Important Insights

A few key insights that I have gleaned from my reporting.

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  Chiarelli

  The DoD is generally considered to be exceptionally good at emergency care – perhaps the best in the world for traumatic injuries. However, its focus is on returning soldiers to duty, to getting them back to the fight. As a result, the DoD medical system is not well designed for, and often not particularly good at, chronic problems. These are things like serious cases of PTSD, long-term problems arising from traumatic brain injuries and other so-called invisible wounds. Soldiers with chronic problems often wind up in a holding pattern, waiting to be discharged from the military.The process by which the DoD processes medical discharges is complicated and filled with delays. Army Gen. Peter Chiarelli tacitly acknowledged this in recent roundtable where he noted, accurately, that nobody ever does stories about military treatment of amputees or burn victims – the negative press is all centered on PTSD and TBI.

• In many medical circles, the VA is considered to provide pretty decent health care. However, since it also handles disability issues, that care is often overshadowed by the controversy over benefits.

• Tricare is one of the country’s most generous health plans, in terms of how much you have to pay for it. However, it has trouble in providing access to doctors, especially in rural areas. And its high cost freaks out the DoD. When Sec. Robert Gates talks about growing medical expenditures “eating the Defense Department alive,” he’s talking about Tricare and its ever-expanding pool of beneficiaries. The military now spends about $12 billion  per year on medical care – the equivalent of developing a new weapons system every year from now through eternity.
• The DOD health system is supposed to work as a smooth, functioning whole. It does not. In practice, each branch (the Army, Navy, Air Force) has its own Surgeon General, who is the highest ranking medical officer. They do not always agree on the best way to do things. For instance, the Army gives out Purple Hearts to any soldier who suffers a concussion, whether knocked out or not. The Marine Corps, operating with the advice of its own doctors, has decided to only award Purple Hearts to Marines who were visibly unconscious. Although in the civilian world, there’s no distinction between the two types of concussion, the Marine Corp and Army simply have decided to disagree.