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
. 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.