Lessons learned from military health care
By John Temple Ligon
Temple@TheColumbiaStar.com

(l to r) Colonel James A. Mundy, Dr. Stephen L. Jones, and Brian Heckert

While the presidential candidates position themselves on health care along the campaign trail, each trying to set up a separate identity to lead on the issue, the American military is indeed leading the country in innovation and application of the delivery of health care services. The No. 2 in health care for the Department of Defense, Dr. Stephen L. Jones was in Columbia July 13.

Jones went to elementary school in Hemingway, S.C., and earned degrees from Clemson University, USC, and the Medical University of South Carolina, the last being a doctor of health administration. For almost 20 years, up to 2001, Jones served as director of Federal Relations and Economic Development for the Medical University of South Carolina.

Jones met with the press around lunchtime at Ft. Jackson's Moncrief Army Community Hospital, an institution with almost 1,000 personnel and a catchment area population of more than 74,000. About half of the catchment area population is on active duty, and the other half is retired.

Also in attendance with Jones were the commanding officer at Mon- crief, Colonel James A. Mundy, and the director at Wm. Jennings Bryan Dorn VA Medical Center, Brian Heckert. Dorn and its six S.C. outpatient clinics have almost 1,300 employees and more than 600 volunteers. For fiscal year 2006, Dorn had 612,000 outpatient visits and treated 4,200 inpatients. On a monthly basis there were 240,000 lab procedures.

The theme of the meeting was cooperation and coordination, the melding of military medical services and the VA into a health care system. In other words, whether the patient is in the Army, the Air Force, the Coast Guard, the Marines, or the Navy, medical care should be uniform and close by. There can't be a whole lot of difference between Army medicine and Navy medicine. And there can't be much distinction between what works for active duty personnel and for the retirees.

The American military is consolidating while it reconsiders cost reduction and uniform control.

The U.S. is spending about 16 percent of its gross domestic product (GDP) on health care, and Canada spends maybe 10 percent, complained New Mexico Governor Bill Richardson from the studio of Columbia's WOIC- AM a few weeks ago. Richardson wants to be the Democrats' choice for president.

All of the world's rich countries except the U.S. have universal health care, and the average cost is somewhere below and close to 10 percent of the GDP. The quality of life statistics - life expectancy, for example - appear to be better for less cost elsewhere.

American research and development is arguably the world's best, as is the medicine, but the delivery systems suffer. The American military is working on the delivery systems well ahead of the civilian population.

Jones said the percentage of GDP has a parallel in the military, and if applied to the country as a whole, the military system would possibly come through at 8 percent, but certainly not much more.

In S.C., there is a huge military retirement population and an impressive presence of military bases. The last round of cuts under BRAC (base realignment and closure) didn't affect S.C. much. Ft. Jackson appeared to have actually gained. The Charleston Navy Yard was closed over 10 years ago, and that was the last major military cutback in S.C.

Jones didn't say, but If the military medical institutions in S.C. evolve more into a systemic connection, more into an efficient cost-effective single delivery system for both active and retired personnel, the odds of military cutbacks in S.C. should possibly become less.

Meanwhile, the presidential aspirants might look inside the U.S., inside its military, for their paradigm to debate improvements in health care coverage and delivery.