Defense Secretary Robert Gates’ prescription for what ails the military health care system includes replacing aging hospitals, and raising Tricare fees for working-age retirees, which Congress has kept frozen since 1995.

“Health care is eating the [Defense] Department alive,” Gates told officers attending the Air War College on Maxwell-Gunter Air Force Base in Montgomery, Ala., following a speech on the budget there Wednesday.

The defense chief is visiting each service war college to explain in more depth plans for “rebalancing” defense spending, starting with the fiscal 2010 budget request to be sent to Congress soon. Goals are to take care of warriors and their families, enhance U.S. capabilities to fight current wars, and reform weapons procurement, acquisition and contracting.

“I want to give you some more insight into the thinking and analysis behind my budget recommendations and then give you a chance to ask questions and share your views,” Gates told the officers.

One question came from a lieutenant colonel in the Louisiana Air National Guard who complained that active duty health services were “worse” than those given “Medicaid recipients.” He told Gates “Tricare does not even require professional board certification for its physicians.” Two pediatricians in the Tricare network “serving the huge Maxwell-Gunter community,” for example, were not board certified.

“It occurs to me that Tricare takes advantage of a community that is unwilling and unused to complain,” the officer said. He asked Gates what initiatives might be in the works to make “uniformed health care providers” the “norm” again or at least to raise standards for Tricare providers that would be deemed acceptable for civilian government employees.

Gates conceded that reports he received on Tricare seem to run in “parallel universes.” In one, Defense health officials present him with survey data showing “how well Tricare is doing and how popular it is and how well it compares with private HMOs … And I leave the room feeling gratified.”

He gets a “very different story from every soldier, sailor, Marine and airman that I talk to” and from military spouses, Gates said. Common complaints range from delays in getting appointments to routine bureaucratic hassles to difficulties getting referred to medical specialists.

Meanwhile, Gates said, the department is to spend $47 billion in health care in 2010, costs that are “eating the Department alive.”

The economic stimulus package passed in February includes money for new hospitals at Fort Hood, Texas, and at Camp Pendleton, Calif. “But I also want the services to try and find the money … to upgrade the hospitals at other posts,” Gates said, because more “world-class hospitals” on base to will relieve pressure on the Tricare network of civilian physicians.

It also might persuade more retirees “to come back on post or base” if the care again is what “people expect and want,” Gates added.

Many retirees likely would tell the secretary they’ve been denied access to base care and forced to use Tricare.

“Another part of the problem,” Gates said, “is we cannot get any relief from the Congress in terms of increasing either [Tricare] co-pays or the premiums. Tricare is now about a dozen years old.There has not been a single premium increase allowed since the program was founded. What medical plan in the nation has not had a single increase in the premium or co-pays in the last dozen years?”

Gates said the department doesn’t seek fee increases for the active duty force or their families or retiree beneficiaries old enough for Medicare.

The targeted, he said, are fees for younger retirees, “mostly working another job. And employers will influence them to stay on Tricare because it saves the employer money.”

But the department also has learned a lesson, Gates said. For 2010, the defense health budget will not assume again $1.2 billion in savings from Congress approving Tricare fee increases. Bush administration budgets did so the last three years to force Congress either to approve higher fees or to find ways to fill the funding hole. Those tactics only made lawmakers angry.

“You know, hit us over the head with a two-by-four three times, and we're beginning to get the message,” Gates explained to Pentagon reporters last week. “We figure maybe we'll have a better chance of having a serious dialogue with [Capitol] Hill if we go ahead and fund it and then begin the conversation. So we'll keep our fingers crossed.”

Congressional staffers on key committees are divided on whether the Obama 2010 budget request will call for any Tricare fee increases. With wars being fought on two fronts, some argue the politics of such a move remain unacceptable. Others note that Sens. Ben Nelson, D-Neb., and Lindsey Graham, R-S.C., chairman and ranking member on the military personnel subcommittee, have said they could support modest Tricare fee increases for working age retirees.

Even some retiree associations have said they wouldn’t protest some fee increases as long as they didn’t exceed the annual percentage increase in retiree cost-of-living adjustments, and that Defense officials first exhausted all other reasonable ways of curbing health care costs.

“Our main objection,” said a senior congressional staffer, “is that the department hasn’t done any thoughtful analysis of what fees should be. They’ve just gone with that massive 10-years-worth of inflation adjustment” to bring relative out-of-pocket costs for retirees back to 1995 levels quickly.

What also upset Congress was that most of the projected savings from fee increases were based on assumptions that many thousands of younger retirees would stop using Tricare, or would be discouraged from using their earned benefits and remain under civilian employer health insurance.

To comment, e-mail, write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111 or visit:

Sign Up for Daily Headlines

Sign up to receive a daily email of today's top military news stories from Stars and Stripes and top news outlets from around the world.

Sign Up Now