Vice Adm. Michael Cowan
Military Officers Association of America
The DoD has proposed a major military medicine downsize, but this could create big problems for deployed soldiers, their dependents at home, and United States allies.
Military medicine has undergone numerous sea-changes over the past four decades, including the switch from a drafted force to an all-volunteer force, downsizing, the development of the TRICARE system, the military’s healthcare program, and now, more downsizing. Through to the present, the system has handled all these challenges successfully (some smoother than others). In these past evolutions, there was sufficient time and flexibility for the system to absorb the changes without damaging its foundations.
However, veterans of these exercises, myself included, are concerned the magnitude and timeline of today’s proposed changes are too great to absorb without fundamental damage to its infrastructure.
The Defense Department’s (DoD) 2020 budget is calling for the elimination of 18,000 medical billets, or about 20 percent of the force. DoD’s stated goal is to move excess medical resources to focus on warfighting, while still improving delivery of healthcare for troops, retirees, and their spouses. These objectives seem sound and reasonable, but will the plans as outlined accomplish those missions? My college physics professor said a 20 percent change in a physical system was a threat to the system itself. The current proposal to implement a 20 percent reduction in forces without compensating resources represents an existential threat to military medicine.
The structure of military medicine is complex. The system recruits, educates, and trains physicians, dentists, nurses, and additional healthcare professionals with a unique ability to provide high quality traditional medical care and to deploy worldwide. No other allied nation can duplicate the capabilities of U.S. military medical departments, and many allied nations are highly dependent on our medical force support for their ability to deploy their own troops. The U.S. military medical capability isn’t just an American treasure; it is a critical part of the defense structure of the free world.
Healthcare has been the top-rated benefit affecting retention of military members in all services for decades. An all-volunteer force requires not only good medical care for deployed forces but also care for dependents left at home. A deployed soldier whose child is sick back home in Nebraska needs the peace of mind that their family is being well cared for by a healthcare system they understand and trust.
Without adequate planning and oversight, unintended consequences could be profound and long-lasting. If the system implodes, it cannot be rebuilt overnight. There is a cautionary saying in medicine that “once the medication has been shot out of the syringe, there is no getting it back.” If military medicine undergoes 20 percent uncompensated manpower reductions, as outlined in the current proposals, I fear there will be no way to get the system back.