Scrap Tricare, Senator says
DoD eyes higher patient fees to lower expenses
By Rick Maze
NavyTimes staff writer
April 27, 2005
The Tricare health plan is too costly, too inefficient and should be
scrapped, with military family members, retirees and their families shifting
to Medicare, which is more widely accepted by health care providers.
That is the blunt assessment Sen. Tom Coburn, R-Okla., gave to the Senate
Armed Services military personnel subcommittee April 21.
Coburn, an obstetrician who is working on legislation to overhaul the
nation’s health care system, said the United States is wasting money on
administrative costs for health care that would be better spent on
treatment.
“We have a health care system that is broken. It is broken for our military
and it is broken for everybody else,” he said. “If I were in the military
and I served my country, I think you should give me a card and let me go
anywhere.”
Tricare, he said, is not so special that it is worth keeping.
There is little difference between Tricare and any other managed-care
program, including the same “micromanagement that interferes with care,” and
getting rid of it would save billions of dollars, he said.
The Defense Department has a slightly less radical idea — making
beneficiaries pay more for care through higher fees, and possibly finding a
way to discourage older retirees from dropping their civilian health
coverage to take the military’s Tricare for Life plan.
Dr. William Winkenwerder Jr., assistant defense secretary for health
affairs, said the problem is that the $35.5 billion medical care budget is
expected to increase to $50 billion in five years, when care for retirees
and their families will make up 70 percent of the costs.
Defense officials want to hold down costs and are trying to revise health
care contracts to lower expenses without cutting benefits.
But the long-term answer involves raising co-payments and deductibles for
beneficiaries who have been protected from increases.
Since 1999, enrollment fees and co-payments of medical expenses have
increased 57 percent to 87 percent for federal civilians, depending on the
health coverage they have chosen, but there has been no increase in Tricare
fees, Winkenwerder said.
A Defense Department comparison of costs found out-of-pocket expenses
average $769 for retirees 65 or older under Tricare Prime, compared to an
average out-of-pocket expense of $3,200 for a federal worker in a health
maintenance organization. The government covers 91 percent of the cost of
the military’s retiree health care, but only 68 percent of the cost for the
federal worker, defense officials said.
Sen. Lindsey Graham, R-S.C., the personnel subcommittee chairman, said
imposing higher fees is not out of the question. He said he is carefully
reviewing the defense health care and personnel budgets, looking for ways to
cut costs, and added that higher fees — if the Bush administration were to
formally ask for them — might be acceptable.
Susan Hosek of the Rand Corp., which has been studying military health care,
said the Pentagon faces a serious problem with retirees who are eligible for
other health coverage deciding to drop their other plans and enroll in
Tricare because of its lower costs.
Hosek said the Pentagon might want to consider paying retirees not to take
Tricare, possibly by providing money to cover their private health care
premiums and even some of their co-pays.