There’s been a lot of traffic the past few days about the proposed changes to military retirement. I’ve been sitting on this post for a while because, well, don’t blog/tweet while angry. Because the fundamental underly question that this commission is trying to answer is the wrong question. They are asking how do we make the army less expensive when the real question they need to be asking is how do we improve the Army’s readiness.
There are real challenges facing the military in managing personnel issues and I’m a fan of getting creative with fixing them. But I am not a fan of transferring financial risk to the individuals in the name of allegedly saving money – and it’s not even that much money. I’m not a fan of designing a system based on “the individual knows what’s best for them” then allowing predators to rob them blind and trust me, this will happen. It already is (for profit schools being in the Army ed centers for one but that’s another post entirely).
If we’re going to design changes to the military compensation system, then we need to figure out how to make the system work harder for readiness of the army. We need to consider how these systems will work in the context of the war in 2005 or during the Surge. How does this proposed system make sure that we recruit and retain the best during those periods? Because if these proposals don’t address times like that, then we are directly impacting national security with these changes.
I’m probably going to break this down over a couple of posts but for now, let’s tackle the first elephant in the room: changes to Tricare.
Lord knows I’ve had my share of complaints about Tricare (and in all honesty, it’s been damn good insurance for my family for the most part). But despite it being not perfect, it still meets the general requirements of making sure soldiers are ready to deploy.
So let’s say we let a soldier opt out of his or her military health care and go to his or her spouse’s insurance. Great, right? Everyone wins. The Army no longer has to fund expensive medical facilities and individuals get to pick providers that are best for them. But how exactly does this enable commanders to track medical readiness? There’s this little thing called HIPPA and well, off post doctors can be quite strict about enforcing it. So while commanders currently have the ability to call up the doc and find out what medications Private Snuffy is taking, under this proposal, commanders will have no legal right or basis to access this information. You want to hold commanders accountable when a soldier ODs on their medication but this is taking away the one (very imperfect) tool we have for tracking it. Exactly how are commanders going to know what’s going on with their soldiers? I’m also pretty sure you can forget about getting off post doctors to update MEDPROS.
Which brings me to my next issue with readiness: the copay good idea fairy. I’m not morally opposed to copays in principle provided they have a catastrophic cap that’s really low and severely restricted as far as debt collection goes. Insurance exists for emergencies. Copays sound good on paper until you’ve got a $100,000 emergency room visit and your copay is 5% of that. And that’s for things which are emergencies and do not require chronic care. Let’s say you have a child who falls off their bunk bed and gets airlifted to a children’s hospital an hour away, and then subsequently spends three days in intensive care. If there’s a copay and no cap, well, you’ve just saddled a soldier with a massive potential debt. Not really doing much for improving readiness there, are we?
And what happens when there’s a copay for an annual physical and the soldier simply cannot or will not pay for the doctor’s visit? Commanders already have their hands full getting soldiers green on MEDPROS. Now we’re going to add in the additional layer of bureaucracy that forces commanders to argue with insurance companies to get their joes to be green on all their shots? What about shots and immunizations? And how are you going to prevent soldiers from showing up at SRP the day they’re supposed to deploy only to find out that they’re being treated off post for a condition that prevents them from getting on that plane? The chain of command had zero visibility on this issue because there is no mechanism to ensure they can get visibility on this issue.
I don’t see how transferring service members to civilian insurance programs is going to increase medical readiness unless these are Cadillac plans that reduce the friction of going to the doctors and require by law that these agencies must communicate with military commanders.
None of these arguments suggest that military medical care isn’t without problems. Fort Hood went through a massive overhaul of medical care while I was there and part of that was because military commanders were able to apply strategic pressure and get the medical system to do what commanders needed it to do: get soldiers ready to deploy. And this took years to implement. Taking this ability away from commanders may be fine in a peacetime army but we’re not a peacetime army. We’ve still got almost 5000 troops on the ground in Iraq and significantly more than that in Afghanistan. That doesn’t account for troops around the globe on various contingency operations.
Additionally, when service members are wounded, the bureaucracy is already bad enough. Let’s not forget how bad our wounded vets were treated when they were sent home. Remember the scandal at Walter Reed The scandals at the WTUs? How does civilian insurance fix these problems?
If the proposed changes to TRICARE give soldiers better access to care and improves readiness, then I’m all for them. But they don’t. They simply add another layer of bureaucracy making the already intensely complex system more complex. They transfer cost and risk to the individual soldier and take away command influence that provides oversight to an imperfect system.
More individual risk does not sound like improved readiness to me. I’d love to be wrong about this, though.