying to essentially raise the visibility. Lets just be cautious. Im optimistic about where the va is going. Im supportive of where the va is going, but being an expert in health care, i see warning signs and i want to make sure we are vigilant that there were unintended consequences that lead towards privatizing the va. Host you said Something Interesting that might confuse the audience because you mentioned how the percentage of private care visits rose from 19 to 36 i believe was the number so some people would say werent you working towards privatization, can you unpack that a little bit so people understand how that relates to not wanting to privatize but improving quality of care. Guest it can be confusing and often do this now what thist happens in washington when you are not at one end of the political spectrum, so the last end of the political spectrum says we want complete control of health care by the government. At the end of the political spectrum on the right as we dont want the government involved at all, thats completely privatized. If you happen to be in the middle of a compromised solution where i am, it is a very lonely place in washington and people tend not to understand it so i appreciate the opportunity to explain it. I believe as a physician that the right answer in health care is when you do the right thing for your patience, in this case the veteran. If you are a veteran what should you want . You should want the very best care possible. Where the va can provide these things that ive said i dont believe are readily available in the private sector to veterans should have a strong va that focuses on areas that they do extra delay while. I mentioned Behavioral Healthcare, ptsd, traumatic brain injury, rehabilitation, prosthetics, orthotics, the environmental exposure to toxic agents when you get in combat. These are things that frankly the va does extraordinarily well. The va cant do everything well and so if you are a veteran and you need specialized care or something isnt available in your community you should be able to get that of the private sector so i envision a hybrid system with a strong modern va focused on centers of excellence and things important to veterans and the ability to see the private sector windows are not available, and i publish about as they model of care in the new england journal of medicine so everybody could see the plans that i had for the va and one that i think frankly just makes sense for veterans. Host going on with privatization, this term comes up for debate when we talk about the recently passed mission act before that the term was choice, things like that. Can you talk about what that bill did, but it does, what it will do, it was passed a year ago, implemented in june of this year. There is still a lot of confusion around. You worked a lot of your time on that so i feel confident you know it very well. Can you explain what it would do . Guest i spent all three years of my government leading up to the passage of the act. When the crisis happened in 2014, Congress Quickly responded and president , signed it that they shouldnt have to wait, they can go into the community if they need to care. That was called the choice act and it was temporary. It was meant to last for three years and it was also hastily put into place so it was very complex, bureaucratic and difficult to navigate. With the mission act date is two important things. It has th put the ability for vs to go into the private sector into a Permanent Program so it was no longer a temporary, something i strongly supported in the second, if simplified the way to use the system of care so that it wouldnt be so difficult veterans just gave up on it and again something i worked hard to get things done. The mission act which is now law is a very good thing and something i support. The danger is something that is somewhat technical but i cannot over emphasize the rules that govern how a veteran is able to go into the private sector are called access standards and the time i was putting the bill through congress and working with the president on this, i knew that was so important we were not ready yet to have those rules in place, so i asked congress to allow that to be at the discretion of the secretary, gave a year so that the secretary could come forth with a really well thought out plan because this is the engine that drives the whole act and so thinking that i would be that secretary, i felt congress felt confident i would be doing that as well and fortunately, i wasnt there, the president had fired me and now secretary wilkey had to produce. And i think that she made a decision that these access standards would continue to be based on what i considered administrative rules and that is how many minutes it takes you to drive to the va and how many ins you have to wait for an appointment. I would have chosen a different path and made them based on clinical rules. Everybody i know they could spare pair out of the va when they use their insurance or go to the private sector, they get decisions based on their clinical situation. Situation. Ii am a doctor and i see my patient, but in the va this is now based on how many minutes you have to drive to the va or how many days you have to wait so i would say if you happen to be a veteran who lives next door to a va Medical Center, and you should have the same ability to get highquality care as somebodofsomebody that happens 5 minutes away. So i think that this is a mistake to use the standards that were picked today. This is in such bad news because since its a discussio if the de secretary not part of the law, this can be changed so that there is flexibility. What im suggesting, im not trying to say that there was a bad intent of picking these acts of standards. What im saying is this needs to be studied very carefully. We have to monitor it because if i am right, this is going to lead to bad consequences for veterans and then lets make the adjustment that we need to make. Host to tie this back into the book, you talk a lot about this, but you also write a lot about how you felt that your efforts to craft legislation and do other work in the va was often undermined by what you referred to and weve read about a separate group you referred to is the political cinema. Could you talk about who these groups, who they were and how they influence your time at the va . Many people may not realize when a president comes into the administration, the groups that supported leads on january 20, and 4,000 new political appointees eventually come into the administration and they are distributed all three governments of the da gets about 30 political appointees who gets put into the leadership positions. These political appointees generally are there for the right reason and are very effective at being able to help their agencies as were most who were given the va, but i had a a number of them that were more politically ideologues than necessarily willing to focus on the mission. And they believe differently than i did about these access standards and mission acts should move towards the direction of using administrative rules to open up the va very broadly which i believe would be leaning towards the privatization. To give you a sense about this when the bill that i proposed went to the Senate Va Committee which is where bills go to their committee for the vote, the vote by five senators both republicans and democrats was 14 in favor of the bill that i proposed including the republican chairman, Johnny Isakson and one sole senators opposed it, these political appointees are aligning themselves with that senator and that minority bill is the one that ended up getting into the access standards so there was two voices, the secretary and then a group of political appointees that ultimately had the support of the white house and that was the issue that led towards the difference to make a change for secretary. Host thats interesting what you just stated because as you wrote in the book the idea of privatization came up very early in your initial conversation with the president elect about you potentially coming on as the secretary. Do you feel president of trump fully understand or has a desire to move the va in the direction of privatization or is this a situation where maybe a lower level politicalowerlevel polits have an agenda that isnt fully communicated all the way up the chain of command . It is a very fair question, jeremy. I dont think im at the point that i feel like i can speak for what the president wants or what the intention is. Every time the president was focused on is what we are doing good for veterans and so im i m going to give him the benefit that hes trying to act in their interest. The political appointees have a much Stronger Political ideology that is much closer affiliated with the coke Brothers Organization called concerned veterans for america that has a political focus to move the government out of services and look, i think every american who cares about veterans has the right to put forth their ideas and should be putting forth their ideas and im not saying all of their ideas are bad. Some of them inserted in the middle on this issue, but i do think that there were two camps of decisionmakers. They were pushing very hard and i think that in many ways they found a way to get to other issues and i think that continuing to drive with a steady course the way i was i happen to believe that within the veterans best interest and now weve seen a little bit of a different Movement Much towards the approach that they wanted but i think that the president i dont know how much he has put himself into the details of these policies. Host time has gone incredibly quickly i would say so im going to jump to a speed of around. Two things i want to talk about, medical cannabis and burn pits. Medical cannabis is something many veteran organizations are actively fighting to get the va to be involved in and to do research there is a bill in congress to give research and drive research around the Utility Companies untold numbers of firsthand anecdotal accounts talking about how much cannabis has helped them overcome signature wounds of war and we talk about if we are not seeing a lot of movement around or leadership from the va on. Topic two is around you mentioned some of the foundational issues around exposure to toxic hazards. Everyone knows about h. And orange, these big open air picks that have been observed in overseas combat zones where we dump everything in, light it on fire and sometimes they turn 24 rec seven resulting in deployed servicemembers breathing in toxic fumes for their entire deployment and now they are coming back with a very Serious Health issues related to them. Can you touch on those topics and what the va is maybe doing or not doing and how we can move forward . Guest i will try to do it quickly but both of these are important topics. I am a physician and have scientific training and i try to look at things scientifically. The cannabinoid system is a system that has extreme potential to help improve health and wellness and im strongly in favor of any effort that will give us more evidence and research into ways we can help veterans. The va should be involved and opened his research for anything that will help them improve their lives including medical cannabis. Its different than recreational cannabis, but to ignore the benefits of this i think is at the peril of the veterans especially with the crisis that weve talked about. So it is time to change that. Help with that would be greatly beneficial. On the issue of burn pits, this is an area that frankly we have backwards. The way our system works today to be able to get benefits is that we wait until there is Scientific Evidence to be able to make our policy changes. That has resulted in our veterans waiting decades to get the help they need. You talked about agent orange. 50 years ago, people were exposed to agent orange. Today, 2019 they are still fighting for their benefits. For some which are scientifically shown to be associated with agent orange they havent been approved. The blue water navy, veterans are still waiting for the help that they need and deserve. Our golf war veterans are not getting benefits when they clearly have exposure to toxic elements and that isnt being recognized because the science has not yet shown up. I think we need to turn that around. When somebody sacrifices the way our veterans have come that they need to be given the benefit of the doubt and if the evidence shows there isnt an association or they were not at the location they said they were, and there is evidence to show that, then we need to change that policy. The burn pits are just us not learning from the mistakes we made for our Vietnam Veterans and we are making them wait and suffer. We are studying it but in the meantime there are people that need our help and we need to start having a government that is responsive to helping our veterans. Those are two issues incredibly important to us and im sorry we dont have more time because they are incredibly important. There is legislation pushing forward for the government and the va to change it so we can take action on this. That said, and you write about this and the book the va actually does have the ability and authority to do research on cannabis and the utility of it. Do you think there is a stalling tactic bear or maybe they generally dont feel they can do anything until they get legislative guidance on cannabis . Guest i think va researchers want to do the research and it has been made so incredibly difficult to get the Research Protocols approved through the process because it is a very restrictive plans so that the researchers in Charleston South Carolina want to do the research for got blocked from these bureaucratic barriers so that is where the legislation will be helpful. Host one thing thats always interesting early on in your tenure as the secretary, youve convened a meeting of the former secretary. How does that go over, did you learn something from that and do you stay in touch with any of them . Guest one of the big problems with an organization like the government is the constant turnover at the top almost every two years theres been a new va secretary. The undersecretary position which i held and i vacated in february of 2017 is still open to this day. There isnt a Senate Confirmed person there so when yo you have the turnover and it takes a long time to fill it there isnt a consistency decision so i believe that it was incumbent upon me to learn from my fellow secretaries who dealt with for the same issuethesame issues i h and i thought would be very helpful in moving things along and knew a lot more than i did in many cases. I brought them all together and they were kind and generous with their time they appreciated it and one of the reasons i wrote the book was because i have all this knowledge. I think i had identified a formula for making great progress and for fixing things and doing important things for veterans but when you leave, no one ever invites you to say what was working and what doesnt. That is a travesty and a failure of leadership, so i wanted to write this book so that future leaders of the va could pick it up and say this has been tried before, this is working or that isnt. I think that is the responsibility that i had and i will continue to speak out to advocate for the things i think are right for veterans. Host thank you, sir. Its an incredible opportunity. I appreciate your service at the va and i know it i noticed chalg regardless of the circumstances that you are in working at the va is a challenge because it is very much under the spotlight. I think that it is often held to a very high standard. Guest it is an honor and i want to thank you, jeremy. A fantastic organization that advocates for the iraq and afghanistan veterans, hard work always standing up and making sure we are doing the right thing. So the community were an important part and continue to be an important part of helping us reach the right decisions. Host excellent. Appreciate it and appreciate your time. This program is available as a podcast. All after words programs can be viewed on the website at booktv. Org. Can everybody hear me okay . Thank you for coming out to book peoplthepeople tonight. We really appreciate you supporting our events. I have a couple of quick housekeeping announcements first. Please silence your cell phone and if you would like to keep them on to take pictures, that would be fine but please turn off your flash. If you havent been to one of our events before, welcome. We have about