Before the end of summer, the Senate is expected to consider the FY2013 National Defense Authorization Act (NDAA). There are some major differences with the House, which passed its version weeks ago. Yet both versions of the FY2013 NDAA repudiate the administration’s reforms to Tricare, the military health-care system. This congressional rebuke comes even as the department’s health-care costs are spiraling out of control, rising at twice the rate of inflation for the civilian health-care sector. In the words of former secretary of defense Robert Gates, these costs are "eating the department alive."
From 2001 to 2012, military health-care expenditures rose over 170 percent, from $19 billion to $53 billion. As a share of defense spending, health care represented 6.1 cents of every dollar spent by DoD in 2010, up from 4.5 cents in 2000. At $53 billion, health care is roughly 10 percent of DoD’s base budget, and without reform it is expected to rise an additional 28 percent to $64 billion by 2015.
Three primary factors are responsible for soaring costs.
First, rates have remained virtually unchanged since the creation of Tricare in 1995. Working-age retirees pay just $520 a year per family to use Tricare. Meanwhile, the average American family spends between $4,000–5,000 per year on health care. When Tricare was implemented in 1996, working-age retirees and their dependents were expected to contribute 27 percent to the cost of their health care; today, that figure has fallen to 11 percent. Retirees over the age of sixty-five pay nothing for their plan, Tricare for Life. Yet, this group represents the highest per capita cost; in 2007, more than half of DoD health-care expenditures went to Tricare for Life beneficiaries.
Second, the number of people eligible for Tricare grew from 6.8 million to 9.7 million people, an increase of 43 percent. Moreover, these beneficiaries have health-service-utilization rates well above the averages of civilian health-care plans.
Third, Congress has significantly expanded Tricare by adding seventeen new programs, covering new procedures and loosening plan restrictions.
The president’s FY2013 budget request attempted some nominal reforms. It proposed modest increases in enrollment fees for working-age retirees, pegging future increases to medical inflation rates and imposing an enrollment fee for Tricare for Life. The House rejected these reforms in the FY2013 NDAA passed two weeks ago, instead including only a modest increase in pharmacy co-pays because of “the firmly-held sense of Congress that prior service to our nation is a pre-payment of health-care benefits in retirement.”
At the same time, Congress has often invoked the war fighter, the men and women serving in Iraq and Afghanistan, as the reason for expanding Tricare benefits and refusing cost increases. But as Brittany Gregerson convincingly shows, the greatest beneficiaries of Tricare in the last decade are retirees and their families, not active-duty service members. Furthermore, only 17 percent of the active-duty force today will serve the requisite twenty years to retain the right to remain on Tricare after retiring. Millions of men and women who faithfully served in Iraq and Afghanistan won’t see this benefit.
One Defense Business Board member, retired major general Arnold Punaro, has compared DoD to the auto industry: “General Motors did not start out to be a health care company that occasionally built an automobile. Today, we're on the path in the Department of Defense to turn it into a benefits company that may occasionally kill a terrorist.” Like other entitlements, military health care has become a political third rail.
Comments
When I became an Air Force officer some 40 years ago, one of the "promises" made was health care for life. I have seen those benefits continually chipped away for myself and increasingly for younger folks entering the service today. Anyone who would argue, as the author does, that the military is smothered with compensation and benefits, regardless of his loyal service as a Marine, is just flat wrong. It smacks too much of the TV newsman who stated some years back that soldiers were a pampered lot. Given the state of perpetual war and perpetual deployments that we seem to be in, compensation and benefits become a crucial means of recruiting and retaining military forces. If, as the author believes, the military is becoming a caste (an assertion with which I profoundly disagree), we have only ourselves to blame, because while we claim to love the profession,as a society we seem to do our best to discourage our sons and daughters from joining the ranks: we counsel them that they can "do better" with their lives, or -- a la Charlie Rangel -- we spout lies about how only the ignorant and the poor serve. These folks who serve us in uniform are our finest, they make incredible sacrifices, and they should be rightly compensated. Raising Tricare fees by several hundred percent is not the way to accomplish that objective. The author needs to remember those who served before him, and for far longer periods.
Mr Rue, some thoughts about your views and article - 1. “First, rates have remained virtually unchanged since the creation of Tricare in 1995.” The discussions I read - including those offered by even the DoD Press Secretary and a legislator or two - seem always to start with this assertion or something similar. It is as if history starts with Tricare. It, of course, does not. There are probably a few million of us retirees left who began service before that. And before that there was an agreement – viewed by some of us as a promise. In return for 20 years of sometimes dangerous jobs and frequently dislocated families and lives, we (the U.S. government) will “take care of our people”. And that included cost free health care to service members and their families. For life. At least what was promised (yes promised - I don’t remember any policy considerations down the line conversations in the recruiting office) to me and what I promised to others, in the name of the United States government, during my tour as a recruiter. Of course “policy” changes have, since Tricare, made a liar out of me an every other pre-Tricare recruiter. 2. “But Congress must acknowledge that Tricare is merely a policy, part of a larger military compensation package that seeks to recruit and retain the best men and women for military service. It was never intended to become an inalienable right.” I don’t think that any of us viewed health care for life as an “inalienable right”. I think we just viewed it as a deal. Like, if you do this, we will do that - simple and straightforward, you’d think. But, reality changes. So be it, we will have to live with it. But, lest it be overlooked yet again, those of us who naïvely bought the deal are not lamenting the loss of anything more than what we were led to believe was promised to us. 3. “I joined the Marine Corps for a lot of reasons. Cheap health care wasn’t one of them.” The same was true of me when I joined the service. But everybody else is not necessarily in the same position as you and me. For many (known to me personally) when faced with a choice between a no benefits job or the pitiable benefits conferred by Home Depot, Walmart, and the like, health care is among the reasons they choose the service. While not the only – not even the major – reason, health care benefits for themselves, their spouses and, most importantly, their children are significant nonetheless. So, even though it may mean be being in harms way and long periods away from their families, health care benefits make their best option the service. It would be good if those of us familiar with people in these circumstances helped policy makers, who are mostly not familiar, to understand what being in the service means.
As we well known with the fact that health care system around the world health care systerm found under a worst condition as due to lack of proper wages and resources. But still health care organizations are used to deliver quality health care service in an affordable cost. In the above post we have found about the truth of military health care which helps to deal with health care system in a military camp.urgent care clinics