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Politics & Government

What's Ahead For The VA As Shinseki Steps Down?


This is TELL ME MORE from NPR News. I'm Michel Martin. We'd like to start with some of the week's political news. And we are joined by two people who are going to help us understand what the politicians are saying. Paul Orzulak wrote speeches for President Clinton, as well as Al Gore during the 2000 election. He's founder and principal of the strategic communications firm West Wing Writers. Mary Kate Cary was a speechwriter for President George H. W. Bush. She's now a columnist and blogger for U.S. News & World Report. And she's also just produced a documentary. So, thank you both so much for joining us once again.

PAUL ORZULAK: Thanks for having us.

MARY KATE CARY: Thanks for having us.

MARTIN: So let's start with a story that has been very troubling for many people. And the investigations into the Departments of Veterans Affairs have revealed that some VA hospitals did conceal the number of patients awaiting treatment by creating unofficial waitlists. There are reports that a number of patients died while awaiting treatment on those unofficial lists. Although that hasn't been confirmed that it was the cause of death - but, at any rate, lawmakers on both sides of the aisle have been demanding that VA Secretary Eric Shinseki - he's a retired four-star general - be held accountable for this. This morning, Secretary Shinseki spoke about this at the National Coalition for Homeless Veterans.


ERIC SHINSEKI: I've initiated the process for the removal of the senior leaders of the Phoenix VA Medical Center.


SHINSEKI: We will use all authority at our disposal and enforce accountability among senior leaders who have found, instigated, tolerated dishonorable or irresponsible scheduling practices at VA health care facilities.

MARTIN: Now, there've been calls, as we said, Paul, on both sides of the aisle for Secretary Shinseki to step down. And the president is under a lot of pressure on this, as well. He's actually scheduled to meet with him today. And you, apparently, think he should resign.

ORZULAK: I think he should resign.

MARTIN: Because?

ORZULAK: Well, it's about accountable leaders and, whether he directly knew about all these things or not, he should step down. But you know, he's a great soldier and everybody is - we respect him as a leader. He's not a great reformer. And what - you know, it's going to take a lot more than a fall guy to fix the VA. There aren't enough doctors. There aren't enough primary care doctors to see people so, you know - he needs to go.

MARTIN: But see, that's the question I have. You know, I have to be honest with you. I kind of feel - and I understand this might be, you know, contrarian - but it just seems like this is more a ritualistic banishment than it actually fixing the problem. How does this fix the problem, when the whole issue here is that he was lied to?

ORZULAK: Well, it's not clear at this point that he was lied to, right? I mean, we still are learning things about this story. To me, it's about accountability. I think, there are - a lot of frustration that nobody's fired in the last eight - in the last six years in this administration, despite some things that went south. There are a lot of people who thought Kathleen Sebelius should've been relieved of her job - over the problem with the Obamacare website - long before she resigned. It's about accountable leadership. General Shinseki knows that. But it's - it's to the point, now, where he needs to go.

MARTIN: Oh, what do you think Mary Kate Cary?

CARY: I completely agree that I think - not only does he need to go. I think a lot of the leadership at some of these 40 or 42 centers that are under investigation, by the IG's office, all need new leadership. And one thing to consider would be - you know, it's a tradition to have the head of Veterans Affairs Department be a general like Shinseki is. But maybe we should have it be a hospital executive. And bring in a health care team that knows how to manage, what is a massive health care system, that is failing in our country.

ORZULAK: Yeah, yeah.

CARY: And I don't think that would be crazy. I think that 's a great thing Republican opposition could call for - is free market reforms. One I saw the other day...

MARTIN: ...Yeah, what would that look like?

CARY: Well, one I saw the other day - which I thought was a great idea - you've got 21 million veterans, almost half of them are older than 65. And I think we should consider giving them vouchers. If they don't get seen within 30 days, let's say, why can't they have a voucher to take for Medicare and go to any doctor, in the country, that accepts Medicare? I think that's a great way to relieve some pressure on the system. And in the long run - do what Paul's saying - get more doctors in there - figure out how to get more primary doctors in the VA system. But I think there need to be some free market reforms - not a one- size-fits-all answer - for what is a very diverse group of veterans.

MARTIN: Having people go to Medicare - is that a free market reform?

CARY: Well, within that system - within the government system...

MARTIN: ...Aren't there a lot of Republicans governors who don't want to expand these programs?


CARY: Well, I think it would be really great - give them a subsidy to go to any doctor in the country. And the government will subsidize it. And let them enter into the private health care system like the rest of us have. I think that would be really great.

MARTIN: I think - I obviously - you know, people want to keep the focus on the people who need this care and aren't getting it - and if - you know - who serve the country and certainly deserve it - I mean, but the politics, Paul - what are the politics of this? Is the fact that there are people from both sides of the aisle calling for Shinseki's resignation - does that kind of neutralize politics in any way? Interesting to note though - that the two leaders of the House, the Speaker and the Majority - the leader of the House minority, Nancy Pelosi, to this point - unless they've changed in the last five minutes - have not been, I mean - 'cause they're making the point that this does not really fix it. But, does that - what are the politics of this?

ORZULAK: Well, the politics of it are that - it's, you know, - you don't have to be a Democrat or Republican to see it as a national disgrace that soldiers are not getting the care they need - coming home for war. But the politics - you know, the policy side of this is we don't have enough doctors. Cases are up 50% the last three years. We've only added - 9% increase in primary care doctors. It's the same problem the system overall is having. So you have doctors, who are supposed to see 1,200 cases, who are seeing 2,000. They're getting paid 30 to 50% less to begin with. And their bonuses are tied to speed of processing. So it invites exactly the kind of situation that you see. These fixes are going to come from Congress. You know, what if - if Congress did loan forgiveness for the primary care doctors, that are graduating right now, to say go into the VA or even the general health system - only 30% are doing today because they don't pay as much. It'll make a big difference. But there are things the VA can do to streamline the process too. You know, let's work out the medical records issue they're having with the Pentagon. You know, let's have a more streamlined form process so we're not getting tangled in forms. Just like the red - you know, like the red tape that's held this agency up for decades.

MARTIN: You know, we have to even - actually think about the fact that we're talking about this Veterans Affairs issue. Now, we're about to welcome a whole new generation of veterans back, you know, to the country as their service winds down and as these campaigns wind down overseas.

And if you're just joining, we're talking about the latest in politics with former presidential speechwriters Mary Kate Cary and Paul Orzulak. And this is the other issue here - is that, you know, on Tuesday, President Obama announced plans to remove all troops from Afghanistan by 2016, except for a few that'll stick around to defend the U.S. Embassy. And then on Wednesday, at the U.S. Military Academy's commencement, he talked about his administration's new approach to foreign-policy. I just want to play a clip -and it's actually a lengthy clip - from my - from his interview with my colleague, Steve Inskeep, who spoke with him right after the speech. I just want to play it.


PRESIDENT BARACK OBAMA: The kinds of issues, though, that dominate the headlines - a conflict in Syria, a Russian incursion into Ukraine, the kidnapping of 200 young girls in Nigeria. In those circumstances, we are going to be most effective when we use a wide range of tools - diplomacy, sanctions, appeals to international law - in some cases, a judicious use of military force may make sense. But in those circumstances, it has to be in a multilateral system, where other countries are participating.

MARTIN: So, translate Paul. What's he saying?

ORZULAK: He's saying the United States can't lead and go alone in any of these places. You know, the United States is one the country in the world who people ask - people don't ask what's China going to do about this? Or what's Europe going to do this? They always ask what's America going to do about this? And it has for 70 years. It's the country that we've been. But, you know, our country right now is - it has little battle fatigue. We've had two wars. We're thankfully winding down the second one. But, you know, there's an overwhelming support for the president in not taking - putting troops on the ground in Syria or in eastern Ukraine. You know, the problem right now is that it's Russia. I mean, Russia fits into a familiar storyline. And now it's - OK well do we look weak? The truth is we're not going to commit troops in all these places. Can we do more these other places? I think we probably can. But it doesn't mean we haven't done a lot.

MARTIN: Mary Kate, how do you respond to this?

CARY: Well, I think he's got the same problem as he has with the previous subject which was - one observer called the revenge of the stump speech - which is, we've got all of this material President Obama -than as a senator even - talking about all the things that are dishonorable about not giving our vets great health care. And it can be used against him in political ads against and against the Democrats who are running for office. We've the same thing here - where you've got the president giving a speech at West Point where his foreign-policy sounds very reasonable and balanced and multilateral and all the sorts of things. And yet you can go back and pull up him saying Assad must go. There's a red line in Syria. And then nothing happened.

MARTIN: Does his speech accomplish anything in your view? I mean, you said revenge of the stump speech -what are you saying? It's just kind of here to create background material for people who are running for office so that they can have, kind of, statements to stand on? What are you saying?

CARY: Yeah.

MARTIN: What does it do?

UNIDENTIFIED SPEAKER: What this does is it adds to the narrative that he has a great rhetorical ability to say these statements. And then the actions fall short time after time after time. And we've now got it - we've got speeches that he's said in Ukraine, Syria, Iran, Afghanistan. I mean, Afghanistan - he talked about the terrible danger of letting the Taliban takeover. And then for years - and then he immediately, this week, announced specific timetable of when we're going to withdraw, which totally tips off the Taliban of when to take over.

MARTIN: What do you think? What is this?

ORZULAK: I think, there's not a lot of nobility and restraint. It doesn't feel like shining-city-on-a-hill stuff that we've always been. But in truth, we've chased Al-Qaida out of Pakistan. We've chased them in places like Yemen. Are the going away anywhere? No. They go to other parts. But we've been active in parts of the world to advance our interests. And actually America is, right now, doing more and more corners of the world than any time in our history - in places like Africa and Burma and other places, which weren't exactly foreign policy priorities before. But - because we haven't not been active everywhere doesn't mean this administration hasn't done a lot in a lot of places. And we could do more in Syria. I believe, we could do more in Ukraine. And I think we will. But it doesn't mean that we've somehow been weak or waddling.

MARTIN: Mary Kate, let me just give you a final though on a different topic, which is Edward Snowden - big interview this week with Brian Williams of NBC. He clearly sees himself as a patriot - seems like he's kind of winning the public relations battle on this. And yet he's still attracts a furious response from people who say that he's, you know - that if he's really a patriot that he should come home and face justice. I take it the both of you actually agree on this. But, Mary Kate, let me give you the final thought on this. Your thoughts about it?

CARY: Yeah, I mean I think Snowden was probably well-intentioned. And I think he was very upset about what the government was doing, in terms of the Constitution. But the minute he ended up in Russia - that sort of told me all I needed to know. And I think Brian Williams asked him why did you go to Russia? And he said because I couldn't get to Cuba. And I thought, well that's the wrong answer. But anyway, I think you should come home. Roll the dice - stand in front of a court of law and see if he can get a jury verdict to acquit him.

MARTIN: Interesting. Big public opinion divide on this one. Mary Kate Cary was a speechwriter for President George W. H. Bush - not here though, but a big public opinion divide elsewhere. She's now a blogger and columnist for U.S. News & World Report. And Paul Orzulak is a speechwriter for President Clinton. He's the founder of West Wing Writers. They were kind enough to join us our Washington D.C. studios. Thank you both for coming.

CARY: Thanks for having us.

ORZULAK: Thanks Michel. Transcript provided by NPR, Copyright NPR.