By David Dayen, The Fiscal Times From Business Insider

You don’t often see Donald Trump pull a punch, but he did it last week. Trump spent his entire campaign deeply angered by how the government treats veterans, particularly regarding their medical care.

He promised to overhaul the Veterans Administration (VA) health care system and “take care” of the vets. Everyone has interpreted this as code for privatizing the VA, a long-awaited conservative goal.

But last week at Mar-a-Lago, after a meeting with health care executives about his VA plans, Trump told reporters this: “We think we have to have kind of a public-private option, because some vets love the VA. Definitely an option on the table to have a system where potentially vets can choose either/or or all private.”

If the current VA system is so reviled, so horrific, so offensive in its unfair treatment of veterans, why do “some vets” love it? Why must it be preserved as a choice?

Trump appears to be running up against a typical problem for those favoring total overhaul to tweaks along the edges, especially in health care: People fear change over what they have. In the case of the VA, that’s certainly true for veterans, who like the current arrangement. And it’s also true of the privatization-friendly group of experts who looked at the VA just last year.

Let’s back up: The VA is a unique feature of the U.S. health care system, more reminiscent of Britain’s National Health Service. Doctors and medical personnel work directly for the VA, and it owns the facilities where they operate. The rationale is that veterans experience several common combat ailments, from traumatic brain injuries to PTSD to amputations requiring prosthetics. Centralizing care at the VA allows for specialization on the unique needs of veterans, which private hospitals lack. The VA serves more than 8.9 million veterans a year at 1,233 facilities.

Trump bases his stance on the VA mostly on a 2014 scandal about backlogs for patient care and falsifications of waiting periods, which led to the dismissal of several top officials. But as The Fiscal Times’ Rob Garver explained, the VA’s new leadership has already acted to reform the system and change the agency’s culture. Pending claims are way down, virtually all VA facilities extend same-day access to care and performance exceeds the private sector by nearly every measure.

On top of that, Trump’s preferred option of giving veterans the choice of VA or private care has already been implemented, with interesting lessons. After the backlog scandal, Congress passed a reform bill co-authored by Bernie Sanders, and as part of it, a pilot program gave veterans a Choice Card to use at private facilities if their local VA hospital is more than 40 miles away, or if the wait time is over 30 days. This theoretically ensures that no veteran has to wait for or be inconvenienced by seeking medical care.

The rollout has been shaky, mainly because the 90-day deadline Congress demanded for setting up the system meant that the VA had to turn to private contractors with a history of botching health care management. This has led to a secondary waitlist for those seeking difficult-to-access private care, along with numerous billing errors and questions of eligibility. There was also no setup for integrating care between VA and non-VA providers, which meant veterans skipping between the two could get duplicative or substandard care. While some have predictably used this to label the VA as incompetent, it says more about the hurdles to delivering a public/private hybrid.