I have to admit, I’m a little nervous. When I write something, I fully expect people to disagree with me and to call me an idiot after reading my “analysis.” But I rarely expect to anger people. My latest article has the potential to really anger a lot of people. About 6 million of them.
I’ve got an op-ed at The National Interest on the need to reform Tricare, the military healthcare system.
The numbers, however, do not allow for continued inaction. Increasing health-care costs in DoD’s budget mean less money for bombs, bullets and training. Fielding a military but supplying it with obsolete equipment and minimal training is the definition of a hollow force. Sensible reforms, like the ones proposed in the administration’s FY2013 budget request, will not break faith with military retirees and their families. 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.
Due to space constraints, I had to omit things that I fear might lead some readers to question my support for military retirees. I want to go on record with some things here.
- I do not believe Tricare should be abolished or that retirees should not have access to subsidized healthcare in some form.
- I do believe military retirees should contribute more than they currently do. They should expect to pay, on average, at least 25% of their healthcare costs as was intended by Congress when it established Tricare in 1996.
- Enlisted veterans should not pay as much as officers. Tricare enrollment fees should be tiered based on retirement pay.
- Working age retirees who earn over a certain amount each year (including retirement pay), say $150,000, should not be allowed to use Tricare. They should be forced to use their civilian employer’s healthcare plan. Once they stop working, they can join Tricare for Life.
- Reforms must grandfather some people into the current system.
- Tricare enrollment fees should be indexed to inflation for the general healthcare sector, which should go a long way toward stabilizing DoD’s costs.
- I do believe that we are dangerously close to viewing veterans as a privileged, entitled class of people. This I fear is corrosive to civil-military relations and widens the gap between those who serve and those who don’t. The challenge is fighting for and receiving the care veterans deserve without becoming entitled.
Andrew Bacevich used a great quote from FDR in a recent book review that I wanted to crib, but didn’t. After General MacArthur broke up the “Bonus Marchers” camp in Washington, DC, Roosevelt let it be known that “no person, because he wore a uniform, must therefore be placed in a special class of beneficiaries.”
Anyway, read the whole thing here.
I couldn’t agree with you more. I’ll say more, but in an email. Semper Fi.
Your analysis is spot-on, and your recommendations make sense. As you point out, the current system is unsustainable, asking retirees to pay more is not “breaking the faith.” What would be a “breaking of the faith” is call by military retirees (i.e. MOAA, et al.) to keep the current structure at the de facto cost of eliminating training and accquisitions, and ultimately blood. I sure you’ll be flamed by the RMOA/AARP crowd, thanks for the moral courage to write this. Semper Fidelis.
Mike, Thanks for your comment and support. It’s been generally well-received; no flaming yet.
s/f
So, from an implied benefit spouted by OFFICERS each time I reenlisted: “Free Healthcare for life if you put in your twenty”…to, “Retirees should pay even more for their medical care now?”
My, my, the lies that have been told by those in leadership positions, all for the purpose of keeping the corporate knowledge around and to ensure that their next rank was made on the backs of those you would later forsake.
Semper Fi, Mac!
Westpac,
Any officer, recruiter, or career counselor who promised “free healthcare for life” to Marines in order to get them to (re)enlist promised something that they never had the power to deliver. As such they should be punished (though we know that’s unlikely). Not even the Secretary of Defense himself can do much to change Tricare; Congress alone has most of this authority. I’m sympathetic to Marines who may have (re)enlisted under such pretenses, but ultimately this seems akin to a recruiter promising the 18 y.o. who signs the open enlistment that the DIs will make sure he gets his choice of MOS. At some point, Marines need to do some research and understand the implications and promises of signing an enlistment contract. A second or third term Marine should know better.
That said, as I stated in this post, I am 100% in favor of having officers pay more than enlisted retirees for medical care. Enlisted retirees may need to pay more than they do now, but any rate increase should be minimal compared to officers.
s/f
Mr. Rue:
As a military retiree, I agree with your assessment. I believe faith has been broken in many other areas than asking me to pay more into my healthcare system. That said, however, there should be a way to grandfather those that are on fixed incomes into *not* having to pay a larger percentage, as generally those are your retirees that served in Korea and Vietnam. Also, instead of *forcing* me to use my company’s expensive and limited HMO/PPO, give me the option of paying an equivalent amount to continue using my Tri-Care and military facilities, or drop off the program until I quit or retire from private sector.
I agree also with your assessment of veteran’s becoming a “privileged” member of society. I believe that it has its place, especially among employers, to give qualified veterans extra consideration for what they have put in over the years, but I think the pendulum is dangerously close to swinging too far from the days of the hated serviceman coming home from Vietnam to the welcomed, war-weary servicemembers returning now.
Semper Fi, Sir.
Chief, Thanks for the comment. I largely agree with your suggestions, though I’m sure we might haggle a bit over the details. There are a lot of ways to skin this cat. The bottom line is that health costs are eating into the other accounts so we need to do something. Anything. S/F.
I won’t back down, either.
It is unimaginable that someone with a military background fails to consider all aspects of the compensation and healthcare system. This author’s comparison is so completely bogus. I am disappointed in you for falling into the current cost-cutting bandwagon argument.
As a military wife and mother with an Ivy League MBA, I see the realities of the military healthcare system very differently. You can only compare the military HC system to the private sector HC system if you factor in the actual process and implementation of benefits. They are not the same. My husband worked in a second career and we always used the private sector insurance. When he retired, I went on to Tricare Prime. I had to change doctors and it took over a year for me to get back to where I was health-wise under my previous private sector doctors. In my daughter’s case, during her husband’s 20-year career I saw countless occasions when she and the children were not be treated appropriately or sufficiently under the military system. My grandson had a necessary orthopedic surgery paid for by a charitable organization, since the military wouldn’t cover it. My daughter was unable to come and stay with us for fear of losing her military coverage during the last month of pregnancy due to the regional rules governing her coverage.
Military families have always had to fight, not for coverage, but for the benefits that the plan says it provides. Repeated visits to doctors [many individuals give up pursuing health issues that can later become problems] and repeated submissions for approvals have been the norm in my experience. So I don’t see how a comparison can be made.
Comprehensively, it is hard to separate the healthcare system from the salary and total compensation practices of the military. There are enormous opportunity costs for military families that must be figured into the equation. My grandchildren have gone to not-so-great schools in fairly rural areas because of their father’s duty locations. Their exposure to career opportunities has been limited. Likewise, military wives are restriced to jobs near the base, which very often limit their opportunities and lifetime compensation. Oh, and my daughter was on WIC for several years while the kids were small. Their requests to us for monetary help were frequent.
Please tell me how this adds up to the categorization of veterans as a “privileged class.” Please also tell me how my husband and I are ‘privileged’ as we now confront his multiple serious health conditions that will cause him to die sooner than if he had not served. We thought the VA might be of some help, but now we find that a medication is not covered in our region, although it’s covered in others. How illogical is that?
A better solution is to merge all healthcare within the U.S. under one umbrella of universal healthcare for civilians and military. Everyone gets the same basic standard of care. Economies of scale could be achieved by eliminating layer after layer of bureaucracy. If the military is great in certain areas like trauma surgery and rehab, then they can share their expertise with civilian medical professionals, and vice versa.
I’m really disappointed in the themes expressed by the author of this article. I would think that he, of all people, would understand the tradeoffs between the system and the sacrifice. Until one is older and understands how the military system affects people over their life cycle, and the lives of those around them, one should not be making policy prescriptions based on the latest fads in thinking. Governments have traditionally waged wars and then come up short when they realized that they have to pay for the consequences of those wars over the lifetimes of all of those so deeply affected. That’s the price. Stand tall and pay for it.
Ma’am (Laocoon):
Thanks for your thoughtful comment. A couple of questions: When did the majority of your anecdotes take place? That is, what years were your daughter and grandchildren not cared for appropriately? Are they still on active duty? Has the care changed or improved since then?
I think our positions are obviously rooted in our own experiences. It sounds like you’ve had an awful experience with military healthcare. I’m sorry and hope that everyone in your family got/is getting the appropriate level of care. I can’t explain why some drugs are covered in some regions, but not others. It makes no sense — governments rarely do, I guess — but I hope you’re getting what you need. My own experience with Tricare was great. I had a medical procedure that required civilian specialists and general surgery. It was all paid for, no questions asked and minimal paperwork. It was as good an experiences as one can ask for when dealing with any kind of doctor or medical insurance system. My staff sergeant took an IED through his torso that almost took off one arm. Besides the obvious and horrific injuries, he never had many problems with getting the right care. Maybe we were the exceptions though, not the rule.
Still, I think you might overestimate the ease with which civilians fight for coverage too. The bottom line is that the American healthcare system, as currently set up, is screwing *everybody.*
My article is not based on “the latest fads in thinking” nor intended to jump on the “current cost-cutting bandwagon.” Military healthcare costs are rising at more than twice the rate of civilian healthcare costs. This money is not appropriated by Congress. That means that money to pay for retirees is being taken from other accounts within DoD, like the Operations & Maintenance account. If these costs are not stabilized (they don’t even have to be reduced necessarily, just stabilized) and extra money is not appropriated to DoD (unlikely in austere fiscal times), we will have a military that has obsolete equipment and minimal training. It will be a military that is large, but hollow. A paper tiger if you will. This is not speculation and it’s not hyperbole — it’s fact.
Of course, Congress could prove me wrong and start appropriating extra money to cover rising healthcare costs or they could institute a universal healthcare system like you suggest that brings down costs. I’m not necessarily opposed to those solutions, but I don’t see them as politically feasible or likely. That being the case, it seems to me that stabilizing costs by raising some enrollment fees is an appropriate and not unreasonable solution. When Tricare was enacted in 1996, retirees were expected to pay 27 percent of their costs via enrollment fees. Due to the fact that those fees have been raised only once in 16 years, they now pay just 11 percent. I don’t think it’s unreasonable to increase enrollment fees slightly, even just to boost that figure to 20 percent. Another option is to not raise enrollment fees and simply tie future increases to the cost of medical inflation. I don’t think it’s unreasonable to ask military retirees to see their healthcare costs rise at the same rate as their fellow citizens. Seems fair, even considering the opportunity costs they may have incurred over the course of a military career.
In an op-ed format, it is impossible to squeeze in every fact or consider every possibility. You note that I fail to connect healthcare to the overall compensation system. I’ll accept some responsibility there. I did note 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.” But, I completely agree that any reforms to Tricare should be included as a larger reform of the entire military compensation and benefits system — compensation, retirement, and healthcare. For my op-ed, I chose to focus on Tricare because that’s what I was asked to do. A recent report by the Center for American Progress looks at all three. I highly recommend reading it. Even if you disagree with the authors’ analysis and conclusions, you can’t fault them for not being comprehensive in their approach.
http://www.americanprogress.org/issues/2012/05/pdf/military_compensation.pdf
Finally, a word on privileged class. You appropriately note the high price of wars that occurs over the lifetime of the men and women who fight them. I couldn’t agree more. We have barely scratched the surface on costs incurred from the last decade of war. You also appropriately note that we should “stand tall and pay for it.” Here’s the problem — nobody is paying for it. The American people aren’t paying for it through higher taxes. But, because they feel the need to support the troops with more than just a bumper sticker, they’re bestowing (via Congress) more and more benefits upon veterans (without paying for them). I fully support higher taxes to pay for our wars and care for our veterans. At the same time, I don’t think veterans should be put in a special class of people, entitled to pay significantly less than their fellow citizens just because they volunteered to serve. Active duty military are well compensated for their jobs, better compensated than the Federal government civilian employees (see the Congressional Budget Office for multiple reports detailing this). I knew what hardships I was taking on when I joined the military (austere living conditions, deployments, crappy hours, etc). I don’t feel like I’m owed cheaper healthcare and more generous pay *because* of it. I feel like we’re approaching a point where veterans are being seen as a separate, better class of people that are entitled to these things. I don’t believe veterans are a special class of people — we’re just people, same as everyone else. I ask for no favors nor seek reward just because I volunteered to serve.
WJR