Joint health care proposal criticized

The military’s top medical officers are divided over a House-passed mandate to reorganize the health care system under a unified medical command. The plan, in effect, would merge commands that the Army, Navy and Air Force have run with separate staffs and resources for decades.

Two of three surgeons general, for Air Force and Navy, oppose the move and hope senators will reject it when preparing their own version of the fiscal 2012 defense authorization bill, and then again when House-Senate conferees meet to negotiate away any differences between the two bills.

The plan to restructure military medicine, which the Army and Navy had embraced five years ago, assumes cost savings of $460 million a year by ending duplication of effort and staff redundancies across the services.

But Lt. Gen. Charles B. Green, Air Force surgeon general, said his service continues to oppose a unified command, in part because it disagrees the restructuring will save money.

“We believe a more effective and efficient joint medical solution can be attained without the expense of establishing a unified medical command,”Green said. “Changes to doctrine can be made within current authorities and do not require a new unified medical command.”

The Navy no longer supports medical command consolidation, at least not now. Vice Adm. Adam M. Robinson, Jr., Navy surgeon general, warned “there is currently no joint construct or doctrine to permit the seamless and safe care for our service members and their families” under a unified command.

But Lt. Gen. Eric Schoomaker, Army surgeon general and commanding general of Army Medical Command, finds “merit in considering the most effective and efficient command structures to support the strategic goals of the military health system, the services and the combatant commanders.”

Under the House bill, the unified medical command would be a major combatant command similar to U.S. Special Operations Forces Command (SOCOM), and reporting directly to the secretary of defense. The four-star officer selected to run it would be given unprecedented authority over medical staffing, training, purchasing, operations and readiness, just as SOCOM is responsible for all aspects of combined special forces. Medical personnel still would be trained for service-unique missions in the culture of parent services. But overall medical training, assignments, procurement and operational support would be centrally controlled.

The unified command would oversee three subordinate commands led by three-star officers. One would be responsible for all fixed military treatment facilities. A second would run all medical training and education plus research and development. The plan is silent on functions such as logistics and information technology, allowing the department to organize those as it deems fit.

A third subordinate command, called the Defense Health Agency, would assume all functions now performed by the TRICARE Management Activity including the multi-billion dollar TRICARE support contracts that support vast networks of civilian health care providers to deliver a triple health care option to family members and retirees.

The House directs the secretary of defense to present details for implementing these changes to defense committees by July 1, 2012.

In 2006, while Donald Rumsfeld was defense secretary, the department came near to recommending a similar restructuring plan to Congress. But it was vigorously opposed by the Air Force.