Many of the details come frankly in the veteran community theres a lot of us who dont understand the breadth and depth of what the v. A. Does. Im excited to talk about the v. A. In general, about your book and about your time in the administration. I would love to begin by hearing about what brought you to the v. A. , youre very successful in the civilian career and a lot of times making the transition from the civilian world into the government world can be a bit jarring. What drove you to want to take up the mantle of working within the government especially within the v. A. . Guest during my 20s i didnt have a chance to serve the way that you did. I spent my time and medical institutions and doing my medical training and it was sort of busy 20s. Its one of the real regrets ipad with this amazing country that we have that it wasnt able to give back. Later on in my career i was the ceo of the hospital, and i had the opportunity to get a call from the white house. This was right at the time in 2014 winter was a very public wait time crisis in the v. A. Where there was allegations that veterans were dying waiting for care. I remember sitting there as a citizen saying i feel terrible about this. If anybody deserves the best care possible its our veterans. I wish there was something i could do to help. As sometimes happenst in strane ways i got a call from the white house saying would you consider coming to help lead the v. A. Healthcare system . Because we are looking for somebody who understands how healthcare works from the private sector. I did what everybody tends to do when they have the choice is to make. I made a of the pros and cons, and the cons side was much, much larger than the pro side. The pro side was simply how could i say no . This is my duty as an american citizen to get back to people who have given us so much. I didnt think much about it. I said yes, im prepared to, dont. Host thats great. For those of you who have read the book no, that was during the obama administration. You are one of the few with served under both the obama and trump administration. I look forward to getting into that. I would love to read a brief quote from your book, early on you right it is important americans understand what the v. A. System is, how it works and why it exists. As i mentioned, a lot of people dont understand the scope of what the v. A. Has and what the responsible for. I wonder if you could start out by giving maybe you had an elevator pitch to those that you gave talking about everything the v. A. Does. E as you well know it goes beyond healthcare that theyre so much that the v. A. Does. Guest one of the reason i wrote the book was for exact what you talked about. Im not sure theat american pubc understands why the v. A. Exists but why its an essential part of our nationalca security syst, that when weou rely on a volunty military, which now less than 1 of americans serve in, these amazing americans raise their hand and are willing to sacrifice themselves on behalf of all of us. When they go theres a commitment the country has made to them that they will take care of them if they need that help when they come back. There is no other organization thats focused on that. As you said the v. A. Provides health care for 9 million veterans but there are 20 million veterans in the country and so the v. A. Has a large effort directed towards education, the g. I. Bill. It has an effort towards an offense, should somebody require assistance if there are no longer able to work for disabled. It also goes all the way through the time of making sure every veteran when the time comes is buried with dignity and respect, and so there are 114 v. A. Somebodies around the country and they did an amazing job supporting families v. A. Cemeteries. This. This is an organization, second largest inzi u. S. Government, employs 370,000 people who are there, many veterans themselves continuing to get back. It does an amazing job and does deserve the support and understanding of the american people. Host thats great. I appreciate that because i often point out to people that the v. A. Is the second largest department, secondlargest agency, secondlargest budget and people just for my civics my point should be moreen informed about everything the v. A. Does. Guest thatsdo right. If i could, just about the healthcare aspect, because i get so much focus of public attention on the v. A. When i came from the private sector, i i never had worked in government before. I had a completely open mind when i was reading all these Horror Stories from the press, that i would go there and find the system was so broken and so dysfunctional that may be my job is going to be just to close up shop and say you know what, the best thing i can do for veterans is eliminate the v. A. Healthcare system and move everybody into private hospitals, something that i knew very well. After i got to the v. A. And begin to see what the v. A. Does, and when i say got to see, i put on my white coat as a doctor and took care of veterans and went out and visit hospitals across the country and went to see places like where we bringth paralyzed veterans skiing down the slopes in aspen, colorado, i really began to understand that what the v. A. Does is very different from what the private sector does. And, in fact, cant be replaced. The private sector doesnt do the things the v. A. Healthcare system does in all cases. Ed for example, our behavioral Healthcare System, it is expensive, it is a large. Wheree the private sector beaver Healthcare System is really struggling and trying to get access, if we were to put these 9 million veterans, just dump them into the private sector system on a system that is already struggling to meet its needs, we just know that the veterans would not come out on the right side of that. I became a very strong advocate for making sure this was a system that works well, that we need to modernize, but that it will be a sustainable system. Host and you touched on a couple things i want to make sure we come back to, privatization and things like that are very important topics, a large part of your book, we will get to that in in a little time but i want to continue with the scene setting because what you mentioned reminded me of a common saying that certainly within the Veterans Community even within the v. A. If youve n to one v. A. , you had been to oe v. A. Pic you mention how in the beginning you did a lot of going around to visit different v. A. And things like that. Why do you think that is thatvi even though we are talking that an agency that has oversight of all of these different areas you get so many different stories . Unfortunately the negative stories are the ones that make it to the press but you hear stories about when v. A. But talk to so many veterans, our membership often tells us they love the care they get at the v. A. They would like to get access to it faster and things like that but why do you think there is such a variety of levels of care that oneac receives from the v. . Guest first of all the v. A. Is under a public scrutiny that no other Hospital System in the country finds, as a hospital seal in the private sector i can tell you Little Things that happen in the v. A. That would never come to the attention of the private sector turn out to be the subject of congressional hearings and major frontpage stories. The public gets a sense that there are lots of things that are happeningo at the v. A. Hospitals that dont happen in the private sector. But again using the private sector comparison, the questin i would get most frequently being a. Physician ceo was whats the best hospital for me to go to . My answer always was interesting, there is no such thing as the best hospital. Her hospitals that are good at some things, excellent and some things and those same hospitals may not be so good in other areas. Thats the same in the v. A. System when you have the largest system in the country with over 1000 facilities, youre going to have some that are excellent at certain conditions and others that frankly need work on them, thats just what you fight in healthcare. The v. A. Has additional complexity in that it needs to provide care to veterans wherever they live in this country. So, therefore, we have a large number of our veterans who live in very rural areas and finding people especially specialists to be able to work in rural areas is a challenge for the v. A. And also a challenge for private sector as well. What works in the va from one place to another place for thats one of the things that of course i worked very hard on two standardized some of these practices. That reminded me of a funny story from your first confirmation hearing. When senator sullivan of alaska basically said, you need to come to alaska because we have a unique set of circumstances here. You need to understand that before he was going to vote for you. I think just so people know more about that. Many people dont understand the Senate Confirmation process. You actually come in order to go quickly through a senate process and not require an entire floor vote, you have to have unanimous consent. The white house said to me, good news, you have unanimous consent. You will be confirmed in the next couple minutes. Right as that vote was happening, senator sullivan said, not so quick. I need to have a conversation with the nominee. He called me up and said, im standing on the senate floor. Im about to cast my vote. But i want you to commit to me that in the first 30 days, if you are confirmed, that you will come to alaska with me. Because alaska is very different than other states in our veterans have different needs. I said, senator, we are going to alaska. And the vote went through. [laughter] which i imagine was your intent anyway. You mentioned there was a lot of variability geographically speaking especially, in terms of making it difficult to get proper professionals to some of the rural areas. Alaska is one of the few states, New Hampshire and hawaii being the others that dont have its own va hospital. So meeting the healthcare needs of those states is extraordinarily challenging with the partner. In anchorage, we partner with the air force hospital. But i was delighted to travel with the senator. Because thats how you understand how to fix problems out there by talking to veterans about what theyre experiencing. Another thing you did issue continue to see patients during your time in the va. Which i think mightsurprise people. That you have the though ai would take the time to do it. But in fact, that was something you felt was necessary and vital to you understanding the needs of the veterans. Could you expand on that . I think every leader can do their job more effectively if they understand what the impact of their decisions are. If i was going to be making a decision as i ultimately did, on which electronic record the va would use. A big decision. How could i make that decision if i had never used the vas electronic record. And if i had never been working with patients and nurses and doctors understanding how they interact with the record. When i would put on my white coat, no one knew i was secretary. It helped me understand what was working and how they were experiencing the decisions i had to make from the ground level. I think that made me a better and more effective leader. You touched on the Electronic Health record which is Something Else i want to talk about it a little bit. You remind me, theres a funny anecdote when you were in your doctor capacity talking to veterans. Youve got your white coat on and they dont necessarily know who you are. Youve got startling responses from a veteran. Could you tell that story . I would see patients to ways. In person in the exam room. Here in the city at the manhattan ba. Then i would see them using telehealth from my office in washington to a clinic in oregon. A very rural part of the country. I got to extend both urban and rural. But i was in the new york manhattan va. I saw a patient and what can i do for you, sir . He said i need a physician to fill out this form and i said id be happy to do that. He said im i need certification because i am suing secretary shulkin. He was homeless and was trying to get additional benefits to get himself out of that situation and get himself back on track. Needed a physician certification of his issues that he was dealing with. I said to him, well, sir. First of all, im going to help you. But i dont think im the person to do it. He said why, i said because i am secretary shulkin. We got him on his way and i got another physician to help them. You early on mentioned five priorities you had when you are coming into the va. Could you talk about those five priorities and how you arrived at what they would be . And maybe you can expand on how you feel you did in achieving those goals . When i first came to the va, i not only, never worked in government before. This was an organization that i was going to have to learn. It was such a Large Organization that if i had waited until i truly understood everything about it, wed be waiting a long time. As i mentioned, i entered at a time of crisis. There were veterans literally waiting for care that needed help and i didnt feel like i have the time that i normally would if this was a normal situation. So i came in having studied the va from the outside the best i could i came in and said we will have priorities right now. If we change them later thats okay. But our single top priority was going to be 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 was that there were 57,000 veterans waiting for an Urgent Medical consultation. That was just, waiting more than 30 days. That was totally unacceptable to me. And outside the bounds of what i call reasonable. I immediately called for every Medical Center to be open on the following weekend and during that weekend, we contacted those 57,000 veterans and by monday morning, we had that list down to less than 1000 veterans. So once we essentially got the backlog taken care of. I wanted to make sure we never got to that situation again. I did a couple things but the first is, as secretary, one of my first decisions was to publicly post our wait times. The va today is the only system im aware of. The second thing was, i established same day services. Throughout the entire country. By december 2016, i was able to tell secretary mcdonald and president obama every va Medical Center had the capability of seeing people on the same day basis. So wed never be in a situation where someone with an urgent issue couldnt be taken care of. We ended up publishing an article. We had made tremendous progress in addressing that issue really with the commitment of the employees and the staff that work there. The other priorities were focusing on establishing and improving employee morale. Because it had been terrible. There were 35,000 vacancies. Recruiting people to an organization that has low morale is a significant challenge. Probably one of the most important priorities was regaining the trust of the biggest veterans we serve. [indiscernible] we can track whether we are beginning the trust we had lost of our veterans. Fortunately, that began to climb as well. Which is very good news. We had established another priority of creating best practices. Learning from one va to another and doing it across the country so we could decrease some of that variation quality of care. That was very successful in being able to do that as well. Some of these things you brought from the private sector. I know there are vast differences as you either eluded to including the ways we as a country can provide care to civilians and how we can provide care to our veterans. Are the things we can continue to learn from . Max interestingly, not only did i not have at the time, to learn all the ways of the government. Because i felt there were urgent issues like the wait time issues. But i also deliberately didnt want to start to think as if i was a government employee. I wanted to deliberately bring the industry best practices, the way we thought about things to government. What i ended up learning was that the government could benefit from many of the practices that the private sectors does. Needed to modernize some of the ways it was thinking. I actually learned there was more i learned in the va that the private sector could benefit from. This is a twoway bidirectional way of learning between the private sector and the government and in this case, the va. Theres an ongoing debate about the future of healthcare. Thats not usually something that people can usually say, we can learn from the government. When you look at the outcomes of care across a population which is very popular right now. Called population health. The va outperforms almost every other major Healthcare System. Not saying its the very best. When you look on average, the va performs better than most private sectors. If you look at what we did for example, i made the declaration that i wanted to eliminate hepatitis c from the entire veteran population. We have a drug, several drugs, that can eliminate the virus. At a 95 percent or higher cure rate. I didnt see any reason why we should have any veteran who had hepatitis. I went out. Congress gave us 1,000,000,000 and a half dollars to do this. [indiscernible] we need to do more of that in the general population. Proactively looking at outreach and population health. But these are lessons we can learn from the va. Here that veterans get through the va often is there are studies that show. Our membership generally likes the care they get from the va. We too often hear the negative stories and not the positive. You didnt mention as one of your priorities but you certainly addressed in the book, another area in which the va gets slammed is around the problem of military and veteran suicide. Its such a collocated issue. Mental health is a collocated issue not only in the veterans and military space but we as a country are struggling to understand. Do you have any insights from your time at the va in your time as to how we can address this issue both within and without of the va . The single highest clinical priority i established was to reduce veteran suicide. 20 veterans a day taking their life. Its a staggering figure that i used to sit there and say, if we let another week go by. There goes another 140 of our veterans. There is still so much work to do on this and thats why im pleased that secretary wilkie has continued to make veteran suicide a priority for the va. One of the things when you start to take a look at this. 20 veterans a day take their life, only six are getting care in the va system. So there are 14 out in the community. My biggest worry is there not getting help at all. So one of the first initiatives we did at the va was to start outreach to community partners. Veterans