[Congressional Record (Bound Edition), Volume 160 (2014), Part 8]
[Senate]
[Pages 11136-11138]
[From the U.S. Government Publishing Office, www.gpo.gov]




                          VETERANS HEALTH CARE

  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

[[Page 11137]]

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

[[Page 11138]]

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.
  The PRESIDING OFFICER (Ms. Heitkamp). The Senator from Texas.

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