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Doane: Military Health Care

04/13/11 4:55PM By Larry Doane
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Vital Signs: Vermont Charts A New Course For Health Care

(HOST) Commentator Larry Doane says changing our health care system is a balancing act between the care we demand and the care we can afford. He says these days even the military is feeling the pinch.

(DOANE)  Growing up in a house with a heavy Beatles playlist I figured they knew what they were talking about when they said that 'Love is all you need'.  But, as Keith Richards famously quipped, 'Try paying the rent with it'.  British invasion aside, those two statements neatly capture the conflicts we're all facing as we grapple with reforming our health care system.  Our hearts want to give world class care to everyone who needs it.  Our wallets want to know just how we're going to pay for it.  

The US military is one of the largest American groups actually operating under a socialized, single payer health care system.  And this group doesn't even include the thousands of discharged Veterans receiving care under the VA system for their wartime injuries.  The US military, through its TRICARE program, delivers healthcare to more than 9 million eligible service members, retirees and their families.  

It's not a perfect system, and having lived through it, I can say there's room for improvement.  But it does cover everyone it's supposed to, pre-existing conditions or not, and does it with very low out of pocket costs for the patient.  There are a few catches, however.  It's a military system, generally delivered by military doctors.  And there's no denying that TRICARE prioritizes military readiness over customer satisfaction.  Sometimes you get both, but there can be conflict when TRICARE and patients disagree on what's a need to vs. a want to.  

Since TRICARE relies on its own in-house military doctors, the fee for service model isn't the primary way things are paid for.  And while this precludes an incentive for unnecessary tests or procedures, it also doesn't push to see patients in a very rapid fashion.  The Army's old adage of 'Hurry up and Wait' certainly applied to every waiting room I ever used.  With the universal pressure to keep costs down the ratio of doctors to patients grows ever wider.  

And even the military's plan is getting too big.  This year's defense budget included $50 billion for the healthcare of all military members, families, and retirees.  That's nearly 10 percent of our total defense spending.  Just a decade ago it was $19 billion for the same group.  This is unsustainable and with this in mind fees for working age retirees are proposed to increase 13 percent.  And even these fee hikes, the first in recent memory, are meeting with stiff resistance in Congress.  Just like everywhere else, nobody wants to pay more for something they're already getting.    

I'll be honest; I've got no idea how to fix health care costs.  It does look like we've got to fix the current system before we all end up in the poorhouse.  But I've also been all over the world, in rich countries and poor ones.  And in places as diverse as Nha Trang or Nebraska or Nuristan people all seem to agree on the same thing.  You don't have anything if you don't have your health.

(TAG) Larry Doane recently returned from a tour of duty with the Vermont National Guard in Afghanistan.  For more information on our Vital Signs coverage of Vermont's health care overhaul, go to VPR dot net.

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