You get what you pay for with military healthcare (which is very little).

Because of DJ’s allergies, eczema and asthma we’ve been through a lot of the ins and outs of getting proper healthcare. We’ve gone through more twists and turns than the typical family that doesn’t require specialized treatment and urgent care visits. One day, maybe soon, I’ll take the time to write down all the ways military healthcare failed us.

But the point is that they failed us.

I always felt like something was wrong. If I told Jesse once, I told him a million times, “It shouldn’t be this hard to get DJ what he needs.”

But at the same time I had no proof. I had lots of evidence that individuals had failed our son and lots of suspicions that it was the system that was broken, not just these individuals. But I had no evidence that military healthcare was failing our son, not even anecdotal evidence.

So, to a certain extent, I’ve just never invested much time thinking about the hows and whys of Tricare’s failings. For one, my husband was in the military, so complaining about the only healthcare we had seemed like biting the hand that fed us, focusing my energy on a problem for which I had no solution. But the other is the strong don’t-be-a-whiner mindset within the military community. Whiners get ostracized. And in a world where work and play hugely, if not totally, overlap, getting ostracized in your social life can get you ostracized at work.

For example, when I had the opportunity to speak with Deborah Mullen, the spouse of the then Chairman of the Joint Chiefs of Staff, someone in base leadership advised me that I should only share compliments and encouraging stories about the base we lived at. He advised me that sharing problems or negative stories would only make our base “look like whiners.” Even if she pointedly asked me what I didn’t like about the base or base leadership I should find a neutral answer and not complain.

This “shut up and be grateful” attitude extends to every facet of military life, including healthcare. And I’m just as guilty as the next military spouse of feeding into the mentality that we should just be grateful.

Tricare Prime, the healthcare program that most active duty members and their families participate in, requires no co-pays for any medical visit with your designated physician or necessary care from specialists. This means that for DJ’s two week stint at National Jewish Health in Denver (we lived in Minot, North Dakota at the time), we paid nothing. And I mean nothing. We didn’t pay for air fare or meals or taxis or hotels. We didn’t pay a single dime in co-pays for his overnight in-patient stay complete with heavily regulated narcotics and constant nurse surveillance. Or for his emergency two hour stay in triage when he went into anaphylactic shock.

I’ve told that story thousands of times, bragging that our insurance was so incredible that they picked up all the cost. I’ve told civilian friends that my husband couldn’t leave the military even if he wanted to because we couldn’t afford DJ’s medical bills under a civilian insurance plan. And it’s a one-sided story, at best. At the worst it’s a dishonest one.

Because, sure, once we got to National Jewish we paid nothing. But my husband and I paid dearly in tears, grief, and struggle for a year while DJ suffered daily in acute pain before DJ received his “free” treatment.

Today I finally got my anecdotal evidence that when you pay nothing you get less. Less patient care, less innovation, less time.

Today my sons had their first well-child check-ups through our civilian healthcare. I paid $40, a $20 co-pay for each of them to see their pediatrician. But in less than an hour both boys had full physicals, DJ had vision and hearing tests done, they both had necessary immunizations, required medical paperwork for the school was filled out, and we had an overview conversation with the pediatrician about DJ’s major medical issues.

In order to get both boys well-child check-ups and immunizations at our last base military clinic, which had been recognized as the best military medical clinic in the region two years running, I estimate it would have taken three hours. It would have been at least a thirty minute wait before we would have seen the pediatrician at all. And immunizations are in a different department, where the wait process starts all over again. I would have had to pick up the paperwork later … probably about three business days later (and I won’t mention the number of times they’ve just lost the paperwork completely and we’ve had to start all over again). I don’t know that the military clinic even had the capabilities to check hearing and vision because they never offered.

But here’s the kicker.

Our civilian pediatrician is going to read DJ’s entire medical record, which is about three inches thick, before coming up with a plan of action for his specialized care.

Want to guess how many military pediatricians did that in four years?

None.

A couple looked up his last blood test electronically, but most, even as he got older and his record got thicker, just listened to me tell them what I wanted and gave it to me. And I preferred this. If they stalled to have time to put in a referral or do more research, I resisted or refused. Because I knew more time could easily mean that DJ’s needs would get lost in the shuffle. The squeaky wheel gets the oil. The patient person in military healthcare gets nothing, just like their co-pay.

The recap, the hindsight 20-20 lesson after today’s visit, is with Tricare in order to get any care at all I had to spent about triple the time and be the aggressive leader of my son’s medical team.

Now I’m paying $20 per visit, but I’d be willing to bet $20 more that DJ’s medical needs are managed by a physician instead of his mom. Like so many things in life, you get what you pay for.

Tags: allergies, asthma, and eczema, and eczema, asthma, military health care