Health care remains top priority

By Tom Philpott: Military Update

Dr. George Peach Taylor Jr., says he doesn’t yet know if President Obama’s defense budget for fiscal 2012 will propose higher TRICARE fees for military retirees or any other beneficiary group.

If past budget requests are any guide, going back deep into the George W. Bush’s presidency, then higher TRICARE fees could be sought anew and perhaps now a more deficit-conscious Congress will be receptive.

But in a phone interview, Taylor, who serves temporarily as the Defense Department’s top health official, mostly discussed higher priorities, for him and Defense Secretary Robert Gates, including sustaining wartime medical support, improving wounded warrior care and coordinating better delivery of services across the $50 billion-a-year military health system.

Intentionally or not, Taylor’s list of top challenges, and impressive recent advances to help the wounded, made the prospect of unfreezing beneficiary fees for the first time since 1995 seem almost incidental.

The health system’s top priority, said Taylor, is ensuring that fighting forces have the medical teams on scene that they need — properly equipped, properly staffed and with the most advanced technology and procedures available anywhere. The result is surviving what was once unsurvivable.

A second priority is that warriors get the best possible care to recover from injuries, particularly lost limbs, traumatic brain injury and post-traumatic stress disorder — the signature injuries of current wars.

Meanwhile, field-level policies have been changed to better protect those exposed to bomb blasts, so all receive medical evaluations after an incident and are not returned to the fight with undetected injuries.

Research is advancing to find biomarkers to detect brain injury. DoD and VA continue to partner on psychological health issues, exploring alternative therapies and more effective clinical guidelines to PTSD. Several thousand behavioral health specialists have been hired into the military direct care system and they partner routinely with civilian mental health experts.

Congress has blocked most attempts to raise out-of-pocket TRICARE costs, even for working-age retirees and their families. But key lawmakers are signaling it may be time to allow at least modest fee hikes.

At a Sept. 28 armed services committee hearing, ranking Republican Sen. John McCain (Ariz.) seemed to be setting the table, asking Deputy Defense Secretary Bill Lynn, “Isn’t the biggest cost escalation to DoD today in health care?”

Lynn conceded medical is the “largest account…growing at a substantial pace” and that in “the fiscal year 2012 budget I think we will be proposing to Congress some ideas about how to restrain health care costs.”

A few days later the Office of Personnel Management announced health insurance premiums paid by federal civilian workers and retirees will jump in 2011 an average of 7.2 percent. That could apply more political pressure on Congress to accept some sort of TRICARE fee increase.

Taylor noted that Gates is “very well on record that health care costs are eating us alive and we need to do something about it. There are only limited things you can do…You can decrease the total number of people that you have; you can change the benefit; you can change the use (of it) and, lastly, the actual technology or state of medicine.”

Looking at past proposals to raise health fees and co-payments, the most successful and accepted have sought to change patient behavior, he said, specifically the tiered co-payments adopted for the pharmacy benefit.