It can be tough to think about military health care costs objectively, because we bring so much historical baggage to the table.

Before TRICARE Prime came along 10 years ago, retirees had no enrollment fees for military health care. But there were other costs to deal with. Most significantly, retirees age 65 and older lost their military insurance coverage entirely and had to depend on Medicare. Some were fortunate enough to get "space-available" care in military medical facilities, but others were closed out.

Active duty members assigned away from military facilities paid 20-percent copayments for care and medications, and retirees under 65 paid 25-percent copayments. What’s changed in the past 10 years?

Since 2001, Medicare-eligibles now have TRICARE For Life (TFL) as second payer to Medicare, so they no longer need to pay $2,000 a year for Medicare supplement insurance. They also have regained their eligibility for military pharmacy coverage. Since 1995, retirees under 65 can enroll in TRICARE Prime and get guaranteed care but pay an enrollment fee of $230 a person ($460 a family). Those under TRICARE Standard pay a deductible of $150 a person ($300 a family) and a 25-percent cost share.

Since 2001, active duty beneficiaries no longer have any copayments in TRICARE Prime, and the TRICARE Prime Remote program protects active duty members and families from having to pay increased costs when they’re assigned away from military facilities. Those who elect coverage under TRICARE Standard pay the $150/$300 deductible and have a 20-percent cost share.

Since 2001, all military beneficiaries have access to TRICARE pharmacy programs, paying $9 for brand-name medications and $3 for generics. Now, faced with the same significant health cost increases affecting the rest of the country, and seeing civilian employers shift a progressively greater share of health care costs to employees and retirees, Pentagon leaders are engaged in an internal review of ways to have military beneficiaries pick up a greater share of the military health care bill. It might be next year before we see any actual proposal, but it's worth pausing now to examine the arguments for and against such actions.

On one hand, it's true that most military beneficiaries have a better health care deal than the vast majority of civilian employees. Active troops pay very little, indeed, and older retirees have what amounts to a free Medicare supplement. Younger retirees have difficulty finding participating providers in some areas, but still can get a significant share of their health care costs reimbursed, even if they see a non-participating provider. A 25-percent copayment isn’t chicken feed, especially for a hospital stay, but many in civilian life would be happy to have 75-percent coverage.

It's also true that the TRICARE Standard deductible hasn't been changed in almost 20 years, and the TRICARE Prime enrollment fee hasn’t been changed since it was first implemented in 1995. Is it reasonable to expect those amounts should never be changed, even after many years of inflation? Probably not.

It's also undeniable that more and more civilian companies are imposing bigger deductibles, more copayments, and less choice on their employees, and especially on retirees.

But there are some pretty significant arguments on the other side, as well.

First, military service is significantly different than civilian employment, in ways that are brought home to the country with every morning headline and evening newscast. It was only a few years ago that the Pentagon endorsed eliminating copayments for active duty Prime enrollees. Have the conditions of service changed since then? We don't think so.

Second, let's not forget that, before 2001, more than a million older military beneficiaries went decades without any military health coverage at all, paying the full bill for their care out of their own pockets. Congress finally acknowledged that wasn't right and specified in law only four years ago that TRICARE should pick up the costs not covered by Medicare for that group. In doing so, Congress recognized that these beneficiaries had endured the same conditions as today's troops in military careers spanning two and three decades of hot and cold wars. Older retirees are due, and the country can afford, a little payback for all that service and sacrifice, and for all the years when the Pentagon didn’t pay a cent for their care.

Third, military beneficiaries can handle rational arguments. What they can't handle is having the Pentagon or Congress try to speak out of both sides of their respective mouths. Flat-dollar enrollment fees and deductibles established years ago might merit periodic revisiting as both health care costs and military compensation rise. Those discussions need to address reasonable standards for adjustment, rather than just arbitrary efforts to shift as much of the cost as possible.

But if active duty troops and families deserved health care without copayments or deductibles four years ago, they still deserve that today. And if older retirees deserved TFL without deductibles or copayments four years ago, they still deserve that today. Finally, let’s not lose perspective on one overriding issue. The United States is absolutely dependent on maintaining a strong all-volunteer force to guarantee our national defense —and the sensitivity to that dependency should be greatest when the country is engaged in a protracted war that is taking a high toll on active duty and Guard and Reserve families.

We must have strong recruiting and retention to sustain readiness, and the Pentagon already is teetering on the brink of significant problems in these areas. Is this really the time to be shifting greater financial burdens onto the people who already have borne, are bearing, and will continue to bear a grossly disproportional burden of national sacrifice?

Col. Steve Strobridge, USAF-Ret., director of MOAA government relations