Readers of Tom Philpott’s Military Update column sound off.

Three Bronx Cheers for Proposed Defense Health Agency

Whoever thought up this idea of a Defense Health Agency has been breathing his own methane too long.

Not only would it be inefficient, costly and degrade the TRICARE system, it would add a new level of political and military incompetence to an already diluted medical care system.

Instead of a large new organization, officials should use common sense to repair the existing structure. Of course, that would be a simple fix and not lead to millions of dollars lost down another governmental rat hole.

This has all the earmarks of fools spending too much time in the halls of the Pentagon.

Please, rethink this bogus idea and find another job for excess high-end military officials.

LESLIE BRADFORD
Gulf Breeze, Fla.

Are we trying to create a three-star job for someone?

Why else create another level [of bureaucracy] rather than consolidate the three medical services?

As they say, “Keep it simple...”  Hum. There's another word too, isn't there?

M. TRONIAR
Colonel, Army Nurse, Ret.
Via e-mail

Somewhere behind this DHA proposal must be some contractors lurking to privatize the effort, right?

SARA MURSCH
Lieutenant Colonel, USAF-Ret.
Lenoir, N.C.

GRATEFUL VETERAN

I am one of the very lucky vets who have received incredible assistance from the Department of Veterans Affairs.

In 2004, I was critically and permanently injured -- made totally blind and in need of supplemental oxygen for lung damage -- in a non-service-related incident. I had not been on active duty in over ten years at the time of my injuries. But I have received great health care and adaptive equipment to help me live alone. The VA even pays veterinary bills for my “prosthetic” guide dog. The only service I do not qualify for is dental care.

I regularly attend mental health groups to help me deal with the loss of my family -- we were shot during a home invasion -- and the subsequent difficulties during my rehabilitation. I even receive an Aid and Attendance pension to supplement my Social Security Disability Income. I cannot imagine where I would be in it hadn't been for the Denver VAMC and its outstanding support staff. Although I have lost my eyes and sense of smell, I have had elective reconstructive surgery, receive a multitude of prescription medications and am provided with the latest in supplemental oxygen equipment to make mobility possible.

I am disturbed when I hear veterans talk of being abandoned when I have been so well treated. I have a 22-year-old son who is a sergeant in the Marine Corps. He has served two tours in Iraq and had to bury his grandmother shortly before his first deployment after we were gunned down in our home. He was given the choice of remaining stateside but insisted on deploying with his light helicopter attack squadron. He takes great satisfaction in knowing his father is so well cared for, and his wife gets some peace from knowing he will be cared for if the need arises.

I am the only physically disabled vet in my PTSD and depression groups who was not injured in combat, yet the other vets treat me with the same respect and understanding they do others in the group, mostly Vietnam-era men. Brotherhood is what will help us to endure to the end.

The VA system is not perfect. There are many ways to improve it. But as a 40-year-client of private health care, I can testify that the VA system is the most compassionate and highest quality care I have ever received. At times it is frustrating to wait two hours at the pharmacy for a refill. When I hear how many vets, from WWII to the present, are being served, I am proud to wait in that line with my fellow Americans. It is an honor to be among those who suffered in combat or from a service-connected incident.

I wish I could say I received three gunshots to the head during some courageous act while leading my men. I was asleep when I was shot and never knew what happened until I awoke three days later in a hospital with my two sons gently telling me I had lost my mother and wife and that my eight-month old son was in foster care. I am in awe of those who have really served and sacrificed for their country and their fellow Americans.

PETER SPITZ
Via e-mail

CATASTROPHIC CAP

Maybe you can find out why military retirees are punished with regard to meeting the annual catastrophic cap on TRICARE out-of-pocket costs if they have a spouse on Medicare disability.

Until about four years ago, the cap was $1500 per year for an individual or $3000 for the whole family. Also, when either of us met our cap, TRICARE began to pay at 100 percent for that individual. Coverage by other insurances was counted toward that annual cap.

Before being put on Medicare, my wife had health coverage with her employer and paid a premium for that. When claims were filed to her insurance, the part that would have been our cost share under TRICARE was counted towards our catastrophic cap. This was also true when she first went on Medicare.

Not so now and I never saw notice of any change. I am told that Medicare payments don't count because Medicare is a benefit. This is not true! We pay a Medicare premium in the form of a monthly deduction from our paychecks for Part A. Part B premiums are deducted from my wife's Social Security check.

Not only do none of her Medicare claims count towards the cap but I have to pay the full $3000 cap before TRICARE will pay 100 percent of my claims. A person at Humana told me it has always been that way. I have Explanation of Benefits to prove it has not!

What is your take on this new erosion of a retiree's benefits?

GARY THOMPSON
Via e-mail

There has been no erosion of benefits here, say TRICARE officials, and your facts appear to be off the mark.

In fiscal 1993, Congress set the catastrophic cap at $7,500 for military retirees, their family members and survivors. In 2000, it lowered that cap to $3,000 while keeping in place a $1000 annual cap on TRICARE expenses for active duty family members. There never has been a $1500 cap.

Your confusion over the affect of Medicare might be tied a misunderstanding of the catastrophic cap itself. When a beneficiary becomes Medicare eligible, Medicare becomes primary payer of healthcare costs and TRICARE provides wrap around or supplemental coverage.

Medicare Part A, which covers inpatient care, becomes an entitlement if an individual (or sponsor) pays into Medicare for 40 quarters. There is no Part A premium once coverage begins. So when your wife began to receive services covered by both Medicare and TRICARE, you incurred no out of pocket costs which could count against the cap.

Regarding your concern of having to pay the “full family cap” before TRICARE Standard begins to pay 100 percent of a beneficiary’s share of allowed charges, that’s...