You will never know. That is the great thing about “benefits”, the recipient has no control or knowledge.

The employer, or politicians, 5, 10, 20 years from now can cut funding and reduce access from MDs to NP/PA, or only cover certain meds, or require excessive prior authorizations to dissuade using the healthcare.

Exactly this. The VA already is hiring as many midlevels (NP/PA) as possible so that they don't have to hire MDs. You wouldn't believe how low the bar is to become an NP. PAs receive substantially better training, but at the end of the day they are still midlevels.

Worse still, many NP programs are now giving out "doctorates" of nursing practice so that NPs can introduce themselves to the patient as "Dr." Smith.

In short, the VA is willing to gamble with your life if it means saving a few bucks. It's pretty harrowing.

Is there any evidence that care by midlevels produces worse outcomes for routine cases?

Plenty. Here is perhaps the most recent: https://www.ama-assn.org/practice-management/scope-practice/...

But of course, nobody cares. The rich will get MDs and the poor will get midlevels.