The Department of Defense should allow military family members and retirees more freedom to choose private-sector providers by expanding its Tricare managed-care program, an independent commission has recommended.
If those beneficiaries of the military healthcare system choose private-sector providers in expected numbers, the Pentagon will be able to shrink its medical corps to a size necessary to serve primarily active-duty personnel, according to the Commission on Roles and Missions of the Armed Forces.
To foster such a transition to private providers, the commission recommended that the Pentagon expand Tricare to allow for competitive civilian plans to cover military beneficiaries, much as the Federal Employees Health Benefits Plan now does for civilian government workers.
Tricare currently is administered through a single managed-care plan with a contract to cover all beneficiaries in a given region.
But the commission, created by Congress in 1993 to review the various functions of the military, stopped short of endorsing proposals to strip down the military medical corps and make preparations for wartime casualties its primary mission.
The military medical force still needs to provide direct care to active-duty members and some beneficiaries, the commission argued, because the armed forces need a robust and challenging healthcare system to attract physicians and other professionals.
"You don't get that by giving physicals to healthy people," said Larry Welch, a retired Air Force general and member of the commission.
The $9.9 billion military health system employs 19,000 active-duty and reserve physicians, serving about 8.2 million active-duty personnel and beneficiaries.
But Welch said surveys of beneficiaries indicate that about half would be satisfied with receiving care from private-sector providers.
Such a transfer of care to private providers would result in a "customer-directed" shrinkage of the Defense health programs, Welch said. But he added that he believed it would be a gradual process, not an instant migration of military beneficiaries out of the system.
The Pentagon's ability to reduce the military medical corps is limited by laws that prohibit cutting healthcare personnel below the number serving in 1989. But legislation now working through Congress could repeal those restrictions.
One group representing military beneficiaries applauded the commission's conclusions.
The report "gives some reasonable, doable suggestions that give us increased choice," said Dorsey Chescavage, senior issue specialist with the National Military Family Association. "By offering us healthcare through the private sector, (the Department of Defense) can go ahead and size the healthcare system where it needs to be. They couldn't do that without a private healthcare plan."