Before you Firebomb my House

 Before you firebomb my house, back away and read this using your critical thinking skills, ok?

I have an acquaintance who, as I am, is a military retiree. Like me, he has one of the best double barreled medical insurance plans available to anyone, anywhere. As a retiree, I am required to have Medicare part B deducted from my Social Security each month.  Unlike non-retirees,  my wife and I are covered by both Medicare, having paid into it, and Tri-care, which was our military health care provider and now serves as a Medicare supplement  for her and for me  for the rest of our lives. Is this a good plan? Hell yes, it is! I have a $33,000 new hip for which I have received no bill.

    It is of no financial benefit for me (or my friend) to use any Veteran's Administration facility or service, as Tricare covers everything that Medicare doesn't. My friend however, frequently sees VA doctors and uses VA facilities instead of using private resources, even though it makes no monetary difference. I would estimate that Tricare has a realistic value to us of probably over $12,000 annually. If we need more rigorous care, it will be worth even more. 

    The sole reasonable exception to this is in the case of those non-retirees or veterans who are on outrageously priced prescription drugs, which the VA gets far cheaper, because they are allowed to negotiate drug prices, while Medicare/Medicaid cannot. I referring here to those on Medicare and Tricare who, having the same (basically no-cost) options as all retirees, continue to clog the VA, not because they must, but because they can.  

Many believe that the military is alone in providing this kind of extended medical coverage to retirees, but I assure you this isn't the case. Some public sector retirees are able to retire on as few as 20 years service with 20 to 25 more working years ahead of them, but only if they so choose, since in many cases their retirement will be sufficient and their health care is essentially free if they so decide. A teacher in Albany, NY for example might  retire at age 59 (for example) with a cash in hand annual retirement pension of about $68,000, they may also elect to continue to keep their same health care coverage until Medicare kicks in, at which time, it converts to a "Cadillac" Medicare supplement program. This healthcare additional coverage has an estimated value of $14,000 annually for a 25 year NYPD retiree.  

I know, "Good for you, so what?" - well here's what. We hear today a lot of concern over the log jams at Veteran's Administration hospitals. Hospitals in Arizona are backed up to the point that we are outraged that veterans aren't able to get treatment immediately. Unfortunately, we rarely hear anyone question why that is and even less frequently does anyone suggest any action other than "build more facilities."

There is, however, plenty of room to discuss this issue in a factual, rather than emotional, manner.  First of all, the VA as we know it was established in 1930. For WWI vets, the government's obligation once discharged was as follows: Congress established a new system of veterans benefits when the United States entered World War I in 1917. Included were programs for disability compensation, insurance for servicepersons and veterans, and vocational rehabilitation for the disabled. By the 1920s, the various benefits were administered by three different federal agencies: The Veterans Bureau, the Bureau of Pensions of the Interior Department, and the National Home for Disabled Volunteer Soldiers. Note that this includes absolutely no provision for lifetime medical treatment for non-service-related health problems.     

Following, (actually still during) WWII, Veterans benefits were greatly expanded for active duty servicemen, while in the years since 1930, the increasing number of older WWI vets was already becoming an issue.  Remember one critical factor here; all (or the vast majority of) these vets were draftees. They had involuntarily been taken from whatever civilian occupation they may have been pursuing and forced into military service. The GI Bill of Rights greatly expanded veterans benefits again, this time as a means of avoiding the usual post war economic doldrums as former soldiers were cashiered out and became gluts on the job market.

     The GI Bill college, job training and zero down mortgage guarantee benefits were aimed specifically at this issue. Meanwhile, the VA became a "go to" source of health care for all veterans, even if they had absolutely no service-connected disability. And why not? We were one of the few industrialize nations not bombed or fought in/on/or over. we could afford it.

  At this point I must come clean and admit that my brother, a two-year draftee, received medical care for his several cancers at the VA in Washington. He had been out of the military for well over 40 years, but because the United States, unlike most developed nations, has no universal healthcare and he was a self-employed musician, what insurance he could afford would have been inadequate in any case. Am I glad Steve had access to the VA? Of course, I am, but I remain unconvinced that he should have. The fact remains, however, that he was a draftee and not a volunteer. 

All this still begs the question, "Why do we provide perpetual  healthcare for any person who serves two years, statistically has a <10% chance of ever seeing combat,  and leaves the military  in good physical condition with no service connected health issues?  Why do we continue to house and treat a man who leaves the service  and works 45 years at a civilian job with medical benefits, and, after he develops a heart condition , treat him as if he is different from, say, a retired 40 year  mechanic who has to pay for his own healthcare?"

Of course, no one in Government will address this issue because it's a political hot potato. There is a simple solution in the near and long term.

  First of all, a military retiree with Tricare for Life, has zero need for VA medical facilities, unless they were separated with a service-connected disability (and yes, PTSD is a service connected issue!). Even then, Tricare and Medicare will cover all their medical expenses after aged 65. Stop non-disabled retirees from using the VA hospital system.  Period. Stop it!  Even an underachiever who retires at 20 years as an E-6 will have about $25,000 annually for life in actual compensation, ($625,000 by age 65) plus medical coverage worth at a bare minimum, $10,000 more per year!        

Additionally, and obviously, current non-retiree users of the system would have to be grandfathered in even if their health issues are not service connected. 

We are now an all volunteer military and have been since 1973, so persons entering the military are doing so because they choose/want to. If these persons are careerists, they will have Tricare upon retirement and should use civilian medical providers. Many will work after separation and, like I was, may be covered under an employer's plan until they retire again and are Medicare eligible, 

Persons enlisting or being commissioned who leave the service before retirement with no service connected medical issues should receive a pat on the back, a job reference and, perhaps as much as 2 years' health care coverage extension, just not at the VA.  Upon becoming employed they should receive coverage under their employer's health plan. At 65 they will become Medicare eligible and can buy a supplement if they wish. 

    Since they left the military voluntarily and in good health, they should not be VA eligible for medical care unless it can be shown that there is an underlying service-connected reason to the contrary. Of course, exceptions could be made for proven indigence. The retiree I previously referred to, who  uses the VA, vice civilian medicine, is retired from the military on 24 years, retired from another  government  job on another 20 plus, has Medicare and Tricare and, with Social Security,  has  a household income in the $120,000 per year range.  

  This should (would) free up a slew of beds and appointment times for veterans with real issues, mental and/or physical which are now lumped in with persons who should have other insurance. 

The large scandal which rocked the VA hospital system in 2014 was far worse in Phoenix that elsewhere. Why do we think  that is? Well, take 37,000 military veterans, some retirees  many not, in Sun City alone, of the roughly 200,000 retirees in the area, many of whom are draft era short service people, and it becomes obvious. People retiring to Arizona are, as a group, not poor, not homeless and have worked for a living. many of them use the VA because they can, not because they need to. Unless specifically diagnosed with a service-connected disability, they should use Medicare and a supplement like non-vets.

This may sound harsh, especially from a long time military member, but when we don't have  beds for soldiers with traumatic brain injury or PTSD, or missing limbs, or other line of duty issues because a 75 year old who left the military in good health at age 24 has  lung cancer from smoking for 50 years after he left the service, our  priorities are skewed. In most states a cop or firefighter who isn't a retiree gets no follow-on health care unless disabled, yet they are exposed to severe hazards on the job, too.