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If spending priorities tell what’s important to an organization, then the Military Health System ranks pretty low. That’s the contention of Dan Grazier, a former Marine Corps tank commander, now a military analyst at the Project on Government Oversight. He said none of the items on the Defense Department’s  unfunded priorities list included anything health related. He joined Federal Drive with Tom Temin for more discussion.

Interview transcript:

Tom Temin: And Dan, reading over your article – that’s pretty tough that the Military Health System in a sense, your contention is that it’s hollowed out. Tell us what you found.

Dan Grazier: Right. Yeah, that’s exactly right. In going through some of the some of the documents and some of the budget materials after the military is called out to help with the coronavirus crisis I was pretty surprised to see exactly how poorly the Military Health System has been treated over the last couple of years. And if you just look at, like a budget chart from 2011, you can see that the top line military budget has ebbed and flowed just a little bit, but it has trended up, generally since 2011. But the Military Health System, the unified military health budget has trended lower in that time.

Tom Temin: And how does that manifest itself? I mean, are there not enough doctors, are the facilities old and crumbling? I mean, how does it show itself – the spending trends that they’ve had for the past few years?

Dan Grazier: Well, the the number of military health professionals in the services has dropped pretty significantly in recent years. So that has led to a shortage of doctors and nurses. You can find numerous examples of that. Even in normal circumstances, the number of military health professionals in the services aren’t enough to cover just the routine health needs. And so the Military Health System was already operating at just about peak capacity before the COVID crisis happened. And so you can get any spike and the system is overwhelmed, which is exactly what we saw. Which is why we saw the the military call for volunteers that come in and kind of backfill some of these positions because they just didn’t have that excess capacity.

Tom Temin: Yes, you’ve cited some of the big reports from the DoD and so on. And that was my next question: Is there evidence that the quality of care or the capacity to take care of wounded soldiers, wounded service members, has been affected by the spending trends?

Dan Grazier: Right? Well, so far this, these cuts have have not been tested in combat. Fortunately, we are bringing people home from Iraq, Afghanistan, Syria, places like that. So we haven’t stressed the system in combat yet. But that is – that’s the big fear is that the next time the military has to go do a big deployment someplace that the number of people aren’t going to be there to care for them. Because that is ultimately why we have a Military Health System. It’s definitely good to have military doctors, nurses, dentists to take care of service members and their families stateside. But the real purpose is to have that ready force to deploy with troops into combat zones to be able to treat them in those situations.

Tom Temin: Now the Veterans Affairs Department has been working to try to increase salaries for certain medical classifications, the so-called Title 38 people that are not subject to the limits of Title 5 federal employees. I think there’s some movement on that recently. Is there a special pay program or retention bonuses, or what does the military do to try to retain the people that it needs in the health system?

Dan Grazier: Sure, there are a number of different retention incentive bonuses that are paid. And there’s also a pretty robust kind of recruiting effort to get doctors into the services. So there’s a lot of loan repayments, no scholarship programs, the Uniform Services University in Maryland – the military’s medical school. There’s a number of ways to get doctors in and then there’s a lot of retention bonuses that are paid to doctors once they’re in the service to keep them in service. And there’s not a lot of data about how effective some of those retention bonuses have been. But, but those kind of programs do exist.

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Tom Temin: We’re speaking with Dan Grazier, he is now a military analyst at the Project on Government Oversight. And could one reason for the military not being willing to put their neck out for spending on the health system be the rising health costs that they have for the people going through that system? I think as far back as Secretary Robert Gates said, you know, the health costs are eating us alive, and it’s a very expensive part of the military budget – the people side. So could that be what is robbing the hardware software provider side, if you will, for the Military Health System?

Dan Grazier: Well, that’s definitely one aspect and if you you read a lot of other a lot of other reports about the Military Health System, it usually does focus on cost. And they are they are significant. You know, health care is expensive in the United States. It’s a little unfair to compare civilian health costs to military health costs just because the salary structure is different. And you know, facilities are run differently. So an apples-to-apples comparison isn’t exactly proper. Another big argument that’s made about this, and this is what I found again and again, in talking to doctors and reading their articles in medical journals – it’s the concern that stateside, the kind of cases that the military health professionals experience in stateside military hospitals don’t adequately prepare them for what they’re going to experience in combat. And so we have the argument is that we have this mismatch of specialties. We have a lot of the biggest cases that military professionals have in stateside medicine are family health care. So they have a lot of young people, they have a lot of babies, so there’s a lot of pediatricians, a lot of deliveries, those kind of things. Well, you don’t have a lot of that in combat zones. And so they are argument is that there’s this mismatch in specialties. We have too many endocrinologists, we have too many obstetricians, and we don’t have enough trauma surgeons. But the issue with that is that you have doctors, they might specialize in endocrinology, but they are doctors and they can adapt once they get over into a combat zone. One of the doctors that I spoke with, Dr. Robert Adams, retired Army colonel, he was a family doctor and you know, in stateside medicine, that’s what he did after he retired from the army. But in 2004, he ended up in Habbaniyah to set up an emergency medical clinic. And he was able to adapt and he saw cases that he’d never seen before. I’m remember schistosomiasis was one that he mentioned specifically when we talked. It was something that he never saw before and he never saw since then. But because he was a doctor, he was able to adapt to the circumstances. The problem is if we cut all these people now, we aren’t going to have them when the force deploys. And the civilian doctors that military’s paying through TRICARE to take care of our people in the United States aren’t going to deploy with a force. So that’s the real issue. Cost is a big problem. But it’s having a, an adequate number of doctors and nurses when the force has to deploy is the main issue that people should be focusing on.

Tom Temin: Would it be accurate to characterize this as a readiness issue?

Dan Grazier: Yeah, I think so. It’s, I mean, well you have to keep the force ready to go, you know, healthy and ready to go in as they train here in the United States. But then it’s definitely important to make sure that they’re taken care of for a number of different reasons. So like, obviously, we want to be able to save people’s lives. But it’s a confidence thing, too. As soldiers, Marines, sailors, airmen are going into combat. They need to know like, one of the first things that I would brief as a platoon commander was the medical evacuation plan. Like I would brief that to all my Marines, and I did it in part so they would know what to do if somebody did get injured or wounded, but it was to instill that confidence that they could push forward knowing that if something did happen to them that they would be taken care of.

Tom Temin: And the evidence that anyone on Capitol Hill is interested in this particular branch of the military spending question?

Dan Grazier: Yes, it has come up repeatedly during during hearings, and certainly since the the COVID crisis has happened, a lot of the proposals, one of the most recent proposals was to cut about 18,000 total military professionals from all three of the service Medical Corps. And that proposal has been put on hold indefinitely and, which is a good thing. That’s good progress. But I anticipate that once things kind of calm down, that these proposals are going to come back up. Plus a number of changes have already taken place that have permanently impacted things. So it’s something that’s going to have to be revisited in the coming years.

Tom Temin: Dan Grazier is former Marine Corps tank commander, now a military analyst at the Project on Government Oversight. Thanks so much.

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Dan Grazier: Hey, thank you very much, Tom.

Tom Temin: We’ll post this interview and a link to his analysis at www.FederalNewsNetwork/FederalDrive. Hear the Federal Drive on demand. Subscribe at Apple Podcasts or Podcastone.

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