This article, written by DefenseWeb Board member Jerry Sanders, M.D., Major General US Air Force, Retired, explores the ongoing discussion over whether the military should establish a joint medical command.  Dr. Sanders provides a glimpse at what a new system might look like and outlines the positions of the Navy, Army, and Air Force—the service branches that stand to be most affected by a new system.

Combining Forces? Why a Joint Medical Command Could Be Only a Matter of Time
By James G. “Jerry” Sanders, M.D., Major General US Air Force, Retired

For more than 60 years, the military’s medical system has operated under separate command structures, with the Army, Navy, and Air Force overseeing their respective hospitals, clinics, doctors, and staffs. As the DoD looks for ways to save money and enhance the military’s overall efficiency and delivery of medical care, a panel of senior business executives is recommending that the Secretary of Defense undertake immediate steps to establish a unified medical command by January 1, 2007.

What would such a system look like? For starters, the Pentagon’s Office of Health Affairs would take over control, budget authority, accountability and oversight of all medical health activities. TRICARE, the health care plan for the Uniformed Services, retirees and their families, would be realigned to work alongside the new system. All fixed military clinics and hospitals – including research, contracting, logistics and training – would also fall under the unified command.

The proposed changes are widely supported by the Army and Navy, as they would continue to deploy service-specific medical personnel with their units.

The Air Force (for the most part) opposes the plan, given that its base facilities would be required to rotate in Army and Navy doctors under a unified command structure. This is a departure from the current system where wing commanders have full decision-making authority over their pilots’ health.

While the idea of a unified medical command has been around for some time, the roots of the current proposal can be traced back to a 1991 Department of Defense Directive that gave the Assistant Secretary of Defense for Health Affairs the authority to develop policies, systems standards and procedures. A 1994 directive re-emphasized the authority of the Assistant Secretary but prohibited any change in the structure of the chain-of-command with respect to medical personnel.

Seven years later, the DoD defined the mission of the TRICARE Management Activity – the governing body of the TRICARE system – to manage and execute the defense health program appropriation and the DoD unified medical program, and to support the Uniformed Services implementation of the TRICARE program and the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

Proponents of a unified system point to its potential benefits, including common standards for training, logistics, and operations. Whereas the current structure requires replication of processes, a recent report by the Center for Naval Analyses estimates that a joint medical command could save the military more than $344 million over a period of several years.

Despite these positive projections, critics of the plan have reason to be optimistic about its potential to simmer. The Defense Business Board, the group that advises the Secretary of Defense, lacks any authority to implement its own recommendations. In the end, Congress and the DoD will decide whether and/or how to move forward.

While the debate is ongoing, neither Congress nor the DoD has publicly indicated any immediate plans for systemic change. As Rep. John McHugh (R-N.Y.), chairman of the House Armed Services military personnel panel, told Army Times in September, “It is important we have the best information available so we do this right because we are, after all, talking about the health of service members, retirees and their families.”

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