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INTERVIEWER: We're checking in with some of Minnesota's congressional delegation during the August recess, before they head back to Washington for what appears will be a busy fall. I am now joined by First District DFL Congressman Tim Walz, who represents Southern Minnesota. He's in our NPR Bureau in Rochester. Congressman, thanks for being here.

TIM WALZ: Thank you for having me. Tom,

INTERVIEWER: I want to actually talk about something that's not on the immediate agenda for Congress but something you've talked about a lot. It was about a year ago that the president signed a $16 billion bill to overhaul the Veterans Affairs Department. There was a scandal, really, about wait times and even fudging some documents there. Do you have any indications that legislation has had any effect on the problems that were at the VA?

TIM WALZ: Well, I think it's had some. Some of them positive. And to be quite honest with you, so just like much legislation, some unintended consequences. I just spent the last few days with my colleague and friend, Congressman Nolan, Rick Nolan, up North. And we were looking and visiting veterans hospitals, meeting with veterans at a stand-down in Duluth and Chisholm, Hibbing, and getting their feedback on this.

And again, these are folks that served their country. We have a responsibility to take care of them. The VA is the second largest organization of the federal government behind the Pentagon. They have about 80 million visits. And as I always say, it's a zero-sum game. If one person doesn't get the quality care, and then we failed.

And I think the purpose was-- and it was a bipartisan meeting of about 16 of us as it was finalized in the choice card that said if you had to wait more than 30 days, you couldn't get an appointment, or you live more than 40 miles away, you could take that card and go get service. The VA always had the ability to do that, the ability to use fee-for-service out in the community. But I heard a lot this weekend that the choice card is not really giving them the choice that they want. And I think we've got to come back and figure that out.

INTERVIEWER: Say more about that. What you're saying there, this was a major tenet of that legislation, that if you're not able to get the care in a timely fashion at a VA clinic, you could go to a private facility, a private provider. Why isn't it happening?

TIM WALZ: Well, I think the good news is as a lot of folks, and we're seeing more and more people since this has happened, that the irony of this is the more attention that was given to the VA, more people started using it again, because a large number of veterans, as you well know, Tom, don't use their benefits or don't even know they had it. I think what's happening is we've got some folks that need to process this. We need to, first of all, make sure they're able to do it. And, of course, I think it's a fair enough bet. You start adding a bureaucratic layer to things. It's going to be more difficult.

So, for example, and this one is very frustrating to me, it was a young physician up in Chisholm at a community-based outpatient clinic, a CBOC. This was meant to put it in closer to the community so they don't have to go to Saint Cloud or Minneapolis. They don't have the capacity to do everything there.

So this physician in the system, who's a private contractor through a third party, says you need to go do this. You need to see this. Well, now they have to go back and get approval to do that. Now there is a private entity that sits in the middle to go back and find the provider who's going to do that, to send them out, to do that. And in some cases it's not been approved.

And I have real heartache with that. If I've got a physician seeing a veteran in Chisholm who says, you need to go see a podiatrist for this ankle or foot injury, whatever it might be, that's exactly what we expected. So when I talked to these veterans, I said, you oftentimes hear congressional intent discussed. Sometimes that goes all the way to the Supreme Court to determine that.

I can tell you what the intent was. The intent was to get veterans the care that they needed as quickly as possible. And if they couldn't get it at the VA in an efficient manner, they needed to go elsewhere. And I think now, to be very honest with you, there's a large number. It rolled out quickly. A lot of folks didn't know what was there.

And I'm hearing assurances from those third-party folks who are responsible for making it happen that it's better, they're getting there, and then we're on the verge of this. But again, when I hear a veteran tell me she dropped her glasses and scratched him and tried to get him replaced, and she's fighting that for three weeks. That makes no sense, both in quality of care or cost.

INTERVIEWER: Why is it, though, that the patients are fighting to get the reimbursement or whatever instead of the providers? Not that they should have the same level of fight as well?

TIM WALZ: Yeah.

INTERVIEWER: Isn't this how-- I mean, in general, Medicare works, where you go--

TIM WALZ: Yes.

INTERVIEWER: --and then it's billed. Why isn't it working this way here?

TIM WALZ: It will. And that was the intent of it. But you brought up a very good point. I use this as an example if you want to know how irritated people are. My colleague from Illinois, Tammy Duckworth, who is an Iraq veteran, shot down, lost both her legs, recently had a baby, and everyone's very excited for her. And because the VA didn't have that prenatal-postnatal care, she had that outsourced. And now she's getting calls from collection agencies because this hasn't been paid to the congresswoman, an Iraq veteran.

There is no excuse for it. It shouldn't be that way. We created it. And again, there's the core care at the VA. And don't get me wrong, many of your listeners now are saying, I get great quality care at the VA. I want to continue to do that. That's great. And they should. But that's not the case for everyone. So we tried to create, which I think the future is going to look like, a blended system where it makes sense. We just can't provide.

When I'm clear up in Bigfork, I hear folks from Bigfork, 400 miles to have a mole looked at by a dermatologist to see what the situation was. That's very cost-ineffective too, in terms of mileage and all those things, plus time for that veteran. So I think it's a challenge. It's a geographic challenge. We have a lot of veterans. As I said, it's 80 million visits a year.

And to be honest with you, I think there's a culture inside the VA that, I have to remind people, we have incredible employees there, and most of them veterans. But there are still some. And I would say that we have to do a better job, especially in leadership. You don't work for the VA. You work for the veteran. And we need to make it as easy for them, again, looking out for taxpayer dollars.

So I would say, in answer, Tom, it's a work in progress. I'm not sure we'll ever totally get there, but that's not an excuse to not try. I think the new system that we came up with to try and alleviate some of those backlogs was the right way to go, to use the private sector when it's appropriate and to use the VA and keep accountability. But we have got to-- and I stress frustrations with this. We're the second largest area of the federal government, yet the VA committee has one of the smallest staffs and the smallest oversight. And that's just not right. They need to be able to do their job.

INTERVIEWER: We're talking with Congressman Tim Walz here, of Minnesota's First District, which is-- cuts across Southern Minnesota here. As members of Congress are on their August recess, we're checking in with as many of them as we can. There were some recent stories in the Star Tribune. We actually did a show about this as well, about prescription painkillers at the VA, specifically in Minnesota, changing how they prescribe those, how they give those. The goal being that they don't want as many people addicted.

But the STrib notes some examples of veterans being cut off, and there's ramifications, and even getting medicines elsewhere. The VA disputed some aspects of the story. Have you found, one way or another, whether that is a problem, whether that is a major problem at the VA?

INTERVIEWER: It is a problem, and it's a problem in America. It's a societal issue on how we deal with opiates. And the core issue, Tom, is pain management. And the thing that frustrates me most that you're hearing what the VA is saying is correct. They're taking the lead, especially in Minneapolis, on some of the reductions. But I get a lot of calls to my office when a veteran is reduced down for all the right reasons, often opioid, to try and get them to a place that's more sustainable. But the pain comes back.

And we had an initiative, one of the first things I got passed when I got to Congress in 2007 was advanced pain management, and this was done with things like Boston Scientific and some of the new things that were coming out. And it was best practices, a stepped reduction plan that by-- when you first prescribe these, you already had to have the plan in place, discussed and ready to go with the veteran on how it would end. And that was never fully implemented across the VA system.

In all fairness, I think we're trying to get at it. But like in Tomah, Wisconsin, where we had all the problems, we're not there. And then when I said it's a broader societal issue, this pain management thing, we go through phases where we overprescribed opiates and now we're on a downward slide. And I'm telling you, we as a society created a lot of folks dependent on these opiates to get through the day on pain management, and then we told them they couldn't have them anymore. That is a really, really-- I would say it's morally irresponsible.

But it is causing all kinds of havoc in the communities because you're right. And we have a pretty good system. And I hear people complain that the administration put this in, making it more difficult to get these drugs. That is true. We can track if you try and get a prescription and try and cross the border, we're OK with that. But you can still do that.

And I think it goes back to the heart of this. The reason this is an issue is that we are not implementing, doing the research, and going forward as strongly as we should on long-term pain management, because that's the core of this. So I think the story is more complex than it's told.

And I think maybe that's where the folks at the VA get a little bit bristled by it, because they are making a great attempt to do this. They are trying to follow best practices, but it is a sticky subject. If you go out and look at the number of folks in society with prescription drug addictions or crimes and thefts associated with them, it's pretty epidemic. So we're going to have to have a broader discussion.

INTERVIEWER: We've been talking-- when we talk the VA, we're talking people who served in the military. But we've also discussed with you before as well about contractors who worked in Afghanistan and Iraq, went through some of the same trauma as active duty personnel. Some are also vets, so they can get some VA benefits, but not all. And if you worked for the private companies, the VA benefits are not there. Is there a working theory, whether it's to give them access or not to the VA? Is there a working theory on how contractors should be handled and addressed here?

TIM WALZ: The short answer is no, that there's not. And I think it-- because that poses a deeper question, especially leading back to the Iraq War. There's still a lot of angst amongst the general population that a lot of the responsibilities of the military were shifted to private contractors, which brought up all kinds of ethical and, I would say, legislative and legal questions that came up.

But the one thing was is that no one was planning when it's a veteran we knew. And I will be the first to tell you, I don't think a lot of planning was done to what the effects of going to the war would be and how that would impact that. Certainly, no planning was done in terms of those contractors. And this brings us back to this issue of there are some that say, well, the VA is so inefficient, just shut it down and let them go into the private sector. That's not the case.

But the problem with that is a lot of veterans don't want to do that because the VA provides specialty care that is directed at the wounds of war and the issues that deal specifically with warriors. And so that's one of the problems with these contractors. They experienced many of those, both mental and physical wounds, that the private sector is not as well equipped as that core mission of the VA is to do it. And no one has had that conversation.

And again, much like anything in health care, if you avoid it, it eventually becomes our problem anyway. If they show up at an emergency room, whether it be a mental or a physical ailment, and they're not covered correctly, they're not covered for the things that happen, we're going to pay for that eventually. So it makes no sense to me. So I think, as you brought it up before, it's been talked about among some, but as a real effort to talk about what to do with these contractors, I think it's not happening. And I think there's a little bit of a mean-spiritedness, and said they knew what they were getting into. They took the pay that was three times as much. And they're on their own.

INTERVIEWER: Exactly.

TIM WALZ: But we made a decision. Everything from how we feed our troops to how we do some of the protection of VIPs. We decided that the most efficient way was to use the private sector. This is certainly open for debate. And I certainly have great reservations with that system. It doesn't change the fact that that's what the law was. That's what we did, and that's what these folks did. So I think it's a valid point you bring up, and one that has not been addressed seriously in any real manner.

INTERVIEWER: Do you have a preference? Send them to the VA, don't, or create some new model? Do you have a preference?

TIM WALZ: Well, for me, the problem is focusing just on the VA with capacity as it stands and the things that they have. Because anytime I do something when I was the one who asked for-- to add Parkinson's, with the research supported it to add Parkinson's to a precursor of Agent Orange, causing Parkinson's, that ended up putting about 300,000 people into the system. And that put everybody back behind a little bit. So I'm saying it's to not do it because it does. But you have to think about that. What would happen if adding them in? And do they deserve those benefits when they could have signed up?

Now the interesting thing with contractors is a large percentage of them are prior military too in certain ways, so they have certain things there. So, for me, it's my preference that they get the care that they need. Because, as I said again, that's both a moral responsibility and an economic responsibility. I'm not sure right now with the transitions we're going through with the VA and some of the, if you will, the growing pains of the Choice Program, that might be the ultimate fix is that they fall under that and can use that system as it went.

But the VA has a priority system, priorities 1 through 8, depending on the severity of your injury and all of those things. And so where you would plug those people into the priority, because someone's going to say, well, why do they get to go ahead of a Gulf War veteran who may be served in Kuwait but was exposed to burn pits and has Gulf War syndrome? So those are all things that would have to be worked out. So, for me, before we get to the point of where we're going with them, there's got to be a real, honest conversation because there are a lot of them.

INTERVIEWER: Tim Walz is joining us from our Rochester Bureau, NPR Rochester Bureau there. We're talking about Congress. Congress heads back. The Iran nuclear deal will be on the plate. Congressman Walz does support that. There's also going to be debt ceiling and budgets due, issues that have led to government shutdowns in the past. The Senate Majority Leader, Mitch McConnell, has said there will be no shutdown this time. We don't have much time, Congressman. But briefly, do you agree, or do you think he's right? There will be no shutdowns this time?

TIM WALZ: I am totally with him that that's what he needs to make sure happens in the House and the Senate. We were told that some of the issues why we had shutdowns is we had divided government between them. That's not an issue now. No one wants to see this. It is reckless. It's irresponsible. We have things, as you mentioned, we have Iran, we have highway bills.

We've got an import-export bank that my business people are clamoring for us to get done. Another veteran-related issue about the Agent Orange Act of 1991 is going to expire at the end of September and having catastrophic implications because it's going to expire before we have the final National Institute of Health study that will come out next year.

All of those things need to be done. This is the basic part of governing. Differences of political ideology, difference of beliefs, that's one thing. Not getting things done. And as you know in the House, all the budget talks on all the budget bills ground to a halt over the Confederate flag. They have not come back up since then. Because if they bring them up, that discussion will happen. And that's where the American people and your listeners right now, there's a big difference between being skeptical of government and being cynical. And we're approaching a cynical season here.

But I give Leader McConnell my full support to get this done. I recognize, being in the minority. I'm certainly not going to get all of what I want, but he needs to recognize he's not going to get all of what he wants because the president needs to be able to sign it. So this is the time to prove leadership. This is the time to show the American public that the glue that holds this country together is compromise. It's compromise and working for the common good. And we've got about a month to do it.

We have common goals. For example, the Iran deal. The common goal is there is a non-nuclear Iran, with the world community standing behind us to enforce the things necessary to make that happen. Now there's a disagreement on what's the best way to do that, but there is no disagreement on what we want to get. So let's have the debate. Let's follow the procedures. Let's get done what can be signed into law. And let's move on. That's where he needs to be.

INTERVIEWER: Congressman Walz, thanks so much for your time. I really appreciate it.

TIM WALZ: Thank you, Tom.