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SEN. LINDSEY GRAHAM (R-SC): Very briefly, what you said is absolutely true, it has been a pleasure working with you and your staff. I think the committee has the right spirit about the way we should approach our job when it comes to the military community, and you have really been a pleasure and joy to work with.
I want to recognize Meredith, she did my defense work before she went on to bigger and better things, and has done a good job on the Wounded Warriors Program.
Thank you all for coming. Thank you all -- all of you for what you do everyday and I am ready to listen and learn.
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SEN. GRAHAM: Well, thank you Mr. Chairman. As always this is very informative. What did people do before TRICARE?
MS. : They had the CHAMPUS program.
MR. : They used the CHAMPUS and had similar problems.
SEN. GRAHAM: Okay.
SEN. GRAHAM: Right, and before CHAMPUS?
MR. : That was before my time, sir.
SEN. GRAHAM: Basically, what we are talking about is the third party payer coverage.
MR. : Right.
SEN. GRAHAM: As what -- (cross talk) -- in the military -- (cross talk) -- yeah, into the military command which has been a good thing. Because if you go back before CHAMPUS it was -- you go to a VA center or some other DoD facility, if you are lucky you would get in, so the whole idea of expanding the network to include private hospitals and private physicians has been a good idea.
And the problems you are talking about are just endemic to third- party payment married to the coverage issue. I mean, there are thousand anecdotal stories about chelation therapy.
Now, Medicare may not authorize that, there maybe a body of people to say, you know, that sounds good, but we don't think we won't invest in, so that's why this is important for you to tell us the types of services that are available out there and you are not getting covered and we can look and see whether or not from our point of view this should be added to the mix.
In 1987, when TRICARE came along, you are right, there has been no premium increases. We've got to deal with it -- I agree with you -- they have just kind of dumped it all over --- all at one time. In terms of a good deal, in 1987 it was 91 percent of the services were covered by the patient, 9 percent -- no, excuse me, by the services and the government, 9 percent by the patient. And that ratio has changed it is not 90 percent any more it's a lot less.
So from the government's point of view, the amount of coverage being offered is that is -- (inaudible) -- with the private sector. But at the same time you don't make it all up at one time, and you don't put a burden on people, you know, that, you know, 400 percent premium increase. And it is budget driven to some extent.
I will be honest with you, I mean, since, there is not unlimited resources to run every program in the government, 12 percent -- 14 percent of the budget and DoD is going to be health care in the next 20 years, and that competes with all of the other things that are important to families and readiness.
So what I want to do is take your 16 suggestions about how to save money, sit down and go over it myself with DoD, then come up with a way to implement some premium changes that are not draconian. Look at how you can save money and how you can expand services.
The one thing, now, I look at TRICARE is how to make it -- not just from the costs but how to make it a better quality benefit. They are probably some things that could be offered in TRICARE, that are not being offered that would keep you out of the hospital.
You know, there are some things that we could do. Now, when it comes to coordinating between the DoD and the VA matter of fact is a -- you know, being a military lawyer for 25 years, one of the big things you want to do is keep everybody on active duty who wants to stay on active duty.
You know, one of the big fights that most service members have is they don't want to leave the military.
So we want to make sure that those boards that are held, the medical boards give people a chance to make a case that I can still serve, and to those who obviously can't serve to make it just as painless as possible, not get caught up in this bureaucracy.
And the committees coordinating, it is never going to happen I think until you get a seamless system out there that works. Because the committee oversight probably -- it is just makes no sense.
So I'm going to focus on trying to make sure that from the moment you leave the battlefield injured, that there is no gap in coverage, and that you have as much access as possible from every available system whether it be DoD, VA or the private sector and you get what you need because that's the whole point of the wounded warriors.
Now, this idea of a GI benefits, that's going to be a big issue in this Congress. But one thing that I have been thinking of for a quite a long time is how can you take that GI benefit and use it the maximum benefit of the service member and their families, and that's where transferability needs to be put into the mix.
I'm convinced, that a lot of people would stay on active duty, if it would -- if their benefit could be transferred to their spouse or their children. You know after three years you get 36 months of tuition assistance at $1,100. Well, the average cost of a state school now, Mr. Chairman, is $1,500. So we need to bump it up. We need to bump up the benefit.
But I think what we need to add into the mix, we are thinking about after six years of active duty service you could transfer half your benefit to your spouse or to your child. And after 12 years you could transfer all of it.
Half the people eligible for VA educational benefits never avail themselves of it, so my program that -- that actually will be more expensive, than some other ideas out there. But I think it would make the program more meaningful.
And the goal is that if you will serve our country to the 12-year point they when it comes down to send a kid to college that you will have that college paid for, through your VA benefit, that you may not use it but your child can use it.
I think that would really help families out there a lot. So those are the type of things that we are talking about and in the VEAP program, who mentioned that?
MR. BARNES: I did.
SEN. GRAHAM: We are not going to leave those people behind.
MR. BARNES: Thank you.
SEN. GRAHAM: Now, that's just -- that is the right thing to do. Whatever I do is going to include a benefit for those folks. And going back to 2001 is a good idea, you know, in terms of the early retirement.
But having said all that, every benefit that we build into the system has an out-year cost and the goal is to treat people fairly, to get the best health care we can, as soon as we can to those who are most severely injured, to make it an attractive endeavor to stay in the military, to -- a rewarding career that has a benefit to you and the ones that you love most.
And that when your 20 years is up or your 30 years is up, you can look back with pride and say, not only did I serve my country well, but I will have a lifetime of -- a lifetime annuity and access to decent health care. That is the goal.
And so your testimony, as far as I'm concerned Mr. Chairman, is valuable, and we are going to deal with the growth of medical cost in the budget.
We are going to phase in some increases that have to be bitten, you know, confronted in a way that's not draconian and so we can get this thing back on a sustainable field.
And just as important to me is to maybe expand TRICARE in terms of what's available out there, to make it a more robust benefit, a benefit that keeps people well. And I think we could do more there.
So I just appreciate your testimony and we will be rolling out a veterans' GI enhanced benefit bill here soon that will have transferability in it. Something that -- well, I think will help families out there. God bless you.
MR. : Thank you.
SEN. GRAHAM: It wasn't a question, it's just a rambling comment.
SEN. GRAHAM: But I do appreciate what you brought to our attention, the three-year deal, that's a good idea to make sure that -- three years of TRICARE coverage.
MR. : Thank you, for your leadership on all these issues, Senator, very much appreciate it.
SEN. GRAHAM: I think, Senator Nelson and I understand that we've got this job in an unbelievable time. No one has ever envisioned a war like this. It is an all-volunteer force, they are more contractors in theater in many ways than there are active-duty people.
We have never gone to war with a contract force like this. We have never gone to war with this much participation by the Guard and Reserve over the same period.
And so it's now time to reshape the benefit package to meet the reality of a war that has forever changed the Guard and Reserve.
And I think it's forever changed the family service component of the volunteer force, and we are going to get more soldiers and more marines that is coming, and that will help.
MS. BECK: Sir, if I could, one point on that, that we -- this is a different type of warfare than we have ever experienced, and we have far fewer casualties than we have had in the past.
And this is an opportunity to take those families who are injured, and who are so severely injured, and treat them as individuals and not as a statistic or a number or a category.
And that they can -- they can -- it will save money in the long- term to do it right the first time.
SEN. GRAHAM: Well, that's the least we can do, and this war, the casualties that we have sustained have been in many cases -- there are people living in this war that would have never lived in any other war. And that is the great news and hats off to the doctors and nurses and health care providers who have gotten them off the battlefield back to home.
But some of them have come back home in really, really bad shape, and so we will do our part to help them.
MR. : Senator, if I can add something -- why you are looking at the health-care benefit, one of the things that has recently come to light is the taskforce on health care said that they could seek $24 million for every 1 percent that moved to the TRICARE Mail Order Pharmacy Program.
What we would like to see is that, that mail order pharmacy be no cost to the member and it would save TRICARE an immense amount if all -- currently, only 8 percent of the people out there are using the mail order pharmacy. 0
SEN. GRAHAM: I have heard that and a lot of pharmacies push back but it makes sense to me particularly about some, you know, average everyday drugs that you just go out and get them refilled.
So, all right, thank you all.
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SEN. GRAHAM: Mister and I don't mean to interrupt, but that is a good point. The Air Force and the Navy, the Air Force is running for most part Camp Bucca the oldest military prison probably ever in history.
You got the Air Force, a lot of Air Force enlisted guys driving trucks from Kuwait, and just a kind of Navy people out there doing things, they augment the Army and the Marine Corps and that's why I share your concern about drawing the Air Force.
You know, the Air Force gave up on end strength so they could just have some money to put into an aging air fleet.
The bottom-line is, Mr. Chairman, the country doesn't spend enough on defense. We are at about 3.6 of GDP historically it has been over 5 percent since Vietnam, it was 18 or 19 percent during World War Basel II.
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