It will come
as a big surprise to most military retirees to hear that they are not
entitled to government-sponsored health care. According to various budgeteers
and other federal officials, medical care for armed forces retirees
and their families is just a "contingent
benefit." It was never established in law as an entitlement. In effect,
it is a privilege rather than a right.
That message is pressed with particular intensity by the Congressional
Research Service in a report about the consequences of closing military
bases and shutting down the military health-care facilities on which
retirees had relied. (This month, we publish a condensed version of that
report. See "Base Closure and Retiree Health Care," p. 74.)
The point, of course, is not a philosophical distinction between entitlements
and benefits. It is saving money, and "contingent benefits" are
a naturally easier target than entitlements.
Budget cutters would like to scale back the service medical programs
to the austere wartime minimum, leaving dependents and retirees to get
their health care from the private sector. This idea is further advanced
by the charge that the military medical system is excessively shaped
by peacetime demands, with the result that hospitals have plenty of obstetricians
and family-care practitioners but not enough specialists in the treatment
of wartime wounded.
The issue, however, is not strictly one of streamlining military hospitals
and clinics for combat and readiness. The Congressional Research Service
and those of similar persuasion do not recognize sponsored treatment
programs, like CHAMPUS and Tricare, as entitlements either.
To the exasperation of the budgeteers, almost ninety percent of military
retirees believe they were promised health-care benefits for life. The
Military Coalition, an alliance of military and veterans' groups, has
collected examples of recruiting literature in which exactly such promises
were made. As recently as 1993, an Army brochure declared, "Health
care is provided to you and your family while you are in the Army, and
for the rest of your life if you serve a minimum of twenty years of active
Federal service to earn your retirement."
Asked by Air Force Magazine to comment, Congressional Research Service
acknowledged that promises were given but took the position that the
people making these promises had no authority to do so. That argument
is legalistic and shabby.
Past generations of recruiters, retention counselors, commanders, and
supervisors did tell people--because they believed it themselves--that
lifetime medical care was a retirement benefit. It was an article of
faith throughout the force, and if the assumption was wrong, it's curious
that so little was said about it until recently. People based their career
plans and retirement plans on a belief that the government would honor
the obligation.
The number of military retirees has now reached 1.5 million, reflecting
the large standing force of the Cold War era. That is a lot of people
expecting to exercise their "contingent benefit" to health
care, either in a military medical facility or in a private-sector alternative.
Since 1988, more than 500,000 retired beneficiaries have lost access
to military hospitals and clinics because of base closures. "Space
available" treatment for retirees is rapidly becoming nonexistent
in the base facilities that remain. The Air Force assured retirees in
a newsletter circulated in May that it has "no intention of cutting
them loose" from the medical-care system, but budget pressures will
make that position increasingly difficult to sustain.
The Department of Defense is moving toward nationwide implementation
by 1997 of the new multiple-option system called Tricare, but retirees
age sixty-five and older, who are eligible for Medicare, are excluded
from Tricare. And if military hospitals treat these individuals--as they
did some 230,000 Medicare eligibles in 1994--they do it without any funding
to compensate for the additional patient load. Present law blocks the
transfer of coverage money from Medicare to the Department of Defense.
At present, the armed forces operate 124 military hospitals and 504
clinics. This infrastructure has not stopped shrinking, and it is obvious
that most beneficiaries, who now total 8.2 million, will have to go elsewhere.
The system cannot continue to deliver care in the same way it has done
in the past.
There is no available solution that will satisfy everyone. A realistic-sounding
view of the future was given by the Commission on Roles and Missions
of the Armed Forces in its May 1995 report, which envisioned a system
with "high accessibility to quality medical care for all beneficiaries
(including the Medicare-eligible) at no cost to active-duty personnel,
at no increased cost on average to active-duty families, and at reasonable
cost to retirees and their families."
However it shakes out, we have heard more than enough about how retiree
medical benefits are some sort of privilege that can be withdrawn at
any time. It is dishonest to pretend that medical care was never promised
as a retirement benefit. It is condescending to claim that the commitment
should not have been taken seriously. Agreement on this point is fundamental
to resolution of the issue.
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