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tv   Newsmakers VA Secretary Robert Wilkie  CSPAN  June 3, 2019 2:06pm-2:41pm EDT

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together over the last 25 years to have made the modern reality where the internet and technology has infiltrated basically every crevasse of modern life. >> tonight at 8:00 eastern on c-span2. >> our guest on newsmakers is the secretary of veterans affairs robert wilke. let me tell you about him as we start. he's the 10th secretary of veterans affairs born in july of 2018. he's also a colonel in the u.s. air force reserve. a long history in national defense. including under secretary james mattis. undersecretary of defense, and served during the bush 43 administration. thank you very much for being with us today. it's particularly timely because next week the congress' big mission which is now law will be rolling into effect on
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june 6. we're also about to celebrate the 75th anniversary of d-day. timely visit, thank you. let me introduce the reporters who will be asking questions. leon shane, deputy editor of military times, and nicki wet lane is stars and stripes reporter. as we start would you please give us a brief synopsis of what this big new law, you called it a transformative time for the veterans administration. >> the first part of mission act comes into effect on june 6. and what that does is it opens choice. ure on if the v.a. cannot provide a medical service that a a veteran requires within a specified amount of time and also if that veteran has to travel a certain distance by give the veteran the option of going into the private sector to get that care. the thing that mission does is correct the mistake of the original choice act which was passed in the aftermath of the
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phoenix v.a. fiasco. the tragedy in phoenix. what this does is it consolidates seven community care payment systems into one so that we have an efficient way of weighing our smalltown doctors and our community care hospitals. it's only the first part. the second part kicks in in october when we do something that no other health system does. we support the families who take care of veterans. in october we begin to close what i consider to be the last loop leftover from vietnam in that we provide financial and educational resources to the families who support warriors from vietnam. that is a revolutionary thing. >> i want to come back to the caregivers point in a minute. to look at the deadline, is v.a. ready for this? is the private sector ready for this? we have seen some estimates that say the new eligibility
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rules for veterans who will be able to seek community care will go as much as triple or quadruple. i know you have said you don't expect to see a spike in usage, there are going to be a lot of veterans going into private sector care now. where maybe they haven't seen veterans before. do you worry the private sector is ready to absorb these folks and take care of them? secretary willingy: i think the private sector is ready. by simply filing the system they'll be much more ready than they were under choice which i think the authors of the legislation would agree that it was an message -- emergency measure passed in the heat of the moment. let me go back to the habits of veterans. what i have seen in the almost one year i have been both the acting and the secretary, is that veterans are now voting with their feet. the number of veterans requesting to go into private sector has dropped. it's down around 30% to 31% when traditionally since the end of world war ii it's been in the 38%, 40% range.
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in addition to the statistics that you have reported on from the annals of internal medicine that say our medical care is as good or better than any in the private sector, they are staying with us. remember what mission is, it is only available if we don't have a particular service. for instance, if we can't provide rheumatology in fayetteville, north carolina, and that veteran lives a certain number of minutes away from our facilities, and there is a wait time to bring a ruletologist in, then we give the veteran the option of going into the private sector. it is not libertarian v.a. i think some of the cost estimates are based on the misunderstanding of what the congress passed. they did not pass total choice. they passed an option in the event that v.a. cannot provide a service. >> one of the major issues, or their major issue that got stoot up in 2014 and throughout
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its life span getting private providers paid on time. some even dropped out because they weren't able to get paid on time. under the mission act, are you able to pay people who opt into this? if so, what changed? secretary wilkie: let me tell you what you reported before you started working for stars and strichese. choice act had seven different payment systems. some sections of the country had a payment system based on medicare reimbursement. another perhaps on try care. what this does is -- tricare. what this does is create one standard and that's based on medicare reimbursement. everybody knows it. we have been out in the field with information and training to doctors and medical centers a across the country. they are certainly used to the medicare reimbursement. the other thing that we have done, we have sent out 9.5 million letters to all of our veterans. our information is up in our medical centers and vet centers.
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we have made clearer to our veterans when they have a concern, come to us. we do expect on june 6 to be ready. i have said that we're going to receipt it as just another day at v.a. i am a' confident that our team -- i'm confident that our team is ready. i have been in 32 states in the last eight months asking those questions. i'm confident there will be a few hiccups, but there always is in an organization that has 370,000 employees. >> could you explain a little bit or describe what the veteran's going to experience from their perspective on june 6? can can he or she go into a v.a. and talk with a front desk person using the mission act? secretary wilkie: they are note going to experience a great change unless they have something scheduled that we don't have available for them. if they want something that we don't have. so they will go to their
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medical team. there is a program that we have and that's now deployed in all of our hospitals and clinics called the decision support tool. that veteran will sit down with his providerer, go back to rheumatology again, if we can't provide it, the screen pops up, the medical professional at v.a. tells the veteran this is what's avail and in our area. we can punch this button and make an appointment for you. the interesting thing that has happened is that we now know that journal of american medical association has reported this, that our wait times in the most important medical specialties are better than in the private sector. give you an example. largest city in florida, orlando. the wait time for specialty surgery at the v.a. center in orlando is 12 days. in metropolitan orlando it's 78 days. my view, one of the things that i have said many times, is that
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i don't expect to see a major spike because of the progress v.a. has made since phoenix. >> you have been talking about this for a while. we have been writing on this. there seems to be still a lot of concern about -- among v.s.o.'s you could see a spike this. could be expensive and undermine the existing v.a. structure. when do you think you'll be able to confidently come before them and say -- secretary wilkie: i'm sure they'll have me standing before them in a short time. let me go back to what the underlying premise to all those questions. and i have been very vocal in knocking down that premise. the premise has been that we're in the process of privatizing the institution. i have had the honor of presenting the largest budget in the history of v.a. to the congress in the last two months. $220 billion. i am a pariah in the cabinet
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room because i'm the only one who did not have to find budget cuts. the budget also calls for 390,000 employees. $9.5 million for mental health services. i mentioned today when you were listening to my speech a billion one for homelessness projects. we're not in a pathway to privatization. if we're we're doing it in a strange way. >> shift topics -- >> before do you that could i ask one related question. it seems as if a veteran is moving in and out of the system that effective transfer of medical records will be critical to this. the private sector hasn't done so well. how will the v.a. do better? secretary wilkie: that's one of the major transformative programs that v.a. has. i will step back and give you a personal view. my father gravely wounded combat soldier returned to active service after recovering from his wounds.
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when he finished after 30 years and jumping out of airplanes and suffering wounds in southeast asia, he had an 800-page paper record. that was the only record that he was -- he had of his service. he had to cart that around the rest of his life. one of the things general mattis and i discussed at length is creating an electronic record that begins to be built when that young american walks into the military entrance processing station. that record is handed over to v.a. when that veteran leaves the active service. we're testing it out in the pacific northwest and alaska with the department of defense. i can't tell you how many yearser it will take to get it online for everyone. but the key here is not only that it gives us a a complete picture of a veteran's health, but in a association with the mission act it is interoperable. an example, if gi to the v.a. in fayetteville, north carolina, and give me something for pain and i go to my private
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doctor and he gives me something to help me sleep, with the interoperable electronic health record, that doctor punches that information in to my record and v.a. now knows that they have a veteran who is on a dangerous spectrum for abuse, addiction, or worse. that is one of the projects that we have that i believe will take the v.a. into the 21st century. >> back to something quickly. the decision support tool that will help veterans and providers decide whether they should go into community care. a couple inspect the u.s. digital service gave a negative review. could you explain has that been scrapped or changed? how did you -- secretary wilkie: we were moving ahead. it was interesting. i will tell you what i said under oath. i disagreed with digital services. they didn't talk to us. they made a decision from afar based on what i would consider to be past practices at v.a.
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we have been testing this thing out for months. our practitioners have it. our b.s.o.'s in the field have been exposed to it. i expect it to be up and running on june 6. digital services, i think, was painting a picture of v.a.'s past i.t. problems. that conflated that past with what is going on right now. >> wanted to shift to another major priority which is veteran suicide. you have said remains the top clinical priority for the department. we have seen with some frustrations the numbers haven't dropped that much. i know you are the head of a new white house task force to look into this. what are you looking into so far, what things are you guys considering? i know you've got several months before that task force wraps up. i also know the urgency behind this. i am a' wondering if you started to see some solutions.
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secretary wilkie: it is a great national tragedy. i have said that we need something broader than v.a. we need the national conversation on life. the day i testified last in front of the appropriations committee, n.p.r., and "the new york times" did a lengthy piece on the spike in teenage suesides to correspondent -- tv espond with the movie -- sears "13 reasons why." if we just look at the last tragic act, we're not doing a service to the veterans of our country. i said today at the coalition to prevent veterans homelessness, that we need to take a look, a strong look, at homelessness, addiction, and mental health. the budget v.a. for mental health services is $9.5 billion. we haven't even reached the sputnik stage in this country in terms of getting our arms around mental health issues. i envision a whole of government approach with a whole health approach to tackle
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veteran suesides. the great tragedy for me is that of the 20 veterans who commit suicide, one or two are on active duty every day. two or three are in the guard or reserve. another 10 we have never seen before. we have to work more closely with the states and localities and nongovernmental organizations to find those veterans who we had no contact with. i have seen it work in many cities on the homeless issue. places like new orleans, jacksonville, houston where the charities go where v.a. can't. i think that will be one of the keys in getting our arms around it. again, it's much larger than veterans. we may be the most visible manifestation of this tragedy, but the entire nation needs to have a very deep discussion about life and particular mental health. >> it is a societal problem. if you are in the charge of the v.a., could you tell us what v.a. can do?
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secretary wilkie: it is a different culture from the culture i was born into. in my father's day in the military i saw growing up you never talked about being wounded. you never talked about feeling fwressed or anxious. it was not --depressed or anxious. it was not part of the ethos. there was a danger if you did talk about those things the military would relieve you of your duties. that has begun to change as the undersecretary of defense under general mattis, we implemented programs whereby we start talking to members of the armed forces from the time they get into boot camp to the time they begin transition. what we're doing at v.a., we have same day mental health services. if you come to us and say i am anxious, i am depressed, i have a serious problem, we will see you. every veteran who comes to v.a. now gets a mental health screening. so that means since october 1 we have screened over 900,000 veterans.
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of those 8900,000 -- 900,000, we're closely following 3,000 because they have given us indications that they might want to harm themselves. the one danger we have is america is not producing enough mental health professionals. we hired 3 kgs 900 in the last year. we shoulded have hired 7,000. we're aware of the rest of america. but mental health, mental health looking at it, talking about it, i think is the key to the future. i have said it before, i think before my children are out of college, we may turn the corner on cancer. we haven't even begun to reach the corner on mental health issues. >> you mentioned that large number of the 20 a day that don't have any contact with v.a. how do you -- obviously you got some control over the folks you have regular contact with.
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what can you do new with outreach? we have been hearing about v.a. trying to get to these folks for years now. to a certain extent it is outside of your arms. once you get them in you can help more. what are you thinking in terms of how to improve that outreach? secretary wilkie: one that all members may have five legislative days to revise and extend their remarks programs is to go to the o country. areas that i believe have been ignored by both parties, both -- republican and democratic administrations, native america and rural america. i use alaska as an example. i was up in alaska in october. i'm going back next month. i talked to the he alaska federation of nativences -- natives, and i asked to double the number of tribal representatives they have specializing in veterans issues to get out into the wilderness and help us find those veterans. more than half the veterans in alaska are not part of the v.a. a. that's obviously a part of america where people go to get away from society. but we need to be more
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aggressive. i have talked to the nations of the southern plains. i'll go to the northern plains. i'm also talking to charities across the country to help us reach into those communities. >> you mentioned native americans and rural vets. on capitol hill talking about women's vets, too, feeling comfortable going to the v.a. are you driving more resources or outreach towards them? secretary wilkie: absolutely. i think what we're looking at v.a. is a massive change in culture. a change in culture that begins with the department of defense. when my father was commissioned two months before kennedy's inauguration, less than one half of 1% of the force was female. as the undersecretary of defense i was responsible for a force that was 17% female. i think it will go to 20 by 2025. what does that mean for v.a.? 10%. about $9 billion in terms of our health expen at this cures
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are spent for american women. i expect that to go up. we have women's clinics now in all our hospitals. our people are now trained to meet the specific needs of american women. there has been a major, major cultural shift. again, though, we're competing with the rest of the country for professionals who specialize in women's health. if i -- will i tell you i have a priority when it comes to hiring and that's mental health, women's health, and primary care. >> do you feel that cultural shift has happened? we still hear reports of women who will walk into a v.a. and they'll be asked does your husband need something? there is that divide that is still v.a. seems to have an idea of older, male veteran. it's a stubborn issue. secretary wilkie: you are talking about a conservative institution, in terms of the military, some areas of the
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country where the veterans population is older, it's based on world ward r war ii, can korea, and now vietnam. it's very different from my home area of north carolina where people are used to and have been used to for a long time to see women walking down the street wearing the beret of the 82nd airborne division. i can't account for all of the attitudes of all of the people who use our services. what i can say is that we have a very aggressive program for all of our employees when it comes to making them culturally aware of the differences that some of our veterans have. their experiences. and again culture in the militarier is key. it's something that begins in basic training and works its way through active service and then comes to us. i think as we move farther along, as the number of women, prsage of women on active -- percentage of women on active
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duty continues to increase, and those areas of the veterans population that have those more ys -- mor a ays leaves the scene, you'll probably see fewer reports. >> four minutes left. >> a few months after you were confirmed to be the secretary and spent months before that as acting, you said the v.a. was getting better but wasn't all the way there. at what point is it all the way what you want it to be? is it with the mission? secretary wilkie: it's a combination of many things. let me tell you quickly in addition to mission we're reforming our supply chain. we're reforming human resources. that's absolutely key if we're going to have a modern health care administration. what i put a great premium is, as i say veterans are voting with their feet, we have a veteran satisfaction rate of about 89.7%. there is nothing in the private sector that compares with that. to me that tells you there is
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an imperative on veterans going someplace where people understand the culture and speak the language. i look at those things. i look at the dip in the number of veterans asking to go in the private sector. because they are comfortable with our services. our wait times are better. our medical services are as good or better than any in the country. i look at those metrics. we're in a better place. i'm very secure in saying that. and i see that when gi out to visit. >> back to caregivers. as you said there is supposed to be a significant expansion early this fall. are you confident you will a' meet that? we heard a lot of questions about the i.t. system of the the new report this week from senator murray's office. she has concerns about it. how the current program is being administered. secretary wilkie: let me tell you how i responded to senator
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murray's concerns can. i'm not removing anyone from the caregiver program unless i'm convinced the system works. you have seen in the last few months on the issue of the forever g.i. bill i said stop the process. we will hand write checks if the i.t. system does not work because we're going to get veterans their money. the same applies to caregivers. i am a' not going to certified a program that does not work. and also that means the i.t. program. that means the training of those who have to go out and support caregivers. one thing i was clear about, i said this in front of both the house and senate, no one is leaving the program. i stopped that and i am confident that we will get there. i am not going to tell you that i think that we will meet all of the parameters of the legislation on the first of october. but i will certify that program when it's ready. our veterans deserve no less. >> a question for you, you talked about the need for a
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base closing style review of v.a. facilities across the country. this network covered so much of that in congress and the local communities. it has enormous impact. what did you learn from that process? secretary wilkie: what i learned from brack -- brac, watch it from afar, is that it did not work in many parts of the country because people weren't educated. let me step back and tell you how that applies to v.a. the congress has told us how we go about doing this. in the mission act it says we have to provide for market acertificatesments across the country. 96 individual markets have to be reviewed. then the congress then mandates the formation of an asset infrastructure review commission that will make those recommendations on how we move resources. one of the problems i have is that i've got five or 600 buildings over 100 years old that i can't close. i have to be able to get those
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things off of our books in order to save money to provide veterans the needs they have. i expect that when we finally get back to the infrastructure debate, and i hope it's soon, i will be discussing the v.a. has a backlog of $60 billion. some of our fastest growing areas like phoenix we're looking at a hospital that was built right after world war ii where we still have four patients in a room. that's not acceptable to anybody. we have to have a clear vision. i think mission act gives us that. i also think we need to be a part of this great infrastructure debate that is long overdue. host: that's it for the time. these are such big conflict issues. can we invite you back? we'd like to see how it's going. thanks for being here. [captions copyright national cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] host: nice makers is back after
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our conversation with v.a. secretary robert wilkie. i want to talk about politics as we start. this is this has big bipartisan support. congress will watch closely. there is another american living at 1600 pennsylvania avenue who has made veterans a a huge part of his campaign for office. he goes after veterans groups all the time. this matters politically going into 2020. what are the stakes like? >> that's the real question is what v.a. is selling. what the president is selling. not always on the same page. the president has been saying he's brought choice to veterans. we had the choice program. it was a program in itself. this is a rethinking of it, expansion. clearly something the president will be campaigning on. clearly an issue he wants to be able to go to the voters and say i helped the veterans. i helped bring the v.a. back into shape. these next few weeks will be important for v.a. how does this get rolled out? as nicki referenced before, the initial rollout of the choice act had major problems, major
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issues with paying doctors. if this flounders again, it becomes a major mess. host: you both watched this carefully, given the stakes being so high, what is v.a. doing that you learned in its approach that will make this a success? >> it's different with the choice act. with the choice act in 2014 i was reporting at a local v.a. and they had 90 days to roll it out. they have had a little longer this time. i think wanted -- think congress wanted to give them locker. we know they have a team set up to respond to problems that might happen. they are expecting problems to happen. maybe that's a good thing. this thing is very complex. there are a lot of criteria for eligibility for which veterans can can go out into the private sector and which can't. that's why i mentioned to secretary wilkie the decision support tool that's supposed to help providers and veterans to figure out if they are able to
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go into the private sector. that was given a very negative review by the u.s. digital service who said it was flawed and could cause confusion and disyou ruppings. i guess they have been working -- disruption. i guess they have been working on it. >> v.a. made a lot of promises. the reports to congress have been we're ready for this. you heard the secretary say that. we'll see. we'll see if it happens. we'll see if in a few months we're reporting on widespread problems. maybe that tool doesn't work. maybe there is confusion about how the eligibility works. maybe everything goes right grate and they live up to the billing anti-president can walk on the campaign trail and say i fixed it for you. >> some lawmakers were asking the v. a a., do we need to put this deadline back? we don't want it to be a catastrophe. if we need to push this back we're happy to do that. they said, no. we can meet this june 6
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deadline. host: clearly anyone if given that opportunity would seem to take advantage. it doesn't come along often in washington. would that indicate that the v.a. feels ready? >> v.a. is expressing complete confidence in it. this is the first step. there is a lot to unpack in this mission act. it was a very, very comprehensive bill. there is caregivers provisions. the base closure. a whole section on emergency room visits and walk-in visits we didn't talk about because it's not as controversial as some of the other ones. it's a lot to unpack. they have been working on t this has been almost a single focus of v.a. for a year now. it's show time. see how it goes. >> there are other parts to roll out. the one thing they have to get right they are promising they'll pay private providers within seven to 14 days after they treat a patient, which is a big difference from what we have seen under the choice act. that's one thing they have to
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get right. they saw providers drop out of the choice act and refuse to treat v.a. patients because they weren't getting paid. if that starts to happen -- >> the community for care. host: we have one minute left. the secretary talked about difficulty in recruiting health professionals into the system. why is that? >> they are not there. they are not enough profession alleges. v.a. has made a big effort. this is one of the times where v.a. has pointed out there is not enough -- professionals with these skills. host: it's not a payment issue. >> i'm sure more money could help them get a few more in. we both talked to health professionals outside v.a. and heard it's a national problem. there is not enough people. host: just about out of time. june 6, the big day. what will you look for as journalists? >> i'm interested from a veterans perspective what they are going to see. if they can can can go in and they know about this mission
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act and say i want that. the president has been promising choice, i want that. what is their experience going to be? i'm hoping to get an idea. >> i'm interested to see how this is advertised. something that's just another tool in the toolbox or will v.a. push this? you should look into community care versus this may be something that could help you out if you bring it up. host: the secretary called it the most transformative period for the veterans administration. you will be busy covering it. thanks for being here with your questions. [captions copyright national cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] >> the house is recess. back at 3:00 eastern time working on a $19.1 billion disaster aid bill today for caused by flooding, wildfires, tornadoes, hurricanes, and other natural disasters. watch live coverage here on c-span. and this evening former u.s. ambassador to the united nations, nikki haley, will deliver the keynote address at
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the susan b. anthony gala. watch live coverage at 8:35 eastern on c. span 2. watch online at or listen life with the free c-span radio app. >> the c-span bus recently traveled to indiana and ohio asking folks what does it mean to be america? >> the questions posed to me what does it mean to be an american. what it means to be an american is understand the freedoms. to understand all of the tenets of the constitution. which is what we try to teach to all our students and to know your rights, which you're going to find in the first part. so understand the individual rights you have. i think it's also important as an american to understand you have a role to play and be an active participant and that's based on voting, even getting involved even more with issues
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and groups and interest groups. >> question of what it means to be an american. i believe it is a theme of liberty we have been granted by our constitution. i don't think it allows race or sexuality, who you are. it's the fact that you're here. the fact that you can exercise that right. without other's rights infringing on them. that freedom is what fundamentally -- what makes us light to everyone else. >> i think the question of what does it mean to be an american. i think it means you're he free. it means you're free to pursue your dreams. your passion. and also free to speak your mind. and free to live your life. i also think it means responsibility. meaning you are responsible to contribute to our society.
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be passionate, be creative. remain free. >> voices from the road on -span. >> queen elizabeth ii welcome president trump and first lady melania trump to buckingham palace today. there will be a number of stops in europe this week for the president and family. on thursday the president will help mark the 75th anniversary of d-day in normandy, infrastructure france. -- in normandy, france.


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