![]() During the same timeframe, military health spending grew 13.9 percent (See Exhibit 1). According to the Centers for Medicare and Medicaid Services (CMS), between 20, civilian health spending increased 32.6 percent. Military health spending grew too, but recently it has increased at a far slower pace than civilian health spending. ![]() Between 19 alone, health spending grew so fast, it wiped out the income gains of average US families. Civilian health spending has outpaced our nation’s economy as far back as 1950. Growth in health care spending is not limited to the military. The Department of Defense’s FY2017 budget for military health is $48.8 billion to care for its 9.4 million beneficiaries. To put this in context, in 2016 Kaiser Permanente collected $64.6 billion to care for its 11.3 million members. In fact, yearly spending varies by $2 billion or more due to fluctuations in military construction. This total includes costs not counted by civilian health systems, such as $1 billion annually for military health research and billions more for “TRICARE for Life,” a first-dollar, wraparound plan Congress mandated to supplement the Medicare coverage of military retirees. Before these ideas receive serious thought, it is worth examining the assumptions on which they are based: CostsĪccording to the Congressional Budget Office (CBO), the Department of Defense spends $52 billion, about 10 percent of its budget, to provide a variety of services to 9.4 million beneficiaries. They want the Department of Defense to close most of its remaining facilities, outsource the care to the private sector, and position more military providers in civilian hospitals. Some critics allege that the military health system’s stateside mission costs too much, delivers care of uneven quality, and doesn’t attract enough complex cases to keep provider skills sharp between deployments. Military hospitals provide valuable platforms for teaching the next generation of uniformed health care professionals and standby capacity for combat casualties. Military health care providers between deployments maintain their clinical skills by treating service members and millions of beneficiaries. This second mission reinforces the first: Service members stay healthy, and when deployed, they can be confident that their families will be looked after. The other mission of the military health system is to deliver health care at home through a network of military hospitals and clinics, supplemented by health care purchased from thousands of private doctors and other providers. Since the founding of our Republic, military medicine has supported our armed forces whenever and wherever they go in harm’s way. Unlike the Department of Veterans Affairs (VA) and large, private health care systems, the military health system must be ready to deploy thousands of health care providers to the other side of the world at a moment’s notice and fly critically wounded warfighters home within one to three days of injury. The core mission of the military health system is unique. How can this be? In part, it is because the military health system has two distinctive missions: support combat and humanitarian assistance missions overseas and provide comprehensive health services to millions of service members, their families, and military retirees at home. ![]() Ironically, the same health care system that worked miracles “down range” in Iraq and Afghanistan faces mounting criticism at home. It is one of the most remarkable accomplishments in the history of US medicine. During Operations Enduring Freedom and Iraqi Freedom (2001–2014), the United States’ military health system completely transformed its approach to casualty care, achieving the highest rate of survival from battlefield wounds in the history of warfare. ![]()
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