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 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 Green, Air Force surgeon general, said his service continues to oppose a unified command, in part because it disagrees the restructuring will save money.
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"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 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 and report 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 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.
I asked each current surgeon general his views on the unified command plan the House passed in HR 1540.
Green said the Air Force recognizes that service and joint medical doctrine "must be improved to assure service capabilities are fully interoperable and interdependent to bolster unity of effort. The services should continue integrating common medical platforms to reduce redundancy and lower costs."
But a unified medical command might "not achieve the intended synergy or unity of effort," Green said.
Robinson argued the medical community "is already highly integrated" with Army, Navy and Air Force working "seamlessly to care for patients from battlefield to bedside. If we were to create a new unified command, it would require extensive study on how it would be best implemented so that we don't jeopardize our current capability or add excessive cost to the system."
But Schoomaker, for Army, noted that "numerous" past studies have endorsed a unified medical command to improve the health of the force and to reduce redundancies. "Like all major organizational transformation efforts, however, the devil resides in the details," he said.
"Army Medicine recognizes the merit inherent in these efforts, providing that the continuum of care remains fully integrated."