By F Todd Silver

WASHINGTON�The Military Health System, dubbed by assistant secretary of defense for health affairs Dr. Sue Bailey as "the only HMO that goes to war," was under a fierce attack last month by the House Appropriations Defense subcommittee.

Committee chair Rep. Jerry Lewis (R., Calif.) asserted that the nation�s military medical health care plans have become so mismanaged that they soon will owe billions, not millions, to contractors�and do not have the money to pay those bills.

"It is clear that we have a system in crisis when we find hundreds of millions in unpaid bills that could actually total $1 billion," said Rep. Lewis, noting that the MHS could face a $6 billion deficit by 2005. "It is a crisis when the health care system is not sure how much it actually owes, how it got so far in the red�and where it is going to get the money to cover these unpaid bills."

MHS administrators have failed to show how they plan to fix the expected $6 billion shortfall in the next three years, Rep. Lewis lamented. Committee members urged MHS officials to come forward as soon as possible with a full accounting of the amount owed to contractors, and to form a fiscal management plan to eliminate the deficit.

Committee members seemed to be learning towards waiting to receive these items before approving what would certainly be a very expensive program to provide millions of military retirees with adequate health benefits.

"Before we build another system, we really have to think about where we�ve been," Rep. Lewis said, adhering to suggestions he has heard that the current system "doesn�t work very well."
�

The $6 Billion Shortfall
The main issue at hand was what military health leaders were doing to pay back contractors. While applauding the MHS for providing better accessibility and using more funding to effectively support beneficiaries, Rep. John P. Murtha (D., Pa.) said he was appalled to hear that "so many people are not getting reimbursed." Where this reimbursement money would come from clearly has become a fiscal dilemma, he noted.

"It won�t be an easy task to find an additional $6 billion when we must address so many unmet needs to restore our nation�s military," Rep. Lewis charged. "But it is more fundamentally a case of mismanagement that has the potential to undermine the medical care for all of our nation�s military personnel."

Rep. Norman D. Dicks (D., Wash.) warranted that contractors who have claimed that they are owed money might not stay in the program much longer unless they are reimbursed. Newly appointed under secretary of Defense for personnel and readiness Rudy de Leon told committee members that the state of the military medical system has mirrored the current environment in the civilian sector, except that many private health maintenance organizations are reducing or closing, while "we are maintaining or expanding our system" to meet the demand. De Leon acknowledged that health care costs are rising higher than anticipated. He added that the MHS is coming to understand that growing pharmacy costs has been a major challenge, and that the department has not been able to control those costs.
�

Retiree Programs
Aside from the "huge money" involved in unpaid bills, Rep. Lewis said he was very concerned that DoD has not delivered on the promise made to military personnel regarding health care for life.
Rep. James Moran (D., Va.) pointed out that millions of dollars has been spent on the Federal Employees Health Benefits Program demonstration project, which has the capacity to enroll 70,000 Medicare-eligible retirees at eight sites. However, "virtually nobody is enrolling," he concluded, pointing to a three per cent enrollment rate.

Rep. Moran advised that retirees have refrained from enrolling because "they know that if they enroll now, [the program] may not be there in the future," he said, "so we wind up with 8 sites and virtually nobody enlisted."

Rep. Moran suggested that if the demonstration project was extended, "we should put in a guarantee that if you enroll you will not be left out in the cold."

Dr. Bailey agreed with the argument that people are afraid of being left out, and suggested that a full-fledge demonstration project may bring more eligible retirees in. Although a number of bills pending in Congress are aimed at providing health care to military retirees, Rep. Lewis warned that "until we can guarantee that this system can efficiently manage� providing health care to those men and women in uniform�we would be irresponsible to consider expansion to any other groups."
�

A Barrage of Criticisms
Dr. Bailey, De Leon, and the military surgeons generals were under fire nearly the entire subcommittee hearing. In responding to questions about the morale of TriCare workers, posed by Rep. Henry Bonilla (R., Texas), Dr. Bailey responded that "morale is very high, but we need to support our team to keep morale high."

Navy surgeon general Vice Adm. Richard A. Nelson, MC, USN, said that TriCare workers he has met with have been very positive about changes being made in the system, "but they�practitioners especially�are concerned about the budget."

Rep. Rodney Frelinghuysen (R., N.J.) hinted in his remarks that DoD has been falling behind the private health sector in terms of technology. "People shouldn�t be walking around with their [medical] folders under their arms," he related. Rep. Frelinghuysen also shared his disappointment with the progress of several innovative programs including the SmartCard.

Responding to Rep. Frelinghuysen�s comments that the military�s prescription system is still largely handwritten-based, Army surgeon general Lt. Gen. Ronald R. Blanck, MC, USA, pointed out that 95 per cent of prescriptions in the military are sent in via computers, whereas 95 per cent of prescriptions in the private sector are handwritten.

Several committee members inquired why the Department of Veterans Affairs and DoD spend billions on "separate" health care systems, and if collaboration between the two entities have really improved.
Dr. Bailey responded that different issues exist that force the military divisions to house separate health programs. She related that several joint ventures between VA and DoD have been conducted, and that existing automation and technological products are being shared.
�
� Or go here to FURTHER see this from it's web site for yourself at:
http://www.usmedicine.com/mhshear.html