June 2010 Navy
by CAPT Ike Puzon, USN (Ret)
In December 2007, we wrote about this subject and provided you with an update on what the Defense Department’s Task Force on the Future of Military Health Care had reported. Fourteen SECDEFappointed members had about one year to study the current military health care system and report.
The Task Force was asked to address ten key issues relevant to the future of military health care and issue a final report with its assessment and recommendations within 12 months or by December 2007. Those key issues to study were:
- Wellness initiatives and disease management programs of the Department of Defense, including health risk tracking and the use of rewards for wellness.
- Education programs focused on prevention awareness and patientinitiated health care.
- The ability to account for the true and accurate cost of health care in the military health system.
- Alternative health care initiatives to manage patient behavior and costs, including options and costs and benefits of a universal enrollment system for all TRICARE users.
- The appropriate command and control structure within the Department of Defense and the Armed Forces to manage the military health care system.
- The adequacy of the military health care procurement system, including methods to streamline existing procurement activities.
- The appropriate mix of military and civilian personnel to meet future readiness and high-quality health care service requirements.
- The beneficiary and Government cost sharing structure required to sustain military health benefits over the long term.
- Programs focused on managing the health care needs of Medicare-eligible military beneficiaries.
- Efficient and cost effective contracts for health care support and staffing services, including performance-based requirements for health care provider reimbursement.
Some of the findings of this Task Force are provided for your review and knowledge. The entire report, at this date, is worth reviewing now that we have national health care reform and the TRICARE system is now protected by recent passage of the TRICARE Reaffirmation Act. The findings of the 2007 Task Force included:
- Better integration of purchased care and direct care at the point of delivery of health care.
- Independent examination of financial controls to ensure health care for those eligible and to ensure that TRICARE operates, as legally required, as a second payer when there is other health insurance.
- Ways to improve wellness, preventive care, and disease management programs, and to measure the effectiveness of those programs, emphasizing the need for more coordination, leadership, and outreach outside of the Department.
- Recommendations for streamlining procurement systems and more effective contracting.
- Continued attention on medical readiness of the Reserve Component and close attention to the implementation and effectiveness of TRICARE Reserve Select.
- Restructuring of the cost-sharing structure for retirees and their families (not active duty and families), e.g., changes to enrollment fees, deductibles, copayments, indexing, etc.), including the pharmacy benefit program, including a modest fee for the TRICARE for Life program.
I am sure some of the recommendations cause you heartburn, as they do me, especially the last one listed above. You can review the entire report on the Future of DoD Health Care and the findings on our Web site www.ausn.org, under advocacy, legislative resources, under reports: http://www.ausn.org/Portals/0/Legislative/122007%20DODHealthTFRpt.pdf.
Over the last eighteen months, the nation, DoD, the Services, and you have been focused on what will happen to TRICARE under the pressures of National Health Care Reform, know as Patient Protection and Affordable Care Act, now Public Law – 111-148. We proactively worked with you and Congress to keep the pressure on Congress to protect TRICARE. TRICARE was protected through H.R. 4887 and S. 3148, The TRICARE Reaffirmation Act – now public law 111-159. We are working with you and Congress to protect Veterans Health Care in the same manner – through H.R. 5014 and S. 3162 that would protect veterans’ health care in the same manner as meeting the minimal essential standards for health care.
We hear your pleas and calls for constant monitoring and action in making sure that TRICARE and Veterans Health Care are protected. We are monitoring every conceivable aspect of Congressional actions on these subjects. A key to protecting these from Congressional actions, intended or unintended, is you the member, your families, and your friends. When you write, e-mail, and visit Congress, they have to pay attention and will respond. This is an election year. Make them respond to your positions on the issues.
One reason you are so important on any defense, military, or veteran issue is the steady decline in Congressional members with military service. A recent review showed the percentage of military veterans in Congress has been declining since it peaked in the late 1960’s with 74 percent. At the beginning of the 111th Congress, only 28 percent of US Senators, and 23 percent of US Representatives have served in the military; active, Guard, and Reserve. Due to recent changes, these percentages have actually gone down. The lack of military service does not mean we do not have strong supporters of military issues. It does mean we have to work harder to educate members of Congress on the issues and the needs of our military.
Originally, the 111th Congress had 121 Members who served in the military, five less than in the 110th Congress. The House has 96 veterans (including two Delegates); the Senate, 25. These Members served from World War II to current war in Afghanistan and Iraq, as well as during times of peace. Some have served in the Reserves and the National Guard. Several Members are still serving as Reservists. The number of veterans in the 111th Congress reflects the trend of a steady decline in the number of Members who have served in the military. For example, there were 298 veterans (240 Representatives, 58 Senators) in the 96th Congress (1979-1981); and 398 veterans (329 Representatives, 69 Senators) in the 91st Congress (1969-1971).
It should be obvious that it is up to us – AUSN – and you to make sure Congress and their staffs are educated on the military and veterans issues – every day. The staffs of Congress have far less percentages that have served in the military. This can be problematic.
Our legislative goals and agenda depend on you and your friends taking action constantly. You have responded well over the last eighteen months. With the critical issues facing us as the Congress decides to cut the defense budget, your action is even more important. We will monitor the issues closely and ask for your involvement. We also need you to recruit a person to join us in the fight to educate Congress and keep the pressure on the Members to focus on the needs and requirements of the military. The wars and conflicts are not going away and will not cease. Downsizing the military is not an option.
What actually is not an option is the reversal of any benefit that was earned by you, the military and veterans, through sacrifice and service. Hollowing out of the force has already happened once through budget cuts. Based on some of the findings and recommendations of the above DoD Health Care Task Force, we have a lot of work and educating to do. We are currently engaged on all fronts to make sure the Navy has the right equipment, the right personnel, and the right benefits. Without any one of these, the US military force will cease to be the first rate force that is needed by this country. Our maritime strategy cannot be placed on hold due to budget issues. Review the Task Force’s recommendations; review the data on Congressional experience with the military and you can see our task is critical. I ask all concerned veterans and military to review our efforts of legislative advocacy at www.ausn.org, or send me an e-mail at ike.puzon@ausn.org. The issues of importance are not shrinking.