Air Force Chief to Medics: Improve TRICARE

"Many of our patients and providers tell us there are still some areas for improvement," Fogleman said during his keynote address to the TRICARE '97 Conference, Jan. 13. "I don't think we ... have to apologize for that. We ought to put it into the context of other great challenges. After all, can you imagine where we would be in the computer business if Bill Gates [head of Microsoft Corp.] stopped with Windows version 1.0? We simply cannot rest on our laurels with 'TRICARE 1.0,'" he said.

"I am convinced that the success of TRICARE as our peacetime health care program is key to maintaining a high quality of life for the men and women of the armed forces," the general said. Fair and effective health care is one of the most important elements of military compensation and absolutely vital to recruiting, retention and military readiness, he said.

"This health care program must keep our active duty members fit for duty and at the same time take care of our families," the general added. He said the program also must take care of military retirees, because "our commitment to our retirees is a visible sign of taking care of our own."

The general said he'd just answered a letter from a retiree lamenting the difficulty the retiree faced in getting health care. "Many people, myself included, believed we were going to be provided lifetime medical care in return for our military service," Fogleman said he wrote the retiree. "The difference is what we were going to be provided access to and in fact what we were entitled to. The entitlement was never there in the law."

Defense medical facilities provide care to retirees on a space-available basis, according to DoD health officials. Under TRICARE, retirees under age 65 can enroll in the plan's Prime benefit, which provides guaranteed health care at fixed annual costs and certain fees per visit. Medicare-eligible retirees (those over 65), however, can't enroll in Prime, a situation DoD continues trying to rectify.

Fogleman said he and the other service chiefs support DoD efforts to expand military health care to Medicare-eligible retirees under a plan called "Medicare Subvention."

"Although the last Congress did not pass the subvention legislation," he said, "[DoD] is evaluating options to proceed with a test while absorbing the cost [and] we're planning to resubmit the proposal for subvention during this next congressional season."

Despite its shortcomings, however, Fogleman said TRICARE is "off to a good start. ... In those places where we have in fact put the TRICARE program into being and it's had a chance to mature, it is beginning to sell itself." Patients surveyed in active TRICARE regions give the plan mostly high marks, DoD health officials said. However, they consistently give low marks for appointment systems and general accessibility to care.

"In the end," Fogleman said, "we have to guarantee good service and quality care, because our people and their families have a right to expect good service and quality care."