Health Care in the Lurch

July 1, 1995

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.