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Military Update

Top doc's focus is troop health, not higher fees

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 group.

If past budget requests are any guide, higher Tricare fees could be proposed. Perhaps 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 both he and Secretary of Defense Robert Gates. These priorities included sustaining wartime medical support, improving wounded warrior care and coordinating better delivery of health services.

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Intentionally or not, Taylor’s list of top challenges 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 — teams that are properly equipped, properly staffed and have the most advanced technology and procedures available anywhere.

A second priority is that servicemembers get the best possible care to recover from injuries, particularly lost limbs, traumatic brain injury and post-traumatic stress disorder.

For amputees, Taylor noted the extraordinary gains in prosthetics but also in the work of the Armed Forces Institute of Regenerative Medicine and partners like Wake Forest University so that, perhaps within a decade or even five years, they “can actually build new fingers and new ears, new noses and new toes, new feet and, eventually, new legs.”

Taylor, a retired three-star officer and former Air Force surgeon general, is deputy assistant secretary for force health protection and readiness. But until Congress confirms Dr. Jonathan Woodson, Obama’s nominee to be assistant secretary of defense for health affairs, Taylor is performing those duties. He is Gates’ principal health advisor on health budget and policy, including Tricare.

On whether higher Tricare fees are in the offing, Taylor said, “Every year for most of the years I’ve been around, the department has proposed changes to the benefit structure.”

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

At a Sept. 28 armed services committee hearing, ranking Republican Sen. John McCain, R-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 costs are 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.”

Pressed by McCain, Lynn agreed health costs are growing “dramatically,” in some recent years by 10 percent or higher.

That same day, at a breakfast meeting with reporters, Adm. Mike Mullen, chairman of the Joint Chiefs, called rising healthcare costs “unsustainable” and said, after 15 years, it’s time to raise Tricare fees.

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.

What might be proposed for the fiscal 2012 budget is still “in department negotiations,” Taylor said. He said he doesn’t yet know what DoD will sign out, or what the White House will accept.

“It’s quite possible the budget won’t contain any benefit changes,” Taylor said. Or “in terms of the core enrollment benefit, it could be that it will contain some pharmacy benefit changes.”

Taylor noted that Gates is “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 the benefit) and, lastly, the actual technology or state of medicine.”

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