The short answer is that the situation is complicated.
The long answer is about what is complicated and why. When I show up to my clinic, my nurses and dental assistants give me hugs and seem to genuinely look forward to seeing me. I make it easy for them because I look for any opportunity to let them know how much I appreciate everything they do, and it's true that I'm very well aware that I'm afforded healthcare whereas much of the society around me does not have this. No matter how shitty the care may seem, you always must take this in the context that you are getting at least some attention to your issue at a good price, whereas most of society around you does not get this. I have actually had dentists and physicians get on the phone with me, most will also respond within a few days to an email (MHV message). This is unheard of in private practice where you are a dollar sign. However, in VA care, you are a number. The only advantage of one to the other, that I see, is that the price to me is much better at the VA, and I get more personalized attention.
OK, so now for the other side, just so you don't think I am trying to defend the VA without a balanced perspective. They have fucked up. Royally. A number of times. I have had providers do unauthorized procedures that resulted in injury to me, and which other providers said should not have been done. I have had providers order the wrong medication, and not even be able to pronounce the right medication nor explain what it's used for. I have had providers try to tell me that newer procedures being used extensively in private clinics would not be a good option for my care, and try to justify their statements using incredibly loose logic that did not hold up to questioning. I have had providers ignore my communication attempts for months and only respond after a patient advocate complaint was issued. I have had my care mismanaged. And all of that is just what I remember off-hand in the last, let's say, 12 months. I'm just telling you this so that you don't think that my first paragraph was because I have not experienced downsides.
As for an expanded use of the choice card. Yes, ideally I think that would help, but you'd be fighting a very uphill battle. First, this stupid crow-flies bullshit that some idiot in charge made up, these sorts of 'gotchas' would be rampant as veterans pushed for this. Who (you ask) is trying to stop it? Think about all the poor contractors and giant construction companies whose owners won't be able to order their 15th yacht. They will lobby against any reduction in VA infrastructure expansion. Also, similar efforts (and possibly lawsuits) will be made by various 3rd party contracting firms that supply the various VAMC's. VA employees will likely also want to band together to have word with someone about the future of their jobs.
The giant looming issue that not many people want to deal with is the future of rapidly changing healthcare and government services. The near future, as in the next 3-5 years. Economically, the unemployment figures (for those who have been under a rock) are bullshit, they are contrived statistics which are cherry-picked to form a simplistic and twisted picture of our employment situation. The reality is that our population-to-employment ratio is about 58%. And dropping. And it's possible that even that is a manipulated figure, since this doesn't take into account under-employment (i.e. a PhD who flips burgers, and others not employed in their field or at their former experience level). Fewer workers means fewer taxpayers, and also fewer consumers. Government services will loose funding as there will be less funding overall, and certainly veterans will not be seen as important as in the past. Newer automated warfare systems will come online that will do more work and need less humans around to help. Drones don't need a VA after they leave service, and the decision-makers will quickly find this to be cost-effective. Dwindling military recruitment will not be seen as a problem. Hospitals will continue to replace more and more of the nursing and tech duties with automated systems and mobile robots to assist in patient care, but that's further out maybe like 10-15 years. The gap years between massive technologically fueled unemployment and the general availability of resources due to post-scarcity, those years will be harsh. Maybe 10 years, depending on which futurist you are going by. Some estimates are 30 years.
The point is that VA healthcare will probably be sustainable for a few more years (maybe 3-5 tops), then the increasing burden on the system (of unemployed veterans) combined with lack of tax revenues at the same time will likely cause some major changes.
Interesting topic. I think we're almost at post-scarcity of information (next up will probably be post-scarcity of communication), so you should be using that to your advantage and be the most informed patient possible. It might save your life.