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Top doctor's focus is troop health, not higher fees

Dr. George Peach Taylor Jr. said he doesn't yet know if President Barack Obama's defense budget for fiscal 2012 will propose higher Tricare fees for military retirees or any other beneficiary group.

If past budget requests are any guide, going back deep into George W. Bush's presidency, then higher Tricare fees could be sought anew and perhaps now a more deficit-conscious Congress will be receptive.

But in a phone interview, Taylor, who serves temporarily as the Defense Department's top health official, mostly discussed higher priorities, for both him and Defense Secretary Robert Gates. Those priorities included sustaining wartime medical support, improving wounded warrior care and coordinating better delivery of services across the $50 billion-a-year military health system.

Intentionally or not, Taylor's list of top challenges, and impressive recent advances to help the wounded, made the prospect of unfreezing beneficiary fees for the first time since 1995 seem almost incidental.

The health system's top priority, said Taylor, is ensuring that fighting forces have the medical teams on scene that they need - properly equipped, properly staffed and with the most advanced technology and procedures available anywhere. The result is surviving what was once unsurvivable.

A second priority is that warriors get the best possible care to recover from injuries, particularly lost limbs, traumatic brain injury and post-traumatic stress disorder - the signature injuries of current wars.

For amputees, Taylor noted the extraordinary gains in prosthetics but also in the work of the Armed Forces Institute of Regenerative Medicine and partners such as Wake Forest University so that, perhaps within a decade or even five years, they "can actually build new fingers and new ears, new noses and new toes, new feet and, eventually, new legs."

Meanwhile, field-level policies have been changed to better protect those exposed to bomb blasts, so all receive medical evaluations after an incident and are not returned to the fight with undetected injuries.

Research is advancing to find biomarkers to detect brain injury. The Defense Department and Veterans Affairs continue to partner on psychological health issues, exploring alternative therapies and more effective clinical guidelines to PTSD. Several thousand behavioral health specialists have been hired into the military direct care system and they partner routinely with civilian mental health experts.

Taylor, a retired three-star officer and former Air Force surgeon general, is deputy assistant secretary for force health protection and readiness. But until Congress confirms Dr. Jonathan Woodson, Obama's nominee to be assistant secretary of defense for health affairs, Taylor is performing those duties. So he is DoD's top health official and Gates' principal health adviser on health budget and policy including Tricare.

Congress has blocked most attempts to raise out-of-pocket Tricare costs, even for working-age retirees and their families. But some key lawmakers are signaling it may be time to allow at least modest fee hikes.

At a Sept. 28 armed services committee hearing, ranking Republican Sen. John McCain of Arizona seemed to be setting the table, asking Deputy Defense Secretary Bill Lynn, "Isn't the biggest cost escalation to DoD today in health care?"

Lynn conceded medical is the "largest account ... growing at a substantial pace" and that in "the fiscal year 2012 budget I think we will be proposing to Congress some ideas about how to restrain health care costs."

That same day, at a breakfast meeting with reporters, Adm. Mike Mullen, chairman of the Joint Chiefs, called rising healthcare costs "unsustainable" and said, after 15 years, it's time to raise Tricare fees.

A few days later the Office of Personnel Management announced health insurance premiums paid by federal civilian workers and retirees will jump in 2011 an average of 7.2 percent. That could apply more political pressure on Congress to accept some sort of Tricare fee increase.

What might be proposed for the fiscal 2012 budget is still "in department negotiations," Taylor said. He said he doesn't yet know what DoD will sign out or what the White House will accept.

"It's quite possible the budget won't contain any benefit changes," Taylor said. Or "in terms of the core enrollment benefit, it could be that it will contain some pharmacy benefit changes."

Taylor noted that Gates is "very well on record that health care costs are eating us alive and we need to do something about it. There are only limited things you can do. ... You can decrease the total number of people that you have; you can change the benefit; you can change the use (of it) and, lastly, the actual technology or state of medicine."

Looking at past proposals to raise health fees and co-payments, the most successful and accepted have sought to change patient behavior, he said, specifically the tiered co-payments adopted for the pharmacy benefit.

Patients pay higher co-pays today if they fill prescriptions in the Tricare retail network where a 90-day supply costs Tricare an average of $294. Lower co-pays are set for Tricare's mail order program, now called "home delivery." A 90-day supply of mail-order drugs costs Tricare an average of $169, or 42 percent less than the neighborhood drug store.

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