Posted on: Monday, July 9, 2001
Military Update
Medical oversight group may have met for last time
By Tom Philpott
Defense Secretary Donald Rumsfeld and his leadership team have rejected a push by the Joint Chiefs to create a joint medical command or some other military-led entity to control what the chiefs fear are runaway TRICARE costs.
Not only has Rumsfeld and staff rejected the notion of giving military officers greater control over health-care resources, but they are expected to dissolve the advisory panel that backed the idea, the 2-year-old Defense Medical Oversight Council, sources said.
Whether it was weak civilian leadership, hidden medical costs or some other conditions that led to formation of the oversight council, they no longer exist, Rumsfeld's staff has suggested. The council no longer will be the dominant voice in debates over the future of military medicine.
Co-chaired by one of the services' vice chiefs on a rotating basis, and supported administratively by the Joint Staff, the Defense Medical Oversight Council has been a powerful tool of the Joint Chiefs of Staff in driving medical reforms since 1999. Under the auspices of Rudy de Leon, then undersecretary for personnel and readiness, the council pressed for accelerated TRICARE reforms, and to document chronic underfunding of military medical budgets during the Clinton administration.
But even as TRICARE services improve, the Joint Chiefs and the military surgeons general, who oversee military medical staffs and facilities, have become increasingly alarmed and frustrated by the rising cost of TRICARE support contracts, which, in turn, squeeze dollars available for the direct care system.
Most informed observers blame the sharp rise in contractor costs to poor fiscal management during the Clinton era. Year after year, military clinics and hospitals were left short of money, forcing patients to use far more costly TRICARE provider networks. Lt. Gen. Paul K. Carlton, Air Force surgeon general, calls it a medical budget "death spiral."
In a June 28 interview, Dr. David Chu, the department's new undersecretary for personnel and readiness, avoided discussing the council and reports that it has held its last meeting. He only praised the council's role in sensitizing uniformed leaders to the impact of timely, quality health care on morale and readiness.
Chu did reject the idea of reorganizing military medicine, at least from the top down. "It's a little early for the administration to decide exactly what the governance of this system needs to be," he said. But he leans toward giving regional TRICARE managers more control rather than the "Stalinist model [where] we do everything from the center."
As far as controlling future TRICARE costs, Chu said the TRICARE Management Activity, as established under the Office of Assistant Secretary of Defense for Health Affairs, already has that authority.
"I'm looking to them to make sure we begin to achieve what Secretary Rumsfeld has set as the goal here: a world-class medical system," Chu said.
But the Joint Chiefs remain concerned that the current organizational structure won't be able to control medical costs, said an official familiar with their views on the issue. They worry that military medicine is "the Pac Man of future defense budgets," swallowing resources of other programs at an alarming pace. Comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com.
