Military Health Care - It's Broken.

If you live in the US and pay any attention to the news, you've probably heard something about the situation at Walter Reed Army Medical Center. A feature article in the February 18th edition of the Washington Post set things off, reporting on atrocious conditions in a building used to house wounded soldiers being treated on an outpatient basis. The mold, mice, and mess in building 18 have, since then, received a great deal of attention. Within days, the commander of Walter Reed was fired, the Secretary of the Army resigned in disgrace, two special commissions have been appointed, and numerous congressional hearings are getting ready to start.

The problems at Wally World have attracted a great deal of attention, which is good, but the attention shouldn't be focused exclusively at Walter Reed. The problems at Walter Reed are not the result of mismanagement at a single hospital. They are symptoms of a medical system that has been subjected to multiple stresses for way too long now. Personnel requirements, increased numbers of patients, and funding constraints all conspire to create a state of permanent crisis and chaos, at the worst of times.

Let's start with personnel. There are actually more jobs for doctors, nurses, and medics in the military than there are people to fill the slots. This situation is not a byproduct of the wars in Iraq or Afghanistan (although they aren't helping) - it actually exists by design. You see, there are a lot of positions that need to be filled during wartime, but not during peacetime. On paper, a combat battalion (for example) should have a doctor, a physician's assistant or two, and a handful of medics. During deployments, these are all necessary personnel. During peacetime, a unit can get by without either a doctor or a PA, and definitely doesn't absolutely need more than one.

It obviously doesn't make much sense to have people assigned to positions where they really aren't needed during peacetime, so a lot of medical slots are filled through a system known as PROFIS - the medical professional filler system. What this means is that doctors, nurses, and other medical personnel are told which unit they will deploy with if necessary, but do not report to that unit until needed. The rest of the time, they work at one of the hospitals or clinics. When they are called on to deploy, their slot at the hospital is filled by a reservist or civilian contractor.

The result of this today is that the staff of any particular medical hospital is in a near-constant state of flux. Officers are pulled out of their hospital jobs to deploy at various intervals, and replaced with reservists. The reservists are activated for different lengths of time, so it's entirely possible, if not probable, that a single active duty doctor will be replaced by not one, but a series of reservists - some activated for months, others just doing their annual two weeks of active duty.

For patients, this means that it's going to be hard to see the same doctor on a regular basis. Continuity of care is very difficult to achieve under such circumstances. The doctors among us can correct me if I'm wrong, but I'm pretty sure that this is, by definition, less than optimal patient care.

The patient load increases the problems. The military medical system is dealing with thousands of additional patients as a result of the ongoing wars, and is doing so without much more in the way of resources than they had before the wars started. Part of the excess can be absorbed by farming the care of dependents (like me) and retirees out to the civilian market, but that's not going to create enough space to take care of the demand.

That problem gets magnified when it comes to the medical bureaucracy. Getting out of the Army on medical grounds and having your military job changed for medical reasons are both lengthy processes, and the patient loads there have gone up even more than the outpatient loads. Wounded soldiers aren't the only ones who need to go through the medical board process - a fair number of soldiers go through it prior to their unit's deployment date.

Oh, and medical boards require that multiple doctors examine the patient, sometimes multiple times, and do a great deal of paperwork. These are not usually special doctors who aren't doing other things. These are the same doctors who are either preparing to deploy with the unit, or working to see all the extra clinic outpatients, or both.

And then there's money. As insanely expensive as the wars in Iraq and Afghanistan have been, the military hasn't been spending money for the sake of spending money. The administration has been trying their best to keep the costs down, to keep the pressure to kill the tax cuts low enough. The military simply does not have all of the money that it needs to do everything that it is supposed to. This means that things like facilities upkeep get shortchanged so that other things - like new armor kits to deal with new explosives - can be taken care of.

There are a lot of people who are to blame for this situation, and quite a few more people should lose their jobs before it's over. Ultimately, though, the bulk of the blame rests with two groups. Most of the blame goes to the executive branch politicians, starting with the President, who decided that it's a good thing to be the first administration ever to cut taxes during a war. Most of the rest goes to the two Republican-led Congresses (the 108th and 109th), who were largely content to use wounded troops for photo ops, without bothering to do the oversight that they were supposed to.

The next member of either of those groups who complains about the effect of Democratic criticisms on the troops should be sentenced to several months in the outpatient hell that they have done so little about.