The Bipartisan Policy Center (BPC) released a March 2017 paper titled “Health, Health Care, and a High-Performance Force,” which I wanted to point out to our readers.

One reason for highlighting this paper is that it was published by a bipartisan group—one does not often see that happening in this day and time. And the subject is one I rarely write about in the GrantWatch section of Health Affairs.

The paper’s connection with philanthropy is that it was funded in part by the Peter G. Peterson Foundation.

Here are some highlights from the paper.


Three components are needed for a high-performing military.

First, the health of military personnel affects “readiness and battlefield performance.” So, health is not only a personnel matter, but also a national security issue.

Second, maintaining the health of service members requires “everything from nutritious meals to medical services.” While battlefield medicine is particularly important, “all of these functions require highly trained and experienced personnel, who must be recruited and retained amid a complex, competitive, and expensive health care market.” Unlike other large employers, the military is unusual because it directly provides comprehensive health care services to active-duty personnel, their families, as well as retirees, the paper says.

Third, health care benefits help to attract and retain men and women in the armed services. Indeed, the benefits offered to the military “are among the most generous of any government or private-sector employer.” It’s not just service members who are covered—benefits are also offered to their families and to military retirees.

Nevertheless, the Military Health System “is a major cost” to the federal government, and the growth of that system “threatens other defense priorities” and attracts “criticism and proposals to reform military health care.”

The Military Health System has various strengths and weaknesses, the BPC explains. For example, combat casualty and rehabilitative care have become “more effective than ever” during the recent wars. However, the “significant reductions in combat operations” in the Middle East now threaten “the readiness of military trauma care personnel.”

The Health Of People Serving In The Military

Interestingly, the BPC points out that the obesity crisis facing the United States has found its way to the military. The paper cites a US Department of Defense (DOD) statistic showing that in 2011, approximately 12 percent of active-duty personnel reported a height and weight indicating obesity—a 61 percent increase for that measure since 2002.

The DOD “has taken some steps to address the health and wellness challenges” faced by members of the services, including, for example, issuing policy guidelines to reduce tobacco use.

Military Health Care

The paper notes that in fiscal year (FY) 2016, the Military Health System covered health care for an estimated 9.4 million TriCare beneficiaries, costing $48 billion. TriCare is the health benefit for members of the military, dependents, and retirees.

TriCare beneficiaries, in general, “are, overall, more satisfied with their health plans” than are civilians enrolled in private-sector plans, the paper notes, citing a DOD evaluation of TriCare. One consistent challenge, though, is “timely access to care.”

Recommendations From Two Panels

Now, “for the first time in decades,” some in Congress “have initiated major changes” to the military health care system, the BPC states. Both the Military Compensation and Retirement Modernization Commission and the National Academy of Medicine have “made comprehensive recommendations to reform the military health care delivery system to better support the readiness of uniformed medical providers, deliver higher-quality services and faster access for beneficiaries, and achieve a more efficient system,” the paper says. Many of the suggested reforms to the delivery system and recommendations on personnel made it into the enacted version of the FY 2017 National Defense Authorization Act.

The commission also recommended substantive changes to TriCare benefit design, including increasing “out-of-pocket costs for dependents of service members and retirees.” Thus far, those recommendations “have not attracted the support of lawmakers” in Congress. Such changes are viewed as “controversial,” and policy makers are reacting cautiously. The FY 2017 authorization law does include much smaller increases in TriCare fees for certain future retirees and their dependents.

The Task Force

Leon Panetta, former secretary of Defense in the Obama administration, is among the four cochairs of the BPC’s Task Force on Defense Personnel, which produced this paper, released on March 9. Members of the panel included former US Sen. Pete Domenici (R-NM) and Donna Shalala, former secretary of Health and Human Services in the Clinton administration.

Read the BPC’s full twenty-three-page paper here.

The BPC’s Subsequent Recommendations

The BPC’s Task Force on Defense Personnel subsequently issued a report on March 20, 2017, with its own recommendations. The report, also funded in part by the Peter G. Peterson Foundation, is on “reforming the Defense Personnel system overall,” and military health and health care is but one of several topics, a BPC policy analyst told me in an e-mail.

That report, for example, makes a few policy recommendations about TriCare. One recommendation is to allow active-duty dependents to decline TRICARE coverage and instead be reimbursed up to $250 per month for premiums and cost sharing for another health plan, such as coverage at work. Proof of coverage would be required. “This new option would encourage dependents who have access to other coverage to enroll in and use that coverage,” thus taking advantage of their employer’s contribution to the insurance premium “and reducing costs for TRICARE.”

Related reading:

“US Military Primary Care: Problems, Solutions, And Implications For Civilian Medicine,” by Benjamin F. Mundell and coauthors, Health Affairs, November 2013.