So, over 20 million veterans in the U.S., but just over 5 million patients enrolled at Veterans Affairs Medical Centers? Well, maybe some of the 15 million veterans who don't use the VA don't live close enough. Maybe. The main reason that the VA only serves about one-fourth of veterans is this, something you rarely read about or hear about during all the hoop-dee-doo over the latest "VA Scandal": Most veterans don't qualify for medical services from the VA because they either 1) don't have a "service-connected disability", or 2) their income isn't low enough. Good luck getting "free" treatment at the VA if you are a veteran and have no service-connected disability and make $40,000 a year. Middle class veterans without service-related disabilities get treated at private hospitals, with their private insurance and co-pays, just like the rest of us. The VA medical system is essentially for poor people, which is fine, but let's just realize what we're talking about here.
As for the argument that the VA must continue to exist until the crack of doom, well, I find that rather dubious. If you lost your leg, either in a car crash or an IED attack, would you rather get care at Cedars-Sinai or a VA hospital? C'mon. Do you think the VA has the world's best PTSD care? You sure? Where's the evidence that they do trauma work any better than psychologists in private practice? What's their success rate with PTSD, i.e., how many of their PTSD patients show significant improvement within 24 weeks of entering treatment? Pretty hard for anyone to get better in a system that gives you monthly disability checks but only as long as you stay sick. "Come to the VA for PTSD treatment -- and leave as a financially secure, but unemployable and chronically disabled veteran!"