California has more veterans — about 1.85 million — than any other state in the country. Many of its former military personnel utilize Veterans Health Administration facilities like Fort Miley in San Francisco or VHA in Sacramento. The nation’s only fully integrated, publicly funded healthcare system has had widely publicized problems with wait times.

In spite of this, a congressionally mandated study recently praised the VHA for providing clinical care comparable to or better than that provided in the private sector. Other research has shown the VHA provides some of the best mental health care services in the country and that its healthcare professionals have specialized knowledge of military related problems — from Agent Orange-related diseases to homelessness — lacking in the private sector.

This is why major veterans groups — often assumed to be politically conservative — almost all favor maintaining the publicly funded hospitals and clinics that now serve nine million VHA patients. Nevertheless, the VHA faces multiple threats from Republican politicians, right-wing ideologues and for-profit providers hoping to increase their “market share” through privatization of veterans’ health care.

Donald Trump, for example, favors total outsourcing of VHA services so its patients can become customers of the U.S. health care industry. In Congress, two prominent Republicans — Arizona Sen. John McCain and U.S. Rep. Cathy McMorris Rodgers, R-Wash. — have proposed legislation that would dismantle the VHA, despite estimates that this would almost triple the overall cost of veterans’ care.

McCain worked with Sen. Bernie Sanders two years ago to add $10 billion to the VHA budget to create a trial program called “Choice,” which allowed veterans faced with appointment delays or long drives to use private sector providers. The program, which was poorly conceived and hastily implemented, has been an abject failure.

To try to remedy problems the VHA has in enhancing access to and reducing wait times for VHA services, another proposal has just been made by members of the congressionally mandated VA Commission on Care.

In its final report, the commission, among many other things, recommends the creation of a new VHA Care System. Veterans eligible for VA services because they have low incomes or service-related health care conditions could choose to seek care from either VHA or private sector providers.

These non-VA providers would be supervised by the VHA, follow its protocols, develop expertise in military-related health problems and utilize a common electronic medical record.

The report predicts that in 20 years, 40 to 60 percent of veterans would use private-sector providers if this approach was implemented,

San Francisco’s Michael Blecker, a Vietnam vet and executive director of the local veterans rights organization Swords to Plowshares, served on the Commission. He bucked the commission majority because of his concerns about the consequences of outsourcing VHA services.

In a dissenting opinion, he argues this approach would deprive the VHA of the patient base it needs to continue operating, fragment specialist from primary care, thus “threaten the viability of VA care for millions of veterans who rely on it. … That is not a veteran health care system worth serving for.”

Blecker says he is not opposed to some expansion of the use of outside physicians or hospitals under limited circumstances.

The VHA has always contracted with providers in the community to provide healthcare services unavailable within the system. Indeed, the VHA’s current undersecretary, David Shulkin, has proposed extending the use of outside providers, as long as the VHA can assure that they provide high-quality care.

That is not the same thing, Blecker says, as creating an entire parallel private-sector network of veterans health care providers, who would potentially deliver inferior care at higher cost than veterans would receive if the VHA itself were properly funded, staffed and managed.

Blecker is not alone in his critique of broader privatization threats.

In an unprecedented letter of protest, 26 veterans service organizations, including the Disabled American Veterans,  Veterans of Foreign Wars, Vietnam Veterans of America, and Paralyzed Veterans of America have denounced the McMorris Rodgers bill. They reminded her that “over the past two years VA has made significant progress to expand access and begun major reforms that could transform the entire system.”

Veterans who actually use the VA health care system overwhelmingly want to see it fixed and reformed, not downsized or dismantled.”

Suzanne Gordon is a Bay Area health care journalist who is writing a book about the veterans health care system.