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PHOENIX -- Although much attention this past week has been focused on political conventions and running mate selections, one of John McCain's only campaign events involved a somewhat defensive speech to a group that many consider a big part of his base. Following up on an appearance at the Disabled American Veterans convention in Las Vegas two weeks ago, McCain addressed the Veterans of Foreign Wars in Florida last week and responded to the allegation that his veterans' health care plan is a step towards privatizing veterans' health care.

For many months, McCain has proposed giving every veteran a "plastic card" to be used for the treatment of routine health care needs outside the Veterans Affairs system. In March, McCain held a town hall at a VFW in Chula Vista, Calif., and used a line he had repeated throughout his campaign to promise the audience he would fix the VA health care system.

"The thing that disturbs all of us is that for a routine health care need, too often someone goes down to the VA and stands in line to stand in line to get an appointment to get an appointment," McCain said at the time. "My friends, that's not right, and what I intend to do as president is for a routine health care need I intend to give a veteran a plastic card" which he or she would take "to the doctor or the health care provider of their choice and never have to stand in line to stand in line again."

As he has laid it out on the campaign trail, McCain's veterans' care proposal doesn't force veterans out of the VA system, but it encourages them to use private health care so that the VA can be free to focus more on grievous combat wounds.

"We have got to spend more effort and devote more time to the treatment of the battle wounds, both seen and unseen," McCain said in an address via satellite to the National Forum on Disability Issues in late July. "There's going to be large numbers of people who are afflicted, unfortunately with PTSD, and I believe we need to relieve the burden on the VA from routine health care."

In recent weeks, he's named this "plastic card" the Veterans Care Access Card, and although the campaign claims that the substance of McCain's plan hasn't changed, his rhetoric encouraging veterans to "relieve the burden on the VA" has become much less enthusiastic. At his speech to the DAV, McCain said his card would be for "veterans with illness or injury incurred during their military service," which is very different than "routine health care needs."

He repeated this same line at the VFW a few weeks later, quickly predicting that Barack Obama's campaign would try to distort the intent of his plan to make veterans think McCain was in favor of privatization.

"As today, as other occasions, I have stated in the plainest, most straightforward terms that the Veterans Health Care Access Card will expand existing benefits," McCain said. "I don't expect this to deter the Obama campaign from misrepresenting my proposals, but lest there be any doubt, you have my pledge: My reforms would not force anyone to go to a non-VA facility. That is my promise. They will not signal privatization of the VA."

And almost before McCain's speech was over, the Obama campaign had released a statement from the chairman of the Military Construction and Veterans Affairs Appropriations Subcommittee, Rep. Chet Edwards, D-Texas, fulfilling the GOP senator's predictions.

"Not only has John McCain repeatedly voted 'no' on needed funding for veterans supported by the VFW, American Legion and Disabled American Veterans, he has now come up with a plan to privatize VA health care that the Disabled American Veterans is saying would be a disservice to veterans," Edwards' statement read.

The details of McCain's plan remain vague, and when asked, a spokesman for his campaign once again affirmed that the plan would represent an "additional option," not a limitation on veterans' care.

"It isn't a requirement for where they access care or a reduction of services," the spokesman said. "In fact, the card is an expansion of care for both combat wounded veterans and those veterans receiving broad-spectrum care."

Yet many veterans still fear that such a proposal would take the VA down a slippery slope towards privatization, not to mention representing a failure in fiscal responsibility. After McCain's appearance before the DAV -- a nonpartisan organization -- the group's national legislative director, Joe Violante, shared his unease about the senator's proposal.

"The problem with contracting out is the costs are greater than it is for VA to treat individuals at VA," Violante said. "So, if we send more veterans out into the private sector we start increasing the costs for VA health care, which then forces VA to ration care to those individuals who are within the system. So, we have concerns about that idea."

His group shared its concerns with both the senator's congressional and campaign staffs, Violante said, but he lacked enough details to see how McCain's plan differed from what the VA already had the authority to do.

"For veterans rated 50 percent or higher, there's what's called a fee-based card that would allow them to go for care in your community if for some reason VA can't provide it or if the distance is too far," Violante said. "The VA also has the authority to contract care in situations where individuals are enrolled for VA health care and VA for whatever reason can't provide those services in house."

So according to the DAV, the real problem with VA is that its funding stream is inconsistent, preventing it from hiring the necessary health care professionals to handle the increases in wounded veterans caused by the current military conflicts.

"We believe if we can correct the funding stream, VA would be in a better situation to take care of more veterans in a timely fashion," Violante said. McCain also addressed this concern in his speech, but he connected it to pork-barrel spending, and by waging a war against earmarks -- as McCain has vowed to do -- he could place another roadblock in the way of a consistent budget.

Violante would not speak directly to the value of McCain's Veterans Health Care Access Card because he said that the senator's public statements on the issue had been confusing.

"At one point he had talked about VA focusing on combat injuries and combat disabled, and veterans looking for routine care would get this card to go elsewhere," Violante said. "That's kind of changed now from what I heard today. He's basically talking about all disabled vets and indigent veterans being cared for by VA being able to get that card if they don't have that access. But again, the details -- it's tough even talking to staff about it. They're not really sure of the details. We're still working it out, and we still continue to talk to them about our concerns about that type of talk."

Given his military history, it's no surprise that McCain enjoys overwhelming support from the military community. But based on the number of questions he receives on the topic at town hall meetings across the country, veterans' health care will play an important role in the decision-making process of military members and their family.

COMMENTS

• Who will issue these plastic access cards? How will the veterans health care providers be chosen? I see 'no bids' somewhere in our future. With a few favorites getting all the 'no bids' to handle these plastic access cards. What we need is more funding for the increase that the wars in Afghanistan and Iraq will generate. Not no wild hair scheme. The VA veterans health care isn't perfect, but it does meet most of the needs of veterans. Ricardo Jacques Posted August 29, 2008 12:02 AM
• I have two first hand comments; 1. Ten years ago at a routine medical exam at Tripler AMC I was told I had blood in my urine. Further testing showed I had bladder cancer. Tripler and my second opinion at the Honolulu VA both told me there was nothing that could be done other than removing my bladder and supplying a urinary leg bag and even then I would have an estimated 6 to 9 months to live. I then went to Kaiser (a HMO) where they removed the bladder and some other soft tissues and constructed a sigmoid neobladde. That was ten years ago and I am still doing great, so much for VA who only was willing to use an extremely outdated procedure because of the cost involved. The last ten years of my life might not mean anything to the VA but it has meant a lot to me. 2. To be completely fair I must say VA medical and Psychological services are night and day. The professionals at the VA mental health clinic helped me immenseley even though the upper level managers get bonuses based on how much money they can save by reducing services. JPW Posted August 28, 2008 7:30 PM
• Contracting out such services as spelled out...laundry, as was pointed out for an example...I can agree with if it's more cost-effective. I can't speak for anyone else, but what concerns me as a veteran is not contracting out the "little services"...it's full-blown carte blanche contracting out to the private sector (or at least a fraction of it to begin with) and the slippery slope that precedent *might* create. While I'm not all that familiar with VA rules and regs (primarily because I got kicked out of the system only two years after my Navy time for "making too much"), but let's face it...the rules and regs the insurance industry creates is a minefield inside of a rat maze at best. If a STRICT contract can be done with a private company for a number of years that doesn't start screwing over veterans because of such things as referrals, providers, authorized network limitations and cherry-picking for what's "medically necessary", then I could end up being for it. In the meantime...well, sorry for being cautious, but there are very few for-profit organizations that wouldn't screw anyone and everyone for a buck, and the medical insurance community is far from an exception. It's not hard to discuss, as profits are not inherently evil...everyone on an individual level tries to profit. However, the majority of motivations behind gaining that profit, where a business is concerned, are. I agree it should be free, and if something like that can be hammered out, then by all means do it. What I'm ultimately wary about is what the system can very easily become vs. what the (somewhat vague) blueprint provides for. The devil is, as always, in the details. I'm just worried those details could end up costing even more, and when it comes to the oxymoron of business ethics, vets and taxpayers may ultimately be paying a much higher price. I don't know about you, but I have no desire to line CEO pockets while they assign lawyers to find and create loopholes to get out of paying for treatment in part or whole. Thus, the reason for my caution and skepticism. Tigerhawk Posted August 28, 2008 11:34 AM