Congress must stop the attempt to dismantle military medicine

The Department of Defense (DOD) continues its relentless attempt to cut 18,000 medical positions in its current budget submission. The cuts would represent a 20 percent reduction in medical personnel across all the services. Congress directed a pause last year to ensure DOD conducted an assessment on the impacts such cuts may have on support to beneficiaries. But as we learn from the coronavirus pandemic, Congress needs to halt the reform in its tracks. The military’s response to the COVID-19 public health crisis provides substantial justification.

Since the pandemic began its global scourge, nearly 4,400 military medical personnel have surged to augment the courageous civilian medical personnel at medical facilities across the U.S. This number does not include the more than 57,000 active-duty, Reserve and National Guard personnel who also have supported the response. The military medical responders have worked at numerous hospitals on the East Coast and in Michigan and Louisiana. The Army also has deployed four active-duty field hospitals and established alternative care facilities in New York and Washington state.

Fortunately, our nation’s military has not had to face a battlefield conflict requiring a surge of medical personnel while simultaneously supporting the coronavirus response. 

Secretary of the Army Ryan McCarthy has expressed concern over how the manpower cuts might impact medical research activities with resultant battlefield consequences. In an internal memo last year in which he addressed the potential cuts, McCarthy referred to the research done at the Army’s Medical Research and Development Command located at Fort Detrick, Md. The command manages and executes research in several areas, including infectious diseases, combat casualty care, military operational medicine and chemical biological defense. 

“As conditions during war may change rapidly, medical research and development is essential to respond quickly and effectively to support warfighter capabilities and survivability. If medical research and development assets are not left with the Army, the Army’s ability to fulfill its Title 10 responsibilities and integrate medical capabilities with warfighting systems for service members will be degraded and at risk,” he wrote.

Noted foreign affairs professor Walter Russell Mead supports Ryan’s concern with a clear warning. Mead says that in a post-COVID world, there will be non-state actors who will seek the capacity to create plagues. Every country will need to defend against them. “The ability to recognize new diseases quickly and to develop treatments and vaccines has become a cornerstone of national defense,” Mead says. The Fort Detrick facility, as one may expect, is one of those facilities that would be doing the work Mead refers to — just as it is working to develop a vaccine for the coronavirus.

One of the issues overlooked when it comes to military medicine is the progress that has been made on the battlefield during the past two decades of war. The achievements made as a result of the wars in Iraq and Afghanistan have been extraordinary. These achievements are a result of not only experience on the battlefield but the incredible research the military undertakes.

Medical research and development is essential if we are to be able to respond quickly and effectively to support warfighter capabilities and survivability. For example, the military’s development of freeze-dried plasma demonstrates how significant a role military medical research plays. Fort Detrick began work with a civilian research firm in 2014 to develop freeze-dried plasma. The Marine Corps began using it in combat situations in 2017. The Marines were so eager to use the product that they requested permission to obtain it from a French firm until it was approved by the Food and Drug Administration (FDA).

Accordingly, a fair question to ask is, “What will be the impact on military medical research if these cuts are approved?” Is this something our military personnel, whom we ask to go into combat, deserve? How do these cuts impact readiness?

Any cuts to military medicine also will have a dramatic impact on the medical care we promise our military personnel, their families and retirees. A survey of 10,000 military families done last year by the nonprofit military support group Blue Star Families clearly showed concerns about their health care in the military health care system. Two-thirds of the respondents cited health care benefits as one of their top reasons for remaining in the military. But their satisfaction with their ability to access care in a timely manner was a concern, citing long waits and rushed care  — not a good incentive for reenlisting. Reducing 18,000 medical personnel certainly would not be an inducement. 

Congress needs to examine any proposed cuts to military medicine very closely before it approves authorizations or appropriations. Several questions must be asked:

• Can the services absorb these reductions and still support combat operations, humanitarian aid and relief missions (e.g., another pandemic or a bioterror event)?
• What will be the impact on current medical forces — more frequent deployments? And how about the impact on the retention of military medical professionals?
• Will reductions compromise the military health benefit to a point where there is no longer a benefit to joining or staying in?
• The DOD proposal has the potential to affect 200,000 beneficiaries, along with eliminating 48 medical treatment facilities. What will be the effect on the civilian communities located near these military facilities? Does the capacity exist to handle more workload resulting from military personnel, their families and retirees who may lose care?

The coronavirus pandemic has made it clear that any continuation of cuts to military medicine would be reckless and misaligned with our national security objectives. Congress must weigh in to halt these cuts.

Tom Jurkowsky is a retired Navy rear admiral who sits on the board of the nonprofit Military Officers Association of America (MOAA), which advocates for a strong national defense and for military service members.