TRICARE is an excellent benefit, there is no doubt. It is a model government healthcare program. However, if that benefit were to be extended to our entire country, we would be in serious fiscal trouble.

Your article gives the impression that TRICARE is free. As Milton Friedman once said, "there is no free lunch." Nothing is truly for free, including healthcare. The U.S. taxpayers fund this well-deserved benefit for our military serviceman and women, as we should given their service to our country.

However, it is completely unrealistic to assume that this model could be replicated on a larger scale without serious tax increases.

Also, keep in mind that TRICARE is administered by private-health plans (Humana, HealthNet, and TriWest) that receive government funding, so this "single-payer" system is not as black and white as you present it to be. The government outsources the adminstration of this program to the private sector, which puts up the capital and takes risk in delivering healthcare to the military beneficiaries.

I understand that you have a point of view that you would like to get across, but sometimes its helpful to do a little research, particularly when you're being fairly loose with your "facts."

AMERICA’S NATIONAL HEALTHCARE EMERGENCY!

It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats the Tri-Caucus and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and request that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

If President Obama has to declare a NATIONAL STATE OF EMERGENCY to rescue the American people from our healthcare crisis, he will need all the sustained support you can give him. STICK WITH HIM! He’s doing a brilliant job.

THIS IS THE BIG ONE!

THE BATTLE OF GOOD Vs EVIL!

Join the fight.

Contact congress and your representatives NOW! AND SPREAD THE WORD!

God Bless You

Jacksmith – WORKING CLASS

It would certainly be relevant to your argument whether all these folks enrolled in TRICARE are actually happy with it.

If 9 million people think it sucks, that wouldn't do much for your argument. Based on a study from about 10 years ago, though, they seem pretty happy:

http://www.defenselink.mil/releases/release.aspx?releaseid=1167

Something addressing this point should have made it in to your original comments. Talking about volume of participants is just a straw man otherwise (millions of Americans are in prison, that doesn't mean they're happy with it).

Thanks for the info on TRICARE. The success of the program is certainly relevant to the current health care debate (read: the trading of disingenuous talking points by elected officials with no particular expertise on the issue).

Best,

--MDT

There are many errors of omission in this article that cause it to be rather misleading. The first and most important, as the previous commenter pointed out, is your contention that Tricare is free. It is not. And it is not in many different ways. Simply stated, many of the people who use the Tricare system, including the vast majority of retirees and their families, do in fact pay a premium for their coverage. I will grant the author that Tricare does offer plans that have no premium to active military personnel, but doing so does not make it free. My employer also offers a plan with no premium to its employees, and goes so far as auto enroll us in it. From there it is our choice/ responsibility to select a better plan with a premium attached, or to opt out of the coverage if we get our health care from elsewhere. Offering this coverage is part of our total compensation plan. It is not free. Without it, we would receive larger salaries. This can best be shown by the fact that if you do in fact opt out of the coverage because you receive coverage elsewhere, the company gives you a credit on each and every paycheck. The same is true for those who use Tricare. Without that coverage being part of their total compensation, they could receive larger salaries. Just because they do not see the dollars does not mean they are not paying for the coverage. With this said, saying we should expand Tricare (or recreate it) for the rest of us is not realistic. We are not federal employees. There is no salary to tap into. As the previous commenter also mentioned, we would still be responsible to pay for the coverage, and without a salary to dock, it would be in the form of new taxes. And these taxes would be assessed whether you opted out of the government plan for better coverage or not, essentially making you pay twice for coverage. Last but not least, Tricare is not free because those covered by it are still responsible for Out of Pocket costs in the form of co-pays and deductibles. Some of these can be quite high if you happen to see a provider that is not approved for the region your coverage is administered by. It is also important to remember that it was due to extreme member dissatisfaction around these OOP costs that caused the Tricare system to under go a drastic overhaul a few years ago. The overhaul was so significant that the powers that be renamed the program to help distance themselves from the past. Some of the other main things to come out of this overhaul was the HMO/ PPO options that many use to help curb OOP costs, and the administration of processes by Health Net, Humana, TriWest Healthcare, Blue Cross Blue Shield, and Wisconsin Physicians Service. In essence, this government program had to become more like, and be administered by private insurers to remain feasible.

Can Tricare be looked at to borrow some of its best aspects in the hope of expanding coverage to the uninsured? Yes. But to say it is a model that can be recreated for the rest of us and be effective and feasible is not true.

The US could find a way to pay for this. If McCain had become President and we were at war with Iran, the US would find the money for it, we can find the money to kill people but the money to heal people. Why reinvent the wheel, look at France's system, and copy it.

France's model healthcare system, by Paul V. Dutton, Commentary, Boston Globe: Many advocates of a universal healthcare system in the United States look to Canada for their model. While the Canadian healthcare system has much to recommend it, there's another model that has been too long neglected. That is the healthcare system in France.

Although the French system faces many challenges, the World Health Organization rated it the best in the world in 2001 because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country's population. The United States ranked 37.

The French system is also not inexpensive. At $3,500 per capita it is one of the most costly in Europe, yet that is still far less than the $6,100 per person in the United States.

An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States.

That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine." Virtually all physicians in France participate in the nation's public health insurance, Sécurité Sociale.

Their freedoms of diagnosis and therapy are protected in ways that would make their managed-care-controlled US counterparts envious. However, the average American physician earns more than five times the average US wage while the average French physician makes only about two times ... average earnings of ... compatriots. But the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free.

http://economistsview.typepad.com/economistsview/2007/08/frances-model-h.html

Ryan and Anonymous #1 --

I certainly didn't intend to give the impression that TRICARE is free. No health care is -- you either pay for it publicly or privately; the advantage of the former is you pay much less in overhead.

Second: Is TRICARE a "single-payer" system? Yes and no. Yes, in the sense that the government is the "single payer" on the provider side of health costs, which is why if you Google "TRICARE" and "single-payer" you see lots of hits referring to it that way.

But as the public is discovering with the "public option," none of these terms are black and white -- there are gradations. And because TRICARE is *managed* by private entities at different levels, that definitely distinguishes it from the "single-payer" we think of in other contexts.

Finally, the point of my piece wasn't that TRICARE should be the model for our national health program. It was a more general point: In the states where political leaders are most vociferously fighting the notion of any government involvement in health care, a disproportionate share of residents are using a public plan -- call it whatever you want -- which undermines the notion that their constituents won't stand for public health care.

Chris

MDT --
I was going to include customer satisfaction data for TRICARE but the original post was already long. There's a lot of good data out there about TRICARE's popularity -- see for example this survey in which TRICARE beat out all private competitors:

http://www.reuters.com/article/pressRelease/idUS211409+16-Jan-2009+BW20090116

Note that TRICARE is a lot like a "public option" -- you're not forced into it, you choose to enroll if your eligible (active-duty or retired military). Lots of eligible people don't enroll in TRICARE. But as our piece showed, a lot do -- and those enrollment figures in the South alone attest to its popularity in the region.

Add on top that the customer satisfaction data -- which, another benefit of publicly-run plans, is well-documented in military evaluation reports -- and it's clear TRICARE is a popular program.

These millions of people have no problem with a "public option."

I believe my health insurance provided by my last employer cost $600 per month. I'm positive the government could provide health care for less, and pay people well. Look at the post office.

I live in a low wage state, yet everyone in the post office including the guy at the counter makes $17 to $20 an hour. They can do that because there aren't CEOs who are making millions at the top.

http://www.huffingtonpost.com/rep-bernie-sanders/health-care-is-a-right-no_b_212770.html

YouTube - Health Care Corporate Fraud.
http://www.youtube.com/watch?v=v_2gFsEHRRU

In Brittan the decided if they could find money to kill Germans, the could find money to help people with health care
http://www.youtube.com/watch?v=a3HyK5rB9jY

One question is the current status of Tricare. The three current contracts were said to expire with new awards happening in May 2009. As that clearly did not happen, something is going on with this program.

Have you ever looked at a insurance companies balance sheet. I figured it out for Humana, if they decided to not make a profit for 2008, they could have saved each member a whooping $6 a month. 3 huge things are wrong with healthcare. The over regulation put on by the government, the threat of malpractice suits, and to many people put on medicare and medicaid. How does just giving everyone insurance help anything, if you go the hospital without insurance the put you on medicaid and give you payment plans for the rest.

By the way I get Tricare because I go to work everyday as a soldier, join up if you want free healthcare. Why should we cover people who don't want to help themselves, I know that is not the case for everybody. So when I get out, I will be on the same plan as a 400lb smoking, drinking 27 year old. Do they really deserve the same healthcare coverage as I do, someone who watches what I eat and stay in shape. Do you think Americans being some of the most unhealthy people in the world has anything to do with such high costs, to much demand not enought supply.

The Federal governement would be better off paying for a gym membership to every American instead.

Chris,

I appreciate your clarifications. And dont get me wrong, I too believe that Tricare is a place we can look for best practices in our effort to expand coverage to the uninsured (a goal most all of us share). However, I think your claim that the large number of people on Tricare in these states means that the constituents would be open to a public single payer plan to be wrong. As the song goes..."You say potato"...You call Tricare a public single payer system, which can be definitionaly argued. I say it is the health plan offered by those particular individuals employers. The fact that they are employed by the United States of America does not change this. Again, the coverage they receive is part of thier total compensation for the work they do. Work that none of us should argue does not deserve the coverage they get.
And you are right, no health care is free, nor should it be. You get what you pay for, after all. The question that lies at the crux of this issue for so many is whether you should have to pay for it if you get it from elsewhere because what you are getting is better?

I'm 65 and on Medicare and Tricare For Life because I earned it. Don't think that because I don't work, I'm unhealthy and not deserving of health care I gave 46 years of my life for. There are people that spent every day of their lives in gyms that have dropped dead way before 65. so don't think that having a gym membership (that you use) will keep you healthy. Thanks for your service, but don't turn your back on the rest of us who also served and deserve what we have earned just because we no longer work. Someday you will not be able to work. I hope health care is there for you. I could work still, but I worked so I would not have to die working.

I am an everyday user of tricare and i just want to point a few things. The first is, you can't sit there and talk about majority of tricare users from southern states blahbalhblah. The overwhelming majority of military personel are stationed in the south east. Its not that the people of these states can and are choosing to use tricare. You dont have a choice your using a military doctor, period. Its nice to have coverage sure. But the doctors are very very substandard. There very good for a obvious large physical trama. Other stuff, not so much. They see so many people a day they often just give you some pain killers and send you home. By about the 15th time you go they might start paying attention to you. I took me 5 years to find a doctor who cared enough and had knowledge to explain an knee injury that bothered me. That includes 4 different mri's the problem was there right in there face and took 5 years. I watched my friends newborn get an iv put in its head incorrectly. I had a friend who's parachute didn't fully deploy, they said he was fine and sent him home. He died an hour later. So yea, you the soldier dont see the cost associated with it. And yes you do have coverage. But you dont have a choice. You dont get great healthcare.

The military health care system that existed prior to the end of the Cold War should be the one we model a public option on. What Rumsfeld did under the guise of saving money was to outsource military health care. He destroyed a great system screwing the taxpayer as health care costs paid by DoD have skyrocketed (and that's not because of the wars in Afghanistan and Iraq).

The taxpayer is now paying third parties to manage our healthcare. They haven't closed military hospitals, but merely reduced their level of service calling them clinics. The result is a bloated infrastructure that costs more dollars to maintain each year.

The military medical system that existed before 1991 offered the best care and did so in an economical way. Today's system is a joke, nothing we would want to model a public health option on.

I am an active duty dependent (my husband is active duty) and I really enjoy Tricare. There are no out of pocket costs if you are on Prime and you use in-network providers. If an in-network provider is not available within a 60 minute drive, the law requires that they refer you to an out-of-network provider and you are NOT required to pay OON costs for that. It's covered as if it is an in-network provider. That is the difference between Prime and Standard. If you use Standard, you don't need a referral to see a specialist, but there are deductibles, co-pays and all the other out of pocket costs associated with private insurance.

Sometimes the base doctors aren't as helpful as they could be. This is not a problem for Standard members, as your PCP will be a civilian in private practice, not a doctor at the MTF. The MTF sees Prime members preferentially. If you are on Prime and you are unhappy with the service you receive at an MTF, you do have the option to request transfer to a civilian doctor in private practice. This option does not exist for military members, but it does exist for dependents.

I've been nothing but completely satisfied with Tricare Prime since I married my husband over 6 years ago. The ONLY problem I've ever had with Tricare was actually caused by the private company that administers the program. (In my region, that's Humana.) They recently denied my referral to a local provider because she was OON, claiming that there was an in-network provider within 60 minutes. However, said in-network provider was over 75 miles away, requiring nearly 90 minutes of drive time, which is against the law and against Tricare rules.

The claim made by the Humana nurse who denied the claim was that the in-network provider was less than 60 minutes away. Obviously, given that the location was over 75 miles from my home, this isn't even physically possible unless Humana has found some sort of space/time wormhole that would transport me there more quickly. She was informed by three different people that access requirements were not being met, yet Humana maintained her denial of my referral. I had to go through multiple military personnel to (hopefully) remedy the situation. (I'm still waiting on the final word, although all government employees have informed me access requirements have not been met and my referral should be granted.) So the *government* is fixing it for me when the private insurance company broke the law. Typical.