Defense Secretary Robert Gates’ prescription for what ails the military health care system includes replacing aging hospitals, and raising TRICARE fees for working-age retirees, which Congress has kept frozen since 1995.

“Health care is eating the (Defense) Department alive,” Gates told officers attending the Air War College on Maxwell-Gunter Air Force Base in Montgomery, Ala., following a speech on the budget there last week.

The defense chief is visiting each service war college to explain in more depth plans for “rebalancing” defense spending, starting with the fiscal 2010 budget request to be sent to Congress soon. 

Goals are to take care of warriors and their families, enhance U.S. capabilities to fight current wars, and reform weapons procurement, acquisition and contracting.

“I want to give you some more insight into the thinking and analysis behind my budget recommendations and then give you a chance to ask questions and share your views,” Gates told the officers.

One question came from a lieutenant colonel in the Louisiana Air National Guard who complained that active duty health services were “worse” than those given “Medicaid recipients.” 

He told Gates “TRICARE does not even require professional board certification for its physicians.” Two pediatricians in the TRICARE network “serving the huge Maxwell-Gunter community,” for example, were not board certified.

“It occurs to me that TRICARE takes advantage of a community that is unwilling and unused to complain,” the officer said. He asked Gates what initiatives might be in the works to make “uniformed health care providers” the “norm” again or at least to raise standards for TRICARE providers that would be deemed acceptable for civilian government employees.

Gates conceded that reports he received on TRICARE seem to run in “parallel universes.” In one, Defense health officials present him with survey data showing “how well TRICARE is doing and how popular it is and how well it compares with private HMOs. … And I leave the room feeling gratified.”

He gets a “very different story from every soldier, sailor, Marine and airman that I talk to” and from military spouses, Gates said. Common complaints range from delays in getting appointments to routine bureaucratic hassles to difficulties getting referred to medical specialists.

Meanwhile, Gates said, the department is to spend $47 billion in health care in 2010, costs that are “eating the Department alive.”

The economic stimulus package passed in February includes money for new hospitals at Fort Hood, Texas, and at Camp Pendleton, Calif. “But I also want the services to try and find the money … to upgrade the hospitals at other posts,” Gates said, because more “world-class hospitals” on base to will relieve pressure on the TRICARE network of civilian physicians.

It also might persuade more retirees “to come back on post or base” if the care again is what “people expect and want,” Gates added.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: milupdate@aol.com