Reforms may raise prices alongside improvements

Retired Navy Lt. Cmdr. Rodric G. Hammond of Pensacola, Fla., said he was mystified when a blue-ribbon commission on military compensation declared last February that the triple-option TRICARE benefit was “broken.”

It proposed replacing TRICARE for active duty families and retirees under age 65 with a menu of commercial insurance plans, like that offered to federal civilians, except that active duty families would get a new health allowance to cover their premiums at least for mid-price-range plans.

The whole idea left Hammond, 77, and retiree friends asking why.

“I have been using TRICARE Prime for my wife since 1993. I used it personally from that year until I turned 65, and have never had a problem with any aspect of the program,” he said. “And TRICARE for Life,” the insurance supplement for Medicare-eligible retirees, “is even better. These pols in Washington and in the Department of Defense need to leave it alone.”

Congress perhaps heard many such complaints from satisfied beneficiaries because a consensus is building on Capitol Hill that TRICARE need not be scrapped but merely improved, and better integrated with military hospitals and clinics, which are seen as underused and inefficient.

As the Senate and House armed services committees have solicited feedback from health care experts and beneficiary groups, their reform plans for next year appear to be moving away from the Military Compensation and Retirement Modernization Commission recommendations.

But there also has been a difference in tone if not goals between the committee chairmen, Sen. John McCain (R-Ariz.) and Rep. Max Thornberry (R-Texas). McCain wants to see health costs tightened, which could mean higher beneficiary co-pays as defense leaders have urged for years.

By contrast Thornberry and Rep. Joe Heck (R-Nev.), an Army Reserve physician who chairs the military personnel subcommittee, insist their top reform goal will not be to dampen TRICARE costs or to raise user fees.

Retired Vice Adm. Norbert Ryan, stepping down as president of Military Officers Association of America after 13 years, described TRICARE strengths and weaknesses from a recent survey of more than 30,000 MOAA members.

More than half of respondents were 65 or older, using TRICARE for Life and well satisfied with the benefit commissioners would leave unchanged.

But 86 percent of those using TRICARE Standard, the fee-for-service option, also were satisfied and 81 percent of enrollees in TRICARE Prime, the managed networks.

The great inefficiency of military health care, Ryan argued, is allowing Army, Navy and Air Force to continue to run separate medical services, allowing for “no single budget or oversight authority.”

Other “serious shortcomings,” he said, are found in TRICARE Prime appointments and referral services, particularly as managed by base hospitals and clinics, and patient care data showing military doctors see “far fewer patients per week than civilian providers.”

Ryan also criticized “a serious disconnect between rhetoric and reality on DoD healthcare costs. Every year, Defense leaders offer dire budget projections of health costs they say are spiraling out of control. But recent history shows those projections have been consistently wrong.”

He said defense budgets over the last five years show medical program costs have been flat or even have fallen, and that TRICARE for Life costs are down 40 percent from their peak.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

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