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.