Air Force opposition has scuttled Army and Navy plans to merge the three services’ large medical bureaucracies, led by three surgeons general, into a single Unified Medical Command.
Deputy Defense Secretary Gordon England decided this month not to endorse such a major streamlining of the military health care system with Air Force leaders so strongly against the move.
Instead, England approved a more modest “new governance plan” for the health care system that directs joint oversight over four “key functional areas.” William Winkenwerder, assistant secretary of defense for health affairs, explained England’s “conceptual framework” during a phone interview.
Areas targeted for joint oversight are:
* Medical research. The Army Medical Research and Material Command, headquartered at Fort Detrick, Md., would oversee all military medical research.
* Medical education and training. The 2005 Base Realignment and Closure legislation already directs creation of a joint center for enlisted medical training at Fort Sam Houston in San Antonio.
* Health care delivery in major military markets. Starting with San Antonio and Washington, D.C., the services are to shift toward a single service being in charge of care delivery in certain regions.
The details are left to a transition team that soon will be named to review options and recommend steps to implement England’s concept. Winkenwerder said he doesn’t know yet who will be on that team. He predicts it will require a minimum of two years to implement the changes.
The TRICARE Management Activity will remain but will focus on health insurance, support contractor management and benefit delivery.
Though the course that England has set is less ambitious than a unified medical command, it still “needs to be planned and implemented in a very careful, detailed, thoughtful way,” said Winkenwerder.
Everyone recognizes, he added, that the military health care system delivers care anywhere in the world, achieves “incredible results” in saving lives and treating wounded and provides “a benefit highly prized by beneficiaries.” Therefore, “an underlying theme in all of this is we did not want break anything that was working well.”
Army and Navy plans for a Unified Medical Command seemed to gain momentum in September after receiving a vigorous endorsement from the Defense Business Board, a group of business leaders who advise the secretary and deputy secretary of defense. Economists with the CNA, a think tank that does a lot of Navy work, had projected savings of at least $500 million a year.
How much England’s revised plan will save isn’t known. But Winkenwerder said it will “create greater efficiencies and cost savings, improve coordination of medical care, improve support to our war fighters, better leverage medical research and create greater ‘jointness’ and standardization in our training and education of … medical personnel.”
Lt. Gen. James G. Roudebush, Air Force surgeon general, had argued against a unified command on the grounds that service missions and cultures were just too different and those differences justify keeping separate medical staffs and resources. In an interview Wednesday, Roudebush was gracious in victory, saying the debate had been important for military medicine.
The Air Force, Roudebush said, “has its medical support intertwined and woven into the mission and the line of the Air Force” and “is something we feel very strongly contributes to our ability to support the joint war fight.”
Vice Adm. Donald C. Arthur, Navy surgeon general, conceded he had “a different concept” for the future of military medicine. But it came down to “what could realistically get done without a lot of disruption to the system.”
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