A New Arbiter

Despite the emotional rhetoric that often surrounds the TRICARE debate, Rumbaugh said, the DoD and Congress need to take a more pragmatic approach to balancing the needs of active-duty service members and retirees. “It’s a policy choice,” he said. “What’s the correct and appropriate burden for American taxpayers for someone who has served, and for somebody who has served but also shares the responsibility for his or her own healthcare? That’s what we’re seeing adjudicated right now.”

For many years there seemed to be no adjudication, but rather a familiar pattern: the Pentagon proposing TRICARE fee increases, Congress rejecting them, the Pentagon throwing up its hands. But despite the relative modesty of the 2011 Tricare Prime fee increase, it was a watershed event. Though legislators have mostly been saying “no,” especially in the 2012 and 2013 budget cycles, they’ve also signaled a willingness to say “yes” if they see a proposal their constituents can get behind.

“What’s the correct and appropriate burden for American taxpayers for someone who has served, and for somebody who has served but also shares the responsibility for his or her own healthcare? That’s what we’re seeing adjudicated right now.”

“This conversation has been twisted in an ironic way,” Rumbaugh said, “where members of Congress are blamed for not making changes to benefits. But their No. 1 job is not actually the defense of the United States. Their No. 1 job is to represent their constituents, who are the ones who are going to have to pay more. It is not unreasonable that members of Congress, duly elected to represent those people, are saying: ‘Hey, I’m not sure how much my constituents should pay in here.’ You’ve seen almost no member of Congress be absolutely unreasonable and say: ‘I will never touch a dime of any benefits. They’re all sacred.’ There is a way forward.”

The way forward seems likely to include input from the new Military Retirement and Compensation Modernization Commission, a panel of former service members created by last year’s defense authorization to find commonsense solutions to overhauling the current military pay and benefits system. Though stripped of much of its power – it was conceived as a Base Realignment and Closure (BRAC)-style commission, whose recommendations could receive only an up or down vote, without a lengthy debate over amendments – it may well serve as a useful arbiter in the back-and-forth between the Pentagon and Congress.

Rumbaugh is guardedly optimistic about the potential for the commission to change the nature of the debate. “You don’t need that BRAC solution,” he said. “What you need is some political momentum. You need it to seem reasonable … We haven’t seen them [the commission] start working yet, but if they come forward with a true reform package that tries to weigh all of these conflicting goals, that’s going to be a significant starting point – probably not something Congress passes blindly, but it will be a huge starting point.”

Pentagon leaders – and especially the service branch chiefs – need to do a better job of articulating their message that healthcare cost increases are out of control and directly affecting mission readiness.

In the meantime, Rumbaugh said, Pentagon leaders – and especially the service branch chiefs – need to do a better job of articulating their message that healthcare cost increases are out of control and directly affecting mission readiness. “They need to care for their service members as a means to an end: to protect and defend the United States,” said Rumbaugh. “Let’s not forget that every one of these guys [branch chiefs] had a job where their responsibility was to turn to those young men and women and say: ‘I want you to go up that hill. I don’t think you’re going to come back, but for the good of the country, for the good of the unit, the hill needs to be taken.’ These are people who are tasked with the utmost responsibility for service members – and not just for caring for them, but for achieving the mission. It doesn’t seem too much of a stretch to note that if we can’t afford to buy a necessary piece of equipment, we are putting our service members at risk too.”

This article first appeared in the The Year in Veterans Affairs & Military Medicine 2013-2014 Edition