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Make fee raise manageable

“Hit us over the head with a two-by-four three times, and we’re beginning to get the message.”

That’s how Defense Secretary Robert Gates explained why the 2010 budget did not include a proposal to increase Tricare fees, as had the Pentagon’s proposals in 2007, 2008 and 2009.

It’s a candid admission that three straight years of iron-fisted congressional rejection means this beaten horse is dead.

But that doesn’t mean the underlying problem will go away.

When Tricare was launched in 1994, defense officials failed to build in a mechanism for raising fees. So while heath care costs have skyrocketed — jumping from less than $18 billion in 2000 to an estimated $47 billion next year — fees paid by Tricare users have remained constant.

The Pentagon’s fee hikes were meant to restore some balance in the share of health care costs shouldered by beneficiaries. But it stalled because the increases were so drastic — they would have doubled, tripled and even quadrupled what people pay now — that Congress rightly shot down the plan.

Still, the status quo can’t hold forever; current growth rates in the military medical budget are unsustainable, and enrollment fee increases are inevitable.

Here’s the way ahead: Index annual adjustments in Tricare fees to nationwide average increases in employer-based health insurance premiums, which are running at about 5 percent a year.

Then the Pentagon and Congress can work out a longer-range plan to begin raising fees at a rate slightly above that rate for a limited time, to make up for the 15 years of no increases.

This would restore the cost balance sought by the Pentagon — but over time, rather than in one painful swoop.