Department of Veteran Affairs, Under Secretary for Health

Department/Agency: Department of Veterans Affairs

Position:

Under Secretary for Health

Executive Schedule: Executive Level III - Presidential Appointment with Senate Confirmation

Major Responsibilities:

•  Deliver health care to more than 5.6 million veterans
•  Manage a $39 billion health system that employs more than 221,000 professionals and support staff
•  Oversee the nation's largest provider of graduate medical education and a major contributor to research

Key Competencies and Preferred Qualifications:

• Seasoned health care administrator
• Medical degree
•  Military service

Insight:

The Under Secretary for Health directs the Veterans Health Administration (VHA), managing a $39 billion budget to provide care for 5.6 million veterans. The under secretary runs the nation’s largest integrated health care system, with 221,000 professionals and support staff at 1,400 hospitals, clinics and rehabilitation facilities across the United States. It is widely regarded as a model for how a unified system can achieve superior results for patients.  

The VA health care budget has nearly doubled from $22 billion in 2001 while the country was at war. Even so, President Bush was accused by Democrats of shortchanging veterans’ needs.  The Democrats claimed Congress, not the White House, deserved credit for the growth of the VA medical budget. Congress also turned back Bush proposals to sharply increase patient co-pays.  

The Bush White House, in its final budget request, boasted that it had provided “the best possible care for our wounded warriors,” including expanded mental health and substance abuse treatment, and the opening of four state-of-the-art polytrauma centers for the most grievously wounded. President-elect Barack Obama has pledged to do better by veterans, and his under secretary for health will be charged with carrying out that promise.  

The topmost priority will be improving care for the growing numbers of wounded returning from Iraq and Afghanistan, including those with severe brain injuries. Advances in frontline care allow more soldiers to survive grievous wounds, but many of these veterans require long-term rehabilitation and care from the VA.  

Adding to the physical injuries of war are combat-related mental illnesses. Nearly 34,000 veterans have been diagnosed with possible post-traumatic stress disorder (PTSD) since 2001. VA Under Secretary Michael J. Kussman told a Senate panel in June 2008 that his agency had taken steps “to ensure they receive prompt and efficient services for PTSD and other mental disorders,” Kussman said. He promised that in fiscal 2009, “funding enhancements will close gaps in services and allow us to implement a more comprehensive and uniform package of clinical services for PTSD and other disorders.” 

The VA has been a pace-setter in use of technology to improve medical record keeping. Both veterans and their physicians have benefited from the VA’s early adoption of paperless medical records, and other public and private health systems have sought to build on the VA’s success. VA physicians and scientists conduct extensive research, with results benefiting the general public as well as war veterans. Still, it took the VA years to recognize the problems that veterans of the first Gulf War faced from exposure to toxins on those battlefields in 1991.

Kussman said the reality of VA health care differs from the public perception. “Although the quality of VA health care has been found equal to, and often superior to, that furnished elsewhere, the popular perception of the quality of VA care is sometimes less favorable,” Kussman told Congress last June. “This is unfortunate and undeserved. Some continue to believe that health care services furnished by a government system can never be as good as those delivered by the private sector. In many cases, we have not done enough to educate the public about VA's many achievements and outstanding programs. And we could do more to ensure our own health care employees are informed about the Department's recognized awards and achievements outside their own areas of expertise.”   

Key Relationships – Within the Department or Agency:

Secretary and Deputy Secretary
Assistant Secretary for Management, Veterans Health Administration
Assistant Secretary for Information Technology, Veterans Health Administration
Assistant Secretary for Policy and Planning, Veterans Health Admnistration

Organizational Chart

Key Relationships – Within the Government:

Assistant Secretary for Health Affairs, Department of Defense
Assistant Secretary for Health, Department of Health and Human Services
Surgeons General, Department of Defense

Key Relationships – Outside the Government:

State Veterans Affairs Offices
Veterans’ interest groups
American Medical Association
American Hospital Association
Allied medical groups

Nomination Referred to:

Senate Committee on Veterans Affairs

Current Position Profile:

1. Robert A. Petzel (Confirmed: Feb 11, 2010). Former acting principal under secretary for health, Veterans Health Administration. Veterans Affairs Department, network director of Midwest health-care network.

Recent Position Profiles:

2. Michael J. Kussman, M.D. (Confirmed 2007). Retired brigadier general. Former commander of Brooke Army Medical Center, Walter Reed Hospital and Europe Regional Medical Command. Responsible for Army health care throughout Europe, the Middle East and Africa. Board-certified internist.

3. Jonathan B. Perlin, M.D., Ph.D. (2005-2006). Former medical director for quality at the Medical College of Virginia Hospitals/Virginia Commonwealth University Health System.  Ph.D. in pharmacology. Now chief medical officer and senior vice president for Hospital Corporation of America.

4. Robert H. Roswell, M.D. (2002– 2004). University of Oklahoma Health Sciences Center professor of medicine. Executive Director of Persian Gulf Veterans Coordinating Board. Expert on management of chronic diseases.