David Cooley is four decades removed from the waters off the coast of Vietnam, where he served his country alongside his fellow Navy veterans.

Today, the 69-year-old from Excelsior finds himself fighting again — this time against the potential consequences from increased privatization of his health care provided by the Department of Veterans Affairs.

More than 10,000 American Legion members have gathered in Minneapolis for the organization’s annual convention this week, while Veterans for Peace wraps up its own event Sunday in St. Paul. Key among their concerns is growing trend of VA care being deferred to private health care providers — and who will pay for it.

“Our position is that when a veteran earns a benefit they should not have to pay for that benefit through the degradation of another benefit or service provided by the VA,” said Joe Plenzler, a spokesman for the American Legion’s national headquarters in Washington, D.C.

In June, President Donald Trump signed into law the Veterans Affairs Mission Act, a major overhaul of veterans’ health care that would streamline the agency’s community-care efforts into one permanent program. The legislation preserves the current system established in 2014, after reports of excessive wait times for medical services at several VA facilities were viewed as a national scandal, triggering reforms. The government now pays for private care for veterans who live at least a 40-mile drive away from the nearest VA facility or who can’t schedule a doctor’s appointment within 30 days. The administration has told Congress it wants the VA to absorb the $50 billion costs of the Mission Act by cutting spending elsewhere in the agency. It may come to a head next year when new VA federal appropriations will be required.

“Congress has to allocate additional funding, specifically earmarked to fund the VA Mission Act,” said Suzanne Gordon, a national expert on privatization and co-author of the American Legion’s analysis on the VA who spoke Friday at the Veterans for Peace convention. “If they don’t, every dollar spent on more expensive lower quality, private sector care will come out of the Veteran Administration’s budget.”

The result, Gordon said, could be cuts in vets’ mental health, women’s health and programs for the homeless.

Cooley, a Veterans for Peace activist, has a host of maladies including post-traumatic stress disorder, exposure to Agent Orange and hyperthyroidism. He’s also battled three types of cancer and recently had a pacemaker implanted. Cooley said he relies on the VA for “everything” and because of its integrated care system, he feels there is a high level of treatment, coordination and understanding of medical issues of combat veterans that would not be possible in private hospitals.

“We believe the VA provides the best care anywhere that a vet can get,” Cooley said as he delivered bumper stickers that oppose privatization to local halls of the American Legion and Veterans of Foreign Wars.

Randy Tesdahl, adjutant for the American Legion in Minnesota, said there is a stark difference between VA and privatized care.

“It is important that medical service providers understand what veterans went through and the VA understands that very well,” he said. “They use a lot of civilian doctors but they learn quickly that veterans are a different breed.”

The campaign to give veterans more choices in private sector medical care has been championed by Concerned Veterans for America (CVA). Among the goals of the group, co-founded by billionaire conservative political donor Charles Koch, is “advancing common goals of a free society,” said executive director Dan Caldwell. He insisted there is no serious effort to entirely privatize VA health care.

“Unfortunately you have some using privatization as a boogeyman who are trying to mislead people in regards to reforms in giving veterans more health care choices and better integrating the VA with the private sector,” Caldwell said. “The VA has been moving in that direction for years.”

Still, he said, scandals such as long wait times continue to plague the VA.

“While on occasion the VA will say they provide better health care than the private sector, that’s inconsistent across the system and there are serious access issues,” he said.

Paul Cox, 70, a Berkeley, Calif. veteran who will be attending both the Legion and Veterans for Peace conventions, said there’s a need to provide private care for veterans who live in rural areas far from veterans hospitals, but he opposes the overall push to outsource care.

“[The Koch brothers] think that private industry is the answer to every problem,” said Cox, who chairs the Legion war memorial commission in San Francisco and was a founding member of that city’s Veterans for Peace chapter.

Louis Celli, executive director of the American Legion national headquarters, said that in his view, the big question is who is going to authorize who is allowed to provide care outside of the VA and how that authorization will be approved.

“The VA needs to be the gatekeeper for taxpayer payments,” he said.

At VFW Post 425 in Hopkins this month, Cooley handed post commander Bob Manders a batch of “Save the VA” bumper stickers.

“I’ve got nothing but positives to say about the VA,” Manders said. “I’ve had zero problems.”