Who Takes The Hit?

Discussion in 'Academy/Military News' started by AF6872, Feb 28, 2012.

  1. AF6872

    AF6872 Member

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  2. kinnem

    kinnem Moderator

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    I read similar articles last night where the same statement about forcing tricare recipients into other low cost programs. I sort of torn on this. Part of me says this is going on in corporate America as well and I'm sure needs to go on here for the same financial reasons. Healthcare costs are getting exorbitant. The part that really ticks me off is that the same changes are not being forced down the throats of federal civilian employees. That's the part that seems most unfair to me. I can understand "shared sacrifice" but this isn't shared at all. And there is no way all this should be means tested. :mad::thumbdown:
     
  3. Packer

    Packer Member

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    I am with you kinnem. The means testing is a bunch of crap. I understand things change and adjustments have to be made but we owe these people a great deal. The first thing we owe them is keeping our word. The whole concept of honor is lost on many of our politicians.
     
  4. MemberLG

    MemberLG Member

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    I don't think you can compare federal employee benefits to miltiary member benefits.

    FERS federal employees have to work until their retirement age plus minimum years of service. I am not aware of any federal employee collecting full retirement around 45 after only working twenty years.

    As for Federal Employee Retiree Health Insurance, they paid the same rate as the federal employees to include all the co-pays. So most, if not all, federal retirees that also qualifies for Tricare based on their reserve military membership to convert to Tricare for Life and drop the Federal Employee Retiree Health Insurance when they become eligiable for Tricare.
     
  5. MemberLG

    MemberLG Member

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    What do we owe "these people?"

    What did we "promise?"

    When I join the military, I remember raising my right hand to serve my country. But I don't remember getting a list of things "promised" to me.
     
  6. AF6872

    AF6872 Member

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    Last edited: Feb 28, 2012
  7. Packer

    Packer Member

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    You know, I kind of enjoy the rights and privleges that I have living here in the USA. I don't feel entitled I feel grateful. Those like yourself that raised your right hand are the ones I feel grateful to.

    Was there a contract that said if you do this for 20 years we will give you this? No but there has been an implied agreement.

    They are not only talking about shifting significantly more of the burden to those that are retired but also to those that are actively serving. Doesn't seem right to me.
     
  8. MemberLG

    MemberLG Member

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    I don't disagree that there is an implied agreement that for services and sacrficises rendered that the country will take care of citizens that served in the military.

    The challenge is that we can't put a price on services performed by the members of the military. One might argue that the current retirement pay is not high enough.
     
  9. hornetguy

    hornetguy USAFA Cadet

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    OK, some facts that we need to think about when discussing this.

    In the US:
    Average per capita cost of healthcare: ~$8,000
    Average cost per military member: ~$20,000

    Average cost for premiums
    2009 per capita: $4,824 per family: $13,375
    Military per capita: $0 per member, ~$500 per family

    The healthcare budget is about to reach 10% of the DoD budget. This does not include the VA.

    I hear everyone on the promises to the military and the expectations. I also know those that argue we do things elsewhere in the government before touching military. As someone who is doing a dissertation in this topic in the next 18 months and gets to interview as well as work with military healthcare professionals, the other arguments don't matter. Healthcare is going to be the quickest route to insolvency of the military budget. As a percent, it will take up more and more at the rising rate which means less money for personnel, capital, weapons, and construction.

    A major issue I hear often, without copay or penalties, dependents have horrendous rates of no shows for appointments where nothing can be done. People use the pharmacy as a one stop shop for free motrin. Retirees come fill paper bags with free drugs (I watch this myself at LAAFB). And there are plenty more opinions and observations.

    It feels like we will argue entitlement to military members and expectations up until the Defense Health System becomes the sole consumer of the military budget. Here at RAND there is considerable talk on this topic. The DoD is realizing the growing bomb that is medical care and is directing more research towards it. My main project team here now is assessing medical care value for the army. They are concerned.

    Something is going terribly wrong. It's not just absolute spending, it is per capita spending. In 1990 it was around ~5000 per member, now it is four times more. $20,000 is :eek:. Something has to be done. Reforming payment plans needs to happen to help with this. It will still be fair, the expected costs based on desired premium increases are still way below average spending in the private sector for premiums.
     
  10. kinnem

    kinnem Moderator

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    Corporate America made similar "promises" and encountered similar problems. When I started with my employer back in '74 (a different time it was) employees and retirees got full health benefits, paid $0.00 for premiums, and had to deal with the usual deductibles. Now there are expensive premiums
    for both and they're more expensive for retirees. Plus there is the copays and deductibles. We see the same thing happening with some state employees now. I think its inevitable that there be some changes. But I still think means testing it turns it into a social program and not an insurance system.

    'nuf said.
     
  11. Packer

    Packer Member

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    $8000 vs $20,000 is an eye-opener. You outlined a few abuses but do the abuses make up a significant portion of the cost or is it that the average age of the pool is higher than the general population?
     
  12. goaliedad

    goaliedad Parent

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    Averages can be deceiving and unfortunately, that is what people try to manage. If you understand your outliers, you can more effectively manage your totals, which is what really matters.

    And I know someone will chime in with the fact that some of the outliers come with the nature of the military enrollee. I'm not suggesting short shifting anyone, but that we need to focus our efforts on delivering better results where the money is actually spent.
     
  13. Packer

    Packer Member

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    Not very clearly, but this is what I am getting at. Are the $8000 and $20,000 dollar numbers a fair comparison? Without knowing where these numbers come from I can't even guess if this is data or propaganda.

    Hornet, I am not taking a swipe at you with the propaganda comment.
     
  14. hornetguy

    hornetguy USAFA Cadet

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    No worries, I anticipated a request for sources. I have them up and will post after my meeting in 5 min along with some responses to your comments. :)
     
  15. hornetguy

    hornetguy USAFA Cadet

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    In addition, this slide show is concise and shows some illuminating figures on costs over time for both military and civilian.
    http://www.health.mil/Libraries/Documents_Word_PDF_PPT_etc/2012_MHS_Stakeholders_Report-120207.pdf
     
  16. hornetguy

    hornetguy USAFA Cadet

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    The average age pool is LOWER than the population at large. The MHS treats very few veterans as the VA covers most of them in a separate (but about equal) pot of money (~$30B for each program).

    As far as the abuses, I can't quantify them now to be honest. I will have too eventually though. Another cited example in general healthcare research (including RAND's 1980 landmark insurance study) is that copays are necessary to limit overuse. "Free" care with no copay encourages people to over consume healthcare. Even a $5 copay makes a huge difference in limiting this.

    Absolutely. In the general population the spending is very much boosted by high-cost outliers. This is especially true in Medicare spending. Keep in mind though that military health requirements really reduce the impact and rate of outliers among military members. Even among dependents I doubt this is a huge cause. (can't say for sure on dependents).

    The military health spending is really concerning because you have a relatively healthy population by comparison to the general population and it is spending drastically more on healthcare. That is alarming!
     
  17. raimius

    raimius USAFA Alumnus

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    Do we know how much of an influence wounded service members have on this?
    How much do minor illness appointments cost? (I would assume most civilians would take a sick day for a cold/flu, whereas military would go to sick call so as not to have an unauthorized absence).
     
  18. hornetguy

    hornetguy USAFA Cadet

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    So, the disabled veterans have a much larger and significant presence in the VA. Since anything above 20% disability (IIRC) means automatic discharge, the majority of wounded vets who have higher medical costs go into the VA system rather than the MHS. Doing a report for the Wounded Warrior Project on their population so I learned about this there.

    As far as cost per appointment, I can't gander DoD specific since they kind of avoid doing that (which is forcing us to make our own estimates) but you could probably make a comparison with the civilian side as a low end estimate:

     
  19. goaliedad

    goaliedad Parent

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    Lots of numbers, but nobody has identified what exactly has driven the numbers from my cursory reading. With the number of people in the military healthcare system, they should be able to slice and dice the number so many ways, your head will spin. They should be able to tell you if it is an aging issue, whether it is dependent driven, whether the number of visits per person in a given age/gender range is increasing or decreasing (an indication of lots of potential problems). From these numbers you should be able to get an idea of things you can control (appropriate use of resources) from things you can't (aging population with more service-related issues). Things that can be incentivized to yield results should be done. Where we identify potential buying power (anything from pharma purchases to walk-in clinic preferred provider arrangements) should be pursued. Military members and their dependents are given benefits, but the management therof is something that should be done by the provider therof.

    The military actually runs one of the best medical systems in the world, considering the mission. It has a great source of providers brought up through its ranks - one of its great strengths that I think hasn't been leveraged enough.

    Personally, I've always wondered with the number of doctors the military pays to go to med school, why the military does not run its own. It is going to be in the business of employing doctors for the forseeable future, and quite frankly what they pay to private medical schools is highway robbery. They have the facilities to do the job and personnel to staff it (who earn a heck of a lot less than those who currently teach at med school and can better prepare their student for what they will see in a military practice).

    I've read a couple of places that one of the major reasons doctors fees are so high in this country (going back to one of the graphs in hornet's links), is that military MDs aside, all US docs come equipped with $250,000+ in student debt on top of the years of lost income getting into the profession. It is how medical education is financed in this country that drives a lot of the cost. In the countries (Japan for example) where medical school is either free or very inexpensive, the MDs can come out and afford to live on the more restricted reimbursement rates the payers offer. What I am saying here is a lot the rest of the world's cost advantage is paid for by subsidized medical education.

    If the federal government (through the military) were to become a major player in the minting of MDs (even requiring years of service as a payback) who come out without the debt, these doc will be able to handle the ever lowering reimbursement rates that seem to be coming both from private insurers and from the federal programs (medicare). Quite frankly, if you think the cost of undergraduate education suffers from inflation, you should check out the cost of med school!

    I'm sure a lot of free market types will gnash their teeth at this, but our over-leveraged medical provider system feeds a service provider system that is boutique (private practice) managed because the payers for the service cannot control the use of the service nor the cost of the inputs. This is hardly the way any other free market works and perhaps we need to re-examine services in a free market that because of their nature (the cost of shopping in terms of health cannot be measured in $) should not be purely an unregulated free for all where economic power is magnified by the vulnerability of the customer.

    Perhaps the government should use its leverage in what it does well (medical medicine delivery), expand it through a med school military academy, and use it to potentially solve a broader problem in the broader market.
     
  20. SamAca10

    SamAca10 Ensign - DWO

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