Universal Health Care and Military Retention

Worries that universal health care will hurt military recruiting:

Health’s Gain May Be Army’s Loss, by Floyd Norris, Commentary, NY Times: Call it the law of unintended consequences. When you fix one thing, it messes up other things.

If the Democrats win the election this year, and are able to enact a health care plan that extends adequate coverage to all Americans, the loser could be the Army. Getting enough people to enlist could become a major problem for the next president. ...

Government polls show that the proportion of young people who think they might enlist is roughly half what it was in the late 1980s. The military has responded with more recruiters and higher cash enlistment bonuses, and has met its goals. A significant factor for many recruits, it turns out, is the military’s generous health benefits for dependants.

Michael Massing, writing in the April 3 issue of The New York Review of Books, tells the story of one part-time college student from Brooklyn, who was holding down two jobs but still going into debt. “Meanwhile, he got married, his wife got pregnant, and he had no health care. From a brother in the military, he had learned of the Army’s many benefits, and, visiting a recruiter, he heard about Tricare, the military’s generous health plan.” He enlisted. ... All that could change if the push for some kind of national health insurance program were to be successful. ...

[I]f such a program were adopted, it seems likely that the military, and particularly the Army, would feel the immediate effect. To expand the Army, as all the candidates say they want to do, would require some other incentive for enlistment... In the near term, it is possible that a recession will improve the military’s recruiting success. ...

One partial solution to the negative effect on enlistment of a health care plan for all could be a new G.I. education benefit. Both the House and Senate have approved such a plan... President Bush is opposed to the legislation, which its sponsors say would cost $50 billion over 10 years, and it is far from clear it will be enacted. ...

Senator Jim Webb, a freshman Democrat and Vietnam veteran, is the principal Senate sponsor of the legislation. He argued — with something less than precise data — that passage of the bill would increase enlistment by 16 percent...

Senator McCain has proposed a less costly alternative that would provide better benefits to those who stay in the military longer. He may have a point. Last year about three-quarters of Army volunteers who completed their first term of enlistment, and nearly as many marines, chose not to re-enlist. ...

If we get a real health care plan for all Americans, it might require something like the Webb bill — or a very unpopular revival of the draft — just to keep fighting in Iraq and Afghanistan. The backers of health care legislation do not want to hurt the Army, but that is what could happen.

Continuing a discussion of this topic from not too long ago, the right way to do this is to state the the goals we are trying to reach, then build incentives into the polices that direct people toward those goals with as few negative consequences as possible.

One possible goal is retention. If you want people to stay longer, deferred compensation schemes are a way to accomplish that goal. We need to decide how many people we want to stay for additional terms, and then set the compensation incentives accordingly (these can be tweaked as needed, e.g. you can have incentives for reenlistment at each decision point, or you can discourage reenlistment after some number of terms if there is some reason to do so). Yes, it may require that the government pay people serving in the military more, at least those who stay longer, but that is simply what it will cost to reach the goal, that's the price to command these resources. People who applaud the ability of markets to value resources should understand that. If it costs too much to induce sufficient reenlistment, i.e. if the costs of producing higher retention rates are greater than the benefits, then it's not a very good policy anyway.

But if the goals are different, e.g. if the goal is to provide educational benefits to make up for lost opportunities in the private sector due to service in the military, the the policy will, of course, be different as well. When evaluating a proposed policy to, for example, increase educational benefits all of the consequences, including the effects on retention, should be examined. But this is part of a cost benefit calculation. If the educational benefit - the goal of the policy - exceeds the retention cost, then it's still worthwhile.

And it may not be necessary to give up on the retention goal just because you offer educational benefits, one does not have to be traded against the other. It's possible - if you are willing to pay the cost - to offer both higher education benefits and higher deferred compensation so that both goals are attained. More help for education is available for those who choose to leave when their term ends, but since deferred compensation is higher for those who reenlist, just as many stay as before. Whether it's worth it to do this is  matter of comparing the costs and benefits, but increasing education benefits does not have to lower retention rates.

If national health care is enacted and that lowers the incentive to enlist, or to reenlist, then the compensation levels will have to be adjusted to compensate, but it doesn't have to change retention rates or the ability to provide education benefits after people leave the military if we are willing to pay what's needed to induce the desired behavior.

Comments

[reason]

This is just what I have always said, the military (and the MIC and PIC) are the American rights alternative to proper social insurance. As it is potentially deadly, it can't possibly compete with real social insurance.

[save_the_rustbelt]

So Norris bases his work on a single second hand anecdote? And some vague comments about a poll?

Gee Mark, is this "celebration of bad writing day?"

[ken melvin]

Not sure we should accept as fact that retention is an overriding concern given the whole military industrial complex in questionable. Beyond this, sure let the market work. Better to incent with pay rather than with harsh economic conditions on the outside, as is now the case.

[robertdfeinman]

I think this is a case where there are competing interests. The military professionals who have to keep their staff up to levels where they can perform whatever missions are thrown at them see only one factor - recruitment and retention.

The Daddy Warbucks faction sees big money to be made by providing mercenaries to do jobs usually done by grunts. The harder it is for the military to fill positions, the stronger their case that the private sector should take over more functions.

The neo-cons, (let's you and him fight) in both the think tanks and in congress, know that asking too much of the public in terms of military service would constrain their foreign policy agenda. Just look at all the reasons given as to why Congressman Rangle's proposal for mandatory service is a bad idea. He and they both know that if the middle class had to serve, antiwar sentiment would rise quickly. So this group wants to keep the number serving small and mostly consisting of those without any economic or political power. If they leave the service relatively quickly then they will never become a coordinated pressure group which will lobby for better conditions.

[Lafayette]

Have a look at TRICARE services, here. It's a damn fine model for all-of-America universal Health Care.

See, it CAN be done, by maintaining HC-pricing at government-run hospitals by a skilled staff of practitioners who work for a decent salary, but without ripping off their clientele.

Makes one wonder how they do it and survive. Must be ... uh, government subsidized Health Care? Yep, they took a hint from the Europeans. Not so dumb, that ...

[Jack]

Wait--a successful national health care might force us to leave Iraq? Where's the bad news?

[TigerPaw]

Only bad news is if the US ever actually stopped dragging its feet and implemented decent health care for the masses then the insurance companies and related orgs that now make out like bandits wouldn't be able to keep ripping off the public.

Course that's why they're dragging their feet.

[Lafayette]

What BO promises will NOT do the job in Health Care

TP: Course that's why they're dragging their feet.

I wish I could have laughed at this remark, but of course you're right. Too many vested interests are involved in not changing Health Care in America.

The most "vested" is of course the AMA and its members. The insurance companies are simply trying to make a profit, by managing the system to contain costs in a business that has seen the go orbital. (Next stop, the moon.)

We've heard ALL the arguments on this forum for keeping the status quo. Foremost of which is, "Well, if you had to pay to get your ass through medical school and then internship before you can earn a living, you'd want a decent salary as well".

The answer to this myopia is twofold. First, a salary three times the national average for Health Care GPS and Specialist is more than decent. It's a ripoff. I think, personally, either they never took the Hippocratic Oath or, if they did, they forgot it a nanosecond later.

Secondly, if educating doctors/nurses/whoever is expensive, then it is because the educational system that does the job is too damn expensive. And, the best way around that is for the "gummint" to invest in the training program. Which means both stipends and tuition for people who specialize in Health Care -- with the promise that they "pay back" the investment with a minimum service period in a Nationalized Health Care program.

Note that some will make a lifetime of that Public Service career, as do a great many Civil Servants, because they are genuinely concerned for helping their fellow citizens. Which is the sort of motivation that moves a great many destined for the Health Care profession ... until they see their peers driving BMW SUV's and living in suburban houses with large, green, well-kept lawns.

This country has the resources to do precisely what it wants to do: Go the moon, go to war, build interstate highways, stimulate renewable energy resources, AND implement a Federally funded system of universal HC, etc., etc. It would run in parallel to the present private system (and allow the latter to be really private). Those without private insurance would go to the federal national HC-system, because Health Care is not a business but a birthright. Like National Defense.

(Which is the point being made regarding the military's health care system and the privilege it offers those in military service. It is a MAJOR incentive to pursue a career in the military. Which is why it is fully-funded by the DoD.)

National Health Care simply needs the will to do so, that is, be implemented. And, THAT is the problem. There is no will to do so. Even BO, in his nearsightedness, has suggested tweaking the present private HC system. He took the idea from Romney in Massachusetts, and that idea is going no where. It will not contain costs and it will not be truly universal. So, it's just pap for Massachuesetts Masses. (It was supposed to get Romney elected PotUS ... which was its real purpose.)

In fact, I have been asking on this forum for a while now and no one has come up with an adequate solution. We get a lotta talk about single-payer systems, but the administrative bit will NOT lead to lower cost Health Care. (And shifting Health Care priority from cost-avoiding Preventive Care from hallucinatory-cost Remedial Care.)

We've watched the Dem candidates go through a Public Pantomime of heart-wrenching concern for a national Health Care solution and we have ..... absolutely nothing to show for that catharsis.

What BO promises will NOT do the job. And, as we shall see, McCain will NEED health care more than he involves himself in devising an adequate universal health care scheme. (Do not expect universal/affordable health care from the Repubs. They haven't a clue.)

[ken melvin]

Hear, hear bon ami.

[robertdfeinman]

I never understand the selective resentment of those making a decent living. OK, doctors make $100-200K. So what. They are highly trained and literally have your life in their hands.

On Angry Bear there is a thread where a troll is complaining about the "high" salaries of postal workers. Apparently he resents the fact that they are unionized and have a decent contract.

Meanwhile the same libertarian strain sees nothing wrong with a Wall street leech hedge fund manager making $1.2 billion.

I guess a working stiff can visualize $100K and feel resentful, but earning billions is beyond their imagination.

Doctors in Japan, France and Germany all make high salaries (not as high as in the US, but their expenses are also lower), yet the systems provide better care at a lower price. It's not the doctors that are causing the high costs in the US, it's for-profit firms like drug companies, private hospitals and nursing homes, insurance companies and various other middlemen.

I must say that the plutocracy has been unusually successful at dividing the working class. They have succeeded in getting workers to resent immigrants, unionized workers, civil servants, professionals and foreign workers. As I keep saying there are only two classes: those who have to work to eat and those who don't.

Figure out where your common interests lie and wake up!

[Lafayette]

rdf: I never understand the selective resentment of those making a decent living. OK, doctors make $100-200K. So what. They are highly trained and literally have your life in their hands.

Because, you never ask yourself "Why do they make so much?" And, you never obviously bother yourself with the fact that income inequity is a key question in a developed society that purports to guaranty the "pursuit of happiness".

If these matters do not perturb you, then you cannot understand the fact that Health Care pricing, like gas at the pump, is inelastic. It's not just another market where supply effectively meets demand at a reasonable price. You can ditch the car and use a bike when gas prices are too high. You can’t do that when you have an illness. An illness, even the most common cold, shuts all other questions, matters, preoccupations out of your life whilst it installs itself.

Secondly, neither have you any conception of what a Public Service should be. Health Care is a birthright (since it is so crucial), not a business, so it should be provided at affordable rates such that all can access it reasonable easily. Like national defence or any other public service.

Thirdly, I (for one) would not like to put my life in the hands of doctors, however well trained they may be. I would prefer an HC-system so affordable that the accent is shifted from Remedial Care (which due to its lateness is highly risky) to Preventive Care (which saves one helluva lotta money). You know, "an ounce of prevention is worth ..." And all that.

Fourthly, unless all three of the above are absolute drivel ... then tell me how I am wrong. Explain how one specific but key group in the furnishing of a key public service has the right to exact monopoly prices. I'm all eyes.

NB: Just remember when rebutting, rdf, that we're not talking about Windows here. This discussion is about your health; which, when something goes wrong, you lose your life and not just your data.

[superdestroyer]

Any benefit currently received by the military that is not a universal benefit helps in recruiting in retention. Giving everyone free health care would hurt the military especially since the payroll taxes that the military pays would have to go up to fund universal health care. The same would happen with Senator Obama's plan to give $4K per year for college to everyone. It makes the value of any GI Bill less.

One of the problems in trying to raise military pay in that members of Congress such as Steny Hoyer have adopted the policy that the military cannot get a higher pay hike than what is given to the Civil Servants.

I wonder how free healthcare for all will affect civil service recruitment since the fringe benefits of civil service try to make up for the slow promotions and the low level of pay?

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