The surgeons general of the Army, Navy and Air Force have criticized defense officials for imposing $650 million in "efficiency wedges" on their medical budgets, which will not produce real efficiencies but will only mean cuts in on-base medical services.

The feud between the medical officers and Dr. David Chu, undersecretary of defense for force readiness and personnel, got its first public airing at a February meeting of the Task Force on the Future of Military Healthcare. It intensified March 27 before the House armed services subcommittee on personnel.

To illustrate the effect of a $343 million cut to Navy medicine, Vice Adm. Donald Arthur said it was comparable to closing a large family practice hospital at Camp Lejeune, N.C., or at the naval base in Pensacola, Fla.

Unless Congress intervenes, Arthur said, "we will have to have a serious conversation about what services we can provide at 16 percent less funding than the year before."

Major Gen. Gale S. Pollock, acting Army surgeon general, said her cut is the "budget equivalent" of losing a large Medical Department Activity, which means a community hospital plus support elements.

The Air Force faces its own $190 million efficiency wedge for the fiscal that begins in October. Lt. Gen. James G. Roudebush said there are ways to handle it besides cutting patient services but none will produce real savings. Patients who can't be treated on base simply move to the private sector which means even higher TRICARE health insurance costs, Roudebush said. But before that happens, the service will slow spending on facility maintenance, new medical equipment, and research and training.

The efficiency mandates are in addition to $1.86 billion withheld from the 2008 defense healthcare budget on the assumption that Congress will approve the Bush administration's plan to raise TRICARE fees on military retirees under age 65 and their families.

Arthur told the military healthcare task force Feb. 20 that, in his opinion, the efficiency wedges directed by Chu are just one more way to show lawmakers the consequences of not raising TRICARE fees.

"I don't like it," Arthur said, "but I think we're being squeezed in the middle of the politics of that."

Defense officials want money shifted from military direct care to help pay for burgeoning TRICARE support contracts for networks of physicians and other providers who treat beneficiaries off base, Arthur said.

The surgeons general also warned of plans to convert another 2,700 military medical billets to civilians starting in October, on top of 5,500 converted since 2005.

The Navy, Arthur said, has been able to fill only 83 percent of healthcare billets converted to civilian positions. If that pattern holds, the 2008 conversions will leave the Navy short 136 more medical staff, he said.