Why is military medicine a unique form of health care?
The recent passage of the health-care reform bill is sure to spark debate about the merits of government-run medicine. As a current provider in the military health-care system, I believe there are several lessons to be learned from this "government-run" option. I have some experience in civilian models as well, with which to compare my military service.
PROPONENTS OF THE current legislation see this reform as necessary, and on that point I have no disagreement. I am not certain, however, what the correct model is, nor do I have the confidence that anyone in Washington does, either. I might feel differently if someone could actually explain exactly what the plan entails or how it proposes to solve the country's health-care woes.
Opponents of the legislation have and will continue to use various arguments related to "big government" and "socialized medicine" as this plan's shortcomings. Inherent in this argument is the supposition that military medicine represents a form of socialized medicine. How does one define socialized medicine? In simplest terms, it's a central government-funded and managed organization that incorporates salaried providers and protocols for access and services rendered.
The Army Medical Department is centrally funded through the U.S. government, and all providers are salaried without performance bonuses. There are however, no mandates or protocols which dictate the care any individual provider will perform, other than standard medical practice and the Hippocratic Oath. This is the primary difference between military medicine and the current practices of Canada and Great Britain.
Does this make the military medicine system better? In a word: Yes.
Medicine always will remain an art and a science, and should be practiced without third-party constraints. The physician has an obligation to his individual patient to evaluate and treat as clinically indicated. This model does not lend itself to generalized protocols, which are created with the whole rather than the individual in mind.
HOW DOES MILITARY medicine compare to civilian practice in the United States? This is a difficult comparison because of the fact that there is no single business model in the private sector, but they generally have the insurance industry in common. Health maintenance organizations remain a prominent player in the private model.
Military medicine can be viewed as an HMO, but I submit there is a key difference. Physicians who practice in the military system are rated based on their ability to provide quality care and not on the amount of money spent per patient on laboratory tests, radiologic studies or prescriptions. This does not mean that providers operate on the premise of a blank check and order various tests simply because they are available.
The training and education of resident physicians and overall practice of medicine in the Army Medical Department is done responsibly; i.e., in the spirit of Hippocrates and William Osler, the renowned clinician from the 19th century. I do not mean to imply that the private sector practices irresponsibly -- rather, that medicine in this sector is practiced with an eye on the bottom line. This includes administrators watching the balance sheet and potentially dictating the types of services that can be offered for certain conditions.
I BELIEVE THAT the practice of medicine in the military is pure, meaning it most closely resembles the ideals of Hippocrates and Osler. In addition, the care is provided over the long term by those of us who choose to function in this system out of duty, honor, and respect for current and past service men and women and their families.
I do not believe that this model is the answer for the entire country. I am simply proud to be a part of a system that works.
(The writer -- a U.S. Army major -- is on the consulting staff of the Division of Pulmonary, Critical Care and Sleep Medicine within the Department of Internal Medicine at Dwight D. Eisenhower Army Medical Center in Augusta.)