A Department of Defense plan to put the Army in charge of all military medical training and research could be pulled soon in favor of establishing a new Defense health agency to handle these responsibilities and more, senior officials have told Defense’s Task Force on the Future of Military Health Care.
The agency would assume oversight of all medical training and research as well as management of the Tricare health program and responsibility for some shared medical activities across the services.
The Tricare activity would form the foundation of the new agency with additional staff drawn from service medical departments. But the Army, Navy and Air Force would continue to run separate medical departments and retain control of their medical personnel and most facilities.
The health agency concept, seen as only an incremental step toward the dramatic streamlining and greater efficiencies projected from creating a unified medical command, has been endorsed by senior medical leaders. It awaits final approval of Deputy Defense Secretary Gordon England.
Dr. Stephen Jones, principal deputy secretary of defense for health affairs, said England still might decide to stick with an alternative governance plan for the military health system that he endorsed last year.
The plan has raised worries over “preserving service equities,” Dr. Michael Dinneen, director of strategy management for the military health system, told the task force at a hearing Wednesday in Washington, D.C.
The health agency, Dinneen said, would be a neutral party for delivering “support functions … in an equitable manner across the three services.”
Unveiling of the agency concept surprised several task force members, in part because they had just listened to presentations by think tank economists on the merits, potential cost-savings and challenges for the department of creating a unified medical command.
“I hope I wasn’t asleep and missed it, but I was expecting a briefing on the joint medical command,” retired Army Maj. Gen. Nancy Adams, former commander of Tripler Army Medical Center in Hawaii, told Jones. She asked him explain why Defense officials had abandoned plans for a joint command.
The Army, Navy and Joint Staff had backed a unified medical command, saying it would make medical care more effective and save several hundred million dollars a year. The Air Force opposed the idea, citing clash of cultures that could weaken medical support of operational missions.
Jones ignored these disagreements in answering Adams.
“Defense leadership, when presented with the unified medical command, kind of saw that as moving all the way,” Jones told her. “And, of course, within the system, there are pros and cons for doing that.”
What has evolved instead, Jones said, is the defense health agency proposal, calling it a “step in the direction” of a unified command, he said.
On a follow-up question from Adams, Jones conceded that agency would oversee delivery of medical care in the San Antonio and Washington, D.C., areas, but not in other major medical markets, including San Diego; Tacoma; Norfolk, Va.; and Hawaii. Oversight of these large markets would fall to whatever service has the dominant medical presence.
In an interview after the hearing, Adams said the agency offers less “predictability” than would a unified or joint medical command.
“I’m trying to sort out logically what the benefit is of this, which is a kind of a kluging together of disparate parts, as opposed to saying, ‘OK, we’re going to unify health care under a joint command structure.’ We all know what that means. It’s defined by doctrine.”
“It’s kind of like we’ve created a hybrid that is worse than the hybrid we’re living with,” Adams said.
Jones laughed off the criticism, saying more bureaucracy isn’t the goal.
“What we tried to do is make it more streamlined, more transparent, but yet respect the execution (responsibility) of the services” in delivering medical care, he said.
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