Army official: Health-care issues complicated for the Defense Dept., too

Army Undersecretary Joseph Westphal's Power Point slide showing the Pentagon procurement process flashed on the screen, prompting laughter from the audience at this week's Wharton Leadership Conference at the University of Pennsylvania.

The tangled web of arrows, blocks and bubbles applied to buying tanks and helicopters. But it also applies to military health care, which — like the civilian version — is no less complicated, costly and important.

Westphal told the group that the military had a "moral obligation" to care for its employees, which might differentiate it from the private sector. Nonetheless, doctors, nurses, hospitals and pharmaceuticals cost money, and part of Westphal's job is to figure out how to get the most care for the least money.

"You have a responsibility when you send somebody into harm's way to ensure they are provided the health care and benefits they deserve," Westphal said in an interview after Wednesday's presentation. "The trick is, how do you make adjustments over time, particularly with the younger generations coming in."

Westphal has served under five presidents (three Republican, two Democrat). One of his recent bosses, Robert Gates, defense secretary under Presidents George W. Bush and Barack Obama, said in May 2010, for the first of several times, that "leaving aside the sacred obligation we have to America's wounded warriors, health-care costs are eating the Defense Department alive."

Beyond money to care for those wounded in combat, the Pentagon's proposed budget for 2013 has $48.7 billion to fund what's called the Military Health System. As Gates suggested years ago, the proposal includes increases in enrollment fees for some slices of Tricare, the military insurance program, and in pharmacy co-pays for future military members.

The proposed fee increases would not apply to current active-duty service members, survivors of service members who died on active duty, or those who retired due to disability. The Pentagon notes that the proposed changes amount to slightly more than 10 percent of savings required under current law, but that pay and benefits are still one-third of the defense budget.

Improvement in battlefield medicine means that soldiers in Iraq and Afghanistan sometimes survive injuries that might have killed them in earlier wars. But the survivors need medical care, including for post-traumatic stress syndrome.

The Pentagon and the Veterans Administration are different departments with different budgets. Critics contend the organizations have for decades failed to coordinate care among their overlapping members, though Westphal said recent relations have improved tremendously. Still, among the current criticisms of both is the overprescribing of antipsychotic drugs, in volume and dosage. Most such drugs are approved by the U.S. Food and Drug Administration only for treatment of schizophrenia and bipolar disorder.

The Pentagon recently ordered military doctors to be more cautious in prescribing antipsychotic drugs. Westphal and Army Vice Chief of Staff Gen. Lloyd Austin are leading a task force to review behavioral-health diagnoses across the Army.

"We've become a lot smarter after the last 10 years of war in dealing with this issue," Westphal said. "Have we solved it? No. But we know more than we ever did."

Contact David Sell at 215-854-4506 or dsell@phillynews.com or Twitter @PhillyPharma. Read his PhillyPharma blog on philly.com.