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

Fees for Family Visits Better Than Aiming At Retirees

I work at a military treatment center and all referrals for civilian care go through my office. I can tell you that 85 percent of the care is consumed by active duty family members, not retirees.

With deployments, separations and transfers, we are losing several of our family practice physicians so we have to send much of our primary care to TRICARE’s civilian network. But active duty family members still have no co-payments and no deductibles!

Most primary care cases that we are forced to send to the network are for coughs, colds or sinus congestion. That is because when there is no cost to patients, they run to doctors for everything, including symptoms that could be taken care of though home care and over-the-counter medication.

My suggestion is this: Give retirees free care because they have already served their country, and give active duty members free care because they currently are serving.  But charge active duty dependents and retiree dependents co-pays for civilian care.

If you do this, TRICARE purchased care costs will drop dramatically.

Everyone should have to pay their fair share. Don’t raise TRICARE fees for retirees and blame rising costs for healthcare on them.

LAVONNE CAMERON
Director, Managed Care
5th Medical Group
Minot Air Force Base, N.D.
 

I was chief officer-in charge of Warrior Transition Unit case management for four-and-a-half years until I left the military last March.  I have worked as a registered nurse both in the military and civilian systems.

One thing I noticed with the military medical system is that there is no oversight of the medical care.  The only thing I can compare it to is Medicaid.  Many people on Medicaid don't have to pay medical bills and therefore they abuse the system.  An example is taking their children to the local emergency room to treat their colds.  That is senseless.

The military system is the same way.  Soldiers and their dependants do not pay for health services and therefore think nothing of going to the doctor for trivial things.  I have seen, on numerous occasions, soldiers demanding MRIs when simple x-rays would suffice.

Our soldiers should get the best medical care.   However, being wasteful and using services improperly must change.  Every soldier and dependent should have an RN case manager, except for emergencies.  A case manager, teamed with a physician, would look at the big picture.

Also, if a medical visit is not authorized, the soldier should have to pay a visit fee.  This is just one of many ideas to curtail health care spending.

ROCHELLE D. SAXON
Via e-mail
 

After reading Defense Secretary Gates’ comments about how new base hospitals will improve my quality of care, I realized there is a true gulf between his perceptions and our realities.

Before I retired we had a new “world class” facility built at Andrews Air Force Base, but it was never adequately staffed, largely due to so many personnel being deployed.  Instead of retaining its credentials as Malcolm Grove Medical Center it was downgraded to “super clinic” status.

I now live in Montana and the only active military base is 120 miles away.  Under the Malmstrom AFB TRICARE policy, I am forbidden to receive routine care there because I do not live within a 40 mile radius of the base.

These are just some of the issues that never get addressed in the DoD TRICARE surveys.  As an officer who often is asked to fill out these surveys, I can understand why the Secretary of Defense gets two different views of our opinions about the system.  The surveys contain highly skewed questions that allow little leeway for posting a broad range of responses.  The underlying assumption appears to be that all that TRICARE needs is a little tweaking to its processes rather than a full review of its policies.

There is no attempt to address its core problems or even admit such problems might exist.  I can assure you they do exist in the very foundation of the program.  Before issuing another vanilla survey, DoD officials should ask us -- users and providers -- to create the questions they need, instead of generating ones they want in-house.  The resulting survey may require some short essay questions which are harder to quantify, but the information received would be of far greater analytical value.

The solutions DoD needs will not be found in simple fee increases; it will require a restructuring of concepts, policies and management of the entire TRICARE program.  For now that appears to be a subject DoD is unwilling to tackle.

WILLIAM M. KOHNKE
Colonel, USAF-Ret.
Elliston, Mont.

Please do not raise TRICARE fees for retirees.  I am unemployed and have been looking for work for the past four months.  My wife is disabled.  I’m now on a fixed income.  When I do find work, I will use my new employer's medical coverage because of numerous difficulties getting specialty care referrals though TRICARE primary care managers.

I have found TRICARE and the current fee structure to be a great benefit, particularly compared to the ridiculous costs of temporary health insurance for the unemployed under COBRA.  While I was working, TRICARE Standard worked just fine as secondary insurance plan.

I would not that TRICARE fees for prescription drugs obtained off base have been increased in recent years as many medicines have been shifted to “non-formulary” status where the co-payments are $22.

Please, no more fee increases.

CURTIS HOSTETLER
Master Sergeant, USAF-Ret.
Via e-mail

I say no to increasing TRICARE fees.

I spent 26.5 years in the Marine Corps.  When I enlisted, I was guaranteed free health care for me and my spouse for the rest of our lives if I spent 20 or more years on active duty.

What have I gotten for my sacrifice?  Not the health care I was promised, that is for sure.

HARRY NELSON
Via e-mail

Regardless of when it was that fees and co-payments last were increased, Congress needs to leave them alone.

Military retirees who pay anything for health benefits are paying too much.  The benefits should be free, as was promised when they agreed to defend this country with their lives.

If there needs to be premiums paid, they should be set for dependents of the retirees only, because they were not part of the agreement.  Such premiums would be acceptable if they were set reasonably.

My husband and I go to the naval hospital in Pensacola.  The care is wonderful. 

GLENDA BUTLER
Via e-mail

Letters may be edited for clarity or length.  Write to Military Forum, P.O. Box 231111, Centreville, VA  20120-1111, send e-mail to militaryforum@aol.com or visit www.militaryupdate.com.

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