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TOM: A look at the changes coming to the Department of Veterans Affairs. The Senate yesterday confirmed for that department a new secretary to lead the VA in the midst of a scandal over how long veterans wait to receive health care in some places. Also, by the end of this week, Congress likely will have sent the president legislation to boost spending and make other changes at the VA.

To talk more about this, I'm joined now by first district Congressman Tim Walz, who represents Southern Minnesota, sits on the House Veterans Affairs Committee, and is a veteran himself. Welcome back to the show, Congressman.

TIM WALZ: Thanks for having me, Tom.

TOM: $17 billion bill boosts spending. You can hire more doctors and nurses, even open up new facilities. And there's policy changes. Is this going to fix what's wrong at the VA?

TIM WALZ: No, not everything. I think it's a good first start. I was of the mindset that you first needed to diagnose what the entire problem was, and I don't think we've done that yet. It's certainly cultural and it runs deep. But what this does is it makes sure that we put those veterans who are waiting in line, gives them the opportunity to get the care they need right away. It uses our private sector resources in an efficient manner, and then it beefs up what's working in the VA, because there are many that are receiving quality care once they get in.

And then it does what I think is the most important piece of this, it gives new power to the secretary to make the changes that are necessary to break that culture of gridlock and these little kingdoms they set up. And then it empowers us to get better data, outside data, to be able to understand, What is the most efficient way to deliver this care? What's the most effective, cost-effective way? And what's best for the veterans? So it's not an end all. I think this scaled-back version was what I was advocating for until we have a better idea and can figure out what's the best approach.

TOM: One of the things here is to hire more doctors and nurses. There's funding in there for that. Was the problem the number of doctors and nurses? Or was the problem long wait lists because of administrative SNAFUs?

TIM WALZ: Well, I think it's a combination of both. I don't think anything lets these people off the hook for manipulating the numbers in that. But I do think that we've seen an influx. We have purposely encouraged people, and this generation of veterans is using the VA at a greater number, and we have aging Vietnam veterans now that use it at a greater number.

But to beg off that we just didn't have enough people, that was not the fundamental problem. It certainly is a long-term issue we need to deal with, but my concern was, and then I think doing it the way we've done it on here in this graduated way of looking at it is, is that I was very cautious about, Why would we put more people in there if we're not getting the efficiencies that we demanded already in there? And so it's a step in the right direction.

But there's shortage of positions is not just in the VA. It's in the private sector also. So I think we need to do some things to incentivize people. Certainly, there's the sense of service that people that go to the VA, but they also didn't take an oath of poverty. So we need to pay them. But I think those who say that it was solely because we didn't have enough people, that's not it. There were some ethical breakdowns here that people could have come to us and simply mentioned that. But when I asked directly to two secretaries if they had the resources necessary, the answer was yes.

TOM: I believe that what we're doing is expanding. There is already some ability for vets to go to private doctors, and then there's reimbursement from the VA.

TIM WALZ: Correct.

TOM: And this expands that. We have seen on another program, Medicaid, doctors who stop taking Medicaid patients because the reimbursement rates are so low. Is there a threat that something like that could happen with VA patients?

TIM WALZ: Very good point. That's why we put it in there. It's the Medicare rate, the higher rate. And then I put in a provision, because you're exactly right on that, Tom. The concern is people want to do right and they want to care for our veterans, but you can't expect them to do it at a loss, and you can't expect them to wait months to get reimbursed. So we had a fair pay, quick pay provision that we put in that some of our folks, Mayo Clinic helped us understand how that makes a bigger difference.

So I think for many of these people, if they're going to get the Medicare rate, they're going to get a fair reimbursement rate, and they're going to get it in a timely manner, we think that will alleviate a lot of those problems.

TOM: The bill also includes a billion and a half to lease 27 new VA facilities. Is there any indication, A, whether Minnesota needs more or, B, whether Minnesota would get one of them?

TIM WALZ: Not at this point. And this was one of my concerns, and it was a piece of the bill that came out of Senator Sanders. If we need space, that's great. I certainly have been a critic, if you will, of the VA. They do many things right. Building hospitals is not one of them. And they-- usually there's cost overruns. It takes too long.

And my question is, is, How much space or activity could you get out of the private sector, either through leasing or some partnerships? And we are hoping that what they're going to do, because it should not be political, it should not be influenced by anything other than demographics and numbers of veterans. So at this point in time, we're hoping that what they're doing is they're understanding if the situation was in Phoenix, that you have an influx of veterans during the winter months in the north, perhaps there was a bigger need there instead of treating them all the same.

That idea that one size fits all certainly isn't true. And so we have not yet seen where they'll be. And so I don't know, and I think with the Minneapolis VA being one of the flagship polytrauma centers, and then this expansion of CBOCs, I think we've been addressing those. But at this point in time, I have to be honest with you, Tom. I'm skeptical of any data that comes from VA that's not third party validated. And I think that's what this bill adds, more of that validation.

TOM: And we've talked about that as well here. And in fact, during some of the reviews, Congressman, two Minnesota clinics were flagged for further study. I mean, the scandal really erupted in Arizona with manipulating records, but the big question is whether Minnesota is at fault at all. And have you been told, do you know why those have been flagged?

TIM WALZ: Yes, well, we think right now, and we've been briefed as of this morning and we've been pushing this. I've been speaking till I'm blue in my face. Every hearing we've had, I've asked someone to go back and try and get this. And so as the final results of their audit came, it appears like that one of the questions asked was, Was there pressure put on you, or were there an inappropriate request to write down a different date than what the system scheduled?

And it looks like the number, the answer we're getting on that is like a 2.3% that someone-- they were using a different system, and up to 12% of the schedulers that were asked said yes. Now that does not-- we don't know yet if that means they did. We're certainly most concerned as we asked veterans, Did you have an unnecessarily long wait? And we know now that the unrealistic nature of the 14 days and then tying it to bonuses was a gross disincentive.

And in my opinion, we'll find out on this, criminal maybe in some cases. So at this point in time, it appears like at least in response to questionings by the auditors, in several cases, someone answered yes, they felt there was pressure put on them.

TOM: So the question remains open for these Minnesota clinics, the VA in Minneapolis and Rochester, as to whether, what, potentially records were changed the way they were in Arizona?

TIM WALZ: Well, the situation there was we're seeing and it doesn't-- no one was kept on, there was no secret wait list. What I think the question was is, Was there pressure to ask someone to attempt to do that? And what I'm saying, Tom, is I don't know the answer yet whether they-- if they changed a date in there, but there was not an off-record list. So the list we're seeing, and the wait times we're seeing up here, even through the audit, to have been validated as correct.

So when it says that the average wait times, and in many cases, Minnesota outpaced by far the rest of the country, that those appear to be accurate. But there was certainly a culture, at least in the minds of these schedulers that asked the question, that maybe there was someone putting pressure on them. And I think that's why in this bill now, there's added strength to the incoming secretary. If this was one of the special executive people who were appointed to this position, and it's proven that they did this, he will have great power to remove them immediately.

TOM: Congressman Tim Walz is with us here. Before you leave, I want to ask about another topic. You sit on another committee that's been looking into how crude oil is transported, especially by rails, and new rules were announced last week that say those oldest cars that are at the biggest risk of puncturing and catching fire need to be retrofitted or retired. Your statement immediately afterwards said though, those rules were not perfect. What's missing from those rules?

TIM WALZ: Well, first of all, it's best if they don't leave the tracks in the first place. And then I think that's a concern. And I think at this point in time, and these rules came out of, I would argue, we had some really great town halls in Minnesota. The PHMSA director, Quarterman, was out, and we had great input. Frank Hornstein and the folks in Minnesota had been pushing this, so we pushed it all the way up. And my request for a hearing out here started to get this thing rolling.

My concern is, though, is we're treating-- in many cases, we're treating all the flammable materials exactly the same. And I think at this point, the science on Bakken oil and its volatility, lumping ethanol in with that, that's one of my concerns right now because to be very honest, Tom, the ethanol industry played by the rules and did a lot of capital investment in these 111, the old cars. And they have a 99.997% safety record.

Now the question is, is that-- that record is not good enough if you've got a Castleton or a New Brunswick or one of those issues. But at this point, I think there needs to be a little more clarity based on the science. I think the railroads, I met with them yesterday with Burlington Northern, they're certainly eager to implement these. And as we saw, their willingness to work with first responders, that was something that came out time and time again, that our first responders, our fire officials, police, and mayors said, tell us what's on these things and what we need to do if it goes off the track. So great first step.

TOM: Congressman Tim Walz, Minnesota's first district, Southern Minnesota. Thanks so much for your time here this morning.

TIM WALZ: Thank you, Tom.