Surgeons General: Reform Tricare, Not Military Hospitals

Military health care reform must strike a balance between maintaining military readiness and fixing an "antiquated" Tricare system that needs upgrading, lawmakers said at a subcommittee hearing Tuesday on Capitol Hill.

"On not a happy note, I think Tricare as it's designed is really antiquated -- I wouldn't give it a 'B,' " said Sen. Lindsey Graham, R-South Carolina, who chairs the Senate Armed Services subcommittee on personnel. "I'm really going to be hard on you guys to come up with reforms, not just premium increases. We're going to look hard at Tricare and turn it upside down and make it more transparent and make it more accountable."

The hearing was the latest in a series in the House and the Senate examining the military health care system as lawmakers prepare to offer reforms as part of the 2017 National Defense Authorization process.

The surgeons general of each military service, as well as a panel of private-sector health care system experts, testified before the subcommittee. While the surgeons general testified that military treatment facilities are key to maintaining readiness, the civilian experts offered a variety of proposals that would require military families and retirees to receive care through greater contract competitions and, in some cases, higher fees.

When asked to grade the Tricare system, three of the health care experts gave it a "B-plus" grade or lower, while Dr. John E. Whitley, a senior fellow at the Institute for Defense Analyses who has studied military healthcare, gave it a "C, at best."

Whitley, who was very critical of the current system, said reform "should be about replacing a system ... with a modernized system that improves the benefit for our retirees and families while saving the tax payer money."

By some estimates, care given at a military treatment facility costs 50 percent more than care given by a civilian provider, Graham said.

Part of that gap may be because of lower hospital bed occupancy at those facilities. While many civilian hospitals keep occupancies above 90 percent, military officials testified that their occupancy is much lower. Navy Surgeon General Vice Adm. C. Forrest Faison III said his service is about 80 percent, while Air Force Surgeon General Lt. Gen. Mark Ediger said the Air Force is between 50 and 70 percent.

Still, the surgeons general emphasized what they see as a need to maintain the military hospital system.

"I understand reforms are necessary to ensure the long-term sustainability of Tricare; however, reforms must not increase the financial burden on our active-duty soldiers or active-duty family members, and must minimize any impact to our retired population," said Army Surgeon General Lt. Gen. Nadja West. "Reforms should encourage beneficiary use of our direct care system, to ensure our medical military skills are maintained and should also encourage healthy behaviors ... but reforms must not degrade our combat ready system ... in an environment where we must remain rotationally focused and surge ready, as the next large-scale deployment could be tomorrow."

-- Amy Bushatz can be reached at amy.bushatz@military.com.