The VA Is Being Privatized. Here’s How I’d Stop It.
Congress passed laws letting veterans see private doctors when the VA is too far away or too slow — a good idea. But instead of letting those doctors work directly with the VA, they routed everything through insurance middlemen — Optum (owned by UnitedHealth) and TriWest. They manage the referrals, process the bills, and take their cut. The more veterans they handle, the less money the VA has to hire its own staff. Both parties built this system. The insurance industry donates to both.
Salaried employees serve the mission. Contractors serve the contract. When the VA gets privatized, it doesn’t get more efficient — it changes who it serves. It stops serving veterans and starts serving shareholders.
The Fix: A Guard/Reserve Model for Doctors
The problem was never letting veterans see local doctors. The problem was routing it through insurance middlemen instead of building it into the VA.
Think about how the Guard and Reserve work. A reservist keeps a civilian job. On drill weekends and annual training, they go on military duty — paid for that time, earning retirement credits, covered by federal benefits while on the clock. Then they go back to civilian life.
The same model can work for doctors. A local doctor keeps a private practice. When a veteran walks in, the doctor goes “on VA clock.” That visit runs through the VA system — records, billing, payment — all in one place. The doctor gets paid by time, not per-procedure. They earn credits toward a federal pension. They’re covered by federal malpractice insurance at no cost — instead of paying $30,000 to $226,000 a year in Florida for private coverage. No Optum. No TriWest. No corporate billing system skimming every transaction.
Per-procedure billing at Medicare rates is the number one reason private doctors turn down VA-referred patients today — Medicare pays roughly half what private insurance pays. A salary-by-time model eliminates that complaint and kills the billing overhead entirely.
This does two things at once. It adds to VA staffing — these doctors become part of the VA system. And it costs less because there’s no corporate middleman taking a cut. The money goes to care, not overhead. The reason Optum and TriWest exist in the middle is that Congress treated outside doctors like vendors submitting claims instead of staff working part-time. Claims need a processing system. Payroll doesn’t. The VA already pays full-time doctors every two weeks — a part-time doctor on VA clock gets paid the same way.
The current plan sends our tax dollars to corporate chains and calls it “veteran choice.” My plan gives veterans the same choice — but the money stays in the VA system and the doctor stays in the community.
Two Clinics in Two Places Beat Two Clinics in One Place
A few years ago, the VA opened a brand new primary care clinic about a mile from the VA hospital in Gainesville. It’s really nice, and it’s only about ten minutes from my house — same as the hospital. But the hospital already had primary care. They could have kept the primary clinic on the hospital campus and put the new one in Bronson instead.
If they had, veterans in Cedar Key would have about a 45-minute drive. Williston — 20 minutes. Archer — 15. Newberry, Chiefland, Fanning Springs, Trenton, and all the places in between. And me? I’d have a choice: make an appointment at the hospital ten minutes away and deal with the parking, or drive 30 minutes the other direction to the clinic in Bronson. Two clinics in two different places are better than two clinics in one place.
But getting a new clinic approved can take years. In the meantime, mobile units can set up temporary clinics around the district while we work on getting permanent facilities built. They don’t need new laws. Federal grants already exist to fund them. What’s missing is a representative who connects the pieces and gets them on the road.
This isn’t a ten-year plan. This is a Day One priority.
Eliminate VA Copays
The government’s own auditors have said, more than once, that the VA can’t even tell whether its copay system pays for itself. If the billing system can’t prove it’s worth running, stop running it. Getting rid of copays means getting rid of the whole billing operation that goes with them — the staff, the payment processing, the collections, the letters. Simpler is almost always cheaper, and it means we actually know where the money is going.
Right now, I get a bill in the mail, have to remember to pay it because there is no autopay, log into pay.gov, get identified through ID.me, navigate through several pages of approval checkboxes, enter a multi-digit payment code, then either pay by credit card with a convenience fee or enter my checking account numbers and hope I get them right.
One time I forgot to pay and was only a day late. I got another bill with the amount plus a penalty, so I paid it right then — which meant I double-paid. Some time later I got an envelope from the IRS and my heart skipped a beat. I opened it and the panic dropped — it was a check for $1.89. No explanation. Until I got my next bill from the VA and figured out what happened, I had no idea what it was for. I didn’t cash it for months. Instead of just crediting my next bill, the VA told the IRS to cut me a check for $1.89. Two federal agencies, postage, printing, processing — each step one more thing that can go wrong, each one costing more than the $1.89 it was trying to return.
Every Veteran Deserves Care — Regardless of Discharge Status
Veterans with less-than-honorable discharges have twice the suicide rate of other veterans. Many were discharged for conditions the military itself caused — PTSD, brain injuries, substance use that started as self-medication for wounds nobody treated.
The military gave them the condition. Then it punished them for having it. Then the VA turned them away for being punished.
That’s not a policy failure. That’s a betrayal.
Recent changes have opened some VA services to these veterans, especially mental health and crisis care. But coverage is still patchy, the paperwork is real, and many don’t even know they might now qualify.
Our mobile clinics serve every veteran who shows up. We connect them with the VA benefits they’ve earned, help them get their discharge upgraded, and partner with community health centers for anything the VA still won’t cover. No veteran gets turned away at our door.
That includes recruits who got hurt in basic training before they ever finished. They raised their hand, took the oath, showed up. They got hurt serving. They should be eligible for VA care.
And it includes veterans in prison. Losing freedom shouldn’t mean losing healthcare. The mobile unit can make a stop inside prison grounds with vetted staff. A veteran is still a veteran.
Veterans Connect to Every Issue
- Healthcare — The mobile clinic model starts with veterans and grows to serve the whole community. For the plan to extend this to all FL-3 residents, see the healthcare plan.
- Economy — A veteran who isn’t broke isn’t desperate. Economic stability is suicide prevention. Building a floor under everyone — including those who served — is a long-term goal worth fighting for.
- Housing — Veterans in rural FL-3 face the same housing crisis as everyone else. Hurricane-rated co-op housing serves the whole community.
Let’s Get It Done
We veterans know something most people don’t. We know how to work the system from the inside — call a buddy in supply, get it done before the paperwork catches up. That’s what a good congressman does. Opens doors, carries the big stick when we get blocked, connects the people who need help with the people who can provide it.
I took my oath at a MEPS in Philadelphia in 1983. I still hold myself bound to that oath today. Let’s keep it together.