Podcast appearances and mentions of greg jaffe

This week, Chris and Matt unpack the deepening chaos at the Pentagon as Pete Hegseth's tenure as secretary of defense continues to spiral. From more leaked strike plans on Signal to staff purges and his wife sitting in on sensitive meetings, the dysfunction is reaching new lows. Then, a little-known Russian spymaster emerges as a key player in Ukraine peace talks, just as far-right ideologues inside Russia insist on total victory at any cost. Plus, listener questions on Europe's military independence, Bulgaria's role in Russian espionage, and the EU's Orbán problem. Subscribe and share to stay ahead in the world of intelligence, geopolitics, and current affairs. Please share this episode using these links Audio: https://pod.fo/e/2cd1a9 YouTube: https://youtu.be/p2hm0KZYiYk Articles discussed in today's episode "Info Hegseth shared with wife and brother came from top general's secure messages" by Courtney Kube & Gordon Lubold | NBC News: https://www.nbcnews.com/politics/national-security/info-pete-hegseth-shared-wife-brother-came-top-generals-secure-message-rcna198838 "Under Hegseth, Chaos Prevails at the Pentagon" by Greg Jaffe & Helene Cooper | The New York Times: https://www.nytimes.com/2025/04/22/us/politics/hegseth-chaos-pentagon.html "The White House is looking to replace Pete Hegseth as defense secretary" by Tom Bowman & Quil Lawrence | NPR: https://www.npr.org/2025/04/21/nx-s1-5371312/trump-white-house-pete-hegseth-defense-department "Hegseth Said to Have Shared Attack Details in Second Signal Chat" by Greg Jaffe, Eric Schmitt & Maggie Haberman | The New York Times: https://www.nytimes.com/2025/04/20/us/politics/hegseth-yemen-attack-second-signal-chat.html "Two top Pentagon officials placed on leave in leak probe" by Daniel Lippman & Jack Detsch | Politico: https://www.politico.com/news/2025/04/15/caldwell-pentagon-leaks-00291735 "Real reason Pete Hegseth's wife Jennifer Rauchet won't let him out of her sight …and the secret nickname she has earned from Pentagon staffers" by Susan Greene | Daily Mail: https://www.dailymail.co.uk/news/article-14636555/pete-hegseth-wife-jennifer-rauchet-pentagon-secret-nickname-staffers.html "Who is Sergey Beseda, Russian spy handler leading talks with US?" by Kateryna Denisova | The Kyiv Independent: https://kyivindependent.com/sergey-beseda-russias-negotiator-in-saudi-arabia-and-his-role-in-ukraines-war/ "The Russian Nationalists Pushing for Ukraine's Destruction" by Giovanni Pigni | New Lines Magazine: https://newlinesmag.com/reportage/the-russian-nationalists-pushing-for-victory-in-ukraine/ "Sweden's Bigger Badder Gripen Fighter Packs A Lot Of Punch In An Incredibly Efficient Package" by Jamie Hunter | The War Zone: https://www.twz.com/39081/swedens-bigger-badder-gripen-fighter-packs-a-lot-of-punch-in-an-incredibly-efficient-package "Escalating Trade War Raises Questions Over Canada's F-35 Future" by Thomas Newdick | The War Zone: https://www.twz.com/air/escalating-trade-war-raises-questions-over-canadas-f-35-future "A Weak Link in NATO? Bulgaria, Russia, and the Lure of Espionage" by Mark Kramer | Davis Center for Russian & Eurasian Studies: https://daviscenter.fas.harvard.edu/insights/weak-link-nato-bulgaria-russia-and-lure-espionage Thanks for listener questions from Julie, Sam, and Richard! Support Secrets and Spies Become a “Friend of the Podcast” on Patreon for £3/$4: https://www.patreon.com/SecretsAndSpies Buy merchandise from our Redbubble shop: https://www.redbubble.com/shop/ap/60934996 Subscribe to our YouTube page: https://www.youtube.com/channel/UCDVB23lrHr3KFeXq4VU36dg For more information about the podcast, check out our website: https://secretsandspiespodcast.com Connect with us on social media Bluesky: https://bsky.app/profile/secretsandspies.bsky.social Instagram: https://instagram.com/secretsandspies Facebook: https://facebook.com/secretsandspies Spoutible: https://spoutible.com/SecretsAndSpies Follow Chris and Matt on Bluesky: https://bsky.app/profile/fultonmatt.bsky.social https://bsky.app/profile/chriscarrfilm.bsky.social Secrets and Spies is produced by F & P LTD. Music by Andrew R. Bird Photos by Eric Lee/NYT and Sgt. 1st Class Marisol Walker/US Army Secrets and Spies sits at the intersection of intelligence, covert action, real-world espionage, and broader geopolitics in a way that is digestible but serious. Hosted by filmmaker Chris Carr and writer Matt Fulton, each episode unpacks global events through the lens of intelligence and geopolitics, featuring expert insights from former spies, authors, and analysts.

This summer, at a small recruiting station in Toms River, New Jersey, Sgt. 1st Class Dane Beaston met with a team of Army recruiters to offer some encouragement.“Let's change the places we're looking,” Beaston told his colleagues. “Let's change our messaging. Let's change what we're doing if it's not working, right? But the potential's out there.”Beaston has given a lot of talks like these lately. While his team has gotten closer to meeting its goals since he joined a couple years ago, it fell short of meeting its quota in June. This isn't just a problem in Toms River. Across the country, the Army is struggling to sign people up. Negative trends accelerated by the pandemic have shrunk the number of young people able to meet the Army's academic and athletic requirements. Trust in American institutions is also waning.Today on “Post Reports,” Martine Powers speaks with Greg Jaffe, a national reporter at The Post, about the time he and reporter Missy Ryan spent at the Toms River recruiting station to see how recruiters there are trying to persuade young people to join the Army.Today's show was produced by Sabby Robinson, with help from Peter Bresnan. It was edited by Monica Campbell and mixed by Sean Carter.Subscribe to The Washington Post here.

Across the United States, military recruiters from all branches are facing one of the most challenging periods in the history of the all-volunteer force, as they struggle to find qualified and willing young Americans to join their ranks. Greg Jaffe from The Washington Post shares how this recruitment crisis reflects broader changes in American society, from declining trust in institutions to shifting demographics and evolving perceptions of national service. As the pool of eligible candidates shrinks and competition with the private sector intensifies, recruiters are not just offering jobs – they're selling a vision of service to the country in an increasingly divided nation.

Join Boyd in delving into Friday’s news as he unpacks the Harris and Walz CNN interview and the state of the presidential race. Joe Pitts helps answer the question, “What should men’s role in society be?”. Greg Jaffe shares the hardships of military recruiting in the middle of an increasingly divided nation. Reflect on what society can do to buoy parents up with Lois Collins and More!

So far, polling suggests that young voter turnout in 2024 may not match 2020's rate. In April, only 41 percent of Black people 18 to 39 told a Washington Post-Ipsos poll that they were certain to vote this year, down from 61 percent in June 2020.The poll mirrored what Shannon Salter was seeing among her civics students, whose interest in voting had been hobbled by poverty, racism and two aging presidential candidates seemingly far removed from the world of a struggling Allentown, Pa., teen.To these students, American politics was an ego-driven, aimless mess. She had more than a month to go before the end of the term to convince her students that their participation in American democracy was worth it. She had no idea how hard a sell that would turn out to be.This story is part of our Deep Reads series, which showcases narrative journalism at The Washington Post. It was written and read by Greg Jaffe. Audio narration comes from our partners at Noa, an app offering curated audio articles.

Some Supreme Court justices were wrong if they assumed overturning Roe v. Wade would settle the abortion issue before the high court. At least two cases are awaiting consideration, and more are in the legal pipeline. Meanwhile, Congress once again has only days until the next temporary spending bill runs out, with no budget deal in sight. Lauren Weber of The Washington Post, Shefali Luthra of The 19th, and Victoria Knight of Axios join KFF Health News chief Washington correspondent Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Sandro Galea, dean of the Boston University School of Public Health, about how public health can regain public trust. Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: Julie Rovner: Politico's “Why Democrats Can't Rely on Abortion Ballot Initiatives to Help Them Win,” by Alice Miranda Ollstein, Jessica Piper, and Madison Fernandez. Lauren Weber: The Washington Post's “Can the Exhausted, Angry People of Ottawa County Learn to Live Together?” by Greg Jaffe. Victoria Knight: Politico's “Georgia Offered Medicaid With a Work Requirement. Few Have Signed Up.” by Megan Messerly and Robert King. Shefali Luthra: Stat News' “Medical Marijuana Companies Are Using Pharma's Sales Tactics With Little of the Same Scrutiny,” by Nicholas Florko. Hosted on Acast. See acast.com/privacy for more information.

The House finally has a new speaker: Mike Johnson (R-La). He's a relative newcomer who's been a lower-level member of the House GOP leadership. And while he's an outspoken opponent of abortion and same-sex marriage, his record on other health issues is scant. Meanwhile, the National Institutes of Health appears on track to be getting a new director, and Georgia's Medicaid work requirement experiment is off to a very slow start. Alice Miranda Ollstein of Politico and Rachel Cohrs of Stat join KFF Health News' Julie Rovner to discuss these issues and more. Also this week, Rovner interviews Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank.Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too: Julie Rovner: The Washington Post's “The Pandemic Has Faded in This Michigan County. The Mistrust Never Ended,” by Greg Jaffe and Patrick Marley. Alice Miranda Ollstein: Politico's “Dozens of States Sue Meta Over Addictive Features Harming Kids,” by Rebecca Kern, Josh Sisco, and Alfred Ng. Rachel Cohrs: The New York Times' “Ozempic and Wegovy Don't Cost What You Think They Do,” by Gina Kolata. Hosted on Acast. See acast.com/privacy for more information.

Lexie Rizzo took on Starbucks. Now she's out of a job. Today, a look at the U.S. labor laws that are supposed to protect workers who are organizing unions.Read more:People describe Lexi Rizzo as a “coffee person.” She loves drinking coffee, talking about coffee. And she loved her job at Starbucks. She worked there for nearly eight years, until she got fired in March.Rizzo believes she was fired for being a union organizer. Rizzo joined the unionization efforts in 2021, when her Starbucks became one of the first three stores in the country to successfully unionize. In the past year, judges have ruled that Starbucks violated U.S. labor laws more than 130 times across six states, among the most of any private employer nationwide. The rulings found that Starbucks retaliated against union supporters by surveilling them at work, firing them and promising them improved pay and benefits if they rejected the organizing campaign. Starbucks founder and ex-CEO Howard Schulz has denied any wrongdoing – and remains confident that his company does not need a union for his employees to be happy. Greg Jaffe reports on Rizzo's case and examines the U.S. labor laws that are supposed to protect workers who are organizing unions.

Discussion Session: The Biotechnology Executive Order Discussion facilitated by AgBioFEWS Fellows Jabeen Ahmad and Nick Loschin This Colloquium is dedicated to reviewing the recent Executive Order on Advancing Biotechnology and Biomanufacturing Innovation released on September 12, 2022. Abstract This Colloquium begins with a brief overview of the Executive Order by Nick Loschin and then a discussion facilitated by AgBioFEWS cohort members Nick Loschin and Jabeen Ahmad with GES-Affiliated faculty Dr. Zack Brown. GES Executive Committee members and all three cohorts were invited to attend to discuss the current order and its political implications for the GES Center, each cohort group project, and their respective disciplines. Recommeded Readings: 2022 Executive Order on Advancing Biotechnology and Biomanufacturing Innovation for a Sustainable, Safe, and Secure American Bioeconomy Biden issues executive order promoting agriculture and food biotechnology, Greg Jaffe, September 2022 Executive Order 13874 -June 11, 2019, Modernizing the Regulatory Framework for Agricultural Biotechnology Products 2019: Biotechnology Oversight Gets an Early Make-Over by Trump's White House and USDA: Part 1—The Executive Order, Jennifer Kuzma, June 2019 Optional: A Missed Opportunity for US Biotechnology Regulation, Jennifer Kuzma, Science, 2016 (see: related news post) Just added – Optional: CHIPS and Science Act of 2022 (Fact Sheet, CHIPS and Science Highlights: Bioeconomy) Search for “Engineering Biology” in the CHIPS Bill CRS – White House Initiative to Advance the Bioeconomy, E.O. 14081: In Brief, Marcy E. Gallo and Todd Kuiken, Oct. 2022 Optional: Special Collection: Executive Order on Biotechnology-related publications, GES Center faculty GES Colloquium is jointly taught by Drs. Jen Baltzegar and Dawn Rodriguez-Ward, who you may contact with any class-specific questions. Colloquium will be held in-person in Poe 202, as well as live-streamed via Zoom. Please subscribe to the GES newsletter and Twitter for updates. Genetic Engineering and Society Center GES Colloquium - Tuesdays 12-1PM (via Zoom) NC State University | http://go.ncsu.edu/ges-colloquium GES Mediasite - See videos, full abstracts, speaker bios, and slides https://go.ncsu.edu/ges-mediasite Twitter - https://twitter.com/GESCenterNCSU GES Center - Integrating scientific knowledge & diverse public values in shaping the futures of biotechnology. Find out more at https://ges-center-lectures-ncsu.pinecast.co

Washington Post reporter Greg Jaffe joins Soundside to discuss his profile of Starbucks CEO Howard Schultz.

Today on Post Reports, we follow two union fights at Amazon warehouses with very different outcomes, and what they can tell us about what it takes to go up against a trillion-dollar company.Read more:In early April, the labor movement saw a huge victory: Workers voted to unionize an Amazon warehouse on Staten Island. Our reporter Greg Jaffe went up to New York to meet Chris Smalls, the charismatic leader of a new kind of worker-led movement. Greg had one big question: Could this movement spread?There would be another test just a few weeks later, at a second Staten Island facility across the street. Despite high-profile support, the workers would learn that replicating a truly grass-roots organizing effort would be even more challenging than they thought.

Some are concerned about whether or not the foods they buy contain GMO, genetically modified organisms, or what USDA refers to as Bioengineered. As a result of a 2016 Bill passed by Congress and signed into Law by President Obama,  USDA regulations have just gone in to effect  that specifies that foods that are bioengineered or contain bioengineered ingredients must disclose that information to consumers with text, symbol, QR code or telephone. Greg Jaffe, the Project Director for Center for Science in the Public Interest shares the the history, major components of the requirement and first impressions of in-store implementation. https://cspinet.org/news/blog/whos-labeling-what-examining-how-companies-are-disclosing-bioengineered-ingredients

What happens when an entire fast-food restaurant staff quits? Today for our special series on “Quitters,” the story of a McDonald's walkout, and what it can tell us about the labor market right now.Read more: In September, the entire staff of a McDonald's in Bradford, Pa., walked out and quit their jobs. One of the staff members left a parting note for the customers, written in blue highlighter because he couldn't find a pen: “Due to lack of pay, we all quit.”“The signs are…kind of like primal screams,” says reporter Greg Jaffe. “It's [the worker's] chance to convey a message: We're being mistreated. We're tired of it. This corporation treats us badly, and doesn't care about us.”Today on Post Reports, we're bringing you the second installment in “Quitters,” a three-part podcast series about a few of the millions of Americans who quit their jobs this year. Jaffe takes us inside the fast-food workers' season of rebellion.You can listen to the first part of the series here.

Genetic Engineering and Society Center GES Colloquium - Tuesdays 12-1PM (via Zoom) NC State University | http://go.ncsu.edu/ges-colloquium GES Mediasite - See videos, full abstracts, speaker bios, and slides https://go.ncsu.edu/ges-mediasite Twitter - https://twitter.com/GESCenterNCSU NGO perspective on governance of gene editing Dr. Doria Gordon, Lead Senior Scientist at Environmental Defense Fund, and Gregory Jaffe, JD, Director of the Project on Biotechnology at Center for Science in the Public Interest www.edf.org/people/doria-gordon | cspinet.org/biography/gregory-jaffe and @JaffeGregory This talk will describe six principles for the proper governance of gene editing, addressing issues such as transparency, stakeholder engagement, government oversight, and voluntary stewardship, that were adopted by six US non-governmental organizations. Abstract Biotechnology, which includes gene editing and other technologies, has the potential to address urgent food security, environmental, and human health dilemmas. However, these technologies also raise potential for societal concerns, environmental and health risks, and conflicts with cultural and spiritual values. Previous experience with the introduction of genetically modified organisms (GMOs) into the food system have in some instances resulted in public mistrust, underscoring the need for more transparency, better governance, and oversight of these technologies when they are deployed. To address these potential concerns, representatives of six conservation and consumer non-governmental organizations developed six principles for responsible governance of gene editing in agriculture and the environment, which were published in an August 2021 article of Nature Biotechnology. This webinar will present the principles and invite questions and discussion on both the principles and possible next steps for implementation. Related links: https://www.keystone.org/our-work/emerging-genetic-technologies/ngoroundtable/ Speaker Bios Dr. Doria Gordon is a Lead Senior Scientist in the Office of the Chief Scientist at Environmental Defense Fund, with a focus on ecosystems. Prior to EDF, she spent 25 years working in science, conservation, and management for The Nature Conservancy in Florida. Dr. Gordon is also a Courtesy Professor of Biology at the University of Florida and a Research Associate at Archbold Biological Station. Her current research focuses on the scale and measurement of net carbon sequestration in natural and agricultural systems. She also works on governance of genetically engineered organisms in agriculture and the environment, and risk assessment for invasiveness in plant species. Dr. Gordon completed a M.S. and Ph.D. in Ecology at the University of California at Davis following an undergraduate degree in Biology and Environmental Studies at Oberlin College. Gregory Jaffe is the Director of the Project on Biotechnology for CSPI. Jaffe came to CSPI after serving as a Trial Attorney for the U.S. Department of Justice's Environmental and Natural Resources Division and as Senior Counsel with the U.S. EPA, Air Enforcement Division. He is a recognized international expert on agricultural biotechnology and biosafety and works on biosafety regulatory issues in the U.S. and throughout the world. He was a member of the Secretary of Agriculture's Advisory Committee on Agricultural Biotechnology and 21st Century Agriculture from 2003-2008 and was reappointed to a new term in 2011. He was also a member of FDA's Veterinary Medicine Advisory Committee from 2004-2008. In addition, he provides biosafety expertise to the International Food Policy Research Institute and Cornell University's Alliance for Science. Jaffe earned his BA with High Honors from Wesleyan University in Biology and Government and then received a law degree from Harvard Law School. GES Center - Integrating scientific knowledge & diverse public values in shaping the futures of biotechnology. Find out more at https://ges-center-lectures-ncsu.pinecast.co

Greg Jaffe, national security reporter with the Washington Post, joins Steve Bertrand on Chicago’s Afternoon News to explain why people from all over the country are rushing to buy land in Peoria. Follow Your Favorite Chicago’s Afternoon News Personalities on Twitter:Follow @SteveBertrand Follow @kpowell720 Follow @maryvandeveldeFollow @LaurenLapka

Chris, Zack, and Melanie talk about the Biden administration's disastrous military withdrawal from Afghanistan. Whose fault is this debacle? What is the manner of our exit doing to America's credibility, with friends and adversaries alike, around the world? In a year, is anyone going to remember or care what has happened in the last several weeks? Have we learned any lessons from our two decades in Afghanistan, and will there be any accountability for bad decisions made along the way? Zack pushes back on comments made by Pakistan Prime Minister Imran Khan about the withdrawal, Chris calls out the administration's unwillingness to accept more refugees, and Melanie is grateful for those taking the lead on helping to get refugees settled into new homes.   Gideon Rachman, “Joe Biden's Credibility Has Been Shredded in Afghanistan,” Financial Times, August 13, 2021, https://www.ft.com/content/71629b28-f730-431a-b8da-a2d45387a0c2. Fred Kagan, “Biden Could Have Stopped the Taliban. He Chose Not To,” New York Times, August 12, 2021, https://www.nytimes.com/2021/08/12/opinion/biden-afghanistan-taliban.html. Joe Biden, “Statement by President Joe Biden on Afghanistan, White House, August 14, 2021, https://www.whitehouse.gov/briefing-room/statements-releases/2021/08/14/statement-by-president-joe-biden-on-afghanistan/. Greg Jaffe, “From Hubris to Humiliation: America's Warrior Class Contends with the Abject Failure of Its Afghanistan Project,” Washington Post, August 14, 2021, https://www.washingtonpost.com/national-security/us-hubris-afghanistan-humiliation/2021/08/14/47fb025a-fc67-11eb-9c0e-97e29906a970_story.html. Susannah George, “Afghanistan's Military Collapse: Illicit Deals with the Taliban and Mass Desertions,” Washington Post, August 15, 2021, https://www.washingtonpost.com/world/2021/08/15/afghanistan-military-collapse-taliban/. David E. Sanger and Helene Cooper, “Taliban Sweep in Afghanistan Follows Years of US Miscalculations,” New York Times, August 14, 2021, https://www.nytimes.com/2021/08/14/us/politics/afghanistan-biden.html.  “An incoherent strategy doomed the 20-year US mission in Afghanistan, watchdog says as US withdraws,” CNN Politics, https://www.cnn.com/2021/08/17/politics/afghanistan-sigar-report/. "Afghans have broken 'shackles of slavery', says Pak PM Imran Khan after Taliban seize power," Times of India, August 16, 2021, https://timesofindia.indiatimes.com/world/pakistan/taliban-has-broken-shackles-of-slavery-pakistan-pm-imran-khan-says/articleshow/85368058.cms. "Last Days in Vietnam: Who Goes? And Who Gets Left Behind?," PBS.org, April 28, 2015, https://www.pbs.org/wgbh/americanexperience/films/lastdays/.

Washington Post’s National security reporter, Greg Jaffe joined WGN Radio’s John Williams to discuss his article titled ‘The strange summer land rush in Peoria's dying south end’. Listen in while Greg and john discuss how buyers from all over America are searching for wealth amid the Rust Belt ruins and how Peoria seems to be […]

Has the fight over truth, and the prevalence of misinformation, strained the relationships you have with the people closest to you? With your family? In this hour Stephen Henderson speaks with Greg Jaffe of The Washington Post about his recent piece on this topic. Plus, family therapist Ronnie Evan Hormel weighs in. After that, author and poet Reginald Dwayne Betts talks about his journey from prison to enlightenment.

The relationship between the military and the media is not always an easy one. But, without the news media, the American public would have a far narrower understanding of what our military is doing in our name. As difficult as it sometimes may be for both parties involved, getting the relationship between the Defense Department and journalists right is essential for our democracy. In this episode, Alice and Jim speak with scholar Dr. Amanda Cronkhite, Washington Post National Security journalist Greg Jaffe, and Army Public Affairs Officer Colonel Myles Caggins to get their perspectives on what journalists and members of the military should do to get this relationship right more often.

For better or worse there has been substantial deregulation happening in the US Capitol, now including genetic engineering (GMO/GE).  Greg Jaffe is the Biotech Director for the Center for Science in the Public Interest (CSPI). They believe that GE products deemed safe through an independent science-based assessment have a place in our food system and have long advocated for USDA to revise its regulations to establish a streamlined and efficient regulatory process. However, they have also called for such a system to remain science-based and to address real potential risks posed by GE plants (such as preventing the development of resistant weeds or pests). A new USDA Rule falls far short as it "eliminates any independent, science-based regulatory review by allowing developers to self-determine their products to be exempt from oversight".  CSPI and others are calling on USDA to revisit these provisions and, until they do, "calling on all GE plant developers to commit to requesting USDA confirm any self-determinations they make". cspinet.org    

In the third of our “GMO firsts” series we discuss the AquAdvantage salmon — the world's first and only genetically modified animal approved for food. The AquAdvantage salmon grows to market weight in about half the time of a typical salmon, improving its sustainability. Join AquaBounty CEO Sylvia Wulf and Greg Jaffe, associate director of policy and regulatory affairs for the Cornell Alliance for Science, as they discuss the development of the salmon and its long regulatory journey to earn approval from the United States Food and Drug Administration.

Even before the pandemic, Orlando was plagued by a lack of affordable housing. Then Florida’s tourism economy crashed, leaving hundreds of people trapped in rundown motels on the edge of society.Read more:Greg Jaffe reported on the people trapped at a motel without power just outside of Disney World.Subscribe to The Washington Post: https://postreports.com/offer

Ryan talks to Washington Post reporter Greg Jaffe about the president's pardoning of a convicted war criminal and the impact that move had on those who served alongside him.

Biotech policy expert Greg Jaffe explains the new US Department of Agriculture rule on genetic engineering and answers questions about the topic in this AfS Live! presentation.

Join Chris, Melanie, and Bryan as they assess Jim Mattis' legacy as secretary of defense and the media splash he is making while promoting his new book. Mattis is a complicated character, and his reasons for entering the administration, for leaving the administration, and for coyly restraining his comments after leaving are similarly complicated. Although President Donald Trump's early affinity for having former generals in key positions in his administration has cooled, the debate over the role retired flag and general officers should play in America's national security political discourse rages on.   Links Jim Mattis, "Duty, Democracy and the Threat of Tribalism," Wall Street Journal, August 28, 2019 Jeffrey Goldberg, "The Man Who Couldn't Take It Anymore," Atlantic, October 2019 Issue Dan Lamothe and Greg Jaffe, "Emerging from His Silence, Mattis Faces Criticism for Trying to Take the 'Middle Road' on Trump," Washington Post, August 29, 2019 Jim Mattis and Bing West, Call Sing Chaos: Learning to Lead, (Random House, September 2019) Jim Mattis, "Letter from Secretary James Mattis," Defense, December 20, 2019 Mallory Hughes, "When a Boy with Autism was Overwhelmed on the First Day of School, Another Little Boy Held His Hand," CNN, August 27, 2019 Tyler Jost and Joshua D. Kertzer, “Armies and Influence: Public Deference to Foreign Policy Elites,” American Political Science Association Annual Meeting, 2019, Hannah Natanson, “A Broken Bingo Machine Left Rhis D.C. Veterans’ Retirement Home Mourning. A 16-year-old girl decided to help” Washington Post, September 2, 2019 Stephen Wertheim, “The Quincy Institute Opposes America’s Endless Wars. Why Should that Be a Scandal?” Washington Post, August 30, 2018 The Human Costs of War: Assessing Civilian Casualties since 9/11, Policy Forum, Cato Institute, September 11, 2019 Ted Galen Carpenter, NATO: The Dangerous Dinosaur, Cato Institute, October 18, 2019

Host Jenna Liut continues her conversation with Greg Jaffe, Director of the Project on Biotechnology at the Center for Science in the Public Interest, on everything you need to know about genetic engineering. Eating Matters is powered by Simplecast.

International agricultural biotechnology and biosafety expert from the Center for Science in the Public Interest, Greg Jaffe, joins host Jenna Liut to share everything you need to know about genetic engineering. Whether you are a skeptic or supporter, this episode will help you better understand the facts – including the science, regulation and controversies surrounding the use of this technology. Eating Matters is powered by Simplecast.

Hop aboard! In this episode, the crew dissects the recently released report of the National Defense Strategy Commission. Melanie, Chris, and Bryan weigh in on the report’s strengths and weaknesses. Also, Chris and Melanie reveal themselves to be Scrooges by expressing disdain for Hallmark Christmas dramas.   Links Eric Edelman and Gary Roughead, Providing for the Common Defense: The Assessment and Recommendations of the National Defense Strategy Commission (United States Institute of Peace, 2018). CNBC, “Deadly California Wildfire Now 100% Contained After Scorching 154,000 Acres,” Nov. 25, 2018 Joseph Archer, "Beijing to Assign ‘Personal Trustworthiness Points’ For All Citizens by 2021," Telegraph, Nov. 20, 2018 Greg Jaffe, “John Collins, Army Colonel Who Launched Influential Online Warlord Loop, Dies at 97,” Washington Post, Nov. 23, 2018 “Pentagon Fails Audit and Nobody in Washington is Surprised,” Taxpayers for Common Sense, Nov. 16, 2018 Lara Seligman, “How the Generals are Routing the Policy Wonks at the Pentagon,” Foreign Policy, Nov. 15, 2018 “Anti Vaccine Community Behind North Carolina Chickenpox Outbreak,” BBC, Nov. 19, 2018 Morgan Gstalter, “Disney Screenwriter Says Term ‘Anti-Vax’ is Equivalent to ‘N-Word,’” The Hill, Nov. 24, 2018 Dennis Romboy, “Trump Backs Criminal Justice Reform Legislation that Sen. Mike Lee Helped Write,” Desert News, Nov.15, 2018 Jack Crowe, “Mike Lee Accuses Tom Cotton of Spreading 'Fake News' on Criminal Justice Reform Bill,” National Review, Nov. 19, 2018   Music and Production by Tre Hester

The United States, United Kingdom, and France launched coordinated air strikes against Syria’s military on Saturday. To analyze the fallout, Council President Ivo Daalder and Greg Jaffe, national security reporter from The Washington Post, join this week’s Deep Dish podcast.

Cold War: Part Duex In early February, Defense Secretary James Mattis and Vice Chair of the Joint Chiefs of Staff General Paul Selva testified to Congress about two recently released war strategy documents: The National Defense Strategy and the Nuclear Posture Review. In this episode, hear some of the most powerful people in the world discuss their plans to reboot the Cold War, including an extremely expensive plan, which has already begun, to replace the United States entire nuclear weapons arsenal. Please Support Congressional Dish Click here to contribute using credit card, debit card, PayPal, or Bitcoin Click here to support Congressional Dish for each episode via Patreon Mail Contributions to: 5753 Hwy 85 North #4576 Crestview, FL 32536 Thank you for supporting truly independent media! Recommended Congressional Dish Episodes CD067: What Do We Want in Ukraine? CD093: Our Future in War Short Story Long Podcast Appearance Additional Reading Article: Trump's favorite general: Can Mattis check an impulsive president and still retain his trust? by Greg Jaffe and Missy Ryan, The Washington Post, February 7, 2018. Report: Beijing hits back at US defence strategy and 'cold war mindset' by Kinling Lo, South China Morning Post, January 20, 2018, Report: A top secret desert assembly plant starts ramping up to build Northrop's B-21 bomber by Ralph Vartabedian, W.J. Hennigan, and Samantha Masunaga, The Los Angeles Times, November 10, 2017. Article: Lockheed close to massive F-35 fighter jet deal with 11 nations by Thom Patterson, CNN Money, June 19, 2017. Article: Russian lawmaker: We would use nukes if US or NATO enters Crimea by Patrick Tucker, Defense One, May 28, 2017. Report: Russia is now the world's third largest military spender by Ivana Kottasova, CNN Money, April 24, 2017. Article: The F-35 may carry one of the US's most polarizing nuclear weapons sooner than expected by Alex Lockie, Business Insider, January 12, 2017. Article: Henry Kissinger's war crimes are central to the divide between Hilary Clinton and Bernie Sanders by Dan Froomkin, The Intercept, February 12, 2016. Review: Hillary Clinton reviews Henry Kissinger's 'World Order' by Hillary Rodham Clinton, The Washington Post, September 4, 2014. Resources Congressional Budget Office: Approaches for Managing the Costs of U.S. Nuclear Forces, 2017 to 2046 Congressional Research Service: Navy Columbia (SSBN-826) Class Ballistic Missile Submarine Program: Background and Issues for Congress Defense.gov: 2018 Summary of the National Defense Strategy Indictment: Internet Research Agency Indictment Media.defense.gov: 2018 Nuclear Posture Review OpenSecrets.org: Huntington Ingalls Industries, Profile for 2016 Election Cycle OpenSecrets.org: General Dynamics Organization Summary OpenSecrets.org: Lobbyists Representing General Dynamics, 2017 OpenSecrets.org: Northrop Grumman Organization Summary OpenSecrets.org: Northrop Grumman Lobbying Info Book: World Order by Henry Kissinger Visual Resources Sound Clip Sources Hearing: National Defense Strategy and Nuclear Posture Review, C-SPAN, House Armed Services Committee, February 6, 2018. Witnesses James Mattis - Secretary of the Department of Defense General Paul Silva - Vice Chair of the Joints Chiefs of Staff 12:25 Defense Secretary James Mattis: To advance the security of our nation, these troops are putting themselves in harm’s way, in effect, signing a blank check payable to the American people with their lives. They do so despite Congress’ abrogation of its constitutional responsibility to provide sufficient stable funding. Our military have been operating under debilitating continuing resolutions for more than 1,000 days during the past decade. These men and women hold the line for America while lacking this most fundamental congressional support: a predictable budget. Congress mandated—rightfully mandated—this National Defense Strategy—the first one in a decade—and then shut down the government the day of its release. Today we are again operating under a disruptive continuing resolution. It is not lost on me that as I testify before you this morning we are again on the verge of a government shutdown, or, at best, another damaging continuing resolution. I regret that without sustained, predictable appropriations, my presence here today wastes your time because no strategy can survive, as you pointed out, Chairman, without the funding necessary to resource it. 19:15 Defense Secretary James Mattis: Our second line of effort is to strengthen traditional alliances while building new partnerships. History is clear that nations with allies thrive. We inherited this approach to security and prosperity from the Greatest Generation, and it has served the United States well for 70 years. Working by, with, and through allies who carry their fair share is a source of strength. Since the costly victory in World War II, Americans have carried a disproportionate share of the global-defense burden while others recovered. Today the growing economic strength of allies and partners has enabled them to step up, as demonstrated by more than 70 nations and international organizations participating in the Defeat ISIS campaign and again in the 40-some nations standing shoulder to shoulder in NATO’s Resolute Support Mission in Afghanistan. Most NATO allies are also increasing their defense budgets, giving credence to the value of democracies standing together. 24:33 Defense Secretary James Mattis: As Senator McCain said last week, since the end of the Cold War, we have let our nuclear capabilities atrophy under the false belief that the era of great power competition was over. As the new National Defense Strategy rightfully acknowledges, we now face the renewed threat of competition from Russia and China, and we cannot ignore their investments in nuclear weapons in addition to conventional forces. The 2018 Nuclear Posture Review reaffirms the findings of previous reviews that the nuclear triad—comprised of silo-based intercontinental ballistic missiles, bomber aircraft, and nuclear submarines—is the most strategically sound means of ensuring nuclear deterrence. To remain effective, however, we must recapitalize our Cold War legacy nuclear-deterrence forces, continuing a modernization program initiated during the previous administration. 27:05 Defense Secretary James Mattis: We need Congress to lift the defense spending caps and support the budget for our military of 700 billion for this fiscal year and 716 billion for next fiscal year. Let me be clear: as hard as the last 16 years of war have been on our military, no enemy in the field has done as much to harm the readiness of the U.S. military than the combined impact of the Budget Control Act’s defense spending caps, worsened by operating for 10 of the last 11 years under continuing resolutions of varied and unpredictable duration. The Budget Control Act was purposely designed to be so injurious that it would force Congress to pass necessary budgets. It was never intended to be the solution. 34:50 General Paul Selva: Two supplemental capabilities recommended in the Nuclear Posture Review—the nuclear-armed sea-launched cruise missile and a modification of a small number of existing submarine-launched ballistic missile warheads—would enhance deterrence by ensuring that no adversary under any set of circumstances can perceive an advantage through the use of a limited nuclear escalation or other strategic attack. Fielding these capabilities will not lower the threshold at which the U.S. would employ nuclear weapons; rather, it will raise the nuclear threshold for potential adversaries, making the use of nuclear weapons less likely. 35:45 General Paul Selva: It is important to note that the National Defense Strategy and the Nuclear Posture Review both make the assumption that the military will receive timely, predictable, and sufficient funding to execute these strategies. As General Mattis has emphasized, we in uniform appreciate the support of this committee and the Congress, and we trust that the Congress will provide the funding needed to turn these strategies into reality. 1:03:05 Representative Joe Wilson (SC): Secretary Mattis, your Nuclear Posture Review, NPR, recommends that U.S. develop two supplemental nuclear capabilities: first, a low-yield submarine-launched ballistic missile, SLBM; and second, a sea-launched cruise missile. Why are these needed for deterrence and assurance? And following on that, some are arguing that they lower the threshold for the U.S. to use nuclear weapons. Do you believe that the addition of these capabilities to the U.S. nuclear arsenal is an increase or decrease the likelihood of a nuclear war? And another angle: why should we need a low-yield SLBM when we already have a low-yield nuclear gravity bomb? Are these capabilities redundant? Defense Secretary James Mattis: Congressman, I don’t believe it lowers the threshold at all. What it does, it makes very clear that we have a deterrent. If the Russians choose to carry out what some of their doctrine people have promoted, their political leaders have promoted, which would be to employ a low-yield nuclear weapon in a conventional fight in order to escalate to de-escalate; in other words, to escalate to victory and then de-escalate. We want to make certain they recognize that we can respond in kind. We don’t have to go with a high-yield weapon; thus, the deterrent effort stays primary. It is not to in any way lower the threshold to use nuclear weapons. On the sea-launched cruise missile, as you know, we have an ongoing issue with Russia’s violation of the INF. I want to make certain that our negotiators have something to negotiate with, that we want Russia back into compliance. We do not want to forgo the INF, but at the same time, we have options if Russia continues to go down this path. Discussion: Kissinger and Schultz on Global Challenges, C-SPAN, Senate Armed Services Committee, January 25, 2018. Witnesses: Henry Kissinger National Security Advisor & Secretary of State in Nixon & Ford Administrations George Shultz Secretary of State in Reagan Administration Richard Armitage Deputy Secretary of State in the first term of the George W. Bush administration 12:45 Henry Kissinger: The international situation facing the United States is unprecedented. What is occurring is more than a coincidence of individual crises. Rather, it is a systemic failure of world order, which is gathering momentum and which has led to an erosion of the international system rather than its consolidation, a rejection of territorial acquisition by force, expansion of mutual trade benefits without coercion, which are the hallmark of the existing system are all under some kind of strain. Compounding this dynamism is the pace of technological development, whose extraordinary progress threatens to outstrip our strategic and moral imagination and makes the strategic equation tenuous unless major efforts are made to sustain it. 19:45 Henry Kissinger: There is no doubt that the military capacity of China, as well as its economic capacity, is growing, and there have been challenges from Russia which have to be met, especially in Ukraine, Crimea, and Syria. And this raises these fundamental questions: What is the strategic relationship between these countries vis-a-vis the prospect of peace? Is their strength comparable enough to induce restraint? Are their values compatible enough to encourage an agreed legitimacy? These are the challenges that we face. The balance of power must be maintained, but it is also necessary to attempt a strategic dialogue that prevents the balance of power from having to be tested. This is the key issue in our relationship. 25:10 George Shultz: And I take the occasion to particularly underline one of the things that Henry brought out in his testimony, that is the concern we must have about nuclear proliferation. As you remember in the Reagan period, we worked hard. President Reagan thought nuclear weapons were immoral, and we worked hard to get them reduced. And we had quite a lot of success. And in those days, people seemed to have an appreciation of what would be the result of a nuclear weapon if ever used. I fear people have lost that sense of dread. And now we see everything going in the other direction, nuclear proliferation. The more countries have nuclear weapons, the more likely it is one’s going to go off somewhere, and the more fissile materials lying around—anybody who gets fissile material can make a weapon fairly easily. So this is a major problem. It can blow up the world. So I think we have to get at it. And the right way to start is what Henry said, is somehow to be able to have a different kind of relationship with Russia. After all, Russia and the United States have the bulk of all the weapons. 31:20 George Shultz: First, let me talk about the economy. What is happening as a result of these forces is de-globalization. This is already happening. This is not something for the future. The reason is that it’s becoming more and more possible to produce the things you want close to where you are. So the advantages of low labor costs are disappearing. And the more you produce things near where you are, the less you need shipping, and it has a big impact on energy, and it has a huge impact on the countries that are providing low-cost labor and a huge impact on places like ourselves which will wind up being able to produce these things near where we are. It’s a revolution. And a revolution in the economy has all sorts of security implications that need to be thought about. But this is a very big deal. 33:30 George Shultz: Robotics, 3-D printing, and artificial intelligence are driving manufacturers to reconsider not only how and what they make but where they make it. The world is on the very front end of a big shift from labor to automation. Robot sales are expected to reach $400,000 annually in 2018. This estimate does not account for the newly developed cobots, that is, collaborative robots. They assist human workers and, thus, dramatically increase human productivity. There are other things about all this that I won’t go into which underline it, but the new technologies are bringing manufacturing back to the United States. The United States has lost manufacturing jobs every year from 1998 to 2009, a total of 8 million jobs. Over the last 6 years, it regained about a million of them. With the cost of living no longer a significant advantage, it makes little sense to manufacture components in Southeast Asia, assemble them in China, and then ship them to the rest of the world when the same item can either be manufactured by robots or printed where it will be used. So this is a huge revolution taking place. It also underlines the enhanced ability to protect your intellectual property because you don’t have to ship it around. 35:35 George Shultz: You want to look at the dramatic improvements in nano-energetics, artificial intelligence, drones, and 3-D printing. They’re producing a revolution of small, smart, and cheap weapons that will redefine the battlefield. Open-source literature says nano-aluminum created ultra high burn rates which give nano-explosives four to ten times the power of TNT. The obvious result, small platforms will carry a very destructive power. Then you can put these small platforms on drones. And drones can be manufactured easily, and you can have a great many of them inexpensively. So then you can have a swarm armed with lethal equipment. Any fixed target is a real target. So an airfield where our Air Force stores planes is a very vulnerable target. A ship at anchor is a vulnerable target. So you’ve got to think about that in terms of how you deploy. And in terms of the drones, while such a system cannot be jammed, it would only serve to get a drone—talking about getting a drone to the area of where its target is, but that sure could hit a specific target. At that point, the optical systems guided by artificial intelligence could use on-board, multi-spectral imaging to find a target and guide the weapons. It is exactly that autonomy that makes the technologic convergence a threat today. Because such drones will require no external input other than the signature of the designed target, they will not be vulnerable to jamming. Not requiring human intervention, the autonomous platforms will also be able to operate in very large numbers. 38:48 George Shultz: I think there’s a great lesson here for what we do in NATO to contain Russia because you can deploy these things in boxes so you don’t even know what they are and on trucks and train people to unload quickly and fire. So it’s a huge deterrent capability that is available, and it’s inexpensive enough so that we can expect our allies to pitch in and get them for themselves. 40:10 George Shultz: The creative use of swarms of autonomous drones to augment current forces would strongly and relatively cheaply reinforce NATO, as I said, that deterrence. If NATO assists frontline states in fielding large numbers of inexpensive autonomous drones that are pre-packaged in standard 20-foot containers, the weapons can be stored in sites across the countries under the control of reserve forces. If the weapons are pre-packaged and stored, the national forces can quickly deploy the weapons to delay a Russian advance. So what’s happening is you have small, cheap, and highly lethal replacing large, expensive platforms. And this change is coming about with great rapidity, and it is massively important to take it into account in anything that you are thinking about doing. 54:10 George Shultz: Well, I read what I guess was an early version—somehow it was sent to me—of the national-security strategy. And I liked the beginning of it because it talked about our commitment to getting rid of nuclear weapons. But as you read on, it almost sounded a little bit as though there might be this or that occasion where we would use nuclear weapons. And this notion of using them that is spreading around is deeply disturbing to me. Video: Pinky and the Brain - The Really Great Dictator, March 6, 2011. Video: War on Iraq Breaking News - Shock & Awe Iraq, Sky News, October 20, 2006. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)  

The Veterans Health Administration operates a taxpayer-funded health system to provide our nation’s veterans physical and mental health services. The Veterans Choice Program is a fundamental change to that system as it allows veterans to get taxpayer-funded health care in the private sector. In this episode, learn the history of the Veterans Choice Program, discover the changes that Congress and the Trump Administration have made to the program this year, and get some insights into the future of the program. Please Support Congressional Dish Click here to contribute using credit card, debit card, PayPal, or Bitcoin Click here to support Congressional Dish for each episode via Patreon Mail Contributions to: 5753 Hwy 85 North #4576 Crestview, FL 32536 Thank you for supporting truly independent media! Bills H.R. 3230: Veterans Access, Choice, and Accountability Act of 2014 Allows veterans to get medical care outside the Veteran's Administration system; they can go to any health facility that serves Medicare patients, health centers, the Defense Department, and the Indian Health Service. Veterans are only given this option if they'd have to wait over 30 days for an appointment with the Veteran's Administration or if they live 40 miles or further from a Veteran's Administration clinic. If eligible, the veteran will receive a special identification card. How it works: Veteran notifies VA, VA puts Veteran on an electronic waiting list or authorizes their request, VA works out a payment agreement with the health care provider, VA reimburses health care provider but no more than they would for Medicare services. If the veteran gets treated for a problem that was not related to their military service, their health insurance plan will be responsible for payment and the health care provider will be responsible for going after the insurance company for the money. Veterans can not be charged higher co-payments for care at private facilities than they would have been charged at the Veteran's Administration. This program will end in three years. Orders a private-sector review, establishes a fifteen person commission, and creates a technology task force to review VA practices. Wait times for care can not be considered when determining performance bonuses for top officials at the Veteran's administration and performance goals that disincentivize using private health providers for veteran care will be eliminated. Wait times for health care at the VA, VA facility quality measures, and VA doctor credentials will be published online. The VA will add 1,500 graduate medical education residency positions for five years to address staffing shortages. Extends the program that reimburses medical students for education costs and increases the amounts they'll receive for working for the VA. Expands coverage for mental health care related to sexual assaults, which will include veterans on inactive duty. This will be effective August 7, 2015. Extends a pilot program for assisted living care for veterans with traumatic brain injuries until October 2017. Disqualifies public colleges that charge veterans more than State residents from being qualified schools for veteran education benefits. Makes it easier to fire or transfer senior executives at the Department of Veteran's Affairs. Appropriates $15 billion to implement these changes. S. 544: A bill to amend the Veterans Access, Choice, and Accountability Act of 2014 to modify the termination date for the Veterans Choice Program, and for other purposes Eliminates the end date for the Choice Program, which was supposed to expire when the money ran out of after three years. Changes the payment system from one where the veteran's health insurance plan must pay for non-service related treatments, with doctors getting reimbursed directly from the insurance companies to a new system where the Veterans Department will pay and be reimbursed by the insurance companies. Establishes legal permission for the government to share medical records of veterans with "private entities" S. 1094: Department of Veterans Affairs Accountability and Whistleblower Protection Act Title I: Office of Accountability and Whistleblower Protection Creates a new office, headed by a Presidential appointee, in charge of VA employee accountability and processing of whistleblower complaints. This office will have the power to impose disciplinary actions. The identities of whistleblowers must be protected unless the whistleblower consents to disclosure. The Department of Veterans' Affairs must train employees on the whistleblowing process. Title II: Accountability of senior executives, supervisors, and other employees Gives the Secretary of Veterans Affairs the power to suspend, demote, or fire senior executives as long as the executive receives 15 days advance notice and all evidence against him or her, legal representation, and the ability to argue their case in an official process created by the Secretary that takes no more than 21 days. Gives the Secretary of Veterans Affairs the power to remove, demote, or suspend Veterans Administration employees for performance or misconduct. Demoted employees will have their pay decreased. The demotion or removal process must be completed within 15 business days and the employee has 7 business days to respond. These new procedures "shall supercede any collective bargaining agreement to the extend that such agreement is inconsistent with such procedures.". There is an appeal process but it must be started within 10 business days after the date of the removal, demotion, or suspension. The appeal must be decided within 180 days. The Secretary can not remove, demote, or suspend a whistleblower without approval of a Special Counsel or unless the Assistant Secretary refuses to act on the whistleblower account or unless a final decision has been made regarding the whistleblower's disclosure. Gives the Secretary of Veterans Affairs the power to order the repayment of bonuses or relocation expenses paid to VA employees if the Secretary determines that the employee engaged in misconduct or poor performance before the bonus was awarded. There is an appeal process via the Office of Personnel Management. S.114: VA Choice and Quality Employment Act of 2017 Title I: Appropriation for Veterans Choice Program Deposits $2.1 billion in the Veterans Choice Fund, which will not expire. Title II: Personnel matters Doubles the number of positions that can be labeled has having staffing shortages and gives the Secretary of Veterans Affairs the ability to directly hire people to those positions. "Executive Management Fellowship Program" A program to give VA employees 1 year of training in the private sector and to give private sector employees 1 year of training in the VA. Between 18 & 30 people from the private sector and the same amount from the VA will be selected in August of each year to participate. To accept the fellowship, the person must agree to work as a full-time employee of the VA for two years and is prohibited from working the corresponding private sector industry for two years after completing the program. Performance Evaluations Political appointees of the VA will have annual performance plans similar to the ones administered to career employees. Promotions Gives the Secretary of Veterans Affairs the ability to easily promote existing employees or people who voluntarily left within 2 years, one employment status at a time. Employment Opportunity Database Creates a website that will list vacant positions at the Department of Veterans Affairs. Title III: Major medical facility leases We're paying to replace VA facilities in 28 locations. H.R. 3236: Surface transportation and veterans health care choice improvement act of 2015 Recommended Congressional Dish Episodes CD080: The July Laws Additional Reading Article: VA secretary David Shulkin: I don't consider this Texas church gunman as a veteran by Melissa Quinn, Washington Examiner, November 6, 2017. Article: Funding for a new veterans choice program remains the big, unresolved question for VA by Nicole Ogrysko, Federal News Radio, October 24, 2017. Article: AFGE ramping up anti-privatization campaign, as VA readies new Choice draft by Nicole Ogrysko, Federal News Radio, October 17, 2017. Article: Focus on VA hiring, not Veterans Choice, AFGE says by Nicole Ogrysko, Federal News Radio, October 6, 2017. Article: Trump signs bill to speed up VA disability appeals process by Richard Sisk, Military.com, August 23, 2017. Article: Last-minute Veterans Choice funding bill filled with key VA hiring flexibilities by Nicole Ogrysko, Federal News Radio, July 28, 2017. Article: Fix for Veterans Choice shortfalls fails in the House with little funds left by Nicole Ogrysko, Federal News Radio, July 24, 2017. Radio Transcript: VA pane report to suggest more private care choices for veterans, Morning Edition with David Greene, NPR, July 6, 2017. Article: Shulkin offers first glimpse at a new VA Choice plan by Nicole Ogrysko, Federal News Radio, June 8, 2017. Article: Trump extends program allowing some veterans to use local doctors, hospitals by Lisa Lambert, Reuters, April 19, 2017. News Report: Barry Coates dead; veteran was at heart of VA scandal by Scott bronstein, Nelli Black, Drew Griffin and Curt Devine, CNN Investigations, January 27, 2016. Article: How the VA developed its culture of coverups by David Farenthold, The Washington Post, May 30, 2014. Article: Obama accepts resignation of VA secretary Shinseki by Greg Jaffe and Ed O'Keefe, The Washington Post, May 30, 2014. References Budget Plan: 2018 FY Homeland Security Budget-in-Brief GAO Report: Veterans health care: Preliminary observations on veterans access to Choice Program care House Amendment Act: S.114 of the 115th Congress Interactive Timeline: Veterans Choice Program Slideshow: Billing Procedures, VA Veterans Choice Program and Patient-Centered Community Care Strawman Document: Proposed Strawman Assessment Sound Clip Sources Hearing: Bills related to veterans choice; House Committee on Veterans Affairs; October 24, 2017. 02:42 Rep. Phil Roe (TN): To that end, I believe it’s important to state yet again that this effort is in no way, shape, or form intended to create a pipeline to privatize the V.A. healthcare system. I want to be completely clear about that. Everyone who participated in the roundtable earlier this month and contributed to the development of this legislation should be completely clear on that. Everyone listening today should also be completely clear on that. Supplemental care sourced from within the community has been a part of the V.A. healthcare system since the 1940s and services to expand V.A.’s reach and strengthen and support the care that V.A. provides. Rhetoric aside, strengthening and support V.A. is what this consideration is about—this conversation is about. It should go without saying that V.A. cannot be everywhere providing everything to every veteran. Expecting V.A. to perform like that sets up the V.A. to fail. That’s why my draft bill preserves V.A.’s role as the central coordinator of care for enrolled veteran patients. In addition to consolidating V.A.’s menu of existing community-care programs into one cohesive program, my bill would create a seamless, integrated V.A. system of care that incorporates V.A. providers and V.A. medical facilities where and when they are available to provide care a veteran seeks and a network of V.A. providers in the community who can step up when needed. Under my draft bill, the V.A. generally retains the right of first refusal, meaning that if V.A. medical facilities can reasonably provide a needed service to a veteran, that care will be provided in that facility. But when the V.A. can’t do that, my bill would ensure that veterans aren’t left out to dry. Press Conference: Trump signs veterans health care bill; C-Span; August 12, 2017. 0:30 David Shulkin: The V.A. Choice and Quality Employment Act has three important components. The first is that this helps us expand our ability to hire medical-center directors and other senior executives to serve in the V.A. This is about leadership, and it’s really important that we get the right leaders helping us to do the job for veterans. The second is that this bill authorizes 28 new facility leases that will be in different parts of the country that provide our veterans with updated facilities, something that, again, we are committed to providing our veterans with world-class care. And third, and most important, this bill allows us to continue to be able to provide care in the community for our veterans to make sure that they’re getting high-quality care and not waiting for care. Already this year, in the first six months of this year, we have authorized over 15 million appointments for veterans in the community. That’s 4 million appointments more than what was experienced at this time last year. So we’re making a lot of progress in expanding Choice. Hearing: Fiscal year 2018 Veterans Affairs budget; Senate Veterans Affairs Committee; June 14, 2017. 12:29 David Shulkin: Two years ago—I’m sure you’re going to remember in July of 2015 we had too little money in our community-care accounts within the V.A., which we solved with your help by accessing unused funds in the Choice account. So we transferred money from Choice into community care. We now have too little money in the Choice account, which we’re working to solve, again working with you, with legislative authority, to replenish funds into the Choice account. So this is the situation that we’ve described before where for a single purpose of providing care in the community we have two checking accounts, and I will tell you, I wish it were easier than it is. We have to figure out how to balance these two checking accounts at all times. And obviously it’s not a science, it’s an art; and we’re having difficulty with that once again, and that’s why we need to work with you to solve it. The Veterans CARE program that we outlined for you last week will solve this recurring problem permanently by modernizing and consolidating all of the community-care accounts, including Choice. Hearing: Examining the Veterans Choice program and the future of care in the community; Committee on Veterans Affairs; June 7, 2017. Witness: David Shulkin - Veterans Affairs Secretary 12:55 David Shulkin: Just in the first quarter of fiscal year 2017, we saw 35% more authorizations for Choice than we did in the first quarter of 2016. So far in fiscal year 2017, we have approximately 18,000 more Choice-authorized appointments per day than we did in fiscal year 2016. But we still have a lot more work to do. That’s why we’re seeking support for the Veterans Coordinated Access and Rewarding Experiences program, the Veterans CARE program. Let me just go over that again because you need a good acronym in Washington. The Veterans Coordinated Access—that’s the C and the A—Rewarding Experiences program—the CARE program. I’ve testified before and I’ll report again today that our overarching concern remains veterans’ access to high-quality care when and where they need it. That’s regardless of whether the care is in the V.A. or in the community. Our goal is to modernize and consolidate community care. We owe veterans a program that’s easy to understand, simple to administer, and that meets their needs. That’s the CARE program, and now it’s time to get this right for veterans. So we need your help. 14:23 David Shulkin: Here’s how veterans could experience V.A. healthcare, with your help. The veteran talks with their V.A. provider. That’s a conversation over the phone, virtually, or in person. The outcome is a clinical assessment. The clinical assessment may indicate that the V.A. specialist is the best for the veteran, or it may indicate that community care is best to meet the veteran’s needs. If community care is the answer, then the veteran chooses a provider from a high-performing network. That’s the veteran choosing a provider from the high-performing network. Assessment tools help veterans evaluate community providers and make the best choices themselves. We may help veterans schedule appointments in the community, or in some circumstances, veterans can schedule the appointments themselves. We make sure community providers have all the information they need to treat the veteran. We get the veteran’s record back. We pay the veteran’s bill. This is all about individualized, convenient, well-coordinated, modern healthcare and a positive experience for the veteran. If the V.A. doesn’t offer the necessary service, then the veteran goes to the community. If the V.A. can’t provide timely services, the veteran goes to the community. If there are unusual burdens in receiving care, the veteran goes to the community. If a service at a V.A. clinic isn’t meeting quality metrics for specific services, veterans needing that service go to the community while we work to support that clinic to improve its performance. And veterans who need care right away will have access to a network of walk-in clinics. 19:20 David Shulkin: We want to make sure that if the service is low performing, if it’s below what the veteran could get in the community, that they have the opportunity—they don’t have to leave the V.A. They’re given a choice so that they are able to get care in the community or stay at the V.A., because, you know, if a veteran has a good experience and they have trust in their provider, they’re going to want to stay where they are. But that is the purpose. The whole idea here is to improve the V.A., not to get more care in the community. And the very best way that I know how to improve health care is to give the patient, in this case the veteran, choice and to make those choices transparent to let everybody see, because then if you’re not performing as high-quality service, you’re going to want to provide a higher-quality service, because you want to be proud of what you’re working on. And I want the V.A. to be improving over time, and I think this will help us do that. 24:42 Sen. Patty Murray (WA): Secretary Shulkin, in your draft of Veteran CARE plan, you outline a number of pilot projects that sound to me uncomfortably like a proposals that are made by the so-called straw-man document. It’s from the commission on CARE and by the extreme, and to me unacceptable, plan put forward by the Concerned Veterans of America. And those include creating a V.A. insurance plan and separating it from CARE delivery, dividing the governance of a V.A. insurance plan and the health system, and alternative CARE model that sends veterans directly to the private sector. The goal of those types of initiatives, as originally stated in the straw-man document, is “as V.A. facilities become obsolete and are underused, they would be closed when availability and accessibility of care in the community is assured.” Those policies serve not only to dismantle the V.A. and start the health system down to a road to privatization, I just want you to know I will not support them, and I will fight them with everything I have. So, I want to ask you, why are you agreeing to pursue those unacceptable policy options? David Shulkin: Well, first of all, I appreciate you sharing your thoughts and as clearly as you have. I share your goal. I am not in support of a program that would lead towards privatization or shutting down the V.A. programs. What I am in support of is using pilots to test various ideas about governance, about the way that the system should be, organized in the way that we should evolve, because I don’t know without testing different ideas whether they’re good ideas or not. 35:28 Sen. Jerry Moran (KS): You said something that caught my attention: this will not be an unfettered Choice program— David Shulkin: Yep. Moran: —and I wanted to give you the opportunity to explain to me and to the committee what that means. Shulkin: Yeah. There are some that have suggested that the very best approach is just give veterans a card, a voucher, and let them go wherever they want to go. And I think that there are some significant concerns about that, and you’re going to see this proposal is not that. This proposal is to develop a system that is designed for veterans, that coordinates their care, and gives them the options when it’s best for in the V.A. and when it’s best in the community. Unfettered Choice is appealing to some, but it would lead to, essentially, I believe, the elimination of the V.A. system all together. It would put veterans with very difficult problems out into the community, with nobody to stand up for them and to coordinate their care. And the expense of that system is estimated to be at the minimum $20 billion more a year than we currently spend on V.A. health care. So for all those reasons, I am not recommending that we have unfettered access. At some point in the future, if you design a system right, giving veterans complete choice, I believe in principle, is the direction we should be headed in, but not in 2017. 39:05 Sen. Jon Tester (MT): I want to go back to the Choice program, community care versus V.A. care, and tell you where we’re probably all on the same page around this rostrum, but as we’re all on the same page and the budget comes out and gives a 33% increase for private-sector care versus a 1.2% increase for care provided directly by the V.A., it doesn’t take very many budgets like that and pretty soon you’re not going to have any vets going to the V.A., because all the money’s going to community care, and they will follow the money. I promise you they will follow the money. I think that—I don’t want to put words in the VSO’s mouth. He’ll have a chance here in a bit—but I think most of the veterans I talk to say, build the V.A.’s capacity. In Montana we don’t have enough docs, we don’t have enough nurses, we don’t have enough of anything. And quite frankly, that takes away from the experience and the quality of care, and so by putting 1.2% increase for care provided directly by the V.A. and 33% for private-sector care, we’re privatizing the V.A. with that budget. David Shulkin: Yeah. I told you I wasn’t going to say that you were right again, but there’s a lot that you said that I think that we both agree with. And the goal is not to privatize the V.A. What we’re asking for in this is something we don’t have. We need additional flexibility between the money that goes into the community and the money that can be spent in the V.A. Right now we’re restricted to a 1% ability to transfer money between. We are seeking that you give us more latitude there for exactly the reason you’re talking about, Senator. We need our medical centers and our VISNs to be able to say that they need to build capacity in the V.A. where it’s not available. The reason why we’re letting people go in the community now is because the V.A. doesn’t have it. We have to get them that care. Tester: I got it, but if we don’t make the investments so they can get that health care, they’ll never get that health care there. Shulkin: I— Tester: Okay. Hearing: Veterans affairs oversight; House Appropriations Subcommittee on Military Construction and Veterans Affairs; May 3, 2017. Witness: Dr. David Shulkin - Veterans Affairs Secretary   16:13 David Shulkin: More veterans are opting for Choice than ever before, five times more in fiscal year 2016 than fiscal year 2015, and Choice authorizations are still rising. We’ve issued 35% more authorizations in the first quarter of fiscal year 2017 than in the same quarter of 2016. 18:00 David Shulkin: My five priorities as secretary are to provide greater Choice for veterans, to modernize our systems, to focus resources more efficiently, to improve the timeliness of our services, and suicide prevention among veterans. We are already taking bold steps towards achieving each of these priorities. Two weeks ago the president signed a reauthorization of the Veterans Choice Act, ensuring veterans can continue to get care from community providers. Just last week the president ordered the establishment of a V.A. accountability office, and we’re moving as quickly as we can within the limits of the law to remove bad employees. V.A. has removed medical center directors in San Juan; Shreveport, Louisiana; and recently we’ve relieved the medical center director right here in Washington, D.C. and removed three other senior executive service leaders due to misconduct or poor performance. We simply cannot tolerate employees who act counter to our values or put veterans at risk. Since January of this year, we’ve authorized an estimated 6.1 million community-care appointments, 1.8 million more than last year, a 42% increase. We now have same-day services for primary care and mental health at all of our medical centers across the country. Veterans can now access wait-time data for their local V.A. facilities by using an easy online tool where they can see those wait times. No other healthcare system in the country has this type of transparency. V.A. is setting new trends with public-private partnerships. Last month we announced a public-private partnership of an ambulatory care development center, with a donation of roughly $30 million in Omaha, Nebraska, thanks to Mr. Fortenberry’s help there. Veterans now have, or will have, a facility that’s being built with far fewer taxpayer dollars than in the past. Finally, V.A. is saving lives. My top clinical priority is suicide prevention. On average 20 veterans a day die by suicide. A few months ago the Veterans Crisis Line had a rollover rate to a backup center of more than 30%. Today that rate is less than 1%. In support of our efforts to reduce suicides, we’ve launched new predictive modeling tools that allow V.A. to provide proactive care and support for veterans who are at the highest risk of suicide. And I’ve recently announced the V.A. will be providing emergency mental health care to former service members with other-than-honorable discharges at all of our medical facilities. We know that these veterans are at greater risk for suicide, and we’re now caring for them as well as we can. 23:19 David Shulkin: The VISTA system is something that, frankly, V.A. should be proud of. It invented it, it was the leader in electronic health records, but, frankly, that’s old history, and we have to look at keeping up and to modernize the system. I’ve said two things, Mr. Chairman, in the past. I’ve said, number one is, V.A. has to get out of the business of becoming a software developer. This is not our core competency. I don’t see why it serves veterans. I think we’re doing this in a way that, frankly, we can’t keep up with. So, I’ve said that we’re going to get out of that business. We’re either going to find a commercial company that will take over and support VISTA or we’re going to go to an off-the-shelf product. And that’s really what we’re evaluating now. We have an RFI out for, essentially, the commercialization of VISTA that we wouldn’t longer be doing internally. 27:33 David Shulkin: We also, as we get more veterans out into the community, out into the private-sector hospitals, we have to be very concerned about interoperability with those partners as well. 38:24 Rep. Debbie Wasserman Schultz (FL): Given that your goal is one program, are you analyzing which program ultimately would be phased out, because we have a tendency to instead of phasing out programs because they have people with a vested interest in them, simply— David Shulkin: Yes. Schultz: —going along to get along rather than rocking the boat, and so if we’re adding $3 1/2 billion to the Choice program and it had 950 million left, there have been challenges with the Choice program and confusion, and there are still challenges with the community care program, in what direction is the V.A. thinking of going when we—and what is the timeline for ultimately— Shulkin: Right. Schultz: — phasing out one program and only having one? Shulkin: Right. Well, with almost certainty I can tell you there will not be three programs, because the current Choice program will run out of money— Schultz: Right. Shulkin: —by the end of this calendar year. So, that program is going to go away and should be through December of this year. What we are hoping to do is to work with you so that we can introduce a community-care funding program—the chairman referred to it as Choice 2.0—which is a program that makes sense for veterans, which is a single program that operates under one set of rules for how veterans get care in the community. And that new legislation, which we believe needs to be introduced by late summer or early fall in order to make the timeline, would end up with a single program. Schultz: So, you eventually envision phasing out community care with the advent— Shulkin: Yes. Schultz: —of Choice 2.0. 1:33:11 Rep. Charles Dent (PA): In the one-page FY ’18 skinny budget we received in March, there’s a V.A. request for $2.9 billion in new mandatory funding, presumably to complete the FY ’18 funding for the Choice program after the mandatory $10 billion of the program is completely exhausted in January, I guess. Does this indicate the administration’s intent to fund the successor Choice program out of mandatory funding? David Shulkin: Yes. 1:45:37 Rep. Tom Rooney (FL): And many of the providers that are technically participating in the Choice program are refusing to accept Choice patients because they know that they’ll have to wait a long time to get paid themselves. So some providers that don’t accept the Choice patients will only do so if the veteran agrees to pay for the services up front. And that leaves the veterans in that same bind they were in before Choice, which was either face the excessive wait times at the V.A. facility with no option to obtain immediate care elsewhere without paying out of pocket first. And obviously that’s not the point, or that’s not what we’re looking to do. So, I mean, you as a doctor can probably appreciate, you know, with these people that want to take the Choice program to help veterans but they know that it’s going to take forever to get reimbursed be like, hey, will you pay me first, and then, you know, we’ll deal with getting reimbursed later. I don’t know if that’s the rationale, but it sounds like that. The OIG has criticized the V.A.’s monitoring oversight for these contracts and reported that these contracts still don’t have performance measures to ensure the contractors pay their providers in a timely manner, and the OIG made this recommendation January 30 of this year. So, as you work to expand the Choice program, how are you implementing the OIG’s recommendation specifically with regard to timely reimbursements? David Shulkin: Well, there is no doubt that this is an area of significant risk for us, that monitoring and making sure that the providers are paid is critical because of the issues that you’re saying: the veterans are being put in the middle. I would not recommend the veterans put out money for this. That is, as you said, is not the point of it. What we have done is we have done multiple contract modifications. We’ve actually advanced money to the third-party administrators. I’ve suspended the requirement that providers have to provide their medical records to us in order to get paid. We are improving our payment cycles through the Choice program, but it’s not perfect by any means. We have to get better at our auditing of these processes, and those were the IG recommendations, and we are working on doing that. So this is a significant area of risk for us. In the reauthorization, or the redesign, of the Choice program, what we’re calling Choice 2.0, we want to eliminate the complexity of this process. The private sector does not have to do the type of adjudication of claims that we do. They do auto adjudification. They do electronic claims payments. We just are not able to, under this legislation, do all the things that, frankly, we know are best practices. That’s what we want to get right in Choice 2.0. 1:56:40 David Shulkin: Our care needs to be focused on those that are eligible for care, particularly when we have access issues. So, I’d be glad to talk to you more about that. I do want to just mention two things. First of all, our policy is for emergency mental health care for other-than-honorable, not dishonorably, discharged; dishonorably discharged who were not— Rep. Scott Taylor (VA): Sorry if I misspoke. David Shulkin: Yeah, yeah, okay. Rep. Scott Taylor (VA): But I do applaud you for those efforts. David Shulkin: I just wanted to clarify that. Rep. Scott Taylor (VA): I know that there are a lot of wounds that are mental, of course, and— David Shulkin: Absolutely. Rep. Scott Taylor (VA): —I get that. I applaud you for those efforts. Hearing: Veterans affairs choice program; House Committee for Veterans Affairs; March 7, 2017. Witness: David Shulkin - Veterans Affairs Secretary Michael Missal - Veterans Affairs Inspector General Randall Williamson - GAO Health Care Team Director 20:35 David Shulkin: However, we do need your help. The Veterans Choice Program is going to expire in less than six months, but our veterans’ community-care needs will not expire. This looming expiration is a cause for concern among veterans, providers, and V.A. staff, and we need help in eliminating the expiration date of the Choice program on August 7, 2017 so that we can fully utilize the remaining Choice funds. Without congressional action, veterans will have to face longer wait times for care. Second, we need your help in modernizing and consolidating community care. Veterans deserve better, and now is the time to get this right. We believe that a modernized and revised community-care program must have seven key elements. First, maintain a high-performing integrated network that includes V.A., federal partners, academic affiliates, and community providers. Second, increase Choice for all veterans, starting with those with cer—(audio glitch). Third, ensure that enrolled veterans get the care they need closer to their homes, when appropriate. Fourth, optimize coordination of V.A. healthcare benefits with the health insurance that an enrolled veteran already has. Fifth, maintain affordability of healthcare options for the lowest-income enrolled veterans. Sixth, assist in coordination of care for veterans served by multiple providers. And last, apply industry standards for performance quality, patient satisfaction, payment models, and healthcare outcomes. 23:24 Michael Missal: In October 2015, V.A. provided Congress with a plan to consolidate all V.A.’s purchased care programs into V.A.’s community-care program. Under consolidation, V.A. continues to have problems determining eligibility for care, authorizing care, making accurate payments, providing timely payments to providers, and ensuring the necessary coordination of care provided to veterans outside the V.A. healthcare system. 30:30 Randall Williamson: Finally, substantial resources will likely be needed to carry out Choice 2.0. Resources needed to fund IT upgrades and new applications for Choice are largely unknown but could be costly. Proposed changes in Choice eligibility requirements, such as eliminating the 30-day, 40-mile requirement for eligibility, could potentially greatly increase the number of veterans seeking care through community providers and drive costs up considerably. Also, if medical-center staff begin scheduling all appointments under Choice 2.0, as V.A. currently envisions, hiring more V.A. staff will likely be costly and tediously slow. Already, since Choice was established, V.A. medical-center staff devoted to helping veterans access non-V.A. care have increased threefold or more at many locations. 1:04:00 David Shulkin: We are looking primarily at technological solutions, and we are looking at the use of telehealth, which we are doing across V.A. on a scale that no other health system in America is even approaching—2.1 million visits; over 700,000 veterans getting access through telehealth services—and so we are looking at this very seriously about dramatically expanding its use to be able to support where we don’t have health professionals. 1:06:20 David Shulkin: Remember, we have four missions. The clinical care is what we always talk about, but we also have an education mission. We train more American healthcare professionals than any other organization in the country, we have research that’s dedicated solely to the improvement of the wellbeing of veterans, and we also serve a national emergency-preparedness role. So, all four of these missions are very important to us. I would just say two things. One thing is we know from the Choice program that only 5,000 of the several—of more now than a million veterans who’ve used the program chose only to use the Choice program. So they’re saying exactly what your constituent told you, which is the V.A. is essential and important to them. But we are not going to allow the V.A. programs to be diluted, and one of the reasons why that’s so important is that we need to modernize the V.A. system. Our lack of capitalizing the V.A. system in terms of the buildings, the equipment, the IT systems, could make it a noncompetitive system. But we’re going to make sure that the facilities that are open are the best for veterans, and veterans are going to want to continue to get their care there. The community-care program is a way to make sure that we supplement the V.A. in an integrated fashion. 1:10:00 Rep. Mike Bost (IL): The department itself has estimated that it can treat and cure most of the remaining 124,000 diagnosed cases of hepatitis C within the next three years. Is it the V.A.’s commitment that that timeline will be held to and that these will be treated regardless of the level of their liver disease or where they might be at? David Shulkin: Yes. Thanks to the support from Congress, we were provided the resources to meet that timeline. I actually think we’re going to beat it, but with one caveat. What we’ve learned is that our initial outreaches, we were getting thousands and thousands of veterans to come in and to get treatment. We have a treatment, of course, as you know, that now cures more than 95% of hepatitis C. So it’s tremendous medical advance. The doctor to my right is one of those doctors. He’s an I.D. doctor who does this in his clinical work at the V.A. Unknown Speaker: Thank you. Shulkin: What we’re finding now is, and if Dr. Yehia wants to comment on this, we’re finding that we’re now seeing less and less veterans coming in to get cured. There is a substantial number of veterans for a number of reasons, either psychological reasons or social reasons, who are not taking advantage of this care. And so this is now becoming a research question for us. How do we have to begin to approach people that are saying, I have a disease that may end up killing me, but I’m not interested in the treatment. And so I think we’re going to beat your three-year timeline, but there's still going to be a subset of veterans that don’t want to come in and get care. 1:12:50 Rep. Mike Bost (IL): What would happen if we didn’t make that extension go past the August 7, and what would be the final cutoff if we don’t get it past? David Shulkin: Well, first of all, if we don’t do this extension, this is going to be a disaster for American veterans. We’re going to see the same situation that we saw in April 2014, that Senator Kaine started out tonight with, that we saw in Phoenix. And so here’s the timeline. We do need to do this now. As I think Chairman Roe referred to, already today veterans are not able to use the Choice program, because the law states that we have to obligate the funds now for when the care is going to be delivered. So a pregnant veteran who comes to us and says, I want to get care using the Choice program, they no longer can, because nine months from now is past August 7. But this is now beginning to happen with care that is multiple months in length, like oncology care and chemotherapy and other types of therapies. We have a chart that shows that when you start getting towards the end of April to May, this is where you’re going to start seeing a large number of veterans not being able to get access to care, because episodes of care that we’re used to, like hip replacements and other things, are generally three to four months. So we think the time is now that we need to act. Bost: Okay, so, but what we’re doing is not any intention to privatize or anything like that. This is just making sure that those people who are on the Choice program, that we are moving forward to make sure that those services are provided. Shulkin: Not only that, but this is not going to cost any additional money. We are just seeking the authority to spend the money that you’ve already given us past August 7 of this year. 1:17:15 David Shulkin: We are going to go and we are going to start providing mental health care for those that are other-than-honorably discharged for urgent mental health. And we want to work with Representative Coffman on his bill on this, and we want to do as much as we can. But I don’t think it can wait, and so we’re going to start doing that now. I believe that’s in the secretary’s authority to be able to do that.   Hearing: A call for system-wide change; House Committee for Veterans Affairs; October 7, 2015. Witnesses: Robert McDonald: then Secretary of U.S. Department of Veterans Affairs David Shulkin: Under Secretary for Health, U.S. Department of Veterans Affairs Brett Giroir: Senior Fellow at the Texas medical Center Health Policy Institute 13:37 Robert McDonald: As you know, we have five strategies: first is improving the veteran experience, second is improving the employee experience, third is achieving support-service excellence, fourth is establishing a culture of continuous improvement, and fifth is enhancing strategic partnerships, and we would be happy to drill down on those during the question period. 14:17 Robert McDonald: In the past year, we’ve moved out aggressively in response to the access crisis, meeting increasing demand and expanding capacity on four fronts: more staffing, more space, more productivity, and more V.A. care in the community. During that period of time, we’ve completed 7 million more appointments for veterans of completed care: 4 1/2 million in the community, 2 1/2 million within V.A. We’ve added more space, we’ve added more providers, we’ve added more extra hours, all in effect to get more veterans in. But because of that, and because we’ve done a better job of caring for veterans, we have more veterans desiring care. So even those 97% of appointments are now completed within 30 days of the needed or preferred date, the number not completed in 30 days has grown from 300,000 to nearly 500,000. 16:15 Robert McDonald: We simply can’t make many necessary changes because of statutory limitations. We need to consolidate our various care in the community programs. We need a freer hand to hire, assign, and reward the executives we task to act as change agents. We need a freer hand in disposing of outdated, unused, or little-used facilities. We need a freer hand in the management of existing facilities so facilities’ managers can adjust their use of resources to the changing needs of veterans. 25:47 Brett Giroir: As background, in 2014 9.1 million of 21.6 million U.S. veterans were enrolled in the VHA. Of these, 5.8 million were actual patients, and on average these patients relied on the VHA for much less than 50% of their healthcare services. These demographic data combined with access challenges suggest reconsideration of whether the VHA should aim to be the comprehensive provider for all veterans’ health needs or whether the VHA should evolve into more focus centers providing specialized care while utilizing non-VHA providers for the majority of veterans’ healthcare needs. Either paradigm could be highly beneficial to veterans as long as the demand and resources are prospectively aligned and there is a consolidation of current programs to simplify access to non-VHA providers. 30:05 David Shulkin: The V.A. approach is to find the very best care that serves the veterans, and I think that we’ve shown that in response to our access crisis that we have encouraged the use of community care to address our access issues. I think the difference here between—maybe what I would expand on what Dr. Giroir said is that the care that V.A. provides is very, very different than the care that the private sector provides. The V.A. provides a much more comprehensive approach than just dealing with physical-illness issues. It provides psychological and social aspects of care that actually meet the needs of what veterans require. And that's why I think that we really do need to do what Dr. Giroir said, which is to see what VHA provides best for our veterans and what care can be provided by the private sector, and it’s that hybrid-type system that's going to meet our veteran's needs. 34:39 Former Rep. Corrine Brown (FL): I think the elephant in the room is that there are people out there that would actually want to just completely close the V.A. and privatize the entire V.A. system, which is totally unacceptable and it is absolutely not what the veterans want. And as you begin, I want you to discuss flexibility, but I want you to let people know how many people we actually serve every day throughout this country. Robert McDonald: Thank you, Ranking Member Brown. As I was going through my confirmation process, I often got the question from senators why—you know, from some senators, small group—why don't we get rid of the V.A. and just give out vouchers? So I studied that—as a business person, I wanted to know—and what I discovered was V.A.'s not only essential for veterans, it's essential for American medicine and it's essential for the American people. Three-legged stool: research. We spent $1.8 billion a year on research. We invented the nicotine patch. We were the ones who discovered the aspirin was important for heart disease—take an aspirin every day. First liver transplant. First implantable pacemaker. Last year two V.A. doctors invented the shingles vaccine. I could go on. That research is important for the American people, and I didn't even mention posttraumatic stress or traumatic brain injury or prosthetics, things that we're known for. Second, training. We trained 70% of the doctors in this country. Who's going to train those doctors without the V.A.? We have also the largest employer of nurses and the largest trainer of nurses. Third leg is clinical work. Our veterans get the best clinical care because our doctors are doctors that not only do the clinical care but also do research and teach in the best medical schools of our country. So I think the American people benefit from the V.A., and it would be a big mistake to even think about privatizing it. 1:06:06 Rep. Phil Roe (TN): Let me go right to what I wanted to talk about which is my own veteran’s officer at home—person that does my work at home—and basically what she’s saying is, how do you get an appointment through the Veterans Choice Program? She said she had been trying to put together a summary, and what's happening is there’re two ways you get in there: a veteran can either be eligible by a 30-day wait list or more than 40 miles. And the most of problems she saw were the 30-day list. And this is what happens. Below is the information’s been given to me by the roll out of the program. In my experience, there appears to be a breakdown somewhere in this process but have been unable to get clear answers on how to fix it. The V.A. blames TriWest; TriWest blames the V.A. Eligibility is determined by the V.A. primary-care doctor if the appointment’s passed 30 days. The non-V.A. care staff then uploads this list of eligible veterans to the V.A. central office here in Washington nightly, and the veteran’s told to wait five to seven days and then call TriWest. The central office then sends the information to TriWest, can take three to seven days. If the consults don't get added, medical documentation didn't get uploaded, authorizations gets canceled, then the veteran’s on a merry-go-round. Look, when they came to my office to get an appointment, I said, you need an appointment with Dr. Smith. They went out front and made the appointment. That's what should happen. It ain’t that complicated. And all of this in between—and I could go on and on—TriWest has a different view of it, and I want to submit this to the record because it really gets to the bottom of what’s actually going— Unknown Chairman: Not objection. Roe: Thank you, Mr. Chairman. The non-V.A. care staff were given no training on this, and they basically were left just to wing it, how to make these appointments. That was one of the things was brought up in the report. Our local V.A. care—non-V.A. care staff—increased from 5 to 15 but still are struggling to make all these appointments, and there's talk of—now, listen to this right here—there is talk of calling each patient for every appointment to make sure they keep it. If the patient says, I don't want to go, they still are told to call them two times a month until the past the appointment time. That's a complete waste of time. And the outpatient clinics also ought to be able to add patients to the electronic wait list instead of sending them over because appointment may come up; veterans get left out like that. And the TriWest portal is not very friendly. Private doctors did not like jumping through all the hoops of the Choice programmers saying they must give a percent of their fee to TriWest in order for TriWest to file the claim. So, we have a clinic that’s closing in our office, in our V.A., on a chiropractic and pulmonary clinic, because the doctors are just fed up with the way the system is. It’s so bureaucratic. So, anyway, I could go on and on. This is a very extensive—this is on-the-ground stuff that’s going on today at our medical center, and I bet you it's going on around the country. And I think these are things I will submit to you so you can get to work on this, and, again, appreciate the effort that you put into it. Mr. Chairman, there’s some valuable information here for the V.A. to use. And I yield back. Unknown Chairman: Thank you. Ms. Brown, you had a question. Corrine Brown: I do, because I want the secretary to answer that, because I think—I'm meeting with TriWest today—but the important thing is, you can't send a veteran to an agency or anywhere until they get prior approval from the V.A. because the most important thing is that that doctor get that reimbursement. So can you clear this up? I mean, no person in my office can send someone to a doctor; it must go through the system so that you get prior approval. And once that's done, how long—why does it take so long for that physician to get reimbursed, and can he answer that question? Robert McDonald: We have flowcharted that process, and let me let David talk about the improvements that we’ve made to that process. He'll answer questions one and three, and I'll take two on the facilities. David Shulkin: Okay. Dr. Roe, I think your old adage on the three A's is exactly right. And you have to remember we brought this Choice system up in 90 days. This is a national, very complex system, and what we've heard after bringing it up in 90 days is exactly the type of feedback that you've been hearing from your constituents. The secretary and I are both out in the field, we understand that these problems are happening, and so what we've begun to do is to redesign the system and to process-map it out. Both the secretary and I spoke to the CEO of TriWest last evening, and we are beginning now to make outbound calls to the veterans before they had to call in. We are beginning to actually embed TriWest staff in the V.A. so that they're working in teams, and we're beginning to start eliminating some of those steps. It is going to take a while. It is painful to watch this when you hear stories like what you're hearing, but we understand the problems there, we are working very hard, we think TriWest and Health Net are working to help us make the system better, and we're committed to doing this with urgency. 1:58:08 David Shulkin: We do have a crisis in leadership. We have too many open, vacant positions. We have too many people in acting positions and interim positions. You can't expect that you're going to have a transformation in a health system unless you have stable leadership in place. We need your help on this. We need your help to help create the V.A. to be an environment people want to come and serve and to be excited about, and we are asking for your help in Title 38 for the—Hybrid Title 38—to be able to help get the right type of compensation for leadership positions in V.A. That will help us a lot. Hearing: HR 1994 VA accountability act and HR 3236 surface transportation and veterans health care choice improvement act; House Rules Committee; July 28, 2015. 1:28:40 Bradley Byrne (AL): We don’t need to have a government-run healthcare system for our veterans. We need to transition out of it and give all of our veterans a card, just like an insurance card. Hearing: Veterans Affairs health care and budget; House Veterans Affairs Committee; July 22, 2015. 19:20 Robert McDonald Clinical output has increased 8% while budget has increased 2%, 35% more people (1.5 million beneficiaries) 20:22 Robert McDonald Increased Choice authorizations by 44% (900,000), 4% more appointments, percentages of wait times, wait times for types of care 21:50 Robert McDonald Care crisis of 2014 was caused by an imbalance in supply and demand, VA has been governing to fit a budget, not making budget fit the care, stats on new enrollees, 147% increase. enrolled veterans use VA for 34% of their care 56:00 Robert McDonald Here is a packet explaining the transformation of the VA, we have an advisory board full of CEOs, VA is going through the largest transformation in it’s history 1:09:40 Tim Heulskamp (KS) Concerned that money will be redirect away from Choice and he thinks “many employees” are not supportive of Choice, throws out bullshit numbers James Tuchschmidt corrects him and said they took money out to pay for the Hepatitis C drug 1:11:50 Tim Heulskamp wants to know why only two people have been fired for the wait time scandal. Robert McDonald many have retired, one indictment, 1,300 have been fired, new leadership, 7 million more appointments this year 1:27:30 Rep.Jackie Walorski (IN) Veterans died because of the Veteran’s Administration, I wanted to see people go to prison, list of things she’s pissed about, "Nothing is working” Robert McDonald 300,000 on wait list a year ago, low wait times, 1:35:00 McDonald we need a better system for anticipating what demand will be. 34% of eligible people are using VA system right now 1:35:20 Robert McDonald the crisis in 2014 was due to Vietnam vets, not Iraq & Afghanistan and we need to prepare as they age 1:36:00 Rep. Beto O’Rourke (D-TX) Why don’t we “refer out" the care that’s not directly related to military service? Robert McDonald people like to have all their doctors in one place, private sector doctors have to treat veterans differently - different questions to ask 1:41:00 Phil Roe (TN) Getting veterans outside care should be be through 1 program because it "aught to be easy" 1:43:50 Robert McDonald Moral is low because people don't want to be called out for not caring. They work hard every day 1:46:00 Kathleen Rice (D-NY) Why is there a budget shortfall? Robert McDonald 7 million more veterans needed care. "That's the reason" 1:56:00 Mark Takano (D-CA) New way of operating with non-VA providers - "Care in the Community" - not a conspiracy to "disappear the VA" - That's why we changed the name 2:05:00 Brad Wenstrup (R-OH) We should "outsource" collections” of payment from veterans with other insurance James Tuchschmidt We are looking at doing that. Wenstrup we should take bids. 2:18:00 Robert McDonald We are in favor of Choice program & we need to know about any employees who aren't because "that would be wrong" - Don't care where they get care as long as it's great care 2:20:00 Jerry McNerney (D-CA) Do you favor public private partnerships? Robert McDonald Yes, it's part of our transformation strategy. we have an “office of strategic parterships” 2:22:55 James Tuchschmidt We thought more people would use Choice, the goal was to not have vets waiting more than 30 days for care, we're asking to use that money to pay for care we purchased, we want a bill before you leave in August 2:28:00 James Tuchschmidt We’ve treated over 20,000 veterans with hepatitis C and veterans can use the Choice Program to get their treatment Rep.Ralph Abraham (LA) $500 million would be designated for Hepatitis C treatment Robert McDonald yes Hearing: Non-VA care: An integrated solution for veteran access; House Veterans Affairs Committee; June 18, 2014. 50:40 Rep. Beto O’Rourke (TX): Why have the V.A. at all? Why not privatize that care? The private sector could do it better. What’s missing in the V.A. is competition. Our veterans deserve the very best. Let’s not keep them in this institution that’s not working. From veterans, almost to a person, I hear, if I get in the V.A., I love the care. I’m treated very, very well. The outcomes are great. Don’t touch the V.A. So, what do you do best, and what does the V.A. do best? And five years down the road, after we get out of this current crisis, what will this look like? Unknown Speaker: That’s a great question. And it’s an honor to serve El Paso, where I spent part of my childhood when my dad was in the army as a doc. I will tell you that I hope it does not take five years. And I think everybody else would echo that statement. My belief is that the first phase is to make sure that the program that the V.A. has invested taxpayer money in—VAPC3—is put in place, is mature, that the processes on the V.A. side are mature, that our processes are mature, and that together we’re identifying where those pockets of veterans are that might not otherwise be able to get what they need in a complete capacity through the direct V.A. system because they lack the capacity to deliver on all the needs, and that the V.A. syst— Yes, sir. O’Rourke: Let me—I’m sorry to interrupt you, but I do want to understand what you think beyond taking care of capacity issues when the V.A.’s not able to see someone in a reasonable period of time. Are there specific kinds of care that you all would be better equipped to take care of? For example, I often think the V.A. is or should be better at handling PTSD or the aftereffects of traumatic brain injury because they see so many people like that as opposed to your typical health system or hospital. Maybe that’s a V.A. center of excellence. Is there something on the outside that we should just move all appointments or consults or procedures in a given area over to the private sector or let the private sector compete for? Unknown Speaker: Great question. My personal view is that it’s too early to ask that question—or to answer it, probably a better way to put it. It’s early to ask it, it’s right to ask it, you’re looking over the horizon line, but that we first need to get the pieces plugged together. And then there needs to be a make-by decision, category by category, and facility by facility, to look at what’s best done with taxpayer funds. Is it best to have the direct system provide care for four veterans in a particular category? Is that really necessary? Or should we buy that on the outside because it’s more efficient and more effective? 54:30 O’Rourke: You know, I’ve been on this committee for a year and a half now—it’s my first year in Congress—but I’d never been approached by a lobbyist on my way in to a meeting. Today I was, who represents providers in the private sector in El Paso and said, we have a hard time getting paid. It takes us a year sometimes. We want to see these veterans who are not able to be seen by the V.A., but it’s going to be really hard to do this if we don’t get paid. 1:34:00 Jolly: We need to do even more in providing a veteran choice. This, bottom line. The question, though, is how do we do that in a way that’s fiscally responsible? And so my question for you generally—and again, if you don’t have enough information, that’s certainly fine—in your role of supporting non-V.A. care, can you give either an assessment, if you have the technical information, or if it’s just in a working opinion on the cost effectiveness compared to traditional care, realizing that we have hard infrastructure costs within our V.A. system that aren’t reflective when you go to non-V.A. We can look at all sorts of data. I’m somebody who thinks typically data’s manipulated to get whatever outcome or position we want to finally be able to support. But can you give an opinion or assessment on the cost effectiveness of non-V.A. care versus within the V.A.? Ms. Doody: I can tell you from our experience with Project ARCH—and I wish I could give you specific numbers, sir—the company Altarum, who was contracted to collect this information—my understanding is they’re going to report back to you folks in 2015—are looking at the cost of care per veteran. From my understanding, it is less than if they would have gone to a V.A. facility for certain procedures. So, again, it’s anecdotal. It may be geographic; I can’t comment on the other regions or other states in our nation. But also just limiting the amount of mileage, the travelling that the veteran would have to do travelling to a V.A. hospital to receive care as a savings to the system also. 1:45:00 Titus: You confirm that you can’t talk about the cost effectiveness; there’s just not enough data there, yet you think it’s working pretty well, but we don’t have any hard figures, and we also know that CVO’s been kind of unable to assess the cost going forward, and nobody’s talking about how to pay for it. Yet, we are moving pell mell towards more veterans using this kind of non-V.A. care. And it’s not that I’m opposed to that, but I want us to do it right or else we’ll be having hearings five years from now, talking about all the problems with non-V.A. care. Now, to hear y’all talk about it, you’re not having any problems; things are working great under your networks. But we know that’s not true, either. I mean, there are problems out there, and we need to be serious about how to address them from the beginning. Now, as I understand it, y’all are just kind of like the middleman, like Sallie Mae and Medicare Advantage, where you have a contract to provide a service. That’s fine, but as you push more people out into the private sector, do you see your kind of business growing, or is your network going to cover more areas, or are more new networks and competition going to come on to be part of this new system that we’re going to be creating? Hearing: A continued assessment of delays in VA medical care and preventable veteran deaths; House Veterans Affairs Committee; April 9, 2014. 2:35 Rep. Jeff Miller (FL): On Monday, shortly before this public hearing, V.A. provided evidence that a total of 23 veterans have died due to delays and care at V.A. medical centers. Even with this latest disclosure as to where the deaths occurred, our committee still doesn’t know when they may have happened beyond the statement from V.A. that they most likely occurred between 2010 and 2012. These particular deaths resulted primarily from delays in gastrointestinal care. Information on other preventable deaths due to consult delays remains unavailable. Outside of the V.A.’s consult review, this committee has reviewed at least 18 preventable deaths that occurred because of mismanagement, improper infection-control practices, and a whole host—a whole host—of maladies that plagued the V.A. healthcare system all across this great nation. 8:53 Rep. Jeff Miller (FL): Mr. Coates waited for almost a year and would have waited even longer had he not personally persistently insisted on receiving the colonoscopy that he and his doctors knew that they needed. That same colonoscopy revealed that Mr. Coates had Stage IV colon cancer that had metastasized to his lungs and to his liver. 13:55 Barry Coates: My name is Barry Lynne Coates, and due to the inadequate and lack of followup care I received through the V.A. system, I stand here before you terminally ill today

Co-founder and CEO of ComiXology Interview starts at 9:40 and ends at 38:47 “When we made the business plan 10 years ago--it's hard to remember this, but iPhones didn't exist. None of us had any idea we were going to be heading into this world of carrying big pieces of glass around in our pockets or in our bags that would be so amazing for image-based reading.” News “L.L. Bean Beats Amazon.com, Once Again, For Best Customer Service” by Pam Goodfellow at Forbes - August 3, 2017 “Amazon Echo multiroom audio not far off, report says” by Megan Wollerton at CNET - August 8, 2017 “Need Something Extra Fast? Amazon Instant Pickup Launches This Week” - Amazon press release August 15, 2017 “Amazon's Instant Pickup Service Shows Clearly Who Jeff Bezos is Targeting Next” by Eric Jhonsa at TheStreet - August 15, 2017 “Kindle Oasis in Short Supply, New Model Coming Soon?” at The eBook Reader - August 10, 2017 Tech Tip Fire HD 8 - $80 at Amazon.com Interview with David Steinberger ComiXology Guided View Native comics Box 13: The Collected Graphic Novel ComiXology Submit Xkcd John Lewis's March series The Fifth Beatle: The Brian Epstein Story ComiXology Unlimited Star Trek on ComiXology Content Beneath a Scarlet Sky by Mark Sullivan Marketplace with Kai Ryssdal - August 17, 2017 episode includes James Patterson speaking about Amazon and his new book, The Store The Store at Goodreads “National security advisor attempts to reconcile Trump's competing impulses on Afghanistan” by Greg Jaffe and Philip Rucker at The Washington Post - August 4, 2017 Dereliction of Duty: Johnson, McNamara, the Joint Chiefs of Staff and the Lies that Led to Vietnam by H. R. McMaster Next Week's Show Next week's show will originate mainly in Casper, Wyoming, where I will travel to see the total eclipse of the sun on August 21st. Music for my podcast is from an original Thelonius Monk composition named "Well, You Needn't." This version is "Ra-Monk" by Eval Manigat on the "Variations in Time: A Jazz Perspective" CD by Public Transit Recording" CD. Please Join the Kindle Chronicles group at Goodreads!

Can Kelly bring order to the White House? We talk to Kristine Simmons from the Bush White House, Chris Whipple, author of "Gatekeepers: How The White House Chiefs of Staff Define Every Presidency," and Greg Jaffe who has reported on Kelly for years.

Greg Jaffe, one of The Post reporters who broke news of Trump revealing classified information to Russian diplomats, is on the show to explain presidential power when it comes to classified information and what happens next in this developing story.

9 AM - 1 - Washington Post's Greg Jaffe on his story: Trump and his 'America First' philosophy face first moral quandary in Syria. 2 - Songs are getting faster and shorter thanks to streaming. 3 - The News with Marshall Phillips. 4 - ; Final Thoughts.

Today’s episode is about genetically engineered crops – their prevalence, safety, and regulation. What foods contain GMOs? Are they safe? Should they be labeled?   Gregory Jaffe is the Biotechnology Project Director at the Center for Science in the Public Interest.  CSPI is a non-profit consumer organization that concentrates on food and nutrition issues.  They publish Nutrition Action Healthletter, which helps consumers understand the relationship between food, nutrition, and healthy eating.  Greg has been at CSPI for almost 15 years.  He has an undergraduate degree in biology and a law degree.  He has been following issues around biotechnology on and off for more than thirty years.  In this episode, Greg answers common questions about GMOs with the most fair and balanced approach I’ve ever heard. With a background in biotech and law, he understands the complex nature of the topic and shares important insights and resources.  You can read the full show notes and all the resources at www.soundbitesrd.com

Ah, the 2016 presidential election.  Trump still leads the GOP field, Hillary has been challenged in the polls by Bernie Sanders and the shadow of Joe Biden looms large over the Democratic hopefuls.  And whether it's the Islamic State, Russia, cybersecurity, or the politics of the Iran deal, national security issues are going to play a central role.  So to kick off our newest channel, #NatSec2016, we brought together  two experts from different parts of the political spectrum - Doug Ollivant and Mike Waltz - as well as Greg Jaffe of The Washington Post to explore the 2016 politics of national security. Have a listen and enjoy!