The Cost of Expanding Military Health Care


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Medicare and Medicaid aren't the only government health programs driving government spending. Tricare, the health program for military personnel run by the Defense Department also costs a bundle. And one of the reasons why is that Republicans have pushed to expand eligibility for the program, and resisted reforms endorsed by President Obama. Via Charles Lane at The Washington Post:

Military health care's traditional role was to serve active-duty troops and their families, at no out-of-pocket cost. Tricare still does this, except for small prescription co-payments. This makes sense as an incentive to sign up for service and its attendant sacrifices.

Since 2000, however, Congress has repeatedly expanded the access of former military personnel to Tricare. By 2010, the eligible population had increased from 6.8 million a decade earlier to 9.7 million — nearly 85 percent of whom were not active-duty service personnel, according to an excellent May 2012 Armed Forces Journal article by Brittany Gregerson of the Institute for Defense Analyses.

Obama's reforms have been rebuffed every time, by Democrats and by supposedly fiscally conservative, pro-defense Republicans. 

The Defense Department spent about $53 billion on Tricare last year, up from $19 billion in 2001. As Lane notes, that means it now eats up about 10 percent of the total Pentagon budget. Nearly $10 billion of last year's total came from a supplemental Tricare program known as "Tricare for Life" that serves 2 million military veterans who are 65 or over—and thus already covered by Medicare. 

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  1. …at no out-of-pocket cost.

    That’s always a bad idea. Even nominal co-pays will at least give some users pause in abusing a system with unnecessary visits and maybe ease the burden.

    More interesting is why this is an area of health care that Obama finds his fiscal restraint.

    1. there’s nothing left to cut, except for things dealing with the military and veterans.

    2. More interesting is why this is an area of health care that Obama finds his fiscal restraint.

      Because it’s an area in which the government has already been providing healthcare, by tradition.

      You do see the long game at work here, right?

      Government takes more and more control of healthcare for all Americans. Costs rise even faster, government screams “market failure” and takes yet more control. Eventually, you end up with a single-payer system and then… at that point the government becomes interested in fiscal restraint, which is a code word for politically-based rationing.

      1. When care is restricted by private sector they are denying care to the poor so profits can go to the rich.

        When care is restricted by government bureaucrats it’s only because the rich haven’t paid their fair share in taxes.

        Damn those evil rich people wanting to keep their ill-gotten wealth. If only everyone would work together (with a government gun pointed at the back of their head).

    3. “at no out-of-pocket cost.”

      I seem to remember paying premiums and such. Of course, the time I actually used that miserable program I was using TRICARE Reserve Select.

      If I wanted TRICARE Retired Reserve it is $969.10 a month for me and the family. No thankee.

      1. John, I take it you’re a gray area retiree then and will receive ‘Tricare for Life’, which is basically a Medicare supplement, when you get to 65.

        1. I am in the Grey Area – I have 13 more years to go before I leave it. I will cast a very suspicious eye at TRICARE for Life before doing anything. My goal is to be able to take care of myself, so I can stay out of the clutches of the DoD/DVA leviathan.
          Of course by then we may have GLORIOUS SINGLE PAYOR and I won’t have any particular choice.

          1. And the military will defend it against all enemies, both foreign and domestic.

  2. TRICARE sucks.

    That is all.

    1. I’ve heard this several times from service members.

      1. True story time:

        Prior to Desert Storm, the military maintained a large enough medical staff to provide for medical care for a potential big war. This meant enough medical support for military members, their dependents, and military retirees.

        The draw-down after DS caused available medical resources to become scarce along with congresssional finangling in HMOs. CHAMPUS was the TRICARE predecessor and sucked royal ass. TRICARE was the contractor supported take-over and of course was ROCKnROLL when first being sold.

        Now the military has a system that won’t work in a big war, and is so expensive it’ll bankrupt the Military during peace time.

        1. CHAMPUS was an abomination and it stunk in the nostrils of God.

          TRICARE ain’t much improvement, and it costs more.

          You have this spot on.

      2. “I’ve heard this several times from service members.”

        Allow me to pile on… TRICARE sucks.

  3. Obama’s reforms have been rebuffed every time, by Democrats and by supposedly fiscally conservative, pro-defense Republicans.

    The Military: the most politically unassailable class of welfare whores in the country.

    Honestly, I think our troop worship is the most long-lasting legacy of Vietnam. Ever since the mistreatment of Vietnam veterans by the hippies and the inadequate VA system care for disabled and mentally scarred vets entered the popular consciousness the US has been determined to make it up to the military by worshiping them and giving them whatever they want to ‘support the troops’. It’d eventually would die down if we would stop intervening in other countries.

    1. Every time we have a ‘war’, we produce a new generation of people with vague illnesses caused by that ‘war’ which require continues, unending healthcare.

      And just to be clear, I’m not talking about guys on the front lines taking bullets and getting their legs blown off, they deserve healthcare in spades.

      I’m talking about the fine people in the rear with the gear who, upon getting out of the service claim some odd ‘syndrome’ because a dust storm might have blown over their barracks one day and in that dust storm might have been a chemical agent, or depleted Uranium, or Oil residue, or something.

      1. when I was taking BOLC, some of the instructors were telling the butterbars to note every little bump or injury they have while on duty. A lot of that stuff can add up to get them a higher percentage of disability so they can get more disability.

        I work with a lot of vets. Several of them have had severe injuries on duty, including spinal fractures. These guys do deserve attention, but the guy who stubbed his toe a couple of times and pulled a few muscles, or has sore joints? We all get sore joints. It’s called getting older.

      2. Is it fault of the soldiers that there is an army (no pun intended) of lawyers and case workers waiting to game the system?

        1. And they wait at the demob stations, at their little tables, ready to slide you into the loving arms of the G and Uncle Sugar’s unending disability checks and third world, er, VA healthcare.

          Gave me the creeps, it did.

          1. I always skipped all of it. I don’t use Tricare, I never tried to play the disability game. I hate the whole shooting match.

    2. Karma balances troop support against having service members treated by the largest bureaucracy in the history of the universe.

    3. “politically unassailable class of welfare whores in the country.”

      I am very politically assailable – I’m a hetero, white male, libertarian.

      I receive no welfare, no disability, I have refused to even register with the VA (in case I suddenly “discover” the need for free stuff). I fully expect that by the time I become eligible for my small retirement, it will Cyprused – and somehow I will manage to avoid living in a dumpster or going on the dole.

  4. Ont thing to note: reservists are eligible for Tricare, but we pay for it. $50/month for an individual and $200/month for a family.

    I’m sure that’s still heavily subsidized. Just pointing out that not all those eligible for Tricare benefits get them for free like the active duty population.

  5. I’ve been on Tricare. Free is bad. Drove me absolutely nuts. I’d take my daughter in to the pediatrician. Every bored 20 year old wife would be there with their kid running a fever of 99.0, and why not, it was free! Even a $10 copay would have deterred a large portion of them. Make it a sliding scaled based on rank. And don’t get me started on the retirees who would walk into the clinic, past reception, and straight into the doctors’ offices to start demanding this and that.

    The disability stuff drives me nuts, too. You should NOT get disability for things that are normal parts of aging.

    1. Like I said above, the instructors I had were telling the soldiers to basically game the system and get more disability.

  6. Okay Pete, seriously. What happened to you and alt-text?

    1. No kidding, and you want to talk about a ripe target…its a picture of the freakin’ Pentagon.

      “They are planning a sixth side to handle all the medical insurance” or something!

  7. True story time: I was flown to what was reputed to be a decent hospital run by the Air Force in Qatar for injuries sustained while in Afghanistan.

    Guess what still bothers me to this day? Yeah.

  8. Tricare Reserve Select is currently $191.58 per month for a family. For me it is my wife and I, but the same premium covers a family of any size, iirc.

    There is no co-pay, but I get billed for the 20% it doesn’t cover until I hit the cap on my payout. I forget what this is, but it’s fairly low. There is a copay for prescriptions, but it’s not very expensive.

    IMHO, the military needs to quit providing incentives to young, dumb guys to run out and get married. In fact, it would probably be a good idea to make people eligible for family benefits only after the first enlistment.

    1. Your military needs a lot of things, but tinkering with benefits is a very low priority. Better to give the military a tax revolt, abolition of the central bank, and abolition of government borrowing.

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